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HEALTH AND
INSURANCE |
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Hygiene is not one of Nepal's strong points. Sanitation is poor, and
a lot of bugs make the rounds, especially during the monsoon and
immediately after it. But don't panic - by coming prepared and looking
after yourself while you're in the country, you're unlikely to come down
with anything worse than the local version of Delhi belly.
These pages deal with health matters mainly in the context of Western-style
medicine, as opposed to the traditional ayurvedic and Tibetan practices
Before you go
No inoculations are required for Nepal, but hepatitis A, typhoid and
meningitis jabs are recommended, and it's worth ensuring that you're up
to date with tetanus, polio, mumps and measles boosters. Malaria tablets
and injections for Japanese B encephalitis and rabies may also be in
order, depending on where and when you go. All of these can be obtained
in Kathmandu, often more cheaply than at home, but obviously it's better
to get nasty things like injections out of the way before starting your
trip.
If you have any medical conditions or concerns about your health, don't
set off to a place like Nepal without first seeing a doctor . Medicines
are sold over the counter everywhere, but obviously bring any prescribed
medications. Also, consider having a dental checkup before you go. If
you wear eyeglasses, bring an extra pair; if you wear contacts, bring a
backup pair of glasses because of the dust and pollution.
Warning
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 physician who treats you where you've been
Medical resources for travellers
To begin, select a topic in the navigation bar to the left
Precautions
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 run the
risk of rebuffing Nepalese hospitality.
A few common-sense precautions are in order, though, starting with the
water : stick to tea or bottled drinks, or purify water with iodine.
Many guest houses provide water in drip-filter units, but you can't
always be sure the water was boiled first, or that the filters are clean.
Clean or dirty, water is regarded as a purifying agent, and plates,
glasses and cutlery are customarily rinsed just before use: if you're
handed wet utensils it might not be a bad idea to give them a discreet
wipe.
When it comes to food , usually it's flashy tourist restaurants and "Western"
dishes that bring the most grief: more people get sick in Kathmandu than
anywhere else. Be particularly wary of fruit juices and lassis (which
often contain water or ice), prepared dishes that have to be reheated,
and any food that's been sitting out 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 can sometimes be dodgy.
Raw, unpeeled fruit and vegetables should always be viewed with
suspicion, and you should verify that salads in tourist restaurants have
been soaked in an iodine or potassium permanganate solution.
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
boulevards, or wear a face mask if necessary, and avoid breathing around
people who are hacking and wheezing tubercularly. You can help your
immune system by keeping warm, dry and well rested (especially if
jetlagged). 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.
Keep any cuts clean, and treat them with iodine to prevent infection. If
you're staying in cheap guest houses, bring a sleeping sheet to keep
fleas and lice at bay. Wear shoes at all times, since scabies and
hookworm can be picked up through bare feet.
When travelling in the Tarai, minimize your exposure to malaria by
depriving mosquitoes of the opportunity to bite you. They're hungriest
from dusk to dawn: during these times, wear repellent and/or long-sleeved
clothes (watch out especially for ankles), and sleep under netting or
use mosquito "mats" (small tablets that release a mosquito-repelling
scent when heated in an electric device) or old-fashioned coils.
Remember, though, that very few mosquitoes carry malaria, so you don't
need to worry over every bite. If you do get bites or itches, try not to
scratch them as infection may result. Tiger balm and even dry soap may
relieve the itching.
Take the usual precautions to avoid sunburn and dehydration . Obviously
susceptibility to sunburn varies by individual, but during the sunny
times of year you'll probably want at least medium protection, and high
protection will be necessary while trekking. Sunscreen is available in
tourist areas.
Self-diagnosis
Chances are, at some point during your travels in Nepal you'll feel ill.
In the vast majority of cases, it won't be something you need to see a
doctor about, and sod's law says it will happen somewhere remote and
inconvenient anyway. The information on these pages should help with
self-diagnosis , although it is not presented as a substitute for
professional medical advice.
Antibiotics definitely shouldn't be taken lightly: they pre-empt the
body's ability to develop its own immunity to the disease, and can
increase susceptibility to other problems by killing off "good" as well
as "bad" organisms in the digestive system (yoghurt can replenish them
to some extent). Some may cause allergic reactions or other unpleasant
side effects. Also, the more a particular antibiotic is used, the sooner
organisms build up a resistance to it. It's not a bad idea to travel
with a course of one or more of the drugs mentioned here, but make sure
you have the dosage explained to you. In the case of serious or
persistent intestinal problems, you're strongly urged to have a stool
test done at a clinic, where the doctor can make an authoritative
diagnosis and prescription.
Getting medical help
In a non-emergency situation, make for one of the traveller-oriented
clinics in Kathmandu. Run to Western standards, these can diagnose most
common ailments, write prescriptions, and also give inoculations. A
veritable cornucopia of Indian-manufactured medicines is available
without prescription from pharmas (pharmacies) in all major towns, but
always check the sell-by date.
In the event of a serious injury or illness, contact your embassy for a
list of recommended doctors in Kathmandu, which is where virtually all
qualified GPs and specialists are based. Most speak English.
Hospitals are listed in the Kathmandu and Pokhara pages; other hospitals
are located in Dhulikhel, Tansen and the bigger Tarai cities. Most are
poorly equipped and the standard of care is variable. Should you be
unlucky enough to have to spend time in a Nepali hospital, note that
nursing staff do not perform many of what we would consider to be
routine functions: relatives are expected to feed patients, change
bedpans, monitor IVs and so on.
Insurance
Travel insurance is too important to ignore, and your travel agent can
usually recommend a company.
Policies vary: some are comprehensive while others cover only certain
risks (accidents, illnesses, delayed or lost luggage, cancelled flights,
etc). The most important part of any policy is its medical evacuation
provision: believe it or not, the cost of evacuating a really sick
person from Nepal to his or her home country can be as high as
£30,000/$50,000, which would be a catastrophic expense if not covered by
insurance. Coverage of medical expenses is less important because
treatment in Nepal is cheap. It's nice if the policy has a provision for
lost or stolen baggage, but standard per-article limits are usually
quite low and supplementary coverage is prohibitively expensive. Note
that it's almost impossible to buy or extend a travel insurance policy
once you're overseas.
The best premiums are usually to be had through student/youth travel
agencies such as STA, USIT/Council Travel or Travel CUTS. These policies
cost about £35-55/US$85-105 for a month (depending on coverage),
£65-100/$150-200 for two months, on up to £230-400/$500-700 for a year.
If you plan to go trekking or rafting , check whether the policy
specifically excludes such "dangerous activities" . You might have to
pay extra for this coverage, but without it you could be left footing
the bill for an expensive helicopter rescue - worse, the chopper might
not even be sent if it looks like you won't have the funds to pay for it.
If you plan to climb a trekking or expedition peak, you'll probably have
to get a policy through your national mountaineering organization, such
as the British Mountaineering Council or American Alpine Club.
Before you spend money on a travel insurance policy, though, find out
what coverage you already have or might qualify for. For example, if
you're eligible for certain student/teacher/youth ID cards , by all
means sign up, as the health insurance benefit more than pays for the
cost of the card (inquire at student travel agencies). Students also may
find that their student health coverage extends for one term beyond the
date of last enrolment. Bank and credit cards (particularly American
Express) often provide certain levels of medical or other insurance, and
travel insurance may also be included if you use a major credit card to
pay for your trip (but usually only while you're actually travelling to
and from your destination). Homeowners' or renters' insurance may cover
theft or loss of documents, money and valuables while overseas. Canadian
provincial health plans include some overseas medical coverage, although
this is unlikely to pick up the full tab in the event of a mishap.
Keep receipts for any treatment or medicines paid for while overseas.
Similarly, should you have anything stolen, report the theft to the
police as soon as possible, and keep a copy of your statement to
substantiate any later claim.
Earthquake danger in Nepal
Nepal lies along one of the earth's great geological fault zones, where
the Indian subcontinent plate joins the greater Asian plate. The
collision of these two plates, which formed the Himalaya, continues to
this day at a rate of 2cm per year. Most of this compression is absorbed
in the process of mountain-building, but some of it is stored as
temporary tension in the earth's crust and then released in the form of
earthquakes .
Nepal's historical record shows a pattern of infrequent but catastrophic
quakes. The most recent major one, in 1988, registered a whopping 8.3 on
the Richter scale and killed 800 people in the eastern part of the
country; its effects would have been much worse had it struck further
west. The last big one to hit Kathmandu, in 1934, was probably nearly as
great in magnitude.
The next time a major earthquake hits Nepal - particularly if it hits
Kathmandu - there will be major loss of life. In the past few decades
ever taller, more slipshod buildings (many of them tourist guest houses)
have been erected in the capital. A national building code that's
supposed to set mandatory standards still has yet to be implemented, so
essentially no attention is paid to earthquake resistance in
construction. Moreover, the Kathmandu Valley's soils are apparently of
the sort that turn to soup in an earthquake, magnifying the damage.
Maybe the next big one won't be until 2030, maybe it will be tomorrow.
It's not something that should stop you from going to Nepal, but it
might provide yet another reason to spend most of your time outside of
Kathmandu
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