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Himalaya Trekking involves a walking trip following existing trails in Nepal, Tibet and Bhutan. Most of which have been used for communication and trade for many years. Trekking is not mountaineering. Whilst some of the popular trekking trails are used by mountaineering expeditions on their approach marches, most are simply used by the local Himalayan people for everyday travel and trade.
Himalaya undoubtedly offers some of the most spectacular and beautiful scenery, with well-published photographs of Everest, Machhapuchhre, Ama Dablam, mount Kailas and other huge mountains making them instantly recognizable to keen trekkers from every continent.
Himalaya has a virtual monopoly on the world's tallest mountains (eight of the ten highest peaks are located in Nepal) and a number of the popular trekking routes offer wonderful views or even visits to the base camps used by mountaineering expeditions. The hill country is also often breath taxingly beautiful with pretty villages, attractive houses and interesting temples, as well as subtropical lowlands, vast meadows or forests, fast flowing rivers, deep canyons and the cold and barren regions at the feet of the great mountain peaks. The views change with the seasons, such as different stages of planting and harvesting cycles or the brilliant displays of wild flowers in spring and autumn and there is always something interesting to see and experience.
Trekking in Himalaya offers ultimate opportunity for intrepid explorers who are forever in quest for adventures in the Himalayas. With captivating landscape of Himalaya range and unrivaled diversity of flora and fauna, Himalaya is trekkers' paradise. Himalaya trekking holidays is indeed, an inspirational treat to the trekkers. From the warm and lush vegetation of the lower hills to the ice slopes of the highest mountain range on earth, one will experience a truly delightful bond with the nature instilling in you an amazing spirit of adventure. Nothing can be more fulfilling experience than trekking in Himalaya that will let you camp in the jungles, surrender to the wilderness, bond with the nature, eat and sleep under an open sky, sing and dance around campfire and directly interact with local people. It is truly the perfect way to escape the hustle and bustle of everyday life and to relax and enjoy nature at its very best.
Himalayas guide is a highly proactive trekking agency in Himalaya which offers the largest range of Himalaya adventure travel itineraries offering opportunities for people with any grade of experience and almost any time frame. For more than a decade, we've pioneered and led thousands of trips all over Himalayan range in the most eco-friendly way.
Trekking and mountaineering in Himalaya give a deep insight and first hand experience of witnessing the vivid and distinct flora and fauna as well as admire the picturesque natural beauty of Himalaya. It completely depends upon you if you want to venture out on the much-traversed tracts or want to explore the virgin trails. Whatever you choose, you are bound to experience unforgettable spectacles. In short, we can safely conclude that Himalaya is mountaineer's paradise and what is typical of paradise, Himalaya has many courses on its platter. For example, you have tropical and coniferous mountain forests and lofty Himalayan peaks as starters. Then you can have the Mount Everest itself in the main course.
Talking of trekking, it usually consists of an optimal series of ascents and descents. In normal course, you are required to walk for a minimum of 5 to 7 hours (9 to 14 km) per day on average with a guide, cook and porters and, on some occasions, pack animals. The best thing about the mountaineering and trekking in Himalaya is the process itself. The objective of trekking is not just the particular destination, but also the journey. You travel at a modest pace, observing nature, rural communities, and spectacular mountain panoramas.
The most interesting thing about trekking in Himalaya is the range of geographical features that you witness in the process. It is perfectly usual to cross snowfields in the morning and bathe in sub-tropical streams in the afternoon. The only dampener in the process is the absence of signposts. For the most part, trekking routes are well traveled by local people and mountaineers alike, but remain unmarked and are without signposts.
Trekking and mountaineering agencies in Himalaya offer a wide variety of different treks to suit both novices and experienced trekkers. Depending upon your time and budget constraints; these agencies tailor- made itineraries to suit your needs. Talking of accommodations, there are two basic types of accommodation in trekking namely Teahouse and Camping. All the treks are accompanied and lead by professional mountaineers who double up as guides. All of these guides are well trained and licensed by the Government.
The important trekking areas in Himalaya are the Everest region, Annapurna region and Langtang region. The Upper Mustang, Dolpo, Manaslu, Tibet and Bhutan are exotic trekking areas to see preserved natural and cultural heritages. The rara lake region in western Himalaya and the Makalu and Kanchenjunga regions in eastern Himalaya are two other important areas.
Most popular trekking in Himalaya
The Tibet, Bhutan, Everest and Annapurna are most popular regions. Recently Mustang and Dolpo trekking are also getting more popular for their cultural heritage. But this may not be very useful information for you if you want to know the single best trek and do it. Each trek is unique, different and often not comparable to other. But we can definitely suggest that an Everest trekking or an Annapurna trekking will be the most satisfying experience for first time visitors.
The best trekking in Himalaya
The most popular does not mean the best one. Also what is best is a personal choice. There are many treks famous for their own reasons. Some are famous for great mountain views, some for the natural beauties, some for remote and exotic Tibetan villages and some for amazing wildflowers. So the best trek for you depends on what is your interest. Though the Annapurna and the Everest are two most popular regions for trekking, however, there are some other regions with unique treks. Also, there are many exotic, unexplored areas .See our home page for a detailed list of trekking areas.
The best trekking season
The time without snow and without rainfall is the best time to visit the mountain trails. That said October to early December and March to May are the best seasons for trekking in Himalaya. This again depends on which area you want to visit. For example there are some very good treks that are done on relatively low altitudes and they can be done even in January (as there will be no snow there), the Poon Hill Ghorepani trek is one of them. Likewise wildflower treks and also Mustang trekking and Dolpo trekking in rain shadow zones are best done during summer days of July and August.
Trekking styles (Tea house or Camping trek)
The popular trekking routes of Everest, Annapurna and Langtang have lodges at frequent stops .We can have lunch or stay for night in these lodges. A trek in which we use these lodges for our food and accomodation is called tea house trekking. Originally, before trekking was introduced in Himalaya, there were small tea shops in the place where we have lodges now; serving tea and snacks for the local villagers travelling from one place to others, hence the name “tea house." Unlike this, a fully supported trek in which we carry all our foods and equipments is called camping trek or an organized trek. In such a trek our Sherpa crew will make the tents for you and our cook will prepare all the meals.
A typical trekking day
Your trekking day starts at around 6 am with a cup of tea or coffee at your tent. You wash your face with warm water and prepare yourself for breakfast at around 7.30. The trek starts after breakfast; you walk at your own pace frequently stopping to enjoy good views and take photographs .You carry a small bag containg your personal goods that you need during the day. The porters and Yaks will carry the rest. After a walk of about 3 hours we stop for lunch .It lasts for about 1.5 hours .With another session of walking for 3 to 4 hours we reach our camp, which is often a scenic spot. While you rest, the trekking crew will fix the tents for you. You relax or walk around the camp, enjoy tea/coffee. Around 6-7 PM you will have your dinner, talk about the day's experience with other members or enjoy the Himalayan solitude yourself.
Foods on the trek
In a lodge to lodge (tea house) trek you can expect to get mostly continental menus. You can also get some Tibetan, Chinese, Himalayan and even Indian and Italian dishes on the tea houses. The food is good and well enjoyed by the trekkers. In higher altitudes near the base camps of the mountains, you get fewer varieties than in the lower altitudes. We provide three meals with tea or coffee. Where ever possible we try to offer you fresh vegetables from the village, fresh fruits etc. If you are doing high altitude treks like the Everest base camp, do not consume alcohols (you get beers and whisky even in mountains) until you reach your destination. Alcohol consumption may increase the chances of altitude sickness. You are allowed to choose the food you like but it is wiser not to order different dishes for each person’s as cooking so many dishes takes a long time. Some lodges do not have many ovens and may be they have only one cook. Making a combined order saves time, especially in lunch. You can buy bottled water in the mountains but we suggest you to bring water purifiers like iodine and avoid bottled water. Water bottles are major source of pollution in the mountains.
If you are in a camping trek we provide you multicourse dishes from starters to deserts. We have excellent cooks to prepare hot and delicious meals. A full set of facilities including kitchen and dining tents, tables and chairs are provided.
The equipments and clothing list below is for a relatively longer trek involving a cold high altitude destination. If you are doing a short trek to a relatively lower altitude you may not need all these. The list below is for a guideline alone, you may have your own check list as well. Please note that most of the trekking items are easily available for buying or renting in Himalaya and you are suggest not to bring unnecessary items with you.
- Cap for sun protection during trek
- Sunscreen lotion/sun balm
- T-shirts and long sleeved shirts
- Fleece or thermal shirts for colder areas
- Fleece jumper/sweaters
- Down jacket
- Wind /water proof outer garment
For leg and hand
- Casual trousers for walking
- Water proof trouser
- Thermal legging for colder areas
- Hand gloves
- Woolen and cotton socks
- Trainer or casual shoes
- Waterproof hiking boot
- Gaiter for rain and snow
- Rucksack /duffel bags
- Day sack to carry personally
- Personal medicines and first aid kit
- Water bottle and iodine tablets
- Torch (better head torch)
- Film rolls and camera
- Toiletries and towel
- Large handkerchief
- Compass, binoculars, altimeters
- Playing cards, books, guide book
Everest, Annapurna, Langtang and Rara regions do not require a trekking permit but require a national park fee of respectively of USD 31, 15 and 15. However, these following special areas do require a trekking permit:
Lower Dolpo and Kanchenjunga trekking - Equivalent to US$ 10 per person for the first four weeks and US$ 20 per week thereafter
Manaslu and Narphu valley trekking – US$ 90 per person per week for trekking during Sept- Nov and US$ 75 per week during December- August
Humla trekking - US$ 90 per person for the first seven days and US$ 15 per day thereafter.
Upper Mustang and Upper Dolpo trekking - US$ 500 per person for the first ten days and US$ 90 per person per day thereafter.
An entrance fee is levied for visits to all National Parks and Conservation Areas. There is no charge for children under 10 years
Altitude sickness in the mountains
Higher altitude have lesser oxygen in the air. If you ascend the mountains quickly, your body is not adjusted to that low level of oxygen which results with symptoms of loss of appetite, nausea , bad dreams , lack of sleep etc. In serious cases vomitting and other symptoms appear and results in immediate death.There is no medicine to cure altitude sickness.
Generally altitude sickness attacks from an altitude of 3000 m.If you do not ascend much height in a single day from 3000 m onward, if you give proper attention to rest , you are unlikely to have any problem. Incase you have the symptoms of altitude sickness , the best and only treatment to do is immediately descend down.You will be perfectly ok.Each and every cases of altitude sickness is preventable, if you just inform your guide as soon as you experience some of the symptoms. However, if you neglect , altitude sickness may even kill you, it is fatal.In many cases people simply do not care or just hide the symptoms for the fear that their group member will find him/her unfit , or for a mistaken wish to continue together.
People of every age groups are succeptible , while people having heart and breadthing problems need more precaution.In all our treks we give first priority to safety. All our trekking guides have good knowledge of altitude sickness and brief you well before the trek starts. They will frequently check if you have any symptoms and you can best help them informing in time. In serious cases after descending down to required height they will request for the company for helicopter rescue and you will be evacuated to Kathmandu. In all the longer treks we have acclimatisation days , which are the days to relax and adjust the body to the new height. If you just care these points, you will enjoy and complete your trekking in Himalaya successfully.
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.