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Trekking in Nepal and Himalaya is great but sickness is sometimes a problem. Here are some guidelines on staying healthy; if you do get sick consult with your leader.
Arrival: Changing time zones knocks people, add the stress of winding up at work and many people arrive feeling slammed, needing a holiday. This is the time you are most likely to get sick; try to take it easy, and definitely take multi-vitamin tablets.
Drinking water: In developed countries people take for granted clean drinking water, toilets that flush waste away never to be seen again and hygienically packaged food. While trekking in Nepal and Himalaya, these luxuries doesn’t exist however there are clean and nice toilet most of the Teahouse on the trek. Mineral water, boiled water or water with Iodine is safe to drink while you are in Himalaya. Naturally we are serious about hygiene on our every trip so don’t worry about it.
Purifying Water: All the water in the streams and rivers of Nepal and Himalaya is contaminated to some degree and therefore not safe to drink without purifying precautions. This unfortunately even includes all water at high altitudes. Only water made from clean snow is safe. Water that has been brought to the boil, even at 5000 mtrs is safe – it only needs to be pasteurised which is heating to 75ºC, not sterilised (boiling for 10 minutes). At 5800 mtrs water boils at around 81ºC so all tea, coffee and hot lemon etc. is safe to drink.
There are many different methods to purify water; in the lodges boiled water is normally available, while camping our crew provide thermos of boiled water. Sometimes you may want to purify water yourself; the most convenient method is Iodine tablets. If you have a water filter, ask us if it is worthwhile bringing it.
Diarrhoea: This is a common problem in developing countries, especially India & Nepal. In normal circumstances when you get diarrhoea you visit a doctor and they conduct some tests. This is the best way to make an accurate diagnosis. However while trekking obviously this is impossible so you may have to be your own doctor if there is no real doctor close by.
First, diarrhoea will not normally kill you so urgent treatment is not necessary nor always recommended. Many people over-react and start taking drugs at the first loose stool. Instead wait a few days and see what happens.
Unless it is particularly severe, for example food poisoning, there is no need to stop trekking, just drink lots of water and listen to your body: if you feel hungry, eat, and if you don’t then take lots of soup and light foods. If the diarrhoea is still definitely troublesome after a few days and you are fairly sure of what type it is then you may want to treat it, but this is still not entirely necessary.
If you have a pre-existing condition such as stomach ulcers, gall bladder problems, previously perforated intestine etc, be especially careful with self-diagnosis and treatment.
Giardia: Common in Nepal and Himalaya. It is usually from infected water, especially from Kathmandu and high mountain streams near where yaks graze. It generally takes 7-10 days to develop and does not come on suddenly. The classic symptoms are very sulphurous (rotten egg) smelling farts and burps. The other symptoms that make it easier to distinguish from other types of diarrhoea are: a rumbling, churning upset stomach, sometimes cramping and bloating, and normally there is no fever or chills or nausea. In the last couple of years giardia has also presented different symptoms, such as;
Giardia can also be virtually symptom less, just occasional soft stools or constipation even and a vaguely upset stomach. Some forms your body will clear given a month or so and a number of people have had it without realising however if it is obvious and a problem there are two drugs that are effective.
B) Tiniba: this can be bought at all Nepalese pharmacies (without a prescription). The name of the active chemical is Tinidazole. The dose is 2 grams, ie 4 x 500 mg (milligrams)) all at once then 24 hours later, the same dose, and 24 hours later, a third dose.. It is perhaps better taken in the evening because the usual side effects, a strong metallic taste in your mouth and nausea may be slept off. This dose is about 90% effective – it is possible that it may re-occur later. Do not mix with alcohol.
Alternatively take: Flagyl/Metronidazole. The dose is 250mg three times a day for 5 to 7 days. DO NOT not mix with alcohol.
Note! DON’T take Flagyl and Tiniba at the same time.
Occasionally its onset is sudden and weakens a person severely, sometimes to the point of barely being able to lift oneself off the toilet. However it usually comes on slowly, a mild diarrhoea that comes and goes, something that can almost, but not quite, be ignored. This is when it is most dangerous because the symptoms can eventually clear up, but your body is still infested and being slowly damaged. If you suspect you have this then upon return to Kathmandu have a stool test. According to Dr David Schlim of CIWEC clinic, Kathmandu, It causes perhaps 1% or less of all diarrhoea cases in Nepal.
D) Travellers / Bacterial Diarrhoea:
The onset is often accompanied or even preceded by a fever and/or chills and nausea, next is fairly sudden frequent watery diarrhoea and often cramps. It is caused by slightly different strains of bacteria that your body is normally used to. This type of infection is normally the first to attack fresh from home arrivals to Nepal. There are two methods of treatment. Your body generally copes with foreign bacteria quite well so it should clear up given plenty of time however the usual Nepalese version is stronger than many so very effective is to begin short course of Norfloxacin, under the name Normaflox or Norbactin in Nepal. The dose is 400mg every 12 hours for 3 days. An often recommended drug is Bactrim / Bactrim DS or Septra. There are now resistant strains so these are not nearly as effective, and similarly there is increasing resistance to Cipro and so another drug is becoming the standard treatment. See a doctor in Kathmandu.
This comes on suddenly and severely, usually from both ends – vomiting and diarrhoea. It happens about 4 to 8 hours after eating the contaminated food. Luckily it usually lasts less than 24 hours and recovery is quick, although you may feel weakened. There are no drugs that can help – the body just has to eject all the contaminated food and rid itself of the poison. Rest and, once the first severe bout or two is over, drink plenty of fluids. Oral rehydration solutions are helpful.