EVEREST: a TREKKER’S GUIDE Photo: Anna Chmielewska

EVEREST: A TREKKER’S GUIDE photo: Anna Chmielewska

About the Author EVEREST: Radek Kucharski grew up in Poland and lives in Warsaw. Born to a jazz-playing A TREKKER'S GUIDE father, he was probably never destined to have a full-time job. After studying geography, he completed his first overland trip to India and Nepal in 2000, and trekking in the Himalayas quickly became a favourite activity. He has BASE CAMP, KALA PATTHAR AND OTHER TREKKING also trekked in Iran, Pakistan and Scandinavia. He treks independently, often alone, and believes this is the best way to get to know a place and its people. ROUTES IN NEPAL AND TIBET Introduced to the darkroom by his grandfather, Radek uses a camera to document every trip and shows his work in public while speaking about the places by Radek Kucharski that fascinate him. Having worked for a small geographic information systems company for over 10 years, Radek now chiefly guides trekking groups to Ladakh and the Nepali Himalayas, as well as leading adventure travel trips to South Asia and tours to Scandinavia. Having recently become a father, he looks forward to the challenges and inspirations that discovering the world with a child will bring. www. radekkucharski.com

Other Cicerone guides by the author Trekking in Ladakh JUNIPER HOUSE, MURLEY MOSS, OXENHOLME ROAD, KENDAL, CUMBRIA LA9 7RL www.cicerone.co.uk Crossing the glacier moraines between Warning Lobuche and Gorakshep with Pumori and All mountain activities contain an element of danger, with a risk of personal Kala Patthar above (Trek 3) injury or death. Treks described in this guidebook are no exception. Under nor- mal conditions, wandering the trails towards Everest will be neither more nor less hazardous than walking among big mountains anywhere in the world, but trekking involves physically demanding exercise in a challenging landscape, where caution is advised and a degree of stamina is often required, and it should be undertaken only by those with a full and proper understanding of the risks involved, and with the training and experience to evaluate them. Trekkers should be properly equipped for the routes undertaken. The effects of altitude and the potential for altitude sickness (AMS) or worse, and how to deal with it, should be understood before you go trekking. While every care and effort has been taken in the preparation of this guide, the user should be aware that conditions can be highly variable and change rapidly. Rockfall, landslide and crumbling paths can alter the character of the route, and the presence of snow and the possibility of avalanche must be care- fully considered, for these can materially affect the seriousness of a trek. Therefore, except for any liability which cannot be excluded by law, neither Cicerone Press nor the author accepts liability for damage of any nature (including damage to property, personal injury or death) arising directly or indi- rectly from information given in this guide. Readers are warned that trekkers are sometimes badly injured by passing yaks; a few unfortunates die of hypothermia or acute mountain sickness; others simply lose their balance and fall from the trail due to a momentary loss of con- centration. Since there is no organised mountain rescue service in Nepal, such as exists in some mountain regions of Europe, if an accident occurs self-help may be the only option. Note too, that where it is possible to summon a rescue helicopter, the cost of doing so is very high and guarantee of payment essential. Make sure your insurance includes such costs, and carry a credit card with sufficient funds to back its use for the initial call-out. Everyone trekking in the Everest region should assume responsibility for their own safety and look to the needs of those with them. This includes especially porters and members of a trek crew, as well as fellow trekkers. © Radek Kucharski 2018 Fifth edition 2018 ISBN: 978 1 85284 836 1 CONTENTS Fourth edition 2012 Map key...... 9 Third edition 2005 Regional map...... 10–11 Second edition 2000 Location of treks...... 12–13 First edition 1995 Everest from Tibet (China)...... 14 Preface...... 19 Printed by KHL Printing, Singapore A catalogue record for this book is available from the British Library. INTRODUCTION ...... 21 All photographs are by the author unless otherwise stated. Visa arrangements ...... 23 Getting there and travelling around ...... 25 Route mapping by Lovell Johns www.lovelljohns.com Kathmandu Valley ...... 26 Contains OpenStreetMap.org data © OpenStreetMap contributors, The Everest Region (Solukhumbu)...... 31 CC-BY-SA. NASA relief data courtesy of ESRI Trekking routes in Nepal...... 37 Accommodation and food...... 41 Dedication Drinking water...... 43 To the nameless porters who supply lodges along the trail in Khumbu, making the trek Trekking styles ...... 45 easier or even feasible. To those travellers who are ready to compromise some of their Seasons and weather ...... 50 comforts and desires to protect the vulnerable environment and the local cultures. To Weather forecast ...... 52 visitors who come to learn and enrich themselves rather than change others. Fitness, health and emergencies...... 53 Respect others on the trail ...... 58 Hazards en route...... 59 Updates to this guide Equipment...... 60 While every effort is made by our authors to ensure the accuracy of guidebooks Trekking formalities ...... 62 as they go to print, changes can occur during the lifetime of an edition. Any Communication...... 65 updates that we know of for this guide will be on the Cicerone website (www. Budget...... 65 cicerone.co.uk/836/updates), so please check before planning your trip. We Minimum impact trekking ...... 66 also advise that you check information about such things as transport, accom- Cultural interaction...... 68 modation and shops locally. Even rights of way can be altered over time. Using this guide...... 72 The route maps in this guide are derived from publicly available data, data- TREKKING ROUTES IN NEPAL bases and crowd-sourced data. As such they have not been through the detailed checking procedures that would generally be applied to a published map from Trek 1: Jiri or Salleri/Phaplu to Chheplung and Lukla ...... 75 an official mapping agency, although naturally we have reviewed them closely Prologue Kathmandu to Jiri...... 81 in the light of local knowledge as part of the preparation of this guide. Section 1 Jiri to Shivalaya...... 83 We are always grateful for information about any discrepancies between Section 2 Shivalaya to Junbesi...... 87 a guidebook and the facts on the ground, sent by email to updates@cicerone. Section 3 Junbesi to Ringmu ...... 99 co.uk or by post to Cicerone, Juniper House, Murley Moss, Oxenholme Road, Alternative start Salleri or Phaplu to Ringmu...... 103 Kendal, LA9 7RL. Section 4 Ringmu to Surke...... 106 Register your book: To sign up to receive free updates, special offers and Section 5A Surke to Chheplung (for Namche Bazaar)...... 115 files where available, register your book at www.cicerone.co.uk. Section 5B Surke to Lukla...... 118

Front cover: Everest, Nuptse, Lhotse, Ngozumpa Glacier and Gokyo viewed from the way to Renjo Pass Map key Trek 2: Lukla to Namche Bazaar ...... 121 Prologue Flight from Kathmandu to Lukla...... 124 Section 1 Lukla to Phakding...... 128 Symbols used on route maps Section 2 Phakding to Namche Bazaar ...... 134 route Trek 3: Namche Bazaar to Everest Base Camp (EBC) and Kala Patthar. . . . . 148 alternative route Relief Section 1A Namche to Sanasa via Tenzing Norgay Chorten and Khyangjuma. 153 in metres linking route Section 1B Namche to Sanasa via Khumjung...... 157 8400–8800 Section 2A Sanasa to Pangboche via Tengboche and Deboche...... 159 footpath 8000–8400 Section 2B Sanasa to Pangboche via Mong La and Phortse...... 164 track Section 3 Pangboche to Dingboche (or Pheriche)...... 175 7600–8000 road Section 4 Dingboche (or Pheriche) to Lobuche ...... 191 7200–7600 Section 5 Lobuche to Gorakshep...... 197 start or finish point 6800–7200 Section 6A Ascent of Kala Patthar (5645m/18,520ft)...... 202 6400–6800 start/finish or alternative start/finish Section 6B Hike to Everest Base Camp (5275m/17,306ft)...... 204 6000–6400

Trek 4: Namche Bazaar to Gokyo...... 207 alternative start or ﬁnish point 5600–6000

Section 1A Namche to Sanasa via Tenzing Norgay Chorten and Khyangjuma. 211 glacier 5200–5600 Section 1B Namche to Sanasa via Khumjung...... 211 4800–5200 Section 2 Sanasa to Phortse Thanga...... 212 woodland Section 3 Phortse Thanga to Machhermo...... 214 settlement 4400–4800 4000–4400 Section 4 Machhermo to Gokyo...... 219 regional border 3600–4000 Trek 5: Three Passes Trek ...... 227 international border Section 1 Namche to Sanasa...... 233 3200–3600 Section 2 Sanasa to Pangboche ...... 233 national park/conservation area boundary 2800–3200 Section 3 Pangboche to Dingboche...... 234 2400–2800 Section 4 Dingboche to Chukhung ...... 235 peak 2000–2400 Section 5 Chukhung to Lobuche via Kongma La ...... 237 town/village Section 6 Lobuche to Dzongla...... 246 1600–2000 campsite Section 7 Dzongla to Gokyo via Cho La...... 249 1200–1600 Section 8 Gokyo to Namche Bazaar via Renjo La and Thame ...... 256 building/statue or monument 800–1200 buddhist monastery/hindu temple 400–800 EVEREST FROM TIBET...... 269 hospital/clinic/medical aid-post Trek 6 Tingri to Rongbuk Everest Base Camp...... 271 pass Trek 7 Kharta to the Kangshung Face...... 280 bridge/suspension bridge Appendix A Summary of treks...... 296 water feature/waterfall Appendix B Selected trekking peaks in the Everest Region...... 300 Appendix C Index of place names...... 302 helipad Appendix D Useful websites ...... 308 viewpoint Appendix E Selected lodges in the Everest Region...... 311 Appendix F Glossary...... 314

9 r mi Pa an AFGHANISTAN Qarq Y ar Ak Tag Everest: A Trekkerka ’s Guide Ak Tag nt Batura Muztag Feng Mustagh I K2 Yuru Tibet (China) ngk Afghanistan Bhutan Nanga ax 8611m Parbat Nepal Liushi Shan Pakistan Skardu 8126m Bangladesh

Srinagar Ind India Nun us Jh ISLAMABAD e lu Kangju Kangri m 7135m Z Ch a en a b Nganglong um Kangri Jhel Jammu In TibetTibet Autonomous Autonomous d Sh ya PAKISTAN u iquan Za?g s R s Region (China) b a av Region (China) 0 100 miles na e i he B B C e

s s

Amritsar s 0 200km Lahore lej Bogcan Sut Kailash g (Salween) Nu 6714m Nanda Devi 7816m Y tlej Yaa Nyainqentanglha Su rlrlu Ganges unn gg Feng TTs a saan n ngg u ppo m o LHASA a Lunpo Gangri ng Tsangpo Y Yarlu

Dhaulagiri Shigatse a r a 8167m (Xigazê) h Gangkar DELHI M g a Punsum a m h NEPAL PokharaPokhara

G Kanchenjunga a s s s

Y 7550m a 8586m m Mt. THIMPHU INDIA u n G a a Everest n KATHMANDU g Darjeeling BHUTAN Agra e GG 8848m s a a Jaipur n n d d T Lucknow a a is k k ta l Guwahati ba Banas m Kanpur ha Y G tra C am Ghh i pu 10 u agag s Brah11ma na hah o wa raar K et a Patna B BANGLADESH

P a r G b an a ge t n s i o n S o S Everest: A Trekker’s Guide Location of treks Glacier Glacier 7075m Kangshung

Imja Imja Hunku Glacier Hunku Glacier Cho Cho Glacier Glacier 7590m 7590m Chamlang Chamlang Drangka nku Hu Peak Peak Island Island Island Glacier Glacier 6189m 6189m Trek 1 Trek 2 Trek 3 Trek 4 Trek 5 Trek Glacier Glacier Lhotse Lhotse 8516m 8516m

Ambulapcha

Glacier 8848m 8848m

Mount Mount

Ambulapcha Ambulapcha Everest Everest Glacier Glacier Glacier Imja Tsho Imja Tsho

Changtse Lhotse Lhotse Lhotse 7543m 7543m Changtse Changtse

Glacier

a a a

l l l 6363m 6363m Glacier Glacier

Naulekh Naulekh

o o o

Naulekh Naulekh Chukhung Glacier Chukhung Glacier Glacier

h h h Glacier Glacier

Hunku Nup

K K K

Mera Mera

Ama Dablam Glacier

a a a Glacier j Glacier Nare Nare Chukhung Chukhung Glacier Glacier Nare Nare km Lhotse Nup Lhotse Nup Sanu Glacier Sanu Glacier 7861m 7861m Glacier m Glacier Glacier Glacier Nuptse I Nuptse I I 5 Glacier Glacier Rongbuk Rongbuk 5546m 5546m Nare Hinku Shar Hinku Shar Glacier Chukhung Ri Chukhung Ri 6636m 6636m 6476m Khumbutse Khumbutse Glacier Mera Peak Mera Mera Peak Mera Khumbu 6856m 6856m Nuptse Glacier Nuptse Glacier Duwo Duwo Glacier Glacier Glacier 7161m 7161m Lingtren Lingtren Ama Dablam Ama Dablam 2.5 N Glacier Glacier Shep Shep Hinku Nup Hinku Nup Gorak Gorak Dingboche Dingboche 5073m 5073m 5806m 5806m Pokalde Pokalde 0

5648m 5648m

Pumori

Nangkartshang Nangkartshang 7161m 7161m

a a Orsho a

k k k

g g g

n n n

a a Kala Patthar Kala a Kala Patthar Kala

r r r

D D D

u u u H H H i i i k k k n n e n 6769m h 6769m Glacier Kyashar c Kyashar u b o West Rongbuk West Lobuje Lobuje L Glacier Glacier Tsuro Pheriche Pheriche Kyashar Glacier Kyashar Glacier Changri Changri Shar Glacier Shar Glacier Cholo Cholatse Tso Jiuda Jiuda Lobuche Lobuche Glacier Kusum Kusum 6367m 6367m Millingo Millingo Glacier Shomare Shomare Shomare Shomare 6859m 6859m Kangguru Kangguru Pangboche Pangboche 6623m 6623m Chumbu Chumbu Debuche Debuche 6145m 6145m 5813m Lobuche Lobuche Thamserku 6495m 6495m Gonglha Gonglha Tengboche Tengboche Taboche Taboche Changri Nup Glacier Changri Changri Nup Glacier

6440m 6440m

Cholatse Cholatse

i i i

7036m 7036m Phortse Phortse

d d d

Hungchi Hungchi

n n n

Tashinga Tashinga

a Phunki Phunki Kang Kang Thanga Thanga Koshi Koshi Koshi

Dudh Dudh 7952m Dudh 7952m Gyachung Gyachung Thulang Thulang Puiya Paiya Lukla Lukla Kyangjuma Kyangjuma Thare Thare Thaog Thaog Chumoa Chumoa Monjo Monjo Nha Nha Surke Surke Cheplung Cheplung Sanasa Sanasa Thadokosi Thadokosi Chhuthawa Chhuthawa Phakding Phakding Zamphuti

i Zamphuti

i i i

h h

o h

s s s

o o

K o

K K

h h

h h d d d d u u Du u D D Kang II Kang D Kang II Kang Benkar Benkar Khumjung Khumjung Glacier Glacier Gokyo 7743m 7743m Syangboche Syangboche Ngozumpa Ngozumpa Ngozumpa Ngozumpa Kharte Kharte Khunde Khunde Namche Bazaar Toc Toc Toc Toc Toc Toc Machhermo Machhermo Tse Tse Chaurikharka Chaurikharka Dudh Pokhari Dudh Pokhari 7916m 7916m Peak Peak 5553m 5553m 5360m 5360m Gokyo Ri Gokyo Gokyo Ri Gokyo 6017m 6017m Samshing Samshing Kang I Kang Kang I Kang Ngozumpa Ngozumpa Ngozumpa 3735m 3735m Machhermo Machhermo Machhermo Ngozumpa Ngozumpa Balung Glacier Kyajori Kyajori 6151m 6151m Thamo Thamo Donag Tsho Donag Tsho Thame Thame Cho Cho Oyu Oyu 8201m 8201m Samde Samde

a a a

l l l o

5085m 5085m

o o

o h

h h

h K

K K

K u

Tarangar Tarangar k

Sumna Glacier i De

e e e

h Airport Tenzing-Hillary

m m

te K m

a a Bho a

h Tsho Tsho

T Gosum Gosum 6187m 6187m Nangpai Nangpai 7350m 7350m Lumding 6465m 6465m Kongde Ri Kongde Location of treks Lumding Glacier Nangpa Glacier 6735m

12 13 Makalu seen from the Kongma La

Everest: A Trekker’s Guide

Kharta Trek 7 Trek Makalu Lhotse to Lhasa Everest North Base Camp Mt Everest Rongbuk Pumori PARK

Trek 6 Cho NATIONAL Oyu Tingri SAGARMATHA Nangpa La Menlung La NEPAL Tong La Tong Phuma La TIBET (CHINA) Zhangmu Barabise Nyalam Kodari Shishapangma km 30 PARK NATIONAL LANGTANG Bhaktapur N 15 Patan

14 (China) Tibet routes from Everest 15 0 KATHMANDU Everest: A Trekker’s Guide Seasons and weather

year, saw over 9500 visitors – compared from Jiri will be uncomfortably humid as you observe yours or your friends’. Let them rest on arrival at the new lodge at with 5500 in 2016, almost 6300 in 2015 – especially for independent travellers the end of the day – it is their free time. Although many porters and guides will when the earthquake struck and 6900 carrying large rucksacks. Clouds often want to serve you during meals, you may try to limit that by collecting your own in 2014. In the spring season, however, build up during the afternoon, while meal from the kitchen and returning utensils and plates when you have finished. a large number of those who attempt heat haze throughout the day can spoil Never overload your porters, and make sure that the bag they carry for you to climb Everest should be added, as distant views in the foothills and mid- is reasonably comfortable. Although you will see porters carrying uncomfortable the quoted figures exclude members dle hills, although at higher elevations loads weighing at least 80kg, this is unacceptable. Porters are not super-human; of expeditions. Spring is the season the atmosphere is generally clear and they are simply trying to make a living in a tough environment. for commercial expeditions on Everest temperatures moderate. This is the sea- A few organisations try to implement porters’ work standards by publish- when a town of tents appears at the Base son for the keen botanist, as numerous ing guidelines and suggestions. Porters’ Progress UK (www.portersprogressuk.org) Camp, while in autumn the same place wildflower varieties add a riot of colour suggests the weight limit of a load carried by a porter in Nepal should be 30kg is usually empty. The summer monsoon throughout the region. Rhododendrons and this should be further adjusted according to altitude and other conditions. season in 2017 saw 340 tourists in July will be blooming at lower elevations as In the author’s opinion, on a Khumbu trek where a large part of each route runs and 530 in August. In winter 2016/17 early as late February, but coming into above 4000m, the load should be smaller. Remember that in addition to your there were almost 2500 trekkers in flower during March and April at higher bag, your porter needs to carry his own belongings. Consider also that in an December, about 1300 in January and levels. emergency or if you become weak, the porter will also be expected to carry your the same number in February. Summer (monsoon): June–September daypack. It is therefore suggested that the bag you give a porter should weigh Spring (pre-monsoon): March–May From June to September Nepal is no more than about 15kg, and it should be a comfortable rucksack or duffle bag The spring trekking season runs from affected by the monsoon. During this with shoulder straps for convenient carrying. If you came to Nepal with a suit- late March to May. Early March above time paths can be treacherous with mud, case, leave it in Kathmandu. If you hire a porter for two trekkers – although some Namche can be colder than December, rivers and streams become raging tor- organisations dictate ‘one trekker, one porter’ – pack everything in one rucksack but from mid March onwards tempera- rents, torrential rain and mist deny views to ensure the load is comfortable. tures in the lower hills rise considerably, for much of the day, while trees, shrubs Porters should have life insurance (see above). If your porter becomes unwell and by May the first few days of a trek and undergrowth are infested with on the trek, provide him with medicine and do not leave him on his own. If he needs to stay at altitude, make sure he is safe and has someone to care for him. If Rhododendrons are one of the a sick porter needs to descend, it is imperative that someone assists him. Before attractions in spring the trek, make sure your porter has adequate clothing and boots, and consider tipping him when the trek is over (see above). If you have clothes you do not want to take back home, you might ask your porter if he would find them useful. If the answer is no, donate them to the Everest Clothing Bank (see above).

SEASONS AND WEATHER years. Therefore, you might want to con- Although trekking may be possible at sider other seasons to avoid the crowds. any time of the year in Solukhumbu, According to data displayed at the there are generally considered to be two entry gate to the Sagarmatha National main seasons: the pre-monsoon period Park in Monjo, in 2017 the number of (spring), and the more popular post- tourists entering in September (the busi- monsoon months before winter sets in. est month of the year) reached almost However, these periods receive a great 12,500 – the highest monthly number many tourists and the number of visi- since records began in 1998. April, the tors has been rapidly growing in recent busiest pre-monsoon month, the same

50 51 Looking back towards Kongde Ri from Deboche (Trek 3, Section 2A)

Everest: A Trekker’s Guide Fitness, health and emergencies leeches except in the highest valleys. and beyond heavy frosts should be However, the countryside is then green expected. By mid November night-time and lush, wildflowers are impressive, temperatures will have dropped to well and when clouds shred and momentar- below freezing, although views by day ily part the mountains reveal an undeni- have a lustre unrivalled at any other time able drama. There are very few trekkers of the year. along the trails, and village life resumes Winter: December–February December its age-old pattern. Anyone tempted is statistically the driest month, and as to trek during the monsoon, though, long as you’ve got good down clothing should be aware that paths may be re- and sleeping bag, trekking right up to routed, some bridges could be washed Christmas can be magnificent. In mid away and lengthy diversions become winter (January) the intense cold experi- necessary. That being said, when condi- enced above Namche Bazaar can make tions allow, flights to Lukla still operate, nights especially uncomfortable, and in so determined trekkers with sufficient some years heavy snowfall in the higher time to wait for a window of opportunity regions can make travel difficult or even could avoid the worst effects of the mon- impossible. Late winter (February–March) soon and begin there. is sometimes disrupted by snowstorms. Autumn (post-monsoon): October–late Not only can these cause severe trail November The post-monsoon period tra- problems, but on occasion flights are ditionally began at the end of September unable to land at Lukla for several days FITNESS, HEALTH AND mountainous terrain, so what you need and continued until the arrival of win- at a time. Although some lodges close EMERGENCIES to practise before the trek is walking. ter in December, but weather patterns for the season, expect to find accommo- Regular running or any other physical are changing and in recent years the dation along the main routes as owners Fitness activity will of course help, but walk- rains have continued well into October. arrange to keep at least one lodge open You do not need to be extremely fit to go ing is most important. Familiarity with Should this pattern continue, trekkers in each settlement. This particularly refers trekking in the Everest Region. The range mountain walking is especially useful, may face unpredictable weather at least to Lobuche and Gokyo where you can of possible styles of trek, the length and given the ascents and descents involved, until mid October, with more stable expect to find a place all year round. flexibility of stages and the diversity of but if you do not live near mountains conditions in November and December. routes make trekking available to people simply go on frequent long walks in your Autumn remains the most popular trek- of different ages and levels of physical neighbourhood. king period, when trails and lodges are WEATHER FORECAST strength. The Everest Region is a moder- at their busiest, and with the monsoon For a local weather forecast, check Trekking is a matter of walking – ately demanding trekking destination in having cleansed the atmosphere, the www.mountain-forecast.com (which has you don’t need any particular skills to do Himalayan terms. Easier areas should weather is mostly settled. Above 3000m forecasts for various altitudes on moun- it. However, trekking inevitably means be chosen by first-time visitors to this an occasional dump of snow is not unu- tains including Kala Patthar, Gokyo spending days in the mountains, chang- mountain range and – even more impor- sual, however, and when prolonged can Ri and Everest, as well as all the other ing your routine, abandoning home tantly – first-time trekkers at altitude. The have an effect on plans to cross high giants in the region), www.accuweather. comforts, and stepping beyond your Annapurna Himal or Langtang, among passes. Mostly, though, days are blessed com (Lukla, Namche Bazaar), www. comfort zone. It means long hours of others, are generally considered easier with clear, often cloud-free skies with yr.no (for the majority of the region’s constant walking, possibly with a heavy and safer than the Khumbu in terms of a magical light ideal for photography. main settlements), www.meteoblue. rucksack, usually steeply up or down at altitude and acclimatisation, although Daytime temperatures are very pleas- com (main settlements and peaks and altitude, often with unpleasant weather the comprehensive tourist infrastructure ant. Above Namche nights can be chilly any given coordinates), and www.mfd. as a close companion. You need to be in the Khumbu vastly aids its exploration. in October, while at Gokyo, Tengboche gov.np. able to cope with a full day’s activity in Altitude is the biggest challenge here.

52 53 Everest: A Trekker’s Guide Fitness, health and emergencies

Vaccinations and medical preparations to include drugs used to treat altitude A number of vaccinations are recom- sickness – Diamox (acetazolamide) is mended before a trip to Nepal. These an absolute minimum, but carrying are best started a few months, and at Dexamethasone is strongly recom- least four weeks, in advance of your mended (see below). You should take visit. Consult your doctor and treat the painkillers with you as well as medi- following as a basic suggestion only. cines to deal with stomach problems. Although no vaccination is mandatory, Carrying a wide-range antibiotic is also the following are usually advised: diph- recommended. All medication should theria, tetanus, hepatitis A, hepatitis B, obviously be accompanied by notes on typhoid, and meningococcal meningi- their usage – ask your doctor to help tis. Of these, hepatitis A and typhoid you complete your first aid kit. All the vaccines are particularly important necessary medication can be purchased as you may get infected through con- in pharmacies in Kathmandu without taminated water or food. In addition, prescription. if you haven’t already been immunised against tuberculosis (TB), consider get- Altitude sickness Villages around Jiri were badly affected by the 2015 earthquake (Trek 1, Section 1) ting the vaccine. Those who trek from Altitude sickness can be a reality for Jiri during the monsoon, or plan to visit those trekking in the Everest Region and Chitwan, should consider vaccinations the risk should not be ignored or under- • ‘Travel at High Altitude’ – a free 1013hPa at sea level) – meaning there for Japanese encephalitis as well as estimated. If not treated properly, severe book published by Medex, recom- is only 67% of the oxygen available malaria prophylaxis. All visitors should forms of the illness can rapidly become mended by UIAA, BMC and BMG, at sea level. It is 53% at 5275m (EBC). take measures to avoid mosquito bites, fatal. available at www.medex.org.uk; Our bodies adjust to these conditions in as they can transmit Japanese encepha- However, as long as you follow • ‘Emergency Field Management of a process called acclimatisation. Most litis and malaria as well as dengue a few simple rules, you should not be Acute Mountain Sickness, High of us can adapt to an altitude of about fever. Be aware, too, that there is a seri- affected. Consider the following infor- Altitude Pulmonary Oedema, and 5000–5500m, but the process takes ous risk of rabies via dog bites. Rabies mation as a base for further reading – it High Altitude Cerebral Oedema’ time. If the rate of acclimatisation is not vaccinations are often recommended to has not been written by a doctor and – document available at www. adequate, a form of altitude sickness those travelling to Nepal, and should must not be treated as authorised medi- theuiaa.org (select ‘Safety’ > occurs. This might be acute mountain also be considered. (Contact with cal advice. ‘Mountain Medicine’ > ‘High alti- sickness (AMS), high-altitude cerebral stray dogs should be avoided; beware Make sure you understand the pro- tude medical advice’); oedema (HACE) or high-altitude pulmo- of monkeys too.) For more informa- cess of proper acclimatisation and that • articles regarding acclimatisation nary oedema (HAPE). When travelling to tion about vaccines, check the follow- you are able to recognise the various and altitude illness in ‘Resources’ at any altitude above 2500m, acclimatisa- ing sources: www.who.int/ith, https:// symptoms of altitude sickness. Never www.ismm.org; tion must be considered! travelhealthpro.org.uk, www.fitfor ignore any symptoms. If you feel unwell • High Altitude Medicine Guide: AMS is not life-threatening but it travel.nhs.uk, www.nhs.uk/conditions/ at altitude, assume it is altitude-related www.high-altitude-medicine.com; can quickly develop into HACE or HAPE travel-vaccinations, www.cdc.gov, and unless an alternative explanation is obvi- • www.altitude.org if symptoms are ignored. With AMS www.traveldoctor.info. ous. Observe your condition and that The higher the altitude, the lower you may experience symptoms includ- It is also advisable to visit a dentist of those travelling with you. Remember the air pressure. Hence there is less oxy- ing headache, nausea, loss of appetite, well before your trip, to make sure your that anyone can become ill, no mat- gen – as well as other particles – in a dizziness, sleep disorder and vomiting. teeth are in good condition. ter their number of visits, their age, or single breath. At an altitude of 3400m Use a painkiller such as ibuprofen or It is important to take some medi- fitness. (Namche Bazaar) the standard baro- paracetamol, consider acetazolamide cines with you on your trek. Make sure Consult the following sources: metric pressure is 680hPa (it is about (Diamox), hydrate properly and do not

54 55