PRACTICAL INFORMATION

MEDICINAL ADVICE

Trekking in Nepal need not be considered risky affair as far as your health is concerned. Nevertheless, preventive measures such as a through medical check up and inoculations before you start trekking can save you from unexpected hazards. Since the remote places of Nepal are not supplied with necessities that are essential for modern medical facilities and as the rescue and evacuation are measured in days, it is imperative to make a comprehensive first aid box consisting of basic drugs and accessories as part of the paraphernalia for trekking. Modern dentristry is unknown in the hill of Nepal so it is advised to have a checkup before departure from home. Tooth fillings, sometimes loosen in cold temperatures and high altitudes, so it is recommended to have them checked. Travelers are requested to bring medicine prescribed by their doctor at home. Common medicine for stomach problems, headache, and malaria is available in Kathmandu. Medicine is usually not available in remote areas. So necessary medicine is advisable to carry with you. Before going to Nepal, it is advised to get injections against typhoid, meningitis and hepatitis.

OVERCOMMING ALTITUDE PROBLEM:

This is often known as Acute Mountain Sickness (AMS), which is particularly a matter of important medical consideration while trekking in the Himalayas. Altitude Sickness means the effect of altitude on those who ascend too rapidly to elevations above 3000 meters. Early mountain sickness will manifest itself in headache, nausea, shortness of breath, fatigue; etc can be encountered as initials of the sickness.

The major information source on prevention and treatment of the sickness is Himalayan Rescue Association (HRA) and Buddha Treks is the confide life member of it. We assure every trekker that all our guides have followed the training conducted by HRA with the understated information.

CAUSE/FACTOR OF ALTITUDE SICKNESS
1. Less Oxygen
2. Low Pressure i.e. Barometric Pressure
3. Rapid Ascent
4. Possible Dehydration
5. Hypothermia

TYPE OF ALTITUDE SICKNESS
1. AMS - Acute Mountain Sickness
2. HAPE - High Altitude Pulmonary Edema
3. Hace - High Altitude Cerebral Edema

SYMPTOMS
1. (AMS) ACUTE MOUNTAIN SICKNESS
Mild symptom feels like hangover/not feeling good
a. Headache
b. Fatigue/Tiredness
c. Nausea
d. Shortness of breath
e. Loss of appetite
f. Sleep disturbance
g. Dizziness

2. (HAPE) HIGH ALTITUDE PULMONARY EDEMA (Water in lungs)
a. Increasing shortness of breath even at rest
b. Severe cough-dry/Productive
c. Very tired-Unusual fatigue while walking
d. High Pulse rate i.e. 110
e. Blueness of face, lips, finger nails that means inability to transport Oxygen into the blood

3. (HACE) HIGH ALTITUDE CEREBRAL EDEMA (Water in the head)
Severe symptoms of altitude sickness
a. Severe Headache
b. Vomiting
c. Walking like a drunk (Ataxia)
d. Mental confusion/Altered mental status
e. Irritable-Does not want to be bothered by other people
f. Unconsciousness or Coma
TEST - Tandem walking test, Heel to toe step fall off from the line.

DECISION MAKING
1. Find out the main problem i.e. at altitude. Assume all problems are Altitude Sickness unless proven otherwise.
2. If it is an altitude problem with mild symptoms, stay at the same altitude until the symptoms are completely gone. Take an Aspirin tablet, try to go up but listen to your body. If symptoms are worsening, go down.

PREVENTION
1. Acclimatization: - After a 1000m. ascent, stay one more night for acclimatization.
2. Do not make RAPID ASCENT; don't go too fast too high.
3. No alcohol, sleeping pills and smoking.
4. Drink more fluid 3-4ltrs a day… clean, boiled or treated water/tea/coffee/soup/juice etc.
5. Do not carry heavy packs, 10 - 12 Kilograms is ok.
6. Climb higher sleep lower.
7. Over 3000m, 300m. Ascent a day.
8. Do not travel alone.

TREATMENT
1. DESCENT is the best medicine; do not wait for the Helicopter.
2. Medicine:
a. Oxygen.
b. Diamox…for AMS 125mg. Before dinner, for sleeping problem if feeling suffocated.
c. Nafedipine for HAPE
d. Steroids/Dexamethasone for HACE
3. Hyperbolic Bag - Gammow Bag
4. Golden Rules
a. Awareness of ALTITUDE SICKNESS
b. If you have mild symptoms, do not go higher. Take Aspirin.
c. If you have worsening symptoms, go down.
d. Do not leave your team member behind unattended, either trekker or porter.
5. IMPORTANT
a. Go up slowly.
b. Drink plenty of fluids (at least 3 liters per day)
c. Get all information about Altitude Sickness before your trekking tour that will make you confident to make your tour successful.

Our advice: Drink 4ltr of water minimum a day, don't exhaust yourself so much and breathe deep and take rest more than usual.

List of clothing equipments & personal effects:

- Lightweight walking boots and spare laces.
- A pair of track shoes for evening and walk around campsite.
- Warm Jackets (Fibrefill or down) should be adequate.
- A rainproof jacket with hood or a ponchos (Get guaranteed waterproof)
- Woolen shirts and thick sweaters.
- A pair of lightweight/heavyweight trousers and Jeans to wear on campsite.
- Thermal underwear.
- A tracksuit.
- 2 pair of loose fitting long shorts/skirts.
- Few pairs of cotton T-shirts.
- 1 lightweight long sleeved shirt is particularly to avoid sun born.
- A woolen hat for morning and evening.
- A pair of gloves.
- A pair of sandals to shower and campsite.
- Few pair of thin socks and 2-3 pair of thick woolen socks.
- Underwear: normal quantity and swimming costume.
- Sleeping bags for night.

Equipments:

- Duffle bag or kit bag to carry gears while trekking.
- Daypack to carry personal day requirements.
- Water bottle.
- Snow glasses and sunglasses.
- 2-5 large plastic bags to separate clean and dirty clothes. Some small plastic bags for garbage.
- Toiletries with large and small towels.
- Wallet or money belt with compartment for coins.
- Headlamp or torch light with spare batteries and bulbs.
- Candles or lighter to burn toilet paper and to lit on.
- Snow gaiters essential during winter and High Altitude trekking.
- Walking sticks.
- Camera with spare batteries and films
- Reading materials, game items, notebooks, rubber band pen and pencil, envelope, a dairy, a calendar, a pocketknife, binoculars (optional), small pillow or headrest (optional), passport and passport size photos.
- First kit with enough medicine.

MEDICINAL ADVICE

Trekking in Nepal need not be considered risky affair as far as your health is concerned. Nevertheless, preventive measures such as a through medical check up and inoculations before you start trekking can save you from unexpected hazards. Since the remote places of Nepal are not supplied with necessities that are essential for modern medical facilities and as the rescue and evacuation are measured in days, it is imperative to make a comprehensive first aid box consisting of basic drugs and accessories as part of the paraphernalia for trekking. Modern dentristry is unknown in the hill of Nepal so it is advised to have a checkup before departure from home. Tooth fillings, sometimes loosen in cold temperatures and high altitudes, so it is recommended to have them checked. Travelers are requested to bring medicine prescribed by their doctor at home. Common medicine for stomach problems, headache, and malaria is available in Kathmandu. Medicine is usually not available in remote areas. So necessary medicine is advisable to carry with you. Before going to Nepal, it is advised to get injections against typhoid, meningitis and hepatitis.

VISA REGULATION 

A visa is required to enter Nepal. One can get a visa at the Royal Nepalese Embassy or Consulate in your country or at the airport upon arrival or any other entry point in Nepal. Children under 10 years need not pay any visa fees. Two passport sized photos mandatory for visa on arrival. 

01. The single entry tourist visa can be obtained from the entry points of Nepal or from the Royal Nepalese Diplomatic missions abroad by paying US$ 30 for 60 days. Visitors, who wish to obtain the facility of multiple re-entries visa, can fetch it by paying US$ 80 for 60 days. 

02. If the visitor, already visited Nepal under tourist visa, intends to come again within 150 days of the same visa year, he/she can obtain entry visa by paying US$ 30 only for 30 days at the entry points or at the Royal Nepalese Diplomatic Missions abroad. 

03. The visitors who wish to stay for more than 60 days in Nepal can extend their tourist visa by paying the equivalent of US$ 30 in the Nepalese currency for 30 days from the Department of Immigration. 

04. Visitors can extend multiple entries visa by paying US$ 30 for 30 days. If tourist has already obtained multiple entries visa and wish to extend multiple entries visa, it can be extended by paying US$ 30 for 30 days. 

05. Trekking permit is not essential for the general trekking areas such as the Everest, the Annapurna and the Langtang.

06. Business visa with multiple-entry facility for the period of one year and five years can be obtained from the Department of Immigration on the recommendation of the Ministry of Industry by paying the equivalent of US$ 100 and US$250 respectively in the Nepalese currency for the alien investors. 

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