The greatest medical threats for those going off the beaten track in Nepal are;
1) Blisters and foot sores – this is a common problem. Make sure that your boots/shoes are worn in and fit comfortably. The moment you have a problem stop and let your guide know. Blisters do not go away and turn your trek from a dream one into a niggly or nightmarish one. I strongly suggest wearing both a thin pair of socks and a thick pair on your first day’s trekking.
2) Sunburn – this is a common problem. For those of you who think that one only gets sunburnt in hot countries, think again. At altitude there is much less atmosphere protecting you from UV and other rays. Sunburn can be extremely nasty so keep yourself covered, a broad-rimmed sunhat will help and use and carry high protection factor suntan cream/lotion, especially at altitude.
3) Chaffed lips – this is a common problem. Again, like sunburn, protect your lips before they get burnt and always carry lip balm.
4) Altitude sickness (AMS), the least likely, but most threatening problem. On an organised tour you will not be exposed to a high risk of AMS, nevertheless this is an unpredictable condition and you should be aware of the symptoms which should be reported immediately to your guide. AMS is a condition caused by ascending altitude into oxygen thin zones too fast and not giving your body time to adjust. The symptoms include loss of appetite, nausea, vomiting, fatigue, dizziness, insomnia, shortness of breath even when resting, nosebleed, a rapid pulse, a swelling of the hands, feet and face, headache, cough, fever and an unsteady gait. If you start to develop some of these symptoms it’s time to stop, spend a night and adjust to the new altitude. If you’re balance is shaky, your gait unsteady or your cough sputum pink and frothy it’s time to immediately descend. Do not hesitate to consult your guide, AMS is a lethal condition if precautions are not taken.
The most important factor causing AMS is the difference in altitude between the places you sleep, ie you can climb higher during the day, crossing a pass etc, but, once you’re over an altitude of 3,000m, you should not ascend more than 500m a day between sleeping places, though some people prefer to budget on not more than 1,000m over 2 days between sleeping places. Your body adjusts daily to the increased altitude. Over 7,000m (higher than any trekkers will go) the risks increase. If coming from near sea-level then a day should be allowed for at 3,000m before ascending.
Drinking lots of water/tea/soup and eating garlic all help prevent the condition.
Diamox is a drug that effectively brings your altitude down about 500m, it should not be used as a prophylactic because it can not then be used as a last resort. Believe it or not the next best known antidote is viagra.
5) Stomach problems. Only drink mineral or boiled water, if in doubt use some water purifying tablets. Never drink mountain water imagining it to be clean, you don’t know what’s upstream. Never drink from a water container or drink from one which somebody else has put their mouth to. It’s a good idea to refill your water-container with clean water whenever you can.
6) Dodgy knees. Be wise, not macho, always use a walking stick. If you have problematic knees then consult a physio some time in advance and do some muscle strengthening exercises.
7) Snow-blindness. Make sure you have a decent pair of intact sunglasses when above the snow-line.
8) Coughing. Some people develop the ‘Khumbu cough’, probably due to a combination of altitude and dry air. This is most prevalent in the dry Khumbu (Everest) Valley but can develop elsewhere. Take some cough medicine.
Medikit/First Aid Kit – all of which can be bought in Kathmandu if you have the time. A medikit should probably be the responsibility of one person within your group.
Sunscreen (everyone should have ready access), lip balm (one per person), sunburn lotion, plasters, cotton wool, bandages, betadine (or other antiseptic), 2+ broad spectrum antibiotics courses, antibiotic cream, cough medicine, oil of cloves, skin moisturiser if needed, anti-stomach cramp tablets, anti-diarrhea tablets, muscle-relaxant, muscle anti-spasm pills, paracetamol (or other mild painkiller), codeine (or other powerful painkiller), eye drops, oral rehydration sachets plus any personal requirements.
Diamox – not to be used without prior reading up on altitude sickness and/or talking with your guide.
Water purification (iodine) tablets. Surprisingly these are most useful on the more touristy treks when the price of bottled water can soar. On wilderness treks your cook will be boiling water for you each morning, but always carry some water purification tablets with you as you never know when they’ll be needed.
Vaccinations – you will need to consult your doctor at least 6 weeks prior to departure to enable you to have a full course of immunizations. The following is a guideline only, please print this and discuss it with your doctor.
Cholera outbreaks are rare and the cholera vaccination is little more than 50% effective, but that is better than nothing. The best way to avoid this, and many other diseases, is safe (water) drinking habits.
Hepatitis A is a standard travellers’ risk, get yourself covered for safety’s sake.
Hepatitis B can only be got from a shared needle – tattooists etc – or unprotected sex, and the incidence in Nepal is low.
Japanese Encephalitis; this can only be caught in and around the Terai (lowlands) around the monsoon ie in June to September. The JE mosquito likes pigs, paddy fields and rain and no foreigner has ever been documented having caught JE in Nepal. The vaccination is unnecessary for those visiting Pokhara or Kathmandu prior to trekking, though it should be taken for those visiting the Terai, especially during the rainy season.
Malaria, which used to exist in the Terai (lowlands), has been all but eradicated in Nepal, and is not considered a high risk. Chitwan National Park has no malaria.
Meningitis; occasional cases of meningococcal meningitis occur in Nepal and the vaccination should be had.
Polio and Tetanus/Diptheria/Whooping Cough are standard vaccinations that you should have had in any case.
Rabies; a number of street dogs and monkeys in Nepal carry rabies, but as long as you take sensible precautions to avoid animals there is a very low risk. However I personally prefer to be covered and booster vaccinations are available in Kathmandu. People do get bitten or scratched and I would advise the vaccination as a precaution for your own mental health on the retreat to Kathmandu if you are bitten or scratched. Better still do not pet any dogs, cats etc or feed any monkeys.
TB; children should be immunized at any age, this is less important for adults. TB is a growing threat and becoming endemic in neighbouring India.
Typhoid is a risk in Nepal get yourself covered even if the vaccine is only 90% effective, because that’s better than 0%.
Good vaccination web-site info is available at Project Himalaya.