Kathmandu has clinics that treat foreigners well and the rest of the country does not. Insurance must name helicopter evacuation, and never drink the tap water.
- Your policy must name helicopter evacuation and cover the altitude you are actually going to - the cheap ones exclude above 4,000 m.
- A rescue flight costs USD 3,000 to USD 10,000, and helicopters want a guarantee from your insurer before they lift.
- Descent is the treatment for altitude sickness - 500 m usually turns a bad night around. Confusion or breathlessness lying down means go down now, at night, with someone.
- CIWEC Hospital in Kathmandu is the clinic foreigners use, and it knows altitude illness better than anywhere. Outside the valley facilities are basic to none.
- Never drink the tap water, hotels and teeth included. Dal bhat is the safe order - cooked to death, endlessly refilled and served everywhere.
Insurance, which is not optional here
- Your policy must name helicopter evacuation and cover the altitude you are actually going to. A trek to Everest Base Camp tops out around 5,550 m.
- A rescue flight costs USD 3,000 to USD 10,000.
- Helicopters want a guarantee of payment from your insurer before they lift, so carry the insurer's 24-hour number and your policy number where a guide can read them.
- Check the policy does not exclude trekking above a set altitude, which the cheap ones do at 4,000 m.
Altitude sickness
- Ascend slowly and sleep low. Above 3,000 m, gain no more than 300 to 500 m of sleeping altitude a day and take a rest day every 1,000 m.
- Acetazolamide (Diamox) helps you acclimatise; it does not make you safe. Talk to a doctor before you go.
- Descent is the treatment. 500 m of descent usually turns a bad night around.
- HACE and HAPE kill. Confusion, stumbling or breathlessness lying down means go down now, at night, with someone.
- Alcohol and sleeping pills make it worse.
Where to go when ill
- CIWEC Hospital in Kathmandu is the clinic foreigners use, with a Pokhara branch, and it knows altitude illness and traveller's diarrhoea better than anywhere.
- Nepal International Clinic and Mediciti are the other Kathmandu options.
- Outside the valley, facilities are basic to none. Serious illness means getting to Kathmandu.
- Pharmacies are everywhere and sell most things over the counter. Bring your own supply of anything you actually depend on.
Water and food
- Never drink the tap water, including in hotels and including for teeth.
- Bottled water is everywhere and the plastic is a problem; a filter bottle or purification tablets is better and works on the trail.
- Boiled water is sold by the litre in teahouses and is the standard trekking answer.
- Stomach trouble is close to universal. Eat food that is hot and freshly cooked; be careful with salad, ice and anything reheated.
- Dal bhat is the safe order - it is cooked to death, endlessly refilled and served everywhere.
Before you go
- Hepatitis A and typhoid are the standard recommendations, with rabies worth considering.
- Rabies is real here. Dogs are everywhere and a bite or a scratch means treatment the same day, not when you get home.
- Kathmandu's air is genuinely bad in the dry season. If you have asthma, bring what you need and an N95 for the worst days.
- Take a first aid kit, including rehydration salts and blister care. The pharmacy is a week away on a trail.
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