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The Annapurna Circuit is the popular name for a 300 km trek in the Annapurna mountain range. The trek reaches an altitude of 5,300m on the Thorung La pass, touching the edge of the fabled Tibetan plateau. The trek is a magnificent plan, covering two different river valleys. It encircles the Annapurna Massif, crossing Thorung La [5416m], the highest pass on this trek.
The magnificent mountain scenery, seen at close quarters includes Annapurna, Dhaulagiri, Machhapuchhre, Manaslu, Gangapurna [7455m] and Tilicho Peak [7134m]. Ten peaks of 600-800m rises from the Annapurna. Machhapuchhre looks breathtaking from this viewpoint as also the south face of Annapurna.
The trek begins at Besi Sahar and concludes at Kali Gandaki river valley. After a seven hours drive from Kathmandu, you reach the Besi Sahar in the Marshyangdi river valley. The trek finally concludes at Kali Gandaki river valley. En route, you pass along paddy fields and subtropical forests, view the beautiful mountain scenery, several waterfalls and gigantic cliffs, and experience fascinating village life. The entire trip is so exhilarating that you will be kept enthralled, day after day.
A moderate to challenging trek and sometime requires climbing up and down steep mountain paths. This trek can be done anytime of the year except during monsoon and winter, when the Thorung pass gets blocked by snow.
Taking a flight from Jomsom to Pokhara can shorten this trek. It takes just a day’s walk from Jomsom to reach Muktinath..top
Day 1 Arrival in Kathmandu
It is a panoramic thrill flying into Kathmandu on a clear day. The views of snow-capped mountain peaks sprawling down below you are almost ecstatic, beginning a whole chain of memorable experiences that stay with you for a long, long time. A representative and driver from our office will meet you at the airport and escort you to your hotel. The representative will help you check into your designated hotel. At the hotel you will be briefed about your daily activities.
Day 2 Sightseeing of Kathmandu Valley
Kathmandu is the historical and cultural heart of Nepal and has been a popular destination for tourists ever since Nepal opened its doors to visitors. The city presents a wonderful mix of Hinduism, Tibetan Buddhism and Western influence in the Valley. Patan and Bhaktapur, its two major neighboring cities bear immense historical, cultural and religious significances. There will be a half day guided tour to the famous and biggest Hindu shrine of Pashupatinath, the largest Buddhist stupa in Nepal Boudhanath, the 15th century Palace of 55 windows and Swoyambhunath.
Day 3 Drive to Besi Sahar [820m] [drive approx 6 hours]
With high level of physical fitness, adequate acclimatization and good logistic support, we begin our Annapurna trekking. Driving along the Kathmandu-Pokhara Highway to Dumre and then following the rough route by the Marsyangdi River, we pass through the low-lying villages and rice fields. After 6 hours long drive, we finally reach Besi Sahar. Besi Sahar is the capital of Lamjung District.
Day 4 Trek to Khudi [790m]
From Besi Sahar, we trek along the trail turning right at the canal on the outskirts of the village and descending the narrow path to the Pam Khola. On crossing the stream, we ascend towards the village of Denauti where we get to see Nepali village life at close quarters. The route further leads to the banks of the Marshyangdi Khola, passing through paddy fields and subtropical forests. As the trail nears the Khudi Khola, we approach the Gurung village of Khudi.
Day 5 Trek to Bahundanda [1310m]
As we walk northwards up the Marsyangdi Valley, away from Khudi, we get to see the magnificent Annapurna mountain ranges. The trail winds through a suspension bridge and follows terraced rice fields offering breathtaking view of Manaslu and cascading waterfalls. Further, as the trail goes uphill, we spot several shops and teahouses at Ngadi village. On leaving Ngadi after a brief rest, we skirt through the challenging trails to Bahundanda. Bahundanda literally means "Brahmin hill" and as the name suggests Bahundanda is largely inhabited by Brahmins. Here we conclude our trekking journey for the day.
Day 6 Trek to Jagat [1290m]
A steep trail descends from Bahundanda, through rice fields, before crossing a stream at the bottom of a small waterfall. It then climbs again and traverses the hillside high above the river before reaching the village of Hani Gaon. Ahead, the Marshyangdi valley forms a steep V-shape. We follow the winding mountain path down through Syange and along the river for some distance. The trail then climbs steeply and the path is cut into the sheer cliff-face some 200-300m above the riverbed. Eventually we descend to the stone village of Jagat, situated on a shelf, which juts out into the precipitous Marsyangdi valley.
Day 7: Trek to Dharpani [1920m]
The trail from Jagat descends until it reaches the river and then continues through a lush forest. Further ascent leads to sharp-edged cliff facing the riverbank. En route, Chyamje comes into picture amidst the glorious backdrop of towering Annapurna mountain ranges. After crossing a suspension bridge, we climb steeply towards the slippery and physically challenging path to Sattale. On treading along a succession of rock-strewn trails, we descend to a grassy riverbank that leads to Tal. As we walk away from Tal, the path becomes rugged and winding. Then we approach steep forested village of Karte. Meandering along the waterfalls and cliffs, we finally reach Dharapani after crossing a suspension bridge.
Day 8 Trek to Chame [2630m]
We skirt through a narrow field from the village. The Dudh Khola, which originates from the south face of Manaslu and then Marshyangdi veers to the left. Sinuous trails of the. Annapurna II becomes visible as we arrive at Bagarchhap, a Bhotia village with colorful prayer flags fluttering in the breeze. As we continue ascending through forests of pine and oak, we pass through Dhanakyu before coming to a thundering waterfall. Further on, the Marshyangdi river enters a gorge and the trails follows rock-strewn path.
We can pause for a while and take in the splendor of the picturesque Manaslu. When the steep incline ends, we follow a path amid magnificent rhododendrons and continue on a gently rising path. We cross a stream before entering a pine forest. We then enter the pristine hamlet of Kotho, from where we can capture the most enchanting view of Annapurna II. Treading further, the route reaches a large white gate with a corrugated iron roof, which is the entrance of Chame. Chame is the administrative headquarter of Manang district. There is electricity, wireless station, schools, shops, health post, post office, police check post, hotels, lodges and banks in Chame. The hot springs are the major attraction of this place.
Day 9 Trek to Pisang [3190m]
After a mesmerizing sight of the glowing Lamjung Himal [6893m] in the morning, we head off for Pisang. En route, we cross a large suspension bridge along Marshyangdi and approach houses and lodges on the northern side of the river. Our trekking trail meanders through barley field leading to Teleku at 2775 meters. As we leave undulating mountain passes, we enter fascinating apple orchard and near a bridge at 2840 meters. On crossing the bridge, the pristine hamlet of Bratang appears. History has it that Bratang used to be a Khampa settlement. A stone memorial of a Japanese climber has been built in this place.
After leaving the forested village, the valley changes from a V-shape to a gentle U-shape. Before us, the Annapurna mountain range rears up. Further on, we continue our steep rock-strewn trails to the south side and cross a long suspension bridge at 3040 meters. At this vantage point on the bridge, we get to view Paungda Danda rock rising more than 1500 meters from the river. En route, we get to capture splendid views of Annapurna II rearing up on the east and Pisang Peak on the north-east. We cross a bridge and enter the village of Pisang.
Day 10 Trek to Manang [3520m]
As we continue with our trek, further afield from Pisang we head along a steep ridge savoring beautiful sights of the Manang valley and the Tilicho peak towering above 7132 meters. As we descend through Manang's airstrip, we come to Hongde lying beneath the gigantic Annapurna III on the north-east face. The route further leads to the wide plain of the Sabje Khola Valley from where we get the majestic view of Annapurna IV [7525m].
Further on, we cross a wooden bridge, as the Marsyangdi Khola gushes below us. We enter the beautiful village of Mungji. We continue treading along the cultivated fields and after a while we arrive at the village of Bryaga with a splendid monastery. On trekking down to Manang, we enjoy the majestic views of the Annapurna range - Annapurna II, Annapurna III, Annapurna IV, Gangapurna [7455m] and Tilicho Peak [7134m].
Day 11 Rest day in Manang [3520m]
After reaching Manang, we take a day off for complete rest and adequate acclimatization before crossing the Thorung La. We can spend this day strolling down the river to see the tremendous ice-fall cascading down from the glaciated mountain peaks or by simply take in the panoramic beauty of the Annapurna mountain range and the Manang Valley. A short visit to Himalayan Rescue Association [HRA] aid post makes for an interesting visit.
Day 12 Trek to Letdar [4250m]
Thoroughly acclimatized, we advance towards Thorung La. On the way, we cross a stream, climb to Tengi, 120meters above Manang and ascend further past Marshyangdi Valley turning north-west up the valley of the Jarsang Khola. Amid the spectacular vistas of Annapurna mountain range, we trek beyond the lush vegetation of scrub juniper and alpine grasses to reach the small village of Gunsang. Gunsang is a cluster of flat mud roofs just below the trail at 3960 meters. Along the route, we see several lodges.
As we approach picturesque meadows and rich forests of barberry, juniper etc, we encounter horses and yaks grazing. The trail takes us further along a large stream that flows from Chulu West and Gundang, and leads to a rich pasture at 4000 meters.
Day 13 Trek to Thorung Phedi [4500m]
Leaving Letdar, we climb gradually to a ridge before descending to the headwaters of the Marshyangdi and crossing via a covered wooden bridge. After a short ascent up the mountain path on the right bank, we follow a narrow trail across an unstable steep slope and then descend to Thorung Phedi.
Day 14 Trek to Muktinath [3800m]
We have an early start today for the crossing of Thorung La [5416m]. The trail becomes steep immediately on leaving camp, but as local people have used this trail for hundreds of years, the path is well defined. The gradient then eases and after around 4 hours of steady climbing, we reach the chorten and prayer flags of the pass. From the snow-covered mountains above, to the head of the Kali Gandaki valley below and the brown and purple hills of Mustang, which spread out before us, we are presented with a dramatic tableau.
The descent to Muktinath is a 1600m trek. But the excellent views of Dhaulagiri, more then makes up for the tiring journey. Eventually the moraines give way to grassy slopes before a pleasant walk along the Jhong Khola Valley to Muktinath, with its shrines and temple.
Day 15 Trek to Marpha [2665m]
We now begin the descent down the dramatic Kali Gandaki Gorge. After passing through Jharkot and Khingar, villages with typical Tibetan architecture, we follow the valley floor most of the way to Jomsom. Jomsom is sprawled along both banks of the Kali Gandaki and from here we get fine views of the Nilgiri peaks. We continue down to Marpha, a delightful Thakali village, with a well-planned drainage system. Its narrow alleys and passageways provide welcome shelter from the strong winds of the Kali Gandaki Gorge. Marpha is particularly well known for its apples, apple cider and apple, apricot and peach rakshi.
Day 16 Trek to Lete [2470m]
We continue descending the Kali Gandaki Gorge to Tukuche, a Thakalivillage with a large gompa. Beyond Tukuche we walk along the west bank of the Kali Gandaki towards Larjung. Here, as in many of the villages in this area, narrow alleyways and tunnels connect houses with enclosed courtyards, providing protection against the wind blowing up the valley. We make our way through pine, juniper and cypress forests to Kalopani, enjoying fine views of Annapurna I and Fang. We then reach Lete, which lies just twenty minutes beyond Kalopani.
Day 17 Trek to Tatopani [1160m]
Our trail descends steeply through forests to Ghasa, the last Thakali village and the southern-most limit of Tibetan Buddhism. We enter the steepest and narrowest part of the gorge shortly after Ghasa. At the hamlet of Rupse a magnificent waterfall tumbles down beside the trail. Continuing on, we come to Dana, a Magar village from where the massive peak of Annapurna South can be seen across the valley. The trail then descends to Tatopani where we can have apple pie and bathe in the hot springs.
Day 18 Trek to Ghorepani [2775m]
A short distance downstream from Tatopani, we cross the river on a large suspension bridge and leave the Kali Gandaki behind. After passing through the villages of Sikha and Chitre, we climb through the forest to Deorali, a 2834m pass from where we can get excellent views of Dhaulagiri, Nilgiri, Annapurna I, Annapurna South, and Hiunchuli. Just 10 minutes beyond the pass is the village of Ghorepani. Ghorepani literally means "horse water" and is a welcome watering spot for the packs of mules, which ply the route between Pokhara and Jomsom.
Day 19 Trek to Birenthanti [1050m] & drive to Pokhara
Overlooking Ghorepani is Poon Hill [3193m]. An hour-long pre-dawn ascent gives us the opportunity to see the fascinating views of the Annapurnas and Dhaulagiri glowing in the morning sun. After breakfast, we begin the long descent to Birethanti through magnificent oak and rhododendron forests. From the village of Ulleri, a long steep stone staircase seems to go on forever before eventually reaching Hille. A more gradual descent then brings us to Birethanti, from where it is a short distance to the road and our transport that takes us to Pokhara.
Day 20 Flight/drive to Kathmandu
We fly or drive to Kathmandu.
Day 21 Depart Kathmandu
Our Nepalese support team will take you to the airport for your flight home. On the other hand, if you prefer to stay longer, you can go for short tours such as game drive at National parks, rafting, Tibet tours, mountain biking, etc.- ask us.
Start and End dates - Flexible
Price for single pax : USD 1680
Price for 2 to 5 pax : USD 1410 per person.
Single room supplement in Kathmandu and Pokhara : USD 95
Trip Cost Includes
Arrival transfer, 2-3 star category hotels with breakfast in Kathmandu and Pokhara, A full day sightseeing in Kathmandu with guide, transportation from Kathmandu- Besi Sahar and Pokhara-Kathmandu by regular bus, for single pax- 1 guide cum porter other wise 1 porter for each 2 trekkers and 1 guide for above 2 pax, accommodation and meals in lodges en route, Annapurna conservation fee, crew insurance.
Trip Cost Does Not Includes
Flights, Nepal visa, travel health insurance, lunch and dinner in Kathmandu and Pokhara, expenses of personal nature like drinks and tip, expenses due to nature or any unforeseen disturbances beyond our control, personal trekking gears.
Clothing depending on the season, you will have to bring clothes of your need. The lodges in the mountains have very basic facilities. Only few lodges have showers and hot water facilities. Use of hot water is subject of extra charge. The lodges provide blankets or quilts but having one'€™s own sleeping bag is always better.
The following basic equipments check lists should help you with your packing. Please remember that you should always try to keep the weight of your equipment to a minimum. At the start of the trek your packed trek bag should not weigh more than 33 pounds or 15 kg.
- Sun hat or scarf
- Light balaclava or warm fleece hat
- Sunglasses with UV protection
- Under Garments
- Hiking shorts
- Lightweight cotton long pants
- Light and expedition weight thermal bottoms
- Fleece or wool pants
- Waterproof (preferably breathable fabric) shell pants
- Thin, lightweight inner socks
- Thick, warm wool hiking socks
- Hiking boots with spare laces
- Camp shoes (sneakers and/or sandals) Gaiters for hiking in winter to the base camp
- Light and expedition weight thermal tops
- Fleece jacket or pullover
- Fleece Wind-Stopper jacket (optional)
- Waterproof (preferably breathable fabric) shell jacket
- Down vest and/or jacket *
- Lightweight gloves
- Heavyweight gloves or mittens with a waterproof shell outer
- Sleeping bag rated to zero degrees F *
- Headlamp (e.g. Petzl Zoom) with spare bulbs and batteries
- Small pad or combination lock-to-lock
- Trekking Bags *
- Basic First Aid Kit *
- Large plastic bags - for keeping items dry insidetrekbag
- Daypack (approximately 2500 to 3000 cubic inches)
- Thermarest sleeping pad
- Water bottles
- Toiletries (Small wash towel, Toilet papers etc)
- 1 medium sized quick drying towel
- Tooth brush/paste (preferably biodegradable)
- Multipurpose soap (preferably biodegradable)
- Nail clippers
- Face and body moisturizer
- Feminine hygiene products
- Small mirror
- Wet wipes (baby wipes)
- Tissue /toilet roll
- Reading book
- Trail Map/Guide book
- Journal & Pen
- Pencils and small notebooks
- Travel game i.e. chess, backgammon, scrabble
Notes To Be Remenbered
Entry Procedures & Visa Rules
a. Tourist Visa
Visa Facility Duration Fee
Multiple entry 15 days US$ 25 or equivalent convertible currency
Multiple entry 30 days US$ 40 or equivalent convertible currency
Multiple entry 90 days US$ 100 or equivalent convertible currency
b. Gratis (Free) Visa
• Gratis visa for 30 days is available only for nationals of SAARC countries. However, for extension of visa for SAARC nationals, the rule is same as that of other nationals.
• Indian nationals do not require visa to enter into Nepal but Need to carry Passports to travel by Air.
For Visa Extension:
Tourists can stay for a maximum of 150 days in a visa year (Jan 1 to Dec 31) extending the visa at the rate of 2 US $ per day. However, a minimum amount of 25 US$ has to be paid for a period of 15 days or less.
(For further information, please, contact Department of Immigration, Kalikasthan , Kathmandu, Tel: 00977-1-4221996/ 4223590/ 4222453, Web: www.immi.gov.np )
All baggage must be declared and cleared through the customs on arrival at the entry point. Personal effects are permitted free entry. Passengers arriving at Tribhuvan International Airport (TIA) without any dutiable goods can proceed through the Green Channel for quick clearance without a baggage check. If you are carrying dutiable articles, you have to pass through the Red Channel for detailed customs clearance.
Apart from used personal belongings, visitors are allowed to bring to Nepal free of duty: cigarettes (200 sticks) or cigars (50 sticks), distilled liquor (one 1.15 liter bottle), and film (15 rolls). You can also bring in the following articles free of duty on condition that you take them out with you when you leave: binoculars, movie or video camera, still camera, laptop computer, and portable music system.
The export of antiques requires special certification from the Department of Archeology, National Archive Building, Ram Shah Path, Kathmandu. It is illegal to export objects over 100 years old, such as sacred images, paintings, manuscripts that are valued for culture and religious reasons. Visitors are advised not to purchase such items as they are Nepal's cultural heritage and belong here.
For more information on customs matters, contact the Chief Customs Administrator, TIA Customs Office (Phone: 4470110, 4472266).
Foreign Currency and Credit Cards
Payment in hotels, travel agencies, and airlines are made in foreign exchange. Credit cards like American Express, Master and Visa are widely accepted at major hotels, shops, and restaurants. Remember to keep your Foreign Exchange Encashment Receipt while making foreign exchange payments or transferring foreign currency into Nepalese rupees. The receipts may be needed to change left-over Nepalese Rupees into hard currency before leaving the country. However, only 10 percent of the total amount may be converted by the bank. ATM is widely in use in Kathmandu.
Major banks, hotels and exchange counters at Tribhuvan International Airport provide services for exchanging foreign currency.
Exchange rates are published in English dailies such as The Rising Nepal, The Kathmandu Post and The Himalayan Times. Nepalese Rupees are found in denominations of Rupees 1000, 500, 100, 50, 20, 10, 5, 2 and 1. Coins are found in denominations of Rupees 5, 2 and 1. One rupee equals 100 paisa.
Time and Business Hours
Nepal is five hours 45 minutes ahead of GMT.
Business hours within the Valley: Government offices are open from 10 am to 5 p.m. from Sunday through Thursday and close at 3pm on Friday in the Kathmandu Valley. During the winter, they close at 4 pm. Most Business offices are open from 10 am to 5 p.m. Sunday through Friday. Embassies and international organizations are open from 9 am to 5 pm Monday through Friday. Most shops open after 10 am and close at about 8 pm and are usually closed on Saturdays.
Business hours outside the Valley: Government offices outside Kathmandu valley open from 10 am to 5 p.m. from Sunday through Thursday. On Fridays they remain open until 3 pm. Banks are open from Sunday through Thursday from 10 am to 3 pm. On Fridays, banks remain open until 12 pm only. Business offices are open from 10 am to 5 pm Sunday through Friday. Recently many private banks have re-organized to have different branches open at various different times making banking hours longer. If one branch is closed another will be open.
Holidays: Nepal observes numerous holidays, at the least a couple in a month. So please check the holiday calendar. The longest holiday in Nepal is during the Dashain festival in late September or October. Government offices observe all the national holidays and banks observe most of them. Businesses observe major holidays only.
Postal Services: The Central Post Office located near Dharahara Tower, is open from 10 a.m. to 5 p.m. Sunday through Friday. The counters are open from 10 a.m. to 4 p.m. and provide stamps, postcards and aerograms. Post Restante is available Sunday through Friday from 10 a.m. to 5 p.m. Express Mail Service (EMS) is available at GPO and at Thamel, Basantapur and airport postal counters.
Telephone Services: Telephone and fax services are available at the Nepal Telecommunications Corporation at Tripureshwar. Hotels and private communications centers provide long distance telephone and fax facilities. For calling from outside, country code for Nepal is 977 and the area code for Kathmandu is 1.
Internet Services: There are countless Internet cafes and communication centers have opened up in the Valley and around the country. Visitors only have to find a place they are most comfortable in to use the facilities to keep in touch with home. Internet services are also offered by hotels.
Media: Nepali media has made a gigantic leap ahead in just a few years time and what used to be a controlled and tight knit community, is no more. The government audio and television news networks are Radio Nepal and Nepal Television respectively. However, numerous FM radio stations and regional television stations are dominating the market. Major Nepali daily newspapers are Gorkhapatra and Kantipur, while the English dailies are The Rising Nepal, The Kathmandu Post and The Himalayan Times. A number of other newspapers and magazines are also available.
Electricity: Major towns have electricity and the voltage available is 220-volts and 50 cycles. Load shedding is a seasonal phenomenon during the dry season and eases off once it begins to rain. However, most major hotels have uninterrupted power supply through their own generators.
High mountain altitude sickness in Himalaya
Travelers are drawn to high altitude places in ever increasing number- Nepal alone now receives more than Five hundred thousand trekkers from around the world every year. It can be easy to under-estimate the dangers of altitude illness; deaths from these conditions are all the more tragic because they are entirely preventable.
Mountain climbers, serious trekkers, romantics sauntering through the foothills of the Himalayas, native porters, skiers in North America and Europe, pilgrims to high altitude shrines, diplomats posted to La Paz or Lhasa, miners in South America, and Everest marathon runners have something in common: they are all exposed to the effects of high altitude, and may be at risk from a potentially fatal but eminently preventable problem: Acute Mountain Sickness, commonly referred to just as AMS.
AMS consists of headache plus any one of the following symptoms in different degrees: nausea tiredness, sleeplessness or dizziness, occurring at altitudes of around 8000 ft or higher where pathophysiological changes due to lack of oxygen may manifest. Another term, "altitude illness', is also widely used - an umbrella term that includes the benign acute mountain sickness and its two life-threatening complications, water accumulation in the brain (high altitude cerebral edema, HACE) or high altitude pulmonary edema (HAPE, water accumulation in the lungs). The latter two complications may follow AMS, especially when people continue to ascend in the face of increasing symptoms. In keeping with the Jesuit tradition of painstaking documentation, Father Joseph de Acosta, a sixteenth century Spanish Jesuit priest, is credited with having first described the effects of high altitude in humans. In vernacular Nepali, mountain sickness is called "Lake Lagne": in Sanskrit it is aptly called "damgiri" ("dam" means breathlessness and "giri" Means Mountain).
Those most at danger from complications are people who do not "listen to their body", and heed the early warning signals of AMS; they can go on to suffer from HAPE and HACE and may even die-a process that has been carefully documented in important autopsy studies performed by Walter Bond and John Dickinson during the Seventies in the old Patan hospital in Kathmandu.
Chronic mountain sickness is an entirely different condition, recognized by Carlos Monger Medrano in high altitude long-term residents of South America during the Twenties. Such maladaptation is seldom found in the Sherpas or Tibetans, possibly due to thousands of years of exposure to high altitude living. (South Americans populations are relative newcomers to high altitude.) The present discussion will be confined to acute exposure to altitude in short-term sojourners.
Acute Mountain Sickness (Ams)
If a participant on an Everest trek suffers from a mild headache and nausea at Namche Bazaar (12,300ft), he might take an aspirin and wait for these symptoms to go away; however if the symptoms progress to vomiting and a splitting headache, he must assume that he is suffering from AMS and make plans to descend. It is amazing how many people in this situation ignore the dangers and continue to ascend with their friends, trying to blame their symptoms on poor fitness or flu. For some people, it's the high investment of time, effort and money, for others perhaps it's peer pressure or reluctance to accept defeat. A further is that many in the burgeoning adventure travel industry are clueless about mountain sickness.
AMS may set in within hours to days of arrival at high altitude: the onset of symptoms is usually gradual, which is why it is so vital to watch out for early warnings: does a person feel excessively tired; is she the last one to drag herself in to camp?
What causes AMS?
AMS is caused by a lack of oxygen. Although the proportion of oxygen in the atmosphere always remains the same (21%), as we go higher the "driving pressure" decreases. The driving pressure depends directly on the barometric pressure, and forces oxygen from the atmosphere into the capillaries of the lungs. Reduced driving pressure results in decreased saturation of oxygen in the blood and throughout the tissues.
Just what causes some people to suffer from AMS but not others is largely unknown, but there are clear-cut and important preventive factors that are now well- established (see below). The exact mechanism (pathophysiology) of AMS has similarities to that of HACE.
High Altitude Cerebral Edema (HACE)
Our trekker in the above example would probably go on to suffer form HACE if he continue to ascend despite the headache and vomiting; the symptoms of HACE are an extension of those to AMS.
From fatigue, there is progression to lethargy and then to coma. Or there may be confusion and disorientation, A useful test is to see if the person can walk a straight line. If he walks like a drunk or is unsteady, it has to be assumed that he has life-threatening HACE and needs to descend promptly with assistance. This situation is serious enough to justify immediate helicopter evacuation.
HACE is probably caused by shifts of fluid into the tissues of the brain. Reduced oxygen levels cause swelling within the confines of the bony skull. The resulting rise in pressure may lead to lethargy and eventually coma.
High Altitude Pulmonary Edema (HAPE)
This disease may follow AMS, but often it may appear independently. The typical scenario would be a trekker who has no headache or nausea, but finds he has a harder time walking uphill, that he is out of breath on slight exertion compared with the initial days of the trek. There may be a nagging cough and he too may have ascribed these symptoms to a cold. He may be suffering from sub-clinical or early HAPE, a well-recognized entity. With further ascent this may progress to shortness of breath even at rest - descend is now obligatory, or the outcome may be fatal.
Low oxygen causes the pulmonary artery to narrow and this results in exudation of blood near the smaller branches of the lungs (the alveoli). If the exudation continues, blood may escape into the alveoli leading to a cough with watery, blood-tinged phlegm. Such exudation, or "water logging" of the lung tissue interferes further with oxygenation. A popular, compact device called a pulse oximeter can measure the oxygen level in the blood simply and rapidly, using a sensor attached to the index finger. It can be very helpful in confirming if HAPE is present.
What is acclimatization?
Acclimatization is a state of physiological "truce" between the body of a visitor and the hostile low-oxygen environment of high altitude. This truce permits the trekker of ascend gradually. (This is distinct from "adaptation" - permanent change to the organism, perhaps over thousands of years, perhaps even at a genetic or evolutionary level, to facilitate survival at altitude. Scientists are trying to decipher if the Sherpas or Tibetans have made such an adaptation.)
For acclimatization to take place the single most important step is hyperventilation- the trekker unconsciously breathes faster and more deeply than normal, even at rest, to make up for the lack of oxygen. However, hyperventilation also leads to loss of carbon dioxide from the blood, making the blood more alkaline, and it turn depressing ventilation. However, 48 to 72 hours after exposure to high altitude, the kidney comes to the rescue and begins to excrete alkali from the blood to restore a more balanced environment in which hyperventilation can continue unabated.
Preventing altitude illness
There is little doubt that altitude illness is one hundred percent a preventable illness. No one should die from it. For the past quarter of a century, one of the most important objectives of the Himalayan Rescue Association in Nepal has been to preach the gospel of prevention, from its aid posts in Pheriche (at around 14000ft in the Everest region) and Manang (at around 12000ft in the Annapurna region). There are four golden rules, plus some important general principles that should always be followed:
1. Understand and recognize the symptoms of AMS. Recent growth in adventure travel has made trekking at high altitude simpler and more accessible, with the result that more and more people who go trekking are ignorant of the basic facts of altitude illness.
2. Never ascend with obvious symptoms. Incredibly, I have known people who have hired a horse or a yak to go up higher when they were too sick to walk. This is courting disaster.
3. Descend if symptoms increase. It is amazing how striking and dramatic the relief may be with even a couple of hundred feet of descent. People with signs of HAPE or HACE have to descend.
4. Group members need to look out for one another
(Perhaps like the buddy system in SCUBA diving). This rule gets broken with unfailing regularity every trekking season in the Himalayas, because people are just too anxious to complete their trek, even if one of their party members is ill. A trekker with AMS, HAPE or HACE will want nothing more than to be left alone, unbothered, at the same Altitude- potentially a fatal option. There is no alternative but to bring the person Down to a lower altitude accompanied by a friend who speaks the same language.
Following a conservative rate of ascent
Going too high, too quickly, is the single most important cause of susceptibility to AMS. Beyond about 9000ft, the sleeping altitude should be no higher than about 1500ft from the previous night's altitude. The sleeping altitude, not the altitude achieved during the daytime, is what is important. Altitude sickness often manifests at night because during sleep the oxygen level in the blood may dip further. Many mountain climbers will have been to 14000ft or high in the Alps or in North America but few will have slept at the altitude. In the Himalayas, you don't have to be an experienced climber, or use crampons, to be able to "hang out" at 15000ft or higher for days: easy accessibility to these altitudes makes exposure to AMS also mush easier.
While ascending, every second or third day should be rest day for acclimatization. "Climb high and sleep low" is the dictum, but it is important not to exert oneself excessively in trying to fulfil this.
The trekker should not be in a hurry in the mountains. The itinerary should be planned so that there are enough "leeway days" in case more time is needed to acclimatize. Trying to do a high-altitude two-week trek in one week is always fraught with problems.
Avoiding of excessive exertion in the initial days
Excessive physical exertion at high altitude makes one more susceptible to AMS. It is important to take it easy at high altitude, especially in the initial days. People who are very fit for example marathon runners or those who carry very heavy backpacks seem more vulnerable to AMS than others, probably because they push themselves harder. I once looked after a trekker who felt he could not break his morning jogging sessions despite a strenuous trek day ahead, even at 4000m! The feeling of" man against nature" may be stronger in this fitter group.
Jim, a rock star, decided to "whoop it up" with four bottles of beer, on arrival at 3500meters in the Everest region. He felt ill with severe AMS and needed to be helicopter out two days later. He had been warned not to drink alcohol on the trek, especially while ascending. Alcohol may dehydrate the trekker but more importantly it depresses breathing or ventilation. Sleeping pills may have a similar effect.
Maintaining adequate hydration
Adequate amounts of fluid (about 3 liters a day) are necessary in the mountains:- dehydration mimics altitude sickness and may even predispose to it. On the other hand excessive water drinking should also be avoided as this may lead to electrolyte imbalances.
Maintaining a high carbohydrate diet
A high carbohydrate diet aids ventilation and efficient use of oxygen. The good news is that - in many high altitude places - there is not much alternative: rice, potatoes and other strach-laden foodstuffs tend to be the staple, with not much else to choose from.
Drug prevention (prophylaxis)
Diamox (actazolamide) may be necessary for people going on rescue missions at high altitude or flying in to high altitude cities like La Paz or Lhasa. People with sulpha allergy should not take diamox, the primary drug for prevention, and further details are given below. A second drug, dexamethasone (see below) should also be carried, particularly if the destination is remote: this can be life saving if HACE supervenes.
Wherever, possible this has to be attempted. There is really no magic altitude to descend, but the sick patient may suddenly feel something lift and feel hungry. This is the altitude to which the body is adjusted. Patients with HAPE need to descend slowly and with assistance: excessive exertion even during descent may increase the blood flow to the lungs and exacerbate the problem.
Lack of oxygen at altitude is the chief reason why people suffer from altitude sickness, so breathing supplemental oxygen is obviously going to make a difference. But oxygen is a hard commodity to come by in the mountain - cylinders of oxygen are not easily portable. When oxygen available in AMS settings, it should be used.
Acetazolamide (diamox): This is the most tried and tested drug for altitude sickness prevention and treatment. Unlike dexamethasone this drug does not mask the symptoms but actually treats the problem. It seems to works by increasing the amount of alkali (bicarbonate) excreted in the urine, making the blood more acidic. Acidifying the blood drives the ventilation, which is the cornerstone of acclimatization.
For prevention, 125 mg twice daily starting the evening before and continuing for three days once the highest altitude is reached, is effective. A recent article in the British Medical Journal suggested taking a higher dosage -- 750mg daily. Our experience in the Indian subcontinent has consistently been that 250 mg per day has been rewarding, while excessive dosage may just increase the side effects.
Side effects of diamox are: an uncomfortable tingling of the fingers, toes and face (called "jhum jhum" in Nepali); carbonated drinks tasting flat; excessive urination; and rarely, blurring of vision. In most of the treks in Nepal, gradual ascent is possible and prophylaxis tends to be discouraged. Certainly if trekkers develop headache and nausea or the other symptoms of AMS, then treatment with diamox is fine. The treatment dosage is 250 mg twice a day for about three days.
Dexamethasone: This steroid drug can be life saving in people with HACE, and works by decreasing swelling and reducing the pressure in the bony skull. The dosage is 4 mg three times per day, and obvious improvement usually occurs within about six hours. Like the hyperbaric bag (See below), this drug "buys time" especially at night when it may be problematic to descend. Descent should be carried out the next day. It is unwise to ascend while taking dexamethasone: unlike diamox this drug only masks the symptoms.
Dexamethasone can be highly effective: many people who are lethargic or even in coma will improve significantly after tablets or an injection, and may even be able to descend with assistance. Many pilgrims at the annual festival at Gosainkunda lake in Nepal suffer from HACE following a rapid rate of ascent, and respond remarkably well to dexamethasone. Mountain climbers also sometimes carry this drug to prevent or treat AMS. It needs to be used cautiously, however, because it can cause stomach irritation, euphoria or depression.
It may be a good idea to pack this drug for a high altitude trek for emergency usage in the event of HACE In people allergic to sulpha drugs (and therefore unable to take diamox) dexamethasone can also be used for prevention: 4 mg twice a day for about three days may be sufficient.
Nifedipine: This drug is generally used to treat high blood pressure, but also seems able to decrease the narrowing in the pulmonary artery caused by low oxygen levels, thereby improving oxygen transfer. It can therefore be used to treat HAPE, though unfortunately its effectiveness is not anywhere as dramatic that of dexamethasone in HACE. The dosage is 20 mg of long acting nifedipine, six hourly.
It can cause sudden lowering of blood pressure so the patient has to be warned to get up slowly from a sitting or reclining position. It has also been used in the same dosage to prevent HAPE in people with a past history of this disease.
The hyperbaric bag
This is a simple, effective device, made of airtight nylon; it is about 7 feet long ad looks like a long duffel bag. With the patient inside, the bag is inflated with a foot pump until it becomes like a large sausage-shaped balloon. There is a one-way valve to avoid carbon dioxide build up inside, and it has transparent panels to assist communication with its occupant.
The pressure insde the bag is 2 p.s.i,. so the effect is about the same as bringing the patient down a couple of thousand feet. For both HACE and HAPE (but especially, in our experience, for HACE) the changes are usually dramatic within an hour. However there may be a "rebound" tow or three hours after therapy and the patient may need to get in the bag again. Just like the dexamethasone, this bag only helps to "buy tome". Descent is still mandatory as soon as possible.
Other problems at altitude:-
An abnormal breathing pattern whilst asleep is a common occurrence at high altitude: short spells of an increased breathing rate alternate with brief periods when breathing slows down seems to stop the medical term for this is "Cheyne Stokes" respiration. It is only a problem if it makes the suffers wake up repeatedly, breathless, anxious and unable to sleep. An effective remedy is Diamox 125 mg before dinner, which counteracts the low oxygen dips during sleep that trigger the problem. Sleeping pills should be avoided.
Upper respiratory tract infections and symptoms
Many people develop a persistent, bothersome cough and cold-like symptoms in the cold dry air of high altitude. An antihistamine at night like Benadryl 25 mg may help suppress the cough. Antibiotics are sometimes useful, but keeping the head and face covered and breathing through a silk or wool scarf to humidify the air may also help. many studies have shown that upper respiratory tract infections can predispose to AMS.
There may be swelling around the eyes, fingers, ankles at high altitude, but this may not indicate AMS per se unless accompanied by the symptoms of AMS. These symptoms without AMS usually require no treatment.
High altitude syncope (fainting): This is well known but harmless problem, in which fainting occurs suddenly, usually shortly after arrival. Simple measures like keeping the individual in a reclining position and raising the legs is helpful.
Travelers with pre-existing health problems; children, and birth control pills
High blood pressure: Blood pressure initially increases at high altitude due to the initial stress of low oxygen triggering neurohumoral changes. However people who suffer from high blood pressure can go up to high altitude as long as this is well controlled and they continue to take their medication.
Coronary heart disease: People with a history of heart attack (moycardial infarction) and even those with coronary artery bypass grafts or angioplasty but with no angina, can trek up to high altitude provided they are fit and able to walk rigorously at low altitude. The high altitude does not seem to add any extra burden to the heart.
Epilepsy: Although seizures may be provoked by altitude there is no convincing evidence that it is unsafe for well-controlled epileptics travelling to travel to high altitude, though such people should always take their anti seizure medications conscientiously.
Migraine: Sufferers may possibly have more attacks in the mountains and this may sometimes be difficult to distinguish from AMS. In doubt it is best to descend.
Lung disease: Also noteworthy is the limited observation that bronchial asthma does not seem to get exacerbated at high altitude due to the cold and exercise. However it is prudent for asthmatics to carry inhalers and other medications. Obviously people with chronic obstructive lung disease may be more short of breath and travel at high altitude would be inadvisable.
Neck surgery and radiotherapy: People with treated cancers like lymphoma or tumors in the neck who have had extensive surgery or radiation treatment may be especially prone to AMS because of damage to the carotid bodies - tiny organs within the carotid arteries that sense oxygen and aid ventilation.
Diabetes: Diabetics on insulin should have a reliable glucometer to check their blood glucose regularly, but high altitude does not seem to cause additional risks.
Corneal surgery: people who have had non laser surgery (radial keratotomy) to correct their short sightedness may run into problems at high altitude due to swelling of their cornea caused by the low oxygen. Such people should carry corrective lenses as well if travelling to high altitude.
Pregnancy: Pregnant women should not sleep higher than 12000ft as this may endanger the fetus; a further problem is that high altitude places are generally remote, making emergencies more difficult to deal with.
Children: Children do not suffer any more from the effect of altitude than adults. However, it is important that a child should be able to communicate any symptoms to responsible adult, so that prompt descent can be arranged. It may therefore be dangerous to take children to high altitude that is not yet old enough to do this.
Contraception: Oral contraceptive pills may predispose to abnormal blood clotting (thrombosis) at high altitude. the hypoxia (low oxygen), the excessive red blood cells (polycythemia) in the blood, and the possible dehydration in this environment may already be other predisposing factors for thrombosis. Hence it if best to use other forms of contraception at high altitude.
Other disease risks
Many high altitude destinations are in developing countries, so it is important to be up to date with vaccinations against disease like typhoid and hepatitis, to know about travelers' diarrhoea and its treatment, and to understand the other precautions described elsewhere in this book. Malaria is not a risk at altitude - transmission does not take place above 2000 meters.
Conditions that mimic altitude sickness
Improving medical facilities in countries such as Nepal have made it much easier to distinguish between altitude illness and conditions that can produce similar symptoms, such as bleeding in the brain (subarachnoid hemorrhage), strokes, dehydration and blood viscosity related problems like venous thrombosis.
Most of the problems of high altitude are totally preventable. With careful precautions, your experience in the mountains should be safe and rewarding.
Frequently Ask Questions
Why is Nepal such a fascinating country for many people?
The Himalayan kingdom of Nepal is a land of scenic mountains, time-worn temples and some of the best walking trails on Earth. It's a small country, but it's rich in scenic splendour and exotic cultures. The people of Nepal are as diverse as their country and represent distinct cultures and races. Though they speak a variety of tongues and practice different religions, they are the friendliest people that you would ever meet.The kingdom has long exerted a pull on the Western imagination and it's a difficult place to dislodge from your memory once you return. So, wait until you're actually here in Nepal.
As a traveller, there are endless number of surprises Nepal has to offer you. Kathmandu Valley with its thousands of Hindu temples, Buddhist stupas, stunning architecture and rich pageantry can be quite beyond words. If you are careful enough not to get entangled in the superficial facade of a fastly "modernizing" capital city, Kathmandu probably offers you as exotic and urban experience as you can get.
Beyond Kathmandu, its another world altogether. Most travelers to Nepal want to check out the truly spectacular Himalayas along with the higher hills. A few go there to scale the high mountains, but many are nature lovers who trek along landscapes filled with deep valleys, lush forests, snow trails, terraced fields, and above all, the most hospitable people. See the FAQ on Trekking for more.
Travelers to Nepal also love making a safari trip to one of the National Parks in Nepal. The most popular one is the Chitwan National Park in the southern plains which hosts a diverse wildlife reserves including the rare Asian one-horn rhino.
How do I get to Nepal?
In order to fly directly to Nepal from your home country, Tribhuvan International Airport (TIA) in Kathmandu is the only international airport in Nepal. TIA has direct airlink with Osaka, Shanghai, London, Frankfurt, Hongkong, Singapore, Bangkok, Delhi, Dubai, Bombay and Calcutta. Lufthansa, Royal Nepal Airlines (RNAC), Air India, Singapore Airlines, Thai are the airlines that carry most of the foreign travelers into Kathmandu; and if you buy tickets from any other airlines, you will probably connect with one of these airlines for the final leg of your flight.
Alternatively, if you have time and enthusiasm, traveling overland to Nepal via India is an option. British overland travel operators can take you from London to Kathmandu on a six to eighteen week trip for anywhere between $1200 to $ 2500 depending upon the nature of your trip. You will travel from continental Europe through Turkey, Iran, Afghanistan, Pakistan and India to Nepal. For specific details on traveling overland from India to Nepal, read below.
How much does airfare to Kathmandu cost?
Anyone who has done any traveling on air can tell you that one can never say for sure how much they cost. However, an economy class round trip ticket to Nepal from North America, should cost between $1400 to $1700 depending on what airline you fly and when. From western Europe, the fare should be about the same too. From most of East Asia, the cost is about $300 for one-way. If you are flying into Nepal from India or other South Asian cities, one-way fare would be between $100 to $200: Delhi ($150), Varanasi ($80), Bombay ($200), Calcutta ($100), Karachi ($150), Dhaka ($80). These figures are only estimates, and you should check with your travel agents for details.
Should I tag along with organized tours?
It's not a bad idea to tag along with organized tours though it can cost many times more than a self arranged trip. Nevertheless, since Kathmandu is a small city and can be explored easily without organized tour, I recommend people to do self-visit to different places in Kathmandu.
When is the best time to go to Nepal?
The weather is probably the best guide for deciding when to plan your trip to Nepal. October and November are considered the best times of the year. The monsoon will have just ended, and clear skies with optimal temperature will prevail. The main festivals of Dashain and Tihar (Hindu equivalent of Christmas in terms of festivity) fall during these months. However, this is also the busiest tourist season, and the main tourist centers and trekking trails tend to be crowded with travelers like you. The tourist flow ebbs a little, but not significantly, between the winter months of December and mid-February. It catches up once again between mid-February and mid-April. From mid-June to early October, it's the monsoon, during which time it rains almost everyday and most of the Himalayas are hidden behind the clouds. Check the weather section of this FAQ for more details on weather. In short, plan to visit Nepal between October and May, keeping in mind that October-November and February-March are the best times (but crowded with other travelers).
What are my options to come to Nepal from India?
You can fly between Delhi and Kathmandu for about $150 with NAC or Air India. The actual flight time, not counting the endless delays and cancellations, is only a little more than an hour. However, note that Delhi-Kathmandu-Delhi flight is very busy and without proper reservations (or proper strings to pull) can be booked weeks in advance. Make your reservations and buy your ticket well in advance.
Alternatively, you can travel overland to Nepal from India. Buses are usually the quickest and easiest form of transport for this. There are three main crossing points: Sunauli-Bhairawa, Birganj-Raxaul and Kakarbhitta-Silguri. The Sunauli border crossing is the best one from Varanasi, the Birgunj crossing is the easiest from Calcutta; and Kakarbhitta is the best crossing from Darjeeling. These trip can be quite long and stressful, both in terms of time (it takes about two days and nights) and what you may go through during the trip (with tickets, safety, weather, border harassment etc). Not recommended for those people who want to have carefree travelling.
If you plan to enter Nepal in a car, make sure you have a carnet de passage en douanes. These are required to exempt you from customs duty for three months. You may also be required to pay a fee for each day that your car is in Nepal. As in India, in Nepal, vehicles are driven on the left side of the road.
What about getting to Nepal from Tibet?
The crossing between Nepal and Tibet via Kodari is only open to organised groups but not to individual travellers heading north. Be prepared with alternative plans if you're thinking about using this route, because landslides regularly make it impassabe during the monsoon.
What is the weather in Nepal like?
The width of Nepal is only about 200 km on average, but within this short distance the altitude of the land rises from lowly 60m to all the way up to above 8000m.Hence the weather depends upon the altitude of the place in Nepal. However, in general Nepal has four climatic seasons: Spring, Summer, Autumn and Winter. Spring starts from March to May. The temperature of this season fluctuates between 20* C to 30* C(68* F to 86* F). Summer starts from June to August. These are also the pre-monsoon months with occasional evening-thunderstorms and hot temperature. Autumn starts from September and ends by November. During this period, the climate is dry and mild with temperature fluctuating between 20* C to 30* C (68* F to 86* F). Winter starts from December to February. The morning and evening are very cold while the afternoon is pretty sunny. The temperature during these months rises from 15* C to 20* C (59* F to 68* F). For detail information on temperature and rainfall, check the Weather Chart.
What sort of clothing should I bring with me?
Clothing depends on place and time. Medium-weight and easy to wash cottons can be a good choice year-round in the Kathmandu valley. It is recommended that between October to February, woolen sweaters, jackets or similar other warm outfits are necessary. From March through May, light clothing such as short and long-sleeved shorts will do perfectly fine at Kathmandu, Pokhara and most other towns. For mornings and evenings, a jacket or heavy woolen sweater (you can find beautiful ones in reasonable price in Kathmandu) will be essential. For months from June to August, it is recommended that you bring an umbrella or raincoat and a pair of sandals with you as these months are the rainy months of Nepal. Expect lot of walking even if you don't plan to trek. So it's recommended that you bring comfortable footwear: sneakers and sandals are the best
If you intend to go for trekking, a pair of hiking boots will be great. Bring plenty of woolen socks too. Specialized trekking gear is easily available and can be rented in fairly inexpensive charge in Kathmandu and Pokhara: see FAQ on Trekking for details on proper clothing during treks.
I want to go on a trek. When and where can I do so?
There are numerous treks you can try when you are in Nepal depending on the time of the year, amount of time and money you have to spend, and the amount of experience you've had. For limited time and money, the best trekking routes would be the Langtang-Helambu trek just north of Kathmandu, and parts of the Annapurna region trek north of Pokhara. If you have more time, a trek in the Everest region or the full Annapurna circuit can be rewarding. A more difficult trek is the Kanchanjunga area trek in the far-eastern Nepal. A good trekking book is recommended if you want more details on treks. Check out Pilgrims Book House for more details.
Where Can I get more information and maps?
A travel/trek guide book is best for more information. Maps are available in bookstores around Pokhara and Kathmandu.
Is it okay to trek alone?
While trekking alone can be a great way to get to know the country, deciding to trek alone deserves a second thought. Safety-wise, it is generally okay to trek alone on popular trekking route. Incidents involving trekkers do occur occasionally (and probably is on the rise). But as a general advice, you should team-up. Teaming-up can also be of great help if you ever need some medical help. During the main tourist season, you will run across other trekkers who will not mind you joining them. Also, you can find posters in the main tourist areas of Kathmandu and Pokhara looking for trekking partners. An option is also to hire a trek guide or a porter to go along with you.
Should I trek with an agency?
Trekking with an agency can be worthwhile for those who are very tight on schedule but not on money. A trekking agency can organize a trek for you for anywhere in the upwards of $25 a day depending upon the nature of your trek. The deal normally comes with food, shelter, porters and guides. You will be traveling with other similar trekkers. If you hire an agency in Kathmandu or Pokhara, you get a much better bargain than hiring one in your home country. While traveling with an agency offers you a degree of luxury that may not be available if you go independently, it also has its own limitations. You have to stick to the group schedule; you will not be able to design your own plans; the trip is fairly expensive and your interaction with the local culture will be limited.
Should I hire a porter and/or a guide?
Hiring a porter and/or a guide can add greatly to your trek experience in Nepal, especially if this is your first time, and if you are traveling on less frequented trails, thus having to carry a heavy load (tents, food etc). An independent porter costs about $2-$3 a day, and a guide costs about $4-$6. Make sure you agree upon the wage before hiring one. You can ask your hotelier or a local trekking agency in Kathmandu or Pokhara to find one for you. You can also find them in bigger settlements along your trekking route.
If you decide to hire a porter and/or a guide, remember that you are their employer and thus should take full responsibility. You must make sure they have adequate clothes and other gear necessary for the trek. It is your responsibility to rent the gear for them. It is also your responsibility to take care of their medical requirements if they fall sick during the trek. Remember that many porters hired in the lower lands of Kathmandu and Pokhara may not be aware of the problems of trekking in high altitudes.
Do I need a trekking permit?
Except the trekking areas such as the Everest, the Annapurna and the Langtang, one requires trekking permit to visit other trekking areas. Your visa is not good enough. Trekking permits are issued very easily by the Department of Immigration Office in Kathmandu and Pokhara.You need your visa, trekking fee and two colored passport-sized pictures to get your trekking permit. Remember that you require different trekking permits to different trekking areas. Note, however, that a trekking permit does not allow you to go anywhere in the country either. If mountain-peak climbing is your desire, it falls under a whole different category, and will require a different permit.
How Should I dress during a trek?
Nepal is conservative with clothes, and your reception by locals can vary greatly on the way you dress. Men should always wear a shirt (don't go around bare chested) and long pants. In view of local customs, men should try not to wear shorts, and women should avoid them altogether. For women, a skirt of mid-calf length is preferable to slacks or pants. Slacks with sarong or skirt over them, and a (at least half-sleeved) blouse or shirt are probably most appropriate.
Besides the issue of culturally sensitive dressing, it is also important for you to make sure you have appropriate clothing to meet your needs during a trek. Good shoes are of great importance. You will be walking for up to eight hours a day. They must be sturdy and comfortable. Bring along sneakers --or if you have one, a well-broken-in pair of hiking boots-- they are sufficient for most treks. For higher altitude treks where you may have to tread snow for long hours, good boots are available for rent in Kathmandu.
Also bring along a couple of pairs of warm wool, corduroy or jeans pants (for men), a warm sweater (you can also buy beautiful ones in Nepal for a bargain) and a padded jacket, a couple of T-shirts and/or shirts. Thermal underwear can be great especially between November and February. Bring plenty of woolen and cotton socks.
Anything more specialized than all this can be easily rented or bought in Nepal for a good price.
What else should I bring along in a trek?
Most of what you need during a trek is available in Kathmandu, and you can buy them or rent them once you are there. Most books on trekking will list them, check one out before you embark on your trek. If you do not have a book yet and plan to get one only once you are in Nepal, there are some things you may want to bring from home. Bring ear-plugs to help you sleep in spite of barking dogs. A battery operated short-wave radio can be helpful to listen to weather reports or the news. Also bring along a pocket knife, sunscreen, bug spray, sunglasses, photographic equipment, binoculars, a compass, a good watch with possibly an altimeter, and a day pack. Others, you can buy or rent in Kathmandu for reasonable price.
When I go for treks, can I store my luggage somewhere?
Generally your hotel or lodge will let you store your luggage with them for some nominal or no fee. As long as you lock up your bags, they are normally safe.
Any health precautions that I need to consider during my trek?
Get a good travel book to guide you on health matters. There are plenty available in Kathmandu, if you can't find one in a bookstore near you. Stephen Bezruchka's book called Trekking in Nepal addresses health issues in excellent detail. Don't forget to take a first-aid kit: the details of which are also mentioned in most trek books. All of what you will need to take along can be purchased in Kathmandu, so don't bother carrying stuff from home. Read the health guidance in Health and Insurance section and Dining and Drinking section for more details.
Besides minor ailments stomach problems, blisters, cold and headaches, the most important health problem you may run into is altitude sickness. You will not have to worry about it in Kathmandu, Pokhara or other lower places. But once you are on the trekking trails and above 3000m in altitude, watch out for its symptoms. Refer to a good travel book for details on how to recognize altitude sickness and what to do about it. As a suggestion for travel planning, you may want to plan for "rest days" at about 3,700m - 4,300m altitude levels. This means sleeping at the similar altitude for two nights. Also remember that you should not try to climb too high too soon: about 450m per day is the recommended amount.
What do I do in case of emergency?
Though in general, you are not likely to face any emergency, you can never tell. Once again, a good book on trekking will give you details on what to do in case of emergency. In cases of non-urgent situation, you may have to be carried to the nearest health-post or airfield. If the situation is more serious, send word to the nearest village with radio service for a helicopter evacuation. It costs in the neighborhood of $1200 - $2000 for a helicopter evacuation, and generally a guarantee for payment is required before the helicopter actually takes off. Registering with your embassy can greatly speed the process.
What dietary expectations should I have during my trip to Nepal?
The staple food of Nepalese people is "daal, bhaat,tarkari" (lentil soup, curried vegetables with rice). Tarkari or curried vegetables can be bit spicy, hot and oily to people who are not used to eating spicy, hot and oily food. To avoid any stomach problems or diarrhoea in Nepal, I would suggest any foreigners to stick with their normal spiceless food. Daal and Bhaat are not spicy, so go ahead and taste them. For tarkari, I feel you should gradually try it in very less amount. Another thing that one should be aware of while arriving in Nepal is Drinking Water. Drink only bottled mineral water unless you are sure that the water is boiled and filtered.
In Kathmandu and Pokhara, you can also find plenty of restaurants that offer International Cuisine such as Italian, Chinese, Thai, Mexican, Indian and so on. In Kathmandu, you should try Newari cuisine: the Newars (original inhabitantsof Kathmandu Valley) have a very rich history of culinary art. Another food that you shouldn't miss to eat in Nepal is "MOMO". Momo can be both vegetarian and non-vegetarian types. Unless you are a veg person, I would recommend you to taste Non-veg Momos. You can find this food in any Nepalese restaurants and I would like you to discover this new food by your own during your visit to Nepal. However, besides these primary tourist hubs, you may not have much in terms of dietary choice. Trekkers will probably end up eating "daal, bhaat, tarkaari" (lentil soup, curried vegetables with rice) for every major meal.
Since Nepal is a Hindu Kingdom, beef is strictly prohibited among both the Hindus and Buddhist. Hence it is little bit difficult to find restaurants that offer beef.
For drinking, Nepal produces over half a dozen of larger and light beers. Dark beer is available. An amazing variety of other hard liquor such as rum, whiskey, gin, vodka etc. is also produced in Nepal.Imported liquors are available at exorbitant prices. You will also come across a few types of Nepalese home brewed alcohol called "raksi" or "ayla" along your trekking routes. Bottled water is available everywhere, and should be the only water you drink. Coke, Pepsi and other major international brand name sodas are also available.
How much do you think I should expect to spend on drinking and dining?
Eating out in Nepal is generally very reasonable. For about $3, you can buy a good dinner (excluding drinks) in a restaurant of the main tourist centers. A 750ml bottle of beer costs you about $1.75 in a restaurant, and $1.50 if you just buy it off a store. Other Nepalese made hard liquors are quite cheap. If you want an imported alcohol, however, expect to pay an exorbitant price. Sodas such as Coca-Cola, 7UP, Pepsi cost about $0.20 in shops. All these prices are for most of the road-accessible areas of the country. But as you move further into remote areas, the prices rise. For example if you are in Naamche Bazaar in the Everest region, the price can be as much as seven or eight times higher. For an average budget traveler, $10 will be enough for all your daily expenses on drinking and dining.
I am a vegetarian.
There is no problem in this. There are many vegetarian restuarants. And even if you drop into normal restuarants, you can easily get vegetarian food. Just for your information, Vegetarian in Nepal means non-consumption of both meat and egg. Milk and other animal product is allowed.
Do you think it is safe to eat freely in Nepal?
In general, yes. But, it's always good to take sensible precautions in order to avoid any health problems.No matter how tempting --and it can get very tempting after a long trek-- avoid drinking any other water than bottled water. If you have to drink non-bottled water, purify it with iodine or chlorine tablets (available readily in most drug stores in Kathmandu). Asking for bottled water in restaurants is always a best idea.
Do not eat roadside food that is exposed in the open air. Avoid buying and eating raw and unpeeled fruit and vegetables. Other than that, it is fine to have boiled, fried or properly packaged food items. Read the FAQ on Health and Insurance for details on what to do in case of health problems.
What inoculations are advised?
Though Nepal is not any more unsafe than any other developing country, update your preventive inoculations. Injections against meningitis, tetanus, hepatitis B, typhoid, perhaps cholera are recommended. Vaccination against rabies (which is quite rampant in Nepal) can be good but it is too bothersome and expensive to be worth the trouble. Just keep yourself safe from stray dogs and monkeys.
Do you think I should bring some medicines with me when I come to Nepal?
As said, prevention is better than cure, it's highly recommended that you bring medicines for common illness like nausea, vomiting,cold and flu when you come to Nepal. Though there are many pharamacy shops in Kathmandu and Pokhara, it's worth carrying some basic medicinal stuffs like insect repellent, sunscreen, lip balm, eye drops, bandages and so on.
What particular diseases do I have to watch out for?
Malaria is under control in Nepal. The risk of catching it is small and only in the southern plains. Mosquito netting and repellent are advised when there, especially during the summer and monsoon seasons. Also, as a preventive measure, take chloroquine pills starting two weeks before and six weeks after your visit to the plains.
AIDS is a growing problem. Official figures of only a couple of dozen cases of HIV in Nepal is a better indicator of the government's inability to collect data (or deny them) than the actual cases of the disease. Don't be misled into believing that unsafe sex is okay. Though prostitution in Nepal is insignificant compared to other Asian countries, watch out.
Also, doctors in Kathmandu are reporting that health problems due to severe air pollution are rising astronomically in Kathmandu. Old vehicles spewing out black smoke is unfortunately a normal scene on the roads of Kathmandu. Along the main roads traveled mainly by vehicles, the air gets quite nasty especially during rush hour. Make a conscious effort to minimize your walking on these streets used mainly by vehicles during rush hour.
Many, if not most, travelers to Nepal are likely to get stomach problems at some point during their visit. It is generally caused simply because of a change in diet and climate, drinking contaminated water and eating contaminated food. See health guidelines under "Dining and Drinking" to lessen the chances of acquiring diarrhea. But if you do get it, the most effective remedy is to fast for a day and consume plenty of water or some fluid. You can find effective medicines against amoebal diarrhea in any drug store in Kathmandu. Carry some with you when you are going to be away on trekking trails. A rehydration package called "Jeevan Jal" is found everywhere in Nepal; it is quite effective.
Altitude Sickness is the effect of altitude on those who ascent too rapidly to elevations above 3,000 meters. The basic early symptoms of altitude sickness is headache, loss of appetite and sleeplessness. One shouldn't ignore these early symptoms as these symptoms may lead to more serious warnings and cause death sometimes within few hours. Medicine is no substitute for descent. If a doctor is available, he may give medicine and oxygen. However, the patient must go down to lower altitude even if treatment is given.
If I need to see a doctor, where can I do so?
Almost all good doctors and all well equipped hospitals and clinics are in Kathmandu. Visiting a doctor in a clinic is probably better than going directly to a public hospital. Hospitals in Kathmandu can be very crowded with the whole country coming there for medical treatment. Private "nursing homes" and clinics are plentiful in Kathmandu. Elsewhere in the country, there is not much of a choice: you can at best get a service that may pull you through until you reach Kathmandu.
Do I need a travel insurance?
Oh yes, some sort of travel insurance is highly recommended. Most travel insurance covers emergency flights, medical expenses, and theft or loss of possessions. The insurance premium in general is between $50 to $75 for a two week period, and progressively less for longer periods. It's a price worth paying. If you plan to go rafting or trekking, make sure your insurance covers these "dangerous activities." Remember to keep your receipts to make claims. In order to make claims on lost or stolen items, you will need a police report issued in Nepal by the Interpol Section of the Nepal Police.