UKC

Hi Again,

Further to my other thread, I would like to enquire about health & hygiene in my trip to Nepal.

(A few days in Kathmandu, and the rest of the time trekking in around Pokhara, Poon Hill, Chitwan.)

We have just been vaccinated for typhoid, with booster shots received for tetanus, diptheria, whooping cough. And have lifelong protection for hepatitis A (according to our jabs).

We will bring water purification tablets, enough for 3½ litres per person per day.

What tips would you recommend to avoid getting ill, or will that be inevitable ?

In reply to Raymondo:

Quite a few folk avoid eating meat whilst out there. 

In reply to Raymondo:

I wouldn't bother with the tablets, take one of those mini water filters that you can use to fill your water bottle. I take mine everywhere these days. I'd also get used to managing with a jug of water in the loo in place of loo roll. 

It's a long time since I was in Nepal, but I didn't get ill there. I acquired a taste for dal bhat (which is delicious) so I didn't eat meat either.

In reply to Raymondo:

i just had boiled water and was fine. wash your hands regulalry and especially before eating. alcohol gel is great for that. a lot of people recommend bringing a nail brush so you can scrub under nails also.

there is a relatively high chance of getting some kind of mild illness, your immune system is probably very tuned to European bugs and won't be used to what they have out there.

when i visited, i think everyone in our group got ill for at least a day. Mostly it was all very manageable, apart from one guy who lost a week

In reply to Raymondo:

Most Lonely Planet / Rough Guide books to Nepal have good sections under health.

Maybe best to be wary of salads. Faecal contamination of soil and unclean water to wash.

Avoid ice in drinks.

In reply to Raymondo:

I brought a water filter which I used while walking, but I ate on the street, in restaurants and I don't think I got ill at all in Nepal.  I didn't drink the local water which I did do in India which might have been why.

I ate quite a bit of meat as well, yak steaks etc, as long as stuff is well cooked you should be fine.

I got attacked by bed bugs in a hotel on the border with India, and also got head lice, so it's worth checking where you are sleeping.

In reply to Raymondo:

Avoid meat, ice in drinks, etc. Both me and wife drank a full fat coke a day (never normally touch the stuff) which apparently is good at killing off minor bugs although that might be a urban myth. The only evidence is that we didn't get sick. 

We had a guide who was brilliant, he would walk into every kitchen before we ate and on more than one occasion told us not to eat in that venue and we went elsewhere. 

Water filters are great, those tablets are pretty horrible. 

In reply to Raymondo:

Hand sanitiser will go a long way. Watch what you eat, meat or no meat. I ended up in hospital with food poisoning... stay away from milk based sauces in restaurants. There's plenty bottled water everywhere. 

Enjoy Nepal

In reply to Raymondo:

If you go into a restaurant and there’s no soap in the bathroom, don’t eat there. 

You'll probably get a little sick but nothing serious. Take great care not to get bitten by mosquitoes - there is dengue in Nepal and you really don’t want that. Personally I worry more about car accidents on trips to Asia than I do about getting mild sickness. Take a bit of care over whose car you get into. 

In reply to Raymondo:

It's been a while since I was there but a few things to consider.

1. Chances are you will get some form of illness. Not just off what you eat but what you touch (money, door handles, taxi surfaces etc.) we took handwipes but it's best not to sweat it too much and not enjoy the experience of being there. I've been to Nepal and India a few times and always picked up something, though never anything serious.

2. water - check bottled water that it is sealed. (Folk have been known to refill old water bottles and re-sell them). Iced drinks are generally best avoided.

3. food - where is safe to eat was often the topic of conversation when I was there and you soon picked up on the "safe" restaurants. Nepal is a wonderful place to eat with a huge variety of cuisine to choose from. Whatever you eat make sure it is well cooked and don't expect that just because you chose the vegetarian option that they didn't use the meat knife to chop up the veg. A good reputation counts for more than whether the food is nice. Salad can be dodgy. We always checked to see if it had been washed with iodine.

4. Generally the things most likely to be picked up from food are Gardia or if unlucky Amoebic dysentry.

In reply to seankenny:

That reminds me of a taxi we used in Bangalore. The entrance slip to the three lane by-pass was shut for repair so he drove up the exit slip and did a u-turn in front of three lanes of on coming cars and lorries.

Do they still have the bus bangers? Those children who hang off the side of the bus and bang on it to let the driver know he is getting too close to the edge.

In reply to Raymondo:

Good advice everyone, appreciate all you inputs and prudent warnings. Perhaps obvious to some but all warnings are welcome to myself.

The straw filter thing sounds like a good idea, and I will be taking alcohol gel for hands and wet wipes.

I guess no meat, no ice, no salads, no milk products. The dal bhat sounds nice, hope they are spicy ! Curried lentils are the best !

Not had coke in years (lol coca cola) but quite like it, so that sounds like a goer.

Mmm the traffic, I guess you don't want severe diarrhoea when involved in a serious road traffic accident (ie injured). Food for thought.

In reply to Raymondo:

No milk products? Set buffalo milk curds are one of the highlights of a trip to the Indian subcontinent, especially if you can get them in little clay pots. I visited Bangladesh a few years ago in monsoon season (ie when it’s easier to get sick as everything is sodden) and ate this all the time, was fine. 

There’s only one thing you want to avoid more than South Asian hospitals, and that’s South Asian police - and a road accident can involve both. Don’t worry if diarrhoea is really serious you’re in no fit state to go anywhere anyhow! (It is worth planning in the odd slack day just in case you can’t move for 24 hours, if does happen.)

In reply to Raymondo:

I didn't get sick out there either in the city or 30 days on trails.  (My girl did once for 24 hours.)

But on the way back home I ate some pasta salad thing from Boots at Heathrow while waiting for a connection to Edinburgh.  That destroyed me.  Not nice on that Edinburgh flight or the entire night after!

Wrote some post-trip notes including food and hygiene that may be useful:

Good food:
Breakfast – Eggs and Tibetan Bread and Honey; Rice Pudding; Pancakes
Lunch – Bakery and Mars Bar; Chapati with Potato Omelette (juicy); Hard boiled eggs; Yak cheese; Apple Pie
Dinner – Vegetarian Pizza; Dhal Bhat; Spaghetti with Tomato and Cheese; Fried Potatoes
Drinks – Lemon Tea; Hot Mango
Note – Limited vegetables (except perhaps in the Vegetarian Pizza) even though many meals come with vegetables

Namche – Stocks:
Very good stocks including Potable Aqua – Rs980; Hand Gel – Rs340.

Wisdom:
Hand gel is essential (often no running water) so take lots. Approx. 1 bottle per week for 2 people.
Socks get very crusty so need lots or ability to easily wash out.
OK to wear 1 thermal all the time but best to have spare just in case get wet (although don't seem to sweat much).
Neck buff vital for cold air and dust (lots of dust from yaks).
Wet wipes are good. Don't need soap, shampoo, vaseline moisturiser. Small toothpaste is good though.
Lip stuff important.
Water purification essential. Need enough to make 6 litres per day. If using iodine, flavour lightly with 'Tang'
(which can be bought in Kathmandu).
Drugs: Supermarkets central Kathmandu have cheap Diamox, Ibuprofen, purification tabs.
Drugs: Pharmacy Kathmandu have all antibiotics, giardia drugs etc. (Harder to find pharmacy, found some down other end of town from hotel, past Northfields cafe)
Ibuprofen perhaps better than codeine for headaches (and medical paper suggests better for AMS).
Take EURO 2 pin adapter and charger for batteries .220-230V EURO sockets at every lodge. But pay 2-500rps for charge higher up. Free some lower lodges.
Big quilts available in every lodge so don't need massive sleeping bag. But cold at night morning, -10 or so.
When changing money for rps ask for official receipt else won't be able to change back later. They don't always give one.
(Poss. Suggestion)Take small tupperware container to put lodge food in for lunch???
Gokyo has shops (associated with the lodges). Can get supplies such as soups and some freeze-dried stuff.

In reply to seankenny:

I hear yak butter tea is an acquired taste. That might be Tibet though. But I doubt I have acquired the taste for it yet, lol.

In reply to BruceM:

More good advice, thank you.

In reply to Raymondo:

Not much to add to all the above which is great advice other than this . Have been to Nepal several times my experience is that you are most likely to get really sick from the fancy restaurants in Thamel with big menus . If you order something obscure or just fine thing they don’t sell much off chances are it will have been sat in a manky fridge or just in a cupboard slowly festering . Eat where you can see the food or see them cooking , eat the popular thing at the busiest restaurant. Eat stuff that needs to be wok d hot from fresh ingredients . If you are going to eat meat be really careful where you do . 

In reply to Raymondo:

Always surprised when folk obsessively use hand sanitiser but don't apply the same logic to the fork and plate they're eating from, especially if they could see the cloth the Ama of the lodge used to wipe them with

Some suggestions from living in Nepal for 19 years and raising my kids out there. 

Don't drink water from the tap in towns or village with mains water. This includes cleaning your teeth from the tap or singing in the shower.  Most villages on trekking routes have communal outside taps and the water is as good to drink as any other mountain source. If you're happy to drink from a French village fountain or a highland spring then a community tap in Nepal is fine. 

Most lodges will provide boiled and filtered water if you want. Try and avoid the easy option of just buying bottled water. Recycling is limited in Nepal regardless of the signs proudly stating otherwise. As an aside, the extension to the runway in Kathmandu was built on landfill composed mainly of plastic.

You can't go wrong eating Dhal Bhat on trek but it's nice to try the wonderfully varied cuisine when back in towns. Meat is fresh in Nepal, just look at the amount of street butchers around and with the Nepalese love of cooking their meat into oblivion, you're fine eating it. As previously posted salads, normally washed with tap water and ice cubes are the main culprit for dancing the Kathmandu Quickstep.

Curd and lassis are delicious, the only dairy I would avoid is Yak cheese given that Yaks are male, Nak cheese is much nicer.......

In reply to Raymondo: by chance , having not seen him for ages , I bumped into an old climbing mate in the pub last night . Sone years ago we went on a trip to Tibet where another asap Kate had organised the food . He was ex military and most of the food was ration packs which were ok apart from the main meals which were horrible . So we lived on dhal bhat for about 5 weeks . No bad thing in general but not for that long . When we got back to Kathmandu we went to the hotel Annapurna for what I still think was the best Indian meal I have ever eaten . We made the chap who had sorted the food pay for the beer , which was eye wateringly expensive . The Indian food in Kathmandu is some  of the best in the world so well  worth doing a bit of research as to where to go to eat it when you are there .

In reply to Raymondo:

I last went to Nepal in 2019. What did for me was the dust that was left over from the 2015 earthquake. Most of the old mud buildings crumbled to dust in the quake which meant that the dust was being recycled through the air on a daily basis. With the massive increase in vehicles, of all types, since I was there in the early 90s. The dust irritated my nose, I caught a cold which started my nose bleeding (a weakness for me) by the time I got to altitude, which also a nose bleed trigger for me, I had both nostrils bleeding. Couldn't breath at night so I turned back before getting to Basecamp. Dust is a problem.

In reply to Adam Hill:

Mmm, I thought Yak was a species ???

On a more serious thought, I did think about knives and forks as potentially being unclean (forgot about plates, d'oh).

Any advice from anyone on knives/forks - bring your own but how to keep clean ?

Plates - I guess there is no option (maybe don't eat so the plate is spotless after the meal ???)

In reply to thread.

Best curry I had was in a curry house in Cairns, Aus.

The waitress was an old lady and spoke no English. I assumed she was the mother of the owner.

Went back two weeks later and ordered the same meal. Something completely different arrived which was not half as good !

In reply to Raymondo:

NEVER put your fingers anywhere near your mouth.

In reply to Raymondo:

Yes, worth being a bit careful what you eat I stupidly had a yogurt in Bolivia as I couldn't resist it. Boy did I suffer.

In reply to Raymondo:

That would probably make little diff in the scheme of things.  You kind-of have to just play the Nepal game when you are there.  They handle your food and serve you.  The fork is just the very last link in the chain.  My girl got sick after we had a meal in a teahouse where the nice young girl serving us was sniffly and dribbling.  (Awesomely friendly person though.)  Using our forks probably wouldn't have changed much.

In reply to thread

All good advice, looks like everyone has covered the basics (very well, thank you all so much), and that I am now fretting over issues of diminishing size. Time to chill out and make sure I have packed the diacalm tablets, lol.

Thank You All !!!

In reply to Raymondo:

I was going to suggest a course of rabies shots but it looks like you won't be more than 24 hours from a hospital so perhaps not. Worth getting for anyone doing extended treks.

In reply to Andypeak:

Generations of kayakers have sworn by Coca Cola for avoiding river tummy...