Trekking in Bhutan, Tibet and Nepal need not be considered risky affair as far as your health is concerned. Nevertheless, preventive measures such as a through medical checkup and inoculations before you start trekking can save you from unexpected hazards. Since the remote places of Nepal are not supplied with necessities that are essential for modern medical facilities and as the rescue and evacuation are measured in days, it is imperative to make a comprehensive first aid box consisting of basic drugs and accessories as part of the paraphernalia for trekking. Modern dentistry is unknown in the hill of Nepal so it is advised to have a checkup before departure from home. Tooth fillings; sometimes loosen in cold temperatures and high altitudes, so it is recommended to have them checked. Travelers are requested to bring medicine prescribed by their doctor at home. Common medicine for stomach problems, headache, and malaria is available in Kathmandu. Medicine is usually not available in remote areas. So necessary medicine is advisable to carry with you. Before going to Nepal, it is advised to get injections against typhoid, meningitis and hepatitis.
OVERCOMING ALTITUDE PROBLEM: This is often known as Acute Mountain Sickness (AMS), which is particularly a matter of important medical consideration while trekking in the Himalayas. Altitude Sickness means the effect of altitude on those who ascend too rapidly to elevations above 3000 meters. Early mountain sickness will manifest itself in headache, nausea, shortness of breath, fatigue; etc can be encountered as initials of the sickness. The major information source on prevention and treatment of the sickness is Himalayan Rescue Association (HRA) and Adventure Treks Nepal (P). Ltd. is the confide life member of it. We assure every trekker that all our guides have followed the training conducted by HRA with the understated information.
CAUSE/FACTOR OF ALTITUDE SICKNESS
1. Less Oxygen
2. Low Pressure i.e. Barometric Pressure
3. Rapid Ascent
4. Possible Dehydration
5. Hypothermia TYPE OF ALTITUDE SICKNESS
TYPES ALTITUDE SICKNESS
1. AMS - Acute Mountain Sickness
2. HAPE - High Altitude Pulmonary Edema
3. Hace - High Altitude Cerebral Edema
SYMPTOMS
1. (AMS) ACUTE MOUNTAIN SICKNESS
Mild symptom feels like hangover/not feeling good
a. Headache
b. Fatigue/Tiredness
c. Nausea
d. Shortness of breath
e. Loss of appetite
f. Sleep disturbance
g. Dizziness
2. (HAPE) HIGH ALTITUDE PULMONARY EDEMA (Water in lungs)
a. Increasing shortness of breath even at rest
b. Severe cough-dry/Productive
c. Very tired-Unusual fatigue while walking
d. High Pulse rate i.e. 110
e. Blueness of face, lips, finger nails that means inability to transport Oxygen into the blood
3. (HACE) HIGH ALTITUDE CEREBRAL EDEMA (Water in the head)
Severe symptoms of altitude sickness
a. Severe Headache
b. Vomiting
c. Walking like a drunk (Ataxia)
d. Mental confusion/Altered mental status
e. Irritable-Does not want to be bothered by other people
f. Unconsciousness or Coma
TEST - Tandem walking test, Heel to toe step fall off from the line.
DECISION MAKING
1. Find out the main problem i.e. at altitude. Assume all problems are Altitude Sickness unless proven otherwise.
2. If it is an altitude problem with mild symptoms, stay at the same altitude until the symptoms are completely gone. Take an Aspirin tablet, try to go up but listen to your body. If symptoms are worsening, go down.
PREVENTION
1. Acclimatization: Have time for acclimatization.
2. Do not make RAPID ASCENT; don't go too fast too high.
3. No alcohol, sleeping pills and smoking.
4. Drink more fluid 3-4 ltrs a day… clean, boiled or treated water/tea/coffee/soup/juice etc.
5. Do not carry heavy packs.
6. Climb higher sleep lower.
7. Do not travel alone.
TREATMENT
1. DESCENT is the best medicine; do not wait for the Helicopter.
2. Medicine:
a. Oxygen.
b. Diamox…for AMS 125mg. Before dinner, for sleeping problem if feeling suffocated.
c. Nafedipine for HAPE
d. Steroids/Dexamethasone for HACE
3. Hyperbolic Bag - Gammow Bag
4. Golden Rules
a. Awareness of ALTITUDE SICKNESS
b. If you have mild symptoms, do not go higher. Take Aspirin.
c. If you have worsening symptoms, go down.
d. Do not leave your team member behind unattended, either trekker or porter.
5. IMPORTANT
a. Go up slowly.
b. Drink plenty of fluids (at least 3 liters per day)
c. Get all information about Altitude Sickness before your trekking tour that will make you confident to make your tour successful.
Our advice: Drink 3-4 ltr of water minimum a day, don't exhaust yourself so much and breathe deep and take rest more than usual.
Visa/Entry Permit: With the exception of visitors from India, Bangladesh and Maldives, all other visitors travelling to Bhutan need a visa. Indian, Bangladeshis and Maldivian nationals can obtain a permit at the port of entry on producing a valid passport with a minimum of 6 months validity (Indian nationals may also use their Voters Identity Card (VIC).
All other tourists must obtain a visa clearance prior the travel to Bhutan. Visas are processed through an online system by your licensed tour operator directly or through a foreign travel agent.
You are required to send the photo-page of your passport to your tour operator who will then apply for your visa. The visa will be processed by the Tourism Council of Bhutan (TCB) once the full payment of your holiday (including a USD $40 visa fee) has been wire transferred and received in the TCB bank account. Once received, the visa clearance will be processed within 72 working hours.
At your point of entry you will be required to show your visa clearance letter, the visa will then be stamped into your passport.
Online Regional Permit System: In order to streamline and facilitate smooth visitation by tourists from Bangladesh, India and Maldives, the Department of Immigration, Ministry of Home and Cultural Affairs and the Tourism Council of Bhutan have launched the Online Permit System. The system facilitates the online processing of permits for regional tourists through registered tour operators and TCB certified hotels. The facility is offered as an optional channel to process permits for visitors from the region and is applicable for entry from Paro and Phuntsholing. Visitors who use this facility will be able to obtain their permit clearances and route permits ahead of their arrival in Bhutan similar to international tourists.
Travel Requirements: All tourists (excluding Indian, Bangladeshi and Maldivian passport holders) who wish to travel to Bhutan require a visa and must book their holiday through a Bhutanese tour operator or one of their international partners. The tour operator will take care of Visa arrangements for visitors.
In keeping with the Tourism Council of Bhutan's policy of "High Value. Low Impact" tourism a Minimum Daily Package is required for tourists. To learn more about the Minimum Daily Package, please follow the link below:
Getting Into Bhutan: The Kingdom of Bhutan remained largely cut off from the rest of the world up until the early 1960’s. Entering the country was difficult as it was only accessible by foot from two main entry points, one in the North and another from the South. The Northern route was through Tibet, crossing high mountain passes that were inaccessible throughout the winters. The second entry route from the South came through the plains of Assam and West Bengal. The high frozen passes in the North and the dense jungles in the South made it extremely difficult to enter the country.
However, carefully planned economic development has made the country much more accessible and there are now a network of roads entering and traversing the country, as well as one international and multiple domestic airports.
Today the main roads entering the country are through Phuentsholing in the south, linking Bhutan with the Indian plains of West Bengal through the border towns of Gelephu, in the central region and Samdrup Jongkhar in the east, that link Bhutan with the Indian state of Assam.
Travel by Land: Phuentsholing, Gelephu and Samdrup Jongkhar are the only land border areas open to tourists.
The town of Phuentsholing in south-west is located approximately 170 km east of the Indian national airport at Bagdogra. After crossing Phuentsholing, you begin your journey to Thimphu, the capital city with travel time of about six hours for the 170 km stretch.
Gelephu, in south-central Bhutan, is another entry point to Bhutan. It is approximately 250 kms from Thimphu and the journey will take you through the sub-tropical areas of Bhutan before entering the alpine zone and then finally into Thimphu. One will have to traverse across three districts and the travel time will be about ten hours.
The district of Samdrup Jongkhar in south-east Bhutan borders the Indian district of Darranga, Assam and is approximately 150 kms away from Guwahati, the capital city of Assam. The journey from Guwahati is about three hours. Tourists entering Bhutan through Samdrup Jongkhar will take you to Trashigang, and from there over the lateral route to Mongar, Bumthang, Trongsa, Wangdue Phodrang and then finally into the capital, Thimphu. The distance is about 700 kms and will take you a minimum of three days to reach Thimphu.
Travel by Air: There are flights to destinations that include Bangkok, Delhi, Kolkata, Bagdogra, Bodh Gaya, Dhaka, Kathmandu, Guwahati, Singapore and Mumbai.
Paro is situated at a height of 2,225m (7300ft) above sea level and is surrounded by mountains as high as 4,876?m (16,000?ft). At present two carriers operate to Bhutan, Drukair and Bhutan Airlines. There are also domestic airports in Yonphula in eastern Bhutan, Bumthang in central Bhutan, and Gelephu in south-central Bhutan.
Flying into Bhutan’s Paro International Aiport is typically an exciting experience as the descent into Paro valley brings you closer to the mountain tops than most other flights in the world. The flight between Paro and Kathmandu is one of the most exciting ones as the aircraft passes over four of the five highest mountains in the world. In fine weather, as you soar higher up, you can enjoy the spectacular view of Mt. Everest, Lhotse, Makalu and Kangchenjunga at their best.
Payment System in Bhutan: Bhutan’s currency is the Ngultrum (Nu.) It is at par with the Indian rupee which is widely accepted in the country.
ATMs are located within all main towns throughout Bhutan, where money can be withdrawn using a Visa or MasterCard. In addition, POS (Point of Sale) services are available nationwide, meaning visitors can pay by credit card at most hotels and handicrafts stores.
Guides: There are over 1000 licensed and active tour guides working in the country.
In order to ensure that visitors receive high quality professional service, every guide must complete a training course. Guides are trained to specialize in either cultural or adventure tours. Many guides complete language courses in German, Japanese, Thai and other languages so that they can easily communicate with guests and all are proficient in English. All tour operators must employ only registered and certified guides.
