• Adventure Trekking Tour

Make sure you’re healthy before you start travelling to Tibet. If you are going on a long trip, make sure your teeth are OK. If you wear glasses, take a spare pair and your prescription.

If you require a particular medication take a good supply, as it may not be available in Tibet. Take along part of the packaging showing the generic name rather than the brand to make getting replacements easier. To avoid problems, it’s a good idea to have a legible prescription or letter from your doctor to show that you legally use the medication.

Travel Insurance

Keep in mind that Tibet is a remote location, and if you become seriously injured or very sick, you may need to be evacuated by air. Under these circumstances, you don’t want to be without adequate health insurance. Be sure your policy covers evacuation and Helicopter rescue.

Recommended vaccination

China doesn’t officially require any immunization for entry into the country; however, the further off the beaten track you go, the more necessary it is to take all precautions. The World Health Organization (WHO) requires travelers who have come from an area infected with yellow fever to be vaccinated before entering the country. Record all vaccinations on an International Health Certificate, available from a doctor or government health department.

Plan well ahead and schedule your vaccinations because some require more than one injection, while others should not be given together. Note that some vaccinations should not be given during pregnancy or to people with allergies.

It is recommended that you seek medical advice at least eight weeks before travel. Note that there is a greater risk of all kinds of disease with children and during pregnancy. Discuss your requirements with your doctor, but vaccinations you should consider for this trip include the following:

Diphtheria & Tetanus Vaccinations for these two diseases are usually combined and are recommended for everyone. After an initial course of three injections (usually given in childhood), boosters are necessary every 10 years.

Hepatitis A- The vaccine for Hepatitis A (e.g. Avaxim, Havrix 1440 or VAQTA) provides long-term immunity (at least 20 years) after an initial injection and a booster at six to 12 months. Hepatitis A vaccine is also available in a combined form, with hepatitis B vaccine. Three injections over a six-month period are required, the first two providing substantial protection against hepatitis A.

Hepatitis B- China (although not so much Tibet) is one of the world’s great reservoirs of hepatitis B infection, a disease spread by contact with blood or by sexual activity. Vaccination involves three injections, the quickest course being over three weeks with a booster at 12 months.

Polio- This serious, easily transmitted disease is still prevalent in many developing countries, including Tibet’s neighboring countries, India, Pakistan and Nepal. Everyone should keep up-to-date with this vaccination, which is normally given in childhood. One adult booster is then needed (as long as the full childhood course was completed), particularly if travelling to a country with recent polio activity. This should be discussed with your doctor.

Rabies - China has a significant problem with rabies, which is worsening. Rabies is now the most common infectious disease cause of death in China. Only India reports more human cases annually. The vaccination is strongly recommended for those spending more than a month in Tibet, especially if you are cycling, handling animals, caving or travelling in remote areas, and for children. Pretravel vaccination means you do not need to receive Rabies Immune Globulin (RIG) after a bite. RIG is very unlikely to be available in Tibet, and there is such a worldwide shortage that for the first time the CIWEC Clinic in Kathmandu reports that it cannot source any (at the time of writing). If you are revaccinated and then bitten, you need only get two further shots of vaccine, as soon as possible, three days apart. If not revaccinated, you require RIG plus five shots of vaccine over the course of 28 days. Thus the management of any bite or scratch is greatly simplified if you have been vaccinated. Current expert opinion is that the full series of vaccination does not require any boosters unless a bite occurs.

Tuberculosis - The risk of tuberculosis (TB) to travelers is usually very low, unless you’ll be living with or closely associated with local people in high-risk areas. As most healthy adults don’t develop symptoms, a skin test before and after travel to determine whether exposure has occurred may be considered. Recommendations for BCG vaccination vary considerably around the world. Discuss with your doctor if you feel you may be at risk. It is strongly recommended for children under five who are spending more than three months in a high-risk area.

Typhoid - This is an important vaccination to have for Tibet, where hygiene standards are low. It is available either as an injection or oral capsules. A combined hepatitis A-typhoid vaccine was launched recently but its availability is still limited. Check with your doctor to find out its status in your country.

Yellow Fever This disease is not endemic in China or Tibet and a vaccine is only required if you are coming from an infected area. These areas are limited to parts of South America and Africa.

Measles-mumps-rubella (MMR) - All travelers should ensure they are immune to these diseases, either through infection or vaccination. Most people born before 1966 will be immune; those born after this date should have received two MMR vaccines in their lifetime.

Chickenpox (Varicella) - Discuss this vaccine with your doctor if you have not had chickenpox.

Influenza - The flu vaccine is recommended for anyone with chronic diseases, such as diabetes, lung or heart disease. Tibet has a high rate of respiratory illness, so all travelers should consider vaccination.

Pneumonia - A vaccine is recommended for anyone over 65 or those over 55 with certain medical conditions.

Medical checklist

Following is a list of items you should consider including in your medical kit for travelling – consult your pharmacist for brands available in your country.

Antibiotics – useful for everyone travelling to Tibet to avoid risks of receiving poorly stored local medications; see your doctor, as antibiotics must be prescribed, and carry the prescription with you. Antifungal cream or powder – for fungal skin infections and thrush

Antihistamine – for allergies, e.g. hay fever; to ease the itch from insect bites or stings; and to prevent motion sickness

Antiseptic (such as povidone-iodine) – for cuts and grazes Bandages, Band-Aids (plasters) and other wound dressings

Calamine lotion, sting-relief spray or aloe vera – to ease irritation from sunburn and insect bites or stings, Cold and flu tablets, throat lozenges and nasal decongestant

Homeopathic medicines – useful hom­eopathic medicines include gentiana for altitude sickness, echinacea for warding off infections, and tea-tree oil for cuts and scrapes, Insect repellent, sunscreen, lip balm and eye drops

Loperamide or diphenoxylate – ‘blockers’ for diarrhea

Multivitamins – for long trips, when dietary­ vitamin intake may be inadequate

Paracetamol (acetaminophen in the USA) – for pain or fever

Prochlorperazine or metaclopramide – for nausea and vomiting

Rehydration mixture – to prevent dehydration, which may occur, for example, during bouts of diarrhea; particularly important when travelling with children, Scissors, tweezers and a thermometer – note that mercury thermometers are prohibited by airlines

Sterile kit – in case you need injections in a country with medical hygiene problems; discuss with your doctor, Water purification tablets or iodine.

Avian influenza (bird flu) - Influenza a (H5N1) or ‘Bird flu’ is a subtype of the type an influenza virus. This virus typically infects birds and not humans. There have been some cases of bird-to-human transmission, although this does not easily occur. Very close contact with dead or sick birds is the currently principal source of infection.

Symptoms include high fever and typical influenza-like indicators, with rapid deterioration leading to respiratory failure and, in many cases, death. The early administration of antiviral drugs such as Tamiflu is recommended to improve the chances of survival. Immediate medical care should be sought if bird flu is suspected.

Hepatitis- A general term for inflammation of the liver, hepatitis is a common disease worldwide. There are several different viruses that cause hepatitis, and they differ in the way that they are transmitted. The symptoms are similar in all forms of the illness and include fever, chills, headache, fatigue, feelings of weakness and aches and pains, followed by loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-coloured faeces, jaundiced (yellow) skin and yellowing of the whites of the eyes. People who have had hepatitis should avoid alcohol for some time after the illness, as the liver needs quite a while to recover.

Hepatitis A- is transmitted by contaminated food and drinking water. You should seek medical advice if symptoms present, but there is not much you can do apart from resting, drinking lots of fluids, eating lightly and avoiding fatty foods.

Hepatitis A- is most often spread in China and Tibet as a result of the custom of sharing food from a single dish rather than using separate plates and a serving spoon. It is wise to use the disposable chopsticks now freely available in most restaurants in Tibet, or else buy your own chopsticks and spoon. Hepatitis E is transmitted in the same way as hepatitis A; it can be particularly serious for pregnant women.

There are almost 300 million chronic carriers of hepatitis B in the world, and China has more cases than any other country; almost 20% of the population is believed to be carriers. It is spread through contact with infected blood, blood products or body fluids, for example through sexual contact, unsterilized needles and blood transfusions, or contact with blood via small breaks in the skin. Other risk situations include contaminated medical equipment or having a shave, tattoo or body piercing with contaminated tools. The symptoms of hepatitis B may be more severe than those for type A, and the disease can lead to long-term problems such as chronic liver damage, liver cancer or a long-term carrier state. Hepatitis C and D are spread in the same way as hepatitis B and can also lead to long-term complications.

There are vaccines against hepatitis A and B, but there are currently no vaccines against the other types. Following the basic rules about food and water (hepatitis A and E) and avoiding risk situations (hepatitis B, C and D) are important preventative measures.

HIV & aids- Infection with human immunodeficiency virus (HIV) may lead to acquired immune deficiency syndrome (AIDS), which is a fatal disease if untreated. Any exposure to blood, blood products or body fluids may put the individual at risk. The disease is often transmitted by sexual contact or dirty needles. Vaccination, acupuncture, tattooing and body piercing can be potentially as dangerous as intravenous drug use. HIV/AIDS can also be spread through infected blood transfusions; some developing countries cannot afford to screen blood used for transfusions.

HIV cases in Tibet are on the rise, and anyone who intends to work or study in Tibet for longer than 12 months is required by the Chinese authorities to undergo an AIDS test.

If you do need an injection, ask to see the syringe unwrapped in front of you, or take a needle and syringe pack with you when travelling. Fear of HIV infection should never preclude treatment for serious medical ­conditions.

Rabies- This fatal viral infection is found in many countries. Many animals (such as dogs, cats, bats and monkeys) can be infected and it is their saliva that is infectious. Any bite, scratch or even lick from an animal should be cleaned immediately and thoroughly. Scrub gently with soap and running water, and then apply alcohol or iodine solution. Prompt medical help should be sought to receive a course of injections to prevent the onset of symptoms and save the patient from death.

At the time of writing, no treatment for rabies was available anywhere in Tibet. If you have any potential exposure to rabies, seek medical advice in Lhasa (or ideally Kathmandu or Chengdu) as soon as possible in order to receive post-exposure treatment. Even in these centres full treatment may not be available and you may need to travel to Bangkok or Hong Kong.

Respiratory infections -Upper respiratory tract infections (like the common cold) are frequent ailments all over China, including Tibet. Why are they such a serious problem in China? Respiratory infections are aggravated by the high altitude, the cold weather, air pollution, chain smoking and overcrowded conditions, all of which increase the opportunity for infection. Another reason is that Chinese people tend to spit a lot, thereby spreading the disease.

Some of the symptoms of influenza include a sore throat, fever and weakness. Any upper-respiratory-tract infection, including influenza, can lead to complications such as bronchitis and pneumonia, which may need to be treated with antibiotics. Seek medical help in this situation.

The Chinese treat bronchitis, which can be a complication of flu, with a powder made from the gall bladder of snakes – a treatment of questionable value, but there is no harm in trying it.

No vaccine offers complete protection, but there are vaccines against influenza and pneumococcal pneumonia that might help. The influenza vaccine is highly recommended for travellers to China and Tibet, and is good for up to one year.

Sexually transmitted infections- While HIV/AIDS and hepatitis B can be transmitted through sexual contact, other sexually transmitted infections (STIs) include gonorrhea, herpes and syphilis. Sores, blisters or rashes around the genitals and discharges or pain when urinating are common symptoms. In some STIs, such as wart virus or Chlamydia, symptoms may be less prominent or go completely unobserved, especially in women. Syphilis symptoms eventually disappear but the disease continues and can cause severe problems in later years. Although abstinence from sexual contact is the only 100% effective prevention, using condoms is also effective in the prevention of some infections. Gonorrhea and syphilis are treated with antibiotics. Different STIs each require specific antibiotics. There is no cure for herpes or AIDS.

Condoms are available in China – the word is baotao which translates literally as ‘insurance glove’.

Traveller’s diarrhea- Simple things like a change of water, food or climate can all cause a mild bout of diarrhoea (la duzi – spicy stomach – in Chinese), but a few rushed toilet trips with no other symptoms are not indicative of a major problem. Even Marco Polo got the runs.

Dehydration is the main danger with any diarrhea, particularly in children or the elderly as it can occur quite quickly. Under all circumstances, fluid replacement (at least equal to the volume being lost) is the most important thing to remember. Weak black tea with a little sugar, soda water, or soft drinks allowed going flat and diluted 50% with clean water are all good. With moderate to severe diarrhea a rehydrating solution is preferable to replace lost minerals and salts. Commercially available oral rehydration salts (ORS) are very useful; add them to boiled or bottled water. In an emergency you can make up a solution of six teaspoons of sugar and half a teaspoon of salt to a litre of boiled or bottled water. You need to drink at least the same volume of fluid that you are losing in bowel movements and vomiting. Urine is the best guide to the adequacy of replacement –if you have small amounts of concentrated urine, you need to drink more. Keep drinking small amounts often. Stick to a bland diet as you recover.

Loperamide or diphenoxylate can be used to bring relief from the symptoms, although they do not actually cure the problem. However, neither is available in China. A good Chinese alternative treatment is berberine hydrochloride. Only use these drugs if you do not have access to toilets, e.g. if you must travel. These drugs are not recommended for children under 12 years. Do not use these drugs if you have a high fever, are severely dehydrated or have blood in the bowel motions.

In certain situations antibiotics may be required: diarrhea with blood or mucus (dysentery), any diarrhoea with fever, profuse watery diarrhoea, persistent diarrhea not improving after 24 hours and severe diarrhea. These suggest a more serious cause, in which case gut-paralyzing drugs should be avoided without seeking medical advice.

In these situations, a stool test may be necessary to diagnose what bug is causing your diarrhoea, so you should seek medical help urgently. Where this is not possible the recommended drugs for bacterial diarrhea (the most likely cause of severe diarrhea in travelers) are norfloxacin 400mg twice daily for three days or ciprofloxacin 500mg twice daily for three days. These are not recommended for children or pregnant women. There can be resistance to these medications for some of the bacterial causes of diarrhoea; in those cases, azithromycin, 500mg once a day, is recommended. This is also the drug of choice for children with dosage dependent on weight. A three-day course is given. Azithromycin may be considered under medical supervision in pregnancy. There is a new oral cholera vaccine that offers some protection against traveller’s diarrhea, but only about 20% for three months. It may be suggested if you are at high risk of complications from diarrhea.

Two other causes of persistent diarrhea in travelers are giardia and amoebic ­dysentery.

Amoebic dysentery -Caused by the protozoan Entamoeba histolytica, amoebic dysentery is characterized by a gradual onset of low-grade diarrhea, often with blood and mucus. Cramping abdominal pain and vomiting are less likely than in other types of diarrhea, and fever may not be present. It will persist until treated and can recur and cause other health problems.

You should seek medical advice if you think you have giardia or amoebic dysentery, but where this is not possible, tinidazole or metronidazole are the recommended drugs. The better option of the two is tinidazole, which is not easily obtained in Tibet. If you are going to be travelling in high mountain areas, it might be a good idea to keep your own stock with you.

Cholera- This is the worst of the watery diarrhoeas. Outbreaks of cholera are generally widely reported, so you can avoid problem areas. Fluid replacement is the most vital treatment: the risk of dehydration is severe, as you may lose up to 20L a day. If there is a delay in getting to hospital, begin taking Doxycycline. This may help shorten the illness, but adequate fluids are required to save lives. Seek medical advice if you think you may have this disease.

Giardia –Known as giardia, giardiasis is a type of diarrhoea that is relatively common in Tibet and is caused by a parasite, Giardia lamblia. Mountaineers often suffer from this problem. The parasite causing this intestinal disorder is present in contaminated water. Many kinds of mammals harbour the parasite, so you can easily get it from drinking ‘pure mountain water’ unless the area is devoid of animals. Simply brushing your teeth using contaminated water is sufficient to get giardiasis, or any other gut bug. Symptoms include stomach cramps, nausea, a bloated stomach, watery, foul-smelling diarrhoea and frequent gas. Giardiasis can appear several weeks after you have been exposed to the parasite. The symptoms may disappear for a few days and then return; this can go on for several weeks. Treatment is with tinidazole, 2g in a single dose for one to two days.

Acute mountain sickness - Acute mountain sickness (AMS, also known as altitude sickness) is common at high elevations; relevant factors are the rate of ascent and individual susceptibility. The former is the major risk factor. On average, one tourist a year dies in Tibet from AMS. Make sure that it is not you. Any traveler who flies or buses into Lhasa, where the elevation is just over 3600m, is likely to experience some symptoms of AMS. Take care to acclimatise slowly and take things easy for the first couple of days. Lack of oxygen at high altitudes (over 2500m) affects most people to some extent. The effect may be mild or severe and it occurs because less oxygen reaches the muscles and the brain at high altitude, requiring the heart and lungs to compensate by working harder.

AMS is a notoriously fickle affliction and can also affect trekkers and walkers accustomed to walking at high altitudes. It has been fatal at 3000m, although 3500m to 4500m is the usual range.

Acclimatization- AMS is linked to low atmospheric pressure. Those who travel up to Everest Base Camp, for instance, reach an altitude where atmospheric pressure is about half of that at sea level.

With an increase in altitude, the human body needs time to develop physiological mechanisms to cope with the decreased oxygen. This process of acclimatization is still not fully understood, but is known to involve modifications in breathing patterns and heart rate induced by the autonomic nervous system, and an increase in the blood’s oxygen-carrying capabilities. These compensatory mechanisms usually take about one to three days to develop at a particular altitude. You are unlikely to get AMS once you are acclimatized to a given height, but you can still get ill when you travel higher. If the ascent is too high and too fast, these compensatory reactions may not kick into gear fast enough.

Symptoms -Mild symptoms of AMS are very common in travelers visiting high altitudes, and usually develop during the first 24 hours at altitude. Most visitors to Tibet will suffer from some symptoms; these will generally disappear through acclimatization in several hours to several days.

Symptoms tend to be worse at night and include headache, dizziness, and lethargy, loss of appetite, nausea, breathlessness and irritability. Difficulty sleeping is another common symptom, and many travelers have trouble for the first few days after arriving in Lhasa.

AMS may become more serious without warning and can be fatal. Symptoms are caused by the accumulation of fluid in the lungs and brain, and include breathlessness at rest, a dry irrelative cough (which may progress to the production of pink, frothy sputum), severe headache, lack of coordination (typically leading to a ‘drunken walk’), confusion, irrational behaviour, vomiting and eventually unconsciousness.

The symptoms of AMS, however mild, are a warning; be sure to take them seriously! Trekkers should keep an eye on each other as those experiencing symptoms, especially severe symptoms, may not be in a position to recognize them. One thing to note is that while the symptoms of mild AMS often precede those of severe AMS, this is not always the case. Severe AMS can strike with little or no warning.

Prevention -If you are driving up from Kathmandu, you will experience rapid altitude gain. An itinerary that takes you straight up to Everest Base Camp is unwise; plan to see it on your way back if possible. The best way to prevent AMS is to avoid rapid ascents to high altitudes. If you fly or bus into Lhasa, take it easy for at least three days; this is enough for most travelers to get over any initial ill-effects. At this point you might step up your program by visiting a few sights around town. Within a week you should be ready for something a bit more adventurous, but do not push yourself to do anything that you are not comfortable with.

To prevent acute mountain sickness:

Ascend slowly. Have frequent rest days, spending two to three nights at each rise of 1000m. If you reach a high altitude by trekking, acclimatization takes place gradually and you are less likely to be affected than if you fly directly to high altitude.

Trekkers should bear in mind the climber’s adage of ‘climb high, sleep low’. It is always wise to sleep at a lower altitude than the greatest height that’s reached during the day. High day climbs followed by a descent back to lower altitudes for the night are very good preparation for high-altitude trekking. Also, once above 3000m, care should be taken not to increase the sleeping altitude by more than 400m per day. If the terrain won’t allow for less than 400m of elevation gain, be ready to take an extra day off before tackling the climb.

Drink extra fluids. Tibet’s mountain air is cold and dry, and moisture is lost as you breathe. Evaporation of sweat may occur unnoticed and result in dehydration. Eat light, high-carbohydrate meals to keep up energy. Avoid alcohol as it may increase the risk of dehydration, and don’t smoke.

Avoid sedatives

When trekking, take a day off to rest and acclimatize if feeling overtired. If you or anyone else in your party is having a tough time, make allowances for unscheduled stops.

Don’t push yourself when climbing up to passes; rather, take plenty of breaks. You can usually get over the pass as easily tomorrow as you can today. Try to plan your itinerary so that long ascents can be divided into two or more days. Given the complexity and unknown variables involved with AMS and acclimatization, trekkers should always err on the side of caution and ascend mountains slowly.

Treatment

Treat mild symptoms by resting at the same altitude until recovery, usually a day or two. Take paracetamol or acetaminophen for headaches. If symptoms persist or become worse, however, immediate descent is necessary. Even 500m can help.

The most effective treatment for severe AMS is to get down to a lower altitude as quickly as possible. In less severe cases the victim will be able to stagger down with some support; in other cases they may need to be carried down. Whatever the case, any delay could be fatal.

AMS victims may need to be flown out of Tibet as quickly as possible, so make sure you have adequate travel insurance.

The drug acetazolamide (Diamox) is recommended for the prevention of AMS – take 125mg twice a day as a preventive dose. Be aware that even when you are on Diamox, you should not ignore any symptoms of AMS.

However, the use Diamox is controversial. It can reduce the symptoms, but may also mask warning signs; severe and fatal AMS has occurred in people taking this drug. Travellers should discuss the use of Diamox with a travel health expert. Diamox should be avoided in those with a sulphur allergy, but you can discuss taking a trial of the medication at home if necessary.

Drug treatments should never be used to avoid descent or to enable further ascent (although they can help get people well enough to descend).

Several hotels in Lhasa sell a Tibetan herbal medicine recommended by locals for easing the symptoms of mild altitude sickness. The medicine is known as solomano in Tibetan and hongjingtian in Chinese, though locals also recommend gaoyuanning and gaoyuankang. A box of vials costs around Y20 to Y35; take three vials a day.

Cuts & scratches

Wash any cut well and treat it with an antiseptic such as povidone-iodine.

Bedbugs & lice

Bedbugs live in various places, but particularly in dirty mattresses and bedding, evidenced by spots of blood on bedclothes or on the wall. Bedbugs leave itchy bites in neat rows. Calamine lotion or a sting-relief spray may help.

All lice cause itching and discomfort. They make themselves at home in your hair (head lice), in your clothing (body lice) or in your pubic hair (crabs). You catch lice through direct contact with infected people or by sharing combs, clothing and the like. Powder or shampoo treatment will kill the lice. Infected clothing should then be washed in very hot, soapy water and left in the sun to dry.

Leeches

In the damper, low-lying areas of eastern Tibet, leeches may be present. They attach themselves to your skin to suck your blood.

Trekkers often get them on their legs or in their boots. Salt or a lighted cigarette end will make them fall off; however, the shock may cause the leech to regurgitate its stomach contents into the bite. This may lead to infection or just make the wound more difficult to heal quickly. Do not pull them off, as the bite is then more likely to become infected. It’s often best to let them fall off naturally. Clean and apply pressure if the point of attachment is bleeding. An insect repellent may help keep them away.

Food in Tibet

There is an old colonial adage: ‘If you can cook it, boil it or peel it you can eat it…otherwise forget it.’ Vegetables and fruit should be washed with purified or bottled water or peeled where possible. Beware of ice cream that is sold in the street or anywhere it might have been melted and refrozen; if there’s any doubt (eg a power cut in the last day or two) steer well clear. Undercooked meat should be avoided.

If a place looks clean and well run, and the vendor also looks clean and healthy, then the food is probably safe. In general, places that are packed with travellers or locals will be fine, while empty restaurants are questionable. Chinese food in particular is cooked over a high heat, which kills most germs.

Frostbite

This is the freezing of extremities, including fingers, toes and nose. Signs and symptoms of frostbite include a whitish or waxy cast to the skin, or even crystals on the surface, plus itching, numbness and pain. Warm the affected areas by immersing them in warm (not hot) water or with blankets or clothes, only until the skin becomes flushed. Note: frostbitten areas should only be rewarmed if there is not a likelihood they can be frostbitten again prior to reaching medical care. Frostbitten parts should not be rubbed. Pain and swelling are inevitable. Blisters should not be broken. Get medical attention right away.

Heat exhaustion

Dehydration and salt deficiency can cause heat exhaustion. Take time to acclimatize to high temperatures, be sure to drink sufficient liquids and do not do anything too physically demanding.

Salt deficiency is characterized by fatigue, lethargy, headaches, giddiness and muscle cramps; salt tablets may help, but adding extra salt to your food is better.

Hypothermia

Tibet’s cold climate must be treated with respect. Subfreezing temperatures mean there is a risk of hypothermia, even during the summer season. Even in midsummer, passes and high areas around northern Tibet and the Changtang can be hit without warning by sudden snow storms. Exposed plains and ridges are prone to extremely high winds and this significantly adds to the cold. For example, on a 5000m pass in central Tibet in July, the absolute minimum temperature is roughly -4°C, but regularly occurring 70km/h winds plunge the wind-chill factor or apparent temperature to -20°C.

The message is that you should always be prepared for cold, wet or windy conditions, especially if you’re out walking, hitching or trekking at high altitudes or even taking a long bus trip over mountains (particularly at night).

Hypothermia occurs when the body loses heat faster than it can produce it and the core temperature of the body falls. It is surprisingly easy to progress from very cold to dangerously cold through a combination of wind, wet clothing, fatigue and hunger, even if the air temperature is above freezing.

It is best to dress in layers. Silk, wool and some of the new artificial fibres are all good insulating materials. A hat is important, as a lot of heat is lost through the head. A strong, waterproof outer layer and a ‘space’ blanket for emergencies are essential. Carry basic supplies, including food that contains simple sugars to generate heat quickly and fluid to drink.

Symptoms of hypothermia are exhaustion, numb skin (particularly toes and fingers), shivering, slurred speech, irrational or violent behavior, lethargy, stumbling, dizzy spells, muscle cramps and violent bursts of energy. Irrationality may take the form of sufferers claiming they are warm and trying to take off their clothes.

To treat mild hypothermia, first get the person out of the wind and rain, remove their clothing if it’s wet and replace it with dry, warm clothing. Give hot liquids (not alcohol) and some high-energy, easily digestible food. Do not rub victims; instead, allow them to slowly warm themselves. This should be enough to treat the early stages of hypothermia. The early recognition and treatment of mild hypothermia is the only way to prevent severe hypothermia, which is a critical condition.

Sunburn

It’s very easy to get sun burnt in Tibet’s high altitudes, especially if you’re trekking. Sunburn is more than just being uncomfortable. Among the undesirable effects (apart from the immediate pain and agony) are premature skin ageing and possible skin cancer in later years. Wear sunglasses, loose-fitting clothes that cover your arms, legs and neck, and a wide-brimmed hat like the ones Tibetans wear. Calamine lotion is good for treating mild sunburn.

Choose sunscreen with a high sun protection factor (SPF). Those with fair complexions should bring reflective sunscreen (containing zinc oxide or titanium oxide) with them. Apply the Health Safety sunscreen to your nose and lips (and especially the tops of your ears if you are not wearing a hat).

Water

The number-one rule is being careful of the water, especially ice. If you don’t know for certain that the water is safe, assume the worst. In urban centre Tibetans, like the Chinese, boil their drinking water making it safe to drink hot or cooled. In the country and while trekking you should boil your own water or treat it with water-purification tablets, as livestock contaminate many of the water sources. Milk should be treated with suspicion as it will be unpasteurized in the countryside, although boiled milk is fine if it is kept hygienically. Soft drinks and beer are always available wherever there is a shop, and these are always safe to drink, as is tea. Locally brewed beer, chang, is another matter. It is often made with contaminated well water and there is always some risk in drinking it.

Water purification

The simplest way to purify water is to boil it thoroughly. At Tibet’s high altitude water boils at a lower temperature and germs are less likely to be killed, so make sure you boil water for at least 10 minutes.

Consider purchasing a water filter for a long trip. There are two main kinds of filters. Total filters take out all parasites, bacteria and viruses, and make water safe to drink. They are often expensive, but can be more cost-effective than buying bottled water. Simple filters (which can even be a nylon mesh bag) take out dirt and larger foreign bodies from the water so that chemical solutions work much more effectively; if water is dirty, chemical solutions may not work at all. It’s very important when buying a filter to read the specifications, so that you know exactly what it removes from the water and what it doesn’t. Simple filtering will not remove all dangerous organisms, so if you cannot boil water it should be treated chemically.

Chlorine tablets will kill many pathogens, but not giardia and amoebic cysts. Iodine is more effective for purifying water and is available in tablet form (eg Potable Aqua). Follow the directions carefully and remember that too much iodine can be harmful.

Pregnancy

It is not advisable to travel to some places while pregnant as some vaccinations normally used to prevent serious diseases (e.g. yellow fever) are not advisable during pregnancy. In addition, some diseases are much more serious for the mother (and may increase the risk of a stillborn child) in pregnancy.

Most miscarriages occur during the first three months of pregnancy. Miscarriage is not uncommon and can occasionally lead to severe bleeding. The last three months should also be spent within reasonable distance of good medical care. A baby born as early as 24 weeks stands a chance of survival, but only in a good modern hospital. Pregnant women should avoid all unnecessary medication, although vaccinations should still be taken where needed. Additional care should be taken to prevent illness and particular attention should be paid to diet and nutrition. Alcohol and nicotine, for example, should be avoided.

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