Health Nepal

Southern Asia is a region where more diseases are rife then in Europe. The situation is comparable to that in our parts before the Second World War. All dangerous diseases that are common in Nepal almost exclusively affect the poor. Besides, with a timely treatment they can almost always be checked, for those that can afford it. If you pay sufficient attention to hygiene, insect repellents and skin care in South Asia, you will most probably stay healthy, apart maybe from some harmless intestinal problems.

Food and hygiene: Intestinal problems are much more common in Nepal than in Western Europe, and food can be a major source of contamination. Visitors to this country are advised to eat meat and chicken only in reputed restaurants and otherwise stick to vegetarian food. Eat in good restaurants or, if you do go to cheap eating places, look for the busiest ones. Here, the turn-around of the food is highest and hence the freshest. Fried vegetarian snacks can hardly go wrong, although the quality of the frying oil can go down after frequent use, and sit heavy on the stomach. In expensive restaurants, you should be able to trust all the food, including meat, ice creams and salads, but in case of doubt, put it aside. It is best not to eat salads in simple establishments, and the same applies to fruit salads and fruit juices. If you peel the fruit yourself, it is safe. Wash your hands often and check if cutlery and plates are washed properly. Keep your fingernails short.

Sun and heat: Sunburn is a frequent cause for health problems. Sunburn and heat strokes are easier caught than you may think. You should therefore avoid the sun during the hottest hours of the day, always wear a hat (or carry an umbrella) and good sunglasses when you are walking or cycling, and use the recommended factor of suntan lotion when sunbathing. At high temperatures, the body’s need for water increases very rapidly, as does its need for salt. Make sure you drink enough. Take it easy during the hottest hours of the day. Treat small scratches, wounds and insect bites before they become infected.

Insects: Mosquitoes are most active just after sunset or just before sunrise. So take measures then, and during the entire night. Covering up the skin with clothing is an effective measure. Or use an insect repellent like DEET. You can ask for mosquito coils from your hotel desk or the restaurant where you eat. These green spirals can be burnt underneath your table or chair, deterring the mosquitoes. Electric coils are better suited to closed-off spaces. Lastly, you can consider bringing a mosquito net.

Animals: Don’t stroke animals. Rabies and scabies occur widely in Nepal. Should you be bitten, call on a doctor immediately. In case of a bite by a monkey or a dog, you should be flown home immediately; and seek medical care straight away. Rabies that has not been treated in an early stage will be deadly without exception. Bites by snakes and scorpions are rare and as a rule are not deadly. However, do not walk in high grass and other vegetation with open shoes. Keep your travel bags closed, in particular at night, and do not put on your shoes in the morning before you have checked if they are uninhabited.

Diarrhoea: The most common complaints are intestinal disorders, in particular diarrhoea. Diarrhoea is a natural defence mechanism of the intestines to quickly dispose of anything damaging or irritating in the digestive tract. In most cases it is a completely innocuous phenomenon caused by a sudden change in diet, the heat or harmless bacteria, against which your body will quickly gain resistance (traveller’s diarrhoea). The main risk is dehydration. Dehydration occurs when the body continues to emit moisture and salts, while the intestines can no longer absorb these from their contents. The symptoms are a feeling of listlessness, a dry mouth and lips and a low urine production. Test for advanced dehydration by taking some skin on the top of your hand between your thumb and index finger, and release it. If the skin does not smooth itself straight away, you are dehydrated. Please note that this test does not work well on elderly people. Serious dehydration often leads to a confused state of mind. Dehydration can be prevented by drinking lots of water, soft drinks and soup. If you experience dehydration, it is best to drink water mixed with an ORS solution. This powder, available in sachets from chemists both in Nepal and at home, contains all the minerals which the body loses as a result of diarrhoea. Sugar has been added to improve the uptake of salts and water. The amount to be taken is shown on the sachet. If the diarrhoea is accompanied by high fever, vomiting, blood in the faeces or violent retching, call on a doctor immediately. It is probable that you have dysentery, which is caused by bacteria that may need to be fought with medicine. There are excellent medicines to stop diarrhoea, but they do not remove the cause. Medicines containing loperamide, such as the branded medicines Diacura and Imodium, call a complete halt to all bowel activity, which makes sense when you have to travel. However, never take them when the diarrhoea comes with one of the symptoms mentioned above in case you are suffering from a form of dysentry.

Altitude Sickness: Roughly one in two people who visit Ladakh encounter feelings of altitude sickness of varying degrees. It is the body’s reaction to the oxygen supplies which grow scarcer as you travel higher. The most significant and concerning problem is the potential accumulation of fluid in the brain and/or lungs. You must be aware of and look out for any development of the symptoms at all times, both in yourself and your fellow holidaymakers. Before we give you a list of the symptoms, remember that the development of altitude sickness is in no way dependent on your physical fitness and/or routine when walking in mountainous regions. Experienced mountaineers can suffer from altitude sickness for the first time after making many expeditions into high-up regions.
There is a whole scale of symptoms related to altitude sickness. The French Mountaineering Association uses a points scale to assess the severity of symptoms.
- Symptoms receiving 1 point: nausea, headaches, insomnia, dizziness.
- Symptoms receiving 2 points: vomiting, headaches which do not respond to aspirin.
- Symptoms receiving 3 points: extreme fatigue/exhaustion, shortness of breath, tightness of the chest as no result of physical exertion, little or no urination.
If any symptoms you may have do not exceed a total of 3 points, then you are safe to slowly go higher up the mountains. A score of between 4 and 6 points means you should watch out and wait till your symptoms ease before climbing any higher. A score of above 6 points means descend to lower ground immediately; a person with such severe symptoms must not remain at such a high altitude and certainly must not sleep at that altitude. Foaming at the mouth, blue lips and/or tongue, inability to lie down flat and any degree of loss of consciousness are signs of very serious altitude sickness and in such a case, the afflicted person must immediately return downhill. There are several medicines which can make the symptoms of altitude sickness temporarily bearable and these medicines, containing the active ingredient acetazolamide, are available in Nepal. As you will be travelling from Delhi to Leh, you will already be subject to high altitude. It is therefore important to acclimatise in Leh before proceeding to higher grounds.

Prickly heat: Prickly heat is an inflammation of the pores caused by excessive perspiration. It is common and innocent, but very annoying. The skin grows red and irritated in places. Places where skin chafes against itself, such as armpits and thighs, are particularly susceptible. The symptoms will decrease if you take a cold shower – without using soap – a few times a day and dry yourself off well. Applying talcum powder to the affected spots may also help. When it is hot and damp, do not sleep under a sheet but wear a cotton T-shirt. If it is really troubling you, the best thing to do is take an air-conditioned room for a couple of nights.

Doctors, chemists and medicines: Doctors and chemists are usually well trained and reliable in Nepal, although medical facilities are not of good quality. In any case, you can get almost any medicines without needing a receipt, although make sure you check details on the bottle, particularly the use-by date. Besides plasters, bandages and cotton wool, a good first-aid kid for tropical areas might consist of a thermometer, iodine, painkillers, Oral Rehydration Solution packets, Imodium, an insect repellent such as DEET and an itch relief cream. For injuries, elasticated bandages and liniment (cream for muscle pain and stiffness) are useful additions.

Vaccinations: Nepal has no compulsory vaccinations, unless you have been in a region where yellow fever or cholera is prevalent 14 days before your arrival. However, as a precautionary measure, you should consult your doctor for if you have been in an infected area within four weeks of travelling to Nepal. You will usually be advised to get vaccinations against diphtheria, tetanus and polio as well as hepatitis A and typhus. Pills can be acquired to reduce the chances of malaria. Some people receive far less or even no mosquito bites if they begin a course of vitamin B-complex tablets around two weeks before the trip, although unfortunately this treatment does not work for everyone. However, participants in this trip will be staying at an altitude of over 2 miles for the majority of the holiday, and malaria does not affect areas above an altitude of around 1.2 miles. In Nepal, malaria occurs only in the low-lying Terai, so near Chitwan National Park.

Some more advice for a pleasant stay
Take time to allow your body and mind to adjust to the new time zone and location. Avoid stress; do not draw up a busy schedule. In any case, take it easy the first day. It is a good idea to get up early; in hot countries the morning temperature is often the most pleasant. Besides, the people in the country you are visiting are also used to getting up early. If you adjust to the local rhythm, you will be able to do more.

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