Health

Nepali music is inseparable from dance, especially at festivals. Nepali dance is an unaffected folk art – neither wildly athletic nor subtle, it depicts everyday activities such as work and courtship. Each region and ethnic group has its own traditions, and during your travels you should get a chance to join a local hoedown or two, if not a full-blown festival extravaganza. Lookout, too, for the stick dance of the lowland Tharus, performed regularly at lodges around Chitwan National Park. Staged culture shows in Kathmandu and Pokhara are a long way from the real thing, but they do provide a taste of folk and religious dances. Most troupes perform such standards as the dance of the jhankri (shaman-exorcists still consulted by many hill-dwelling Nepalis); the sleeve-twirling dance of the Sherpas; the flirting dance of the hill-dwelling Tamangs; perhaps a formal priestly dance, to the accompaniment of a classical raga (musical piece); and at least one of the dances of the Kathmandu Valley’s Newars.

city of Nepal; their blood is sprinkled on tools, vehicles and even aircraft to impart Durga’s shakti (power). These rituals commemorate Durga’s slaying of the demon Mahisasur, and more generally, the triumph of good over evil. Bijaya Dasami, the “Victorious Tenth Day”, celebrates Ram’s victory over the demon Ravana – with Durga’s help. Various processions and masked dance troupes ply the streets and families visit their elders to receive blessings and tika.

MANGSIR NOVDEC

Ram-Sita Biwaha Panchami As many as 100,000 pilgrims converge on Janakpur for this five-day gathering, beginning on the new moon of Mangsir. The highlight is the re-enactment of the wedding of Ram and Sita, the divine, star-crossed lovers of the Ramayana, one of the great Hindu epics. Janakpur’s stature as a holy city rests on its having been the location of the original wedding.

KAATTIK OCTNOV

Tihaar (Diwali near India). Lasting for five days, starting two days before the new moon, the “Festival of Lights” is associated with Yamraj, the god of death, and Lakshmi, the goddess of wealth and good fortune. On the first day, Nepalis set out food on leaf plates for crows, regarded as Yamraj’s messengers; on the second, they honour dogs as Yamraj’s gatekeepers, giving them tika, flower garlands and special foods; and on the third they garland cows both as the symbol of Lakshmi and as the soul’s guide to Yamarj’s underworld. The festival’s most picturesque event, Lakshmi Puja, comes on the evening of the third day, when families throughout Nepal ring their homes with oil lamps, candles or electric lights to guide Lakshmi to their homes so she can bless them with prosperity for the year. Trusting in her, many Nepalis gamble on street corners, and student groups make the rounds singing “Diusire”, a form of musical fundraising. Firecrackers have also become a big part of the fun for kids. To Newars, the fourth day is known as Mha Puja (“Self-Worship”), an occasion for private rituals, and also their New Year’s Day, marked by banners, well-wishing and motorcycle parades in the Kathmandu Valley’s three main cities. On the fifth day, Bhaai Tika, sisters recall the myth of Jamuna, who tricked Yamraj into postponing her brother’s death indefinitely, by blessing their younger brothers and giving them flower garlands, tika and sweetmeats. Chhath Coinciding with the third day of Tihaar, this festival honours Surya, the sun god, and is one of the most important for the Maithili-speaking people of the eastern Terai. Chhath is celebrated most ardently in Janakpur, where women gather by ponds and rivers to greet the sun’s first rays with prayers, offerings and ritual baths. Mani Rimdu Held at Tengboche and Chiwong monasteries in the Everest region around the full moon of the ninth Tibetan month (usually Oct/Nov), this colourful Sherpa masked dance dramatizes Buddhism’s victory over the ancient Bon religion in eighth-century Tibet. A similar event is held in May or June at Thami.

Health Hygiene is not one of Nepal’s strong points. Sanitation is poor, and lots of bugs make the rounds, especially during spring and the monsoon. But by coming prepared and looking after yourself, you’re unlikely to come down with anything worse than a cold or the local version of “Delhi belly”.

This section deals with health matters mainly in the context of Western-style medicine; you could of course also turn to traditional ayurvedic or Tibetan practices (see p.44). For more detailed advice, refer to our recommended health books (see p.424) and websites (see p.53).

Before you go

No inoculations are required for Nepal, but hepatitis A, typhoid and meningitis jabs are recommended, and it’s worth being up to date with tetanus, polio, mumps and measles boosters. Malaria tablets, injections for Japanese B enceph-ipi8hfBu+Fu1Tqp6g5eaALs= alitis and rabies are also worth considering. All of these can be obtained in Kathmandu, but it’s better to get injections done beforehand. If you have any medical conditions or concerns about your health, don’t set off without seeing a doctor first. Medicines are sold over the counter everywhere, but it’s best to bring your prescribed medications. Consider having a dental check-up before you go.

If you’re planning on trekking, bear in mind the possibility of altitude sickness and other trekking hazards (see p.315).

Recommended inoculations

Most travellers decide to inoculate themselves against the following diseases, which are, on the whole, fairly ghastly but not fatal. Deciding which to protect yourself against is a matter of risk management. Consult your doctor well before you plan to travel for the latest inoculation advice.

Hepatitis A is an infection or inflammation of the liver that causes mild fever, nausea/vomiting, loss of appetite and jaundice. It’s fairly common in Nepal, and while it won’t kill you, it’ll put a swift end to your travels and lay you up for several months. It’s transmitted through contaminated food and water, so sensible hygiene will reduce the risk of catching it, but you can’t count on fastidiousness alone.

Typhoid and paratyphoid are common in Nepal, and are also spread through contaminated food and water. These nearly identical diseases produce a persistent high fever, headaches, abdominal pains and diarrhoea, but are treatable with antibiotics and are rarely fatal. Paratyphoid usually occurs in epidemics and is less severe.

Immunizations against mumps and measles are recommended for anyone who wasn’t vaccinated as a child and hasn’t already had these diseases. You should also ensure you are fully vaccinated against polio.

Flu is no more prevalent in Nepal than elsewhere, but you might consider getting a flu jab before you leave just to reduce the risk of spending several days sick during your holiday.

Malaria prophylaxis

Most visitors won’t need to take malaria tablets. The disease hasn’t been eradicated in Nepal, but it is unknown above 1000m, and rare outside the monsoon months. The risk to short-term travellers is very low, but it’s well worth taking anti-mosquito measures anyhow, especially during the rainy season.

Prophylaxis (regular doses of tablets) is worth considering if you plan to visit the Terai (which includes Chitwan and Bardia national parks) between June and September. Longer-term visitors and anyone visiting India should seek expert advice, and rafters should remember that valleys in the hills can be lower than 1000m. Consult your doctor before you travel for the latest information and drugs available.

Optional inoculations Precautions

The following diseases are all rare, but potentially fatal. Again, consult your doctor for the latest inoculation advice.

Meningicoccal meningitis, spread by airborne bacteria, is a very serious disease that attacks the lining of the brain, and can cause death in as little as a day. While localized cases are occasionally reported in Nepal, the chances of catching meningitis are remote. That said, the injection is very effective and causes few side effects.

Rabies is a problem in Nepal, and the best advice is to give dogs and monkeys a wide berth. It can be cured by five post-exposure injections (available in Kathmandu), administered over a month; these are 100 percent effective if given in reasonable time. The pre-exposure vaccine involves three injections over four weeks, which gives some protection for three years; if you get bitten, you’ll still have to

get two more boosters. It’s probably not worth it except for long-stays and children. Japanese B encephalitis, though potentially fatal, is mostly confined to the more jungly portions of the Terai around monsoon time. Visitors to Kathmandu and the Terai who are staying for a long period between April and October should certainly consider vaccinating against it. Rural areas where pigs are kept are most risky. Hepatitis B is a more serious version of hepatitis A, but is passed on through blood and sexual contact. The vaccine is recommended for those working in a medical environment. Long-term travellers are sometimes vaccinated as they might have an accident and need to receive blood. Don’t bother with the cholera inoculation – the risk in Nepal is minimal. The lack of sanitation in Nepal is sometimes overhyped – it’s not worth getting too uptight about it or you’ll never enjoy anything, and you’ll run the risk of rebuffing Nepali hospitality. The best advice is to follow the guidelines below when you can. Most travellers are careful about drinking dirty water, but food is now thought to be the worst culprit, and it’s usually tourist restaurants and “Western” dishes that bring the most grief: more people get sick in Kathmandu than anywhere else in ipi8hfBu+Fu1Tqp6g5eaALs= Nepal. Be particularly wary of anything reheated, and food that’s been sitting where flies can land on it. Nepali food is usually fine and you can probably trust anything that’s been boiled or fried in your presence, although meat has additional risks. Raw, unpeeled fruit and vegetables – including pickles – should always be viewed with suspicion in local places, though all but the cheapest tourist restaurants

usually have acceptable salads, fruit juices and lassis these days.

Kathmandu’s polluted air gives many people respiratory infections within a few days of arrival; asthmatics and others with breathing problems are particularly affected. Minimize your exposure by staying off the main streets, and seriously consider bringing a filtering face mask if you’re spending much time in the Kathmandu Valley. You can also help your immune system by keeping warm, dry and well rested. Most importantly, get out of the valley to where the air is fresh as quickly as possible.

You need to be particularly vigilant about personal hygiene while travelling in Nepal. That means, above all, washing your hands often – waterless antibacterial soap comes in handy. Keep any cuts clean and disinfected. If you’re staying in cheap guesthouses, bring a sleeping sheet to keep fleas and lice at bay. Scabies and hookworm can be picked up through bare feet, so it’s best to always wear shoes; flip-flops provide reasonable protection in bathrooms.

When travelling in the Terai, don’t give mosquitoes the opportunity to bite you. They’re hungriest from dusk to dawn, when you need to wear repellent and/or long-sleeved clothes, sleep under netting and use plug-in mosquito killing/deterring devices or smoke coils. Very few mosquitoes carry malaria, so you don’t need to worry over every bite. Try not to scratch bites as infection may result.

Travellers in rural areas of the eastern Terai should protect against sandflies in the same way, as they transmit the disease visceral leishmaniasis, also called kala-azar, which causes fever and potentially fatal enlargement of the spleen.

Take the usual precautions to avoid sunburn and dehydration. You’ll probably want at least medium suncream protection, and high protection will be essential while trekking.

HIV/AIDS

Almost ninety percent of transmissions in Nepal are thought to be through heterosexual contact, especially in the context of migrant workers and prostitution. Brothels are full of HIV-positive sex workers. Trekking guides can also be considered a relatively high-risk group. Carry condoms with you (locally available but it’s best to bring some) and insist on using them. Condoms also protect you from other sexually transmitted diseases such as hepatitis B.

Male travellers who get a shave from a barber should make sure that the blade used is clean, and nobody should go for ear-piercing, acupuncture or tattooing unless fully satisfied the equipment is sterile. Should you need an injection, make sure new, sterile equipment is used. And if you need a blood transfusion, bear in mind that the Nepali blood supply isn’t adequately screened.

Common ailments

Water

Untreated water should be avoided when possible and you may not always notice the risk. Plates and glasses are customarily rinsed just before use: if you’re handed wet utensils it’s a good idea to give them a discreet wipe. Use treated or bottled water when brushing your teeth, and keep your mouth closed in the shower. Thamel restaurants generally use clean water for ice, but it’s probably still worth steering clear. Similarly, many guesthouses provide filtered water, but you can’t guarantee it was boiled first, or that the filters are clean. Tea and bottled drinks are generally safe.

Mineral water is available everywhere but purifying your own – either by boiling and filtering,

or by using purification tablets – is cheaper and avoids plastic waste. Iodine tablets are more effective than chlorine (and it’s possible to buy tablets to neutralize the medicinal taste) – be careful to follow the instructions, especially when it comes to giving the tablets enough time to work. Aqueous iodine solution, aka Lugol’s solution, is available in pharmacies across Nepal, together with plastic pipettes; it’s far cheaper than tablets brought from home, and works faster. There are high-tech alternatives; the pocketsized Steropen, which uses UV light, is portable and popular, but requires a battery, and there are various water filters that can filter most harmful bacteria. Note that iodine and chlorine do not kill cyclospora (see p.39), so drink boiled or bottled water if you can during the peak months of June and July. Chances are that at some point during your travels in Nepal you’ll feel ill. In most cases, it won’t be something you need a doctor for but it may well happen somewhere remote and inconvenient. The following information should help with selfdiagnosis, although it is not a substitute for professional medical advice. If you’re unable to get to a ipi8hfBu+Fu1Tqp6g5eaALs= clinic – a strong possibility when trekking – you might choose to self-medicate, and medicine and dosage information for the most common complaints are given below. It’s not a bad idea to travel with a course of the drugs mentioned here (especially as fake, badly stored and out-of-date drugs are not rare in Nepal), but make sure you have the correct dosages explained to you beforehand.

Some of the illnesses and parasites you can pick up in Nepal may not show themselves immediately. If you become ill within a year of returning home, tell the doctor where you’ve been.

Intestinal troubles

Diarrhoea is the most common bane of travellers. If it’s mild and not accompanied by other major symptoms, it should pass of its own accord within a few days without treatment. However, it’s essential to replace the fluids and salts you’re losing – cheap and effective oral rehydration formulas are widely available. Bananas and fizzy drinks are also good for replacing electrolytes. “Starving the bug to death” is an old wives’ tale, though you’re unlikely to be hungry. Tablets containing loperamide, such as Imodium, will plug you up if you have to travel, but won’t cure anything.

If the diarrhoea comes on suddenly and is accompanied by cramps and vomiting, there’s a good chance it’s food poisoning, brought on by toxins secreted by foreign bacteria. There’s nothing you can do other than keep replacing fluids, but it should run its course within around 24 to 48 hours.

If you’re feverish, have severe diarrhoea that lasts more than three days or if you see blood or mucus in your stools, seek treatment. In the eventuality of serious or persistent intestinal problems, you’re strongly advised to have a stool test done at a clinic (see p.40), where a doctor can make a diagnosis and prescription.

Bacterial diarrhoea, which causes 85 percent of identifiable cases, is recognizable by its sudden onset, accompanied by nausea and vomiting, stomach cramps and sometimes fever. The choice of treatments is Norfloxacin 400mg twice a day for three days; Ciprofloxacin 500mg twice a day for three days; or Ofloxacin 400mg twice a day for three days. All three are available inside Nepal, though as with all drugs, it’s safest to bring your own (see p.40).

About five percent of diarrhoea cases in Nepal are giardiasis (giardia), which produces three or four loose stools a day, and is often recognizable by copious, foul-smelling belches and farts. The cure is a 2g dose of Tinidazole at night (four 500mg tablets of locally available “tiniba”), for a maximum of two nights. This can make you tired and nauseous for 24 hours; it absolutely shouldn’t be mixed with alcohol, and you should abstain from alcohol for several days afterwards as well.

Amoebic dysentery is relatively rare. Setting in gradually, it manifests itself in frequent, small, watery bowel movements, often accompanied by fever.

If the diarrhoea is associated with fatigue and appetite loss over many days, and occurs between April and November, it may be the result of cyclospora (sometimes called blue-green algae), another water-borne condition.

Finally, bear in mind that oral drugs, such as malaria pills or the contraceptive pill, are rendered less effective or completely ineffective if taken while suffering from diarrhoea. In all cases, remember that you must keep hydrated.

Flu and fever

ANTIBIOTICS

Flu-like symptoms – fever, headache, runny nose, fatigue, aching muscles – may mean nothing more than the latest virus. Rest and aspirin/paracetamol should do the trick. However, strep throat, bronchial or sinus infections will require an antibiotic course such as Erythromycin or Amoxycillin. Flu symptoms and jaundice point to hepatitis, which is best treated with rest and a plane ticket home. A serious fever or delirium is cause for real concern. Diagnosis is tricky; the sufferer needs to be taken to a doctor as quickly as possible. To begin with, try bringing the fever down with aspirin/paracetamol. Tourists in Nepal tend to rush for If the fever rises and falls dramatically every few hours, antibiotics, but they shouldn’t be it may be malaria (see p.37). If the fever is consistently taken lightly: most tummy bugs cure high for four or more days, it may be typhoid. Minor symptoms Minor muscle cramps, experienced after exercise or themselves in around 48–72 hours, and antibiotics can increase susceptibility to other problems by killing off all organisms ipi8hfBu+Fu1Tqp6g5eaALs= in the digestive system (yoghurt can sweating, may indicate you’re low on sodium – a replenish them to some extent, as can teaspoon of salt will bring rapid relief. Likewise, a acidophilus tablets – also good for thrush simple headache may just mean you’re dehydrated. and fungal infections). Some antibiotics (However, a severe headache, accompanied by eye may cause allergic reactions or unpleasant pain, neck stiffness and a temperature, could mean side effects, and the more a particular antibiotic is used, the sooner organisms become resistant to it. meningitis – in which case get to a doctor pronto.) Itchy skin is often traced to mosquito bites, but can also be fleas, lice or scabies. The last of these,