Wednesday, January 9, 2013

How Medically Dangerous is Nepal?

Travel Warnings and Concerns

One of the most discouraging things you will need to consider prior to taking a trip to Asia is the health issue. It’s downright scary. ‘Should I take vaccines?‘ ‘If so, which ones?’ My doctor wanted me to take just about everything, for any contingency. I highly doubted I would get into too much trouble and promptly ignored most of his advice, but everyone is different. Consider this topic well. This is not America or Europe. You will eat things that you have no idea where they’ve been. I was riding by Changu Narayan when I happened to see people preparing snacks to package and sell. They were sitting outside and the man was literally sitting on bags of rice he would place into the package. I just had to stop to capture it for you: 

Swine flu and bird flu come and go in Nepal from time to time. Additionally, there are malaria outbreaks in the lower regions such as Chitwan and along the Indian border in the lower elevations. How likely are you to contract either of these illnesses? It largely depends on what you will be doing. Will you be around sick people or children, perhaps while volunteering? Are you planning to work with animals? These activities place you in a much higher risk category.   

Westerners who should be most concerned and perhaps take more precaution would be those volunteering in the rural areas or in schools or hospitals. But unless you plan to be up close to sick people for some reason or have a weakened immune system, it shouldn’t be a concern. After ignoring my doctor’s advice on vaccinations for my trip abroad I found that I’d been in contact with a woman diagnosed with TB and wondered if I had erred a bit. There is a tuberculosis hospital here and literally everyone spits in the street. Tuberculosis is one of the main reasons spitting in public was outlawed in the U.S. Being aware is probably the best defense, as would be an early diagnosis. OK, so what if you were to contact TB? It isn’t as serious as it was a hundred years ago and is actually curable with a 30 day treatment. Could it be potentially lethal? Probably, but it really isn’t likely. Conversely, one tourist friend had all the shots her doctor advised and ended up with a compromised immune system by the time she got here. So, either way, life on this planet can be hazardous. But seriously, I had to laugh at my friend who even got a rabies shot. One thing I learned from her is to get this issue settled well before booking your flight; if there is a problem it’s best to have time to allow your body to adjust. And sometimes a 'pound of cure' is better than an ounce of prevention because that little ounce has big risks.

There are health care screenings at the airport sometimes in an attempt to prevent communicable diseases from coming into Nepal, but there are many entrance points on ground routes that are not monitored for communicable diseases. There are also medical NGOs that do free health screening for the local people from time to time.   

Although it is a common belief that the local people are immune to stomach bacteria, this is simply not all together true. For example, my friend in India was quite the miser. When he and his cook would have strong words, his ‘irritable bowel’ would coincidently act up. I seldom complain until after my meal has been served, which has kept me healthy.
This is my favorite scary restaurant. Two can eat for about a dollar. It's delicious but scary. I've eaten here more than a dozen times and haven't got sick from them even once. 

More about Delhi Belly:
Avoid green salads and lettuce leaves that come with your dish. Amoebas on the lettuce leaves cannot be completely removed even with a potassium permanganate wash. Additionally, think about the fingers that were used to arrange it on your dish. Just assume everything is cross contaminated. One time I found a chicken feather in my veg. pakoda. 

Giardia lambilia and other ameba can be found on these raw vegetables. They can cause some of the most common gastric infections for Western visitors. Some of these bugs will last a full week or more if not treated properly. They can even stay with you for many years with problems coming periodically. 

Note: Be very careful with the leafy green vegetables during monsoon. Even the local people do not eat it during this time of year. 

Getting rid of amoeba: 2000 mg Tinidazole in one dosage for organisms such as giardiasis. If you have diarrhea with fever and joint pain it could be salmonella and you will need antibiotics. Some people recommend keeping an antibiotic for this in your first aid kit. The dose of Ciprofloxacin 500 mg should be taken every 8 hours for 5-7 days with a lot of liquid and rest. Don’t worry about bringing it. You can find a good assortment of medications in Nepal. There is a section in the eBook, Nepal: A Tourist's Manual about how to assure yourself of high quality medications in Nepal. Not only can you have quality medications in Nepal, but also great values in medical care if you know where to go.

My best tip for avoiding stomach issues: It's simple. Wash your hands before touching food and avoid touching your hands to your mouth, nose or eyes unless your hands are clean. 

Avoid food poisoning by avoiding certain foods, such as scrambled eggs, mixed fried rice or noodles that have been prepared ahead of time. Ask for food that must be prepared fresh. Avoid buffets. 

This might be one exception. This buffet is in the Civil Mall and seems to be very clean and modern.

Do not eat at bus stops or from street vendors. Bring fresh fruit instead on long, overland bus trips. If I have to eat at such places I ask to use my own fingers to take the donuts or roasted corn. They always laugh with me as I reach for the item.

One of the best natural cures for these stomach bugs is apple cider vinegar and charcoal. You will need to bring them from home. Otherwise, you can pick up medication here for well under a dollar. Do not bother to bring something from home that you can buy here, so unless you want to use a natural remedy like charcoal don’t worry about it. If you want to pull a very frugal trick just ask the stewardess on the airplane for a pill, as if you are feeling a bit of stomach upset from the flight-Be sure she doesn't give you a motion sickness pill. That would get you by until you could find something on your own. This copper pot is another natural preventative. If you put water in this and wait four hours it will be free from bacteria. They are available in local shops for under $10.

Bonus Savings Tip: If you think you might have been exposed to a serious illness like HIV it would be prudent to get tested here. They do not even require an ID at the hospitals. This is the cheapest and most discreet way to get the test and then do what you need to do with your medical insurance issue. All sexually active tourists should probably take a day to deal with personal issues like this. You could get a host of tests for well under $20 and women can even get the three month birth control shot for free.

Take a look at my two other health care posts for more information. Please leave a comment, email me for more information at, also, please check out our fan page on facebook (It needs a bit more interaction) at or check out our web site at

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