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Traveler’s Health

Consult with your personal physician about your physical ability to complete the trip you are enrolled in and the recommended immunizations you will need.

After that, follow the common-sense precautions outlined below. While Mandala Adventures will take every precaution once you arrive at your destination to maintain hygienic and healthy practices, you need to take ultimate responsibility for your own health and well-being before you depart and after you arrive.

Mandala Adventures’s Traveler’s Health primer has been reviewed by Rob Ripley M.D. who serves in the Emergency Department at Harbor View Hospital in Seattle and Peter Hackett M.D., the director of the Emergency Department at Telluride Hospital in Telluride, Colorado. Dr. Hackett is an acknowledged expert on Acute Mountain Sickness and is the author of the book Mountain Sickness: Prevention, Recognition & Treatment.Both emergency physicians have served at the Himalayan Rescue Association (HRA) clinic in Pheriche, Nepal at 13,976 ft. Although both doctors have reviewed this information, neither they nor Mandala Adventures assume any responsibility for your physical condition and medical treatments. Additional medical information can be found on the website of the Centers for Disease Control in Atlanta at www.cdc.gov

Physical Qualifications

Anyone in reasonably good health is able to travel in Asia. Be sure to check the difficulty rating of your trip to make sure you qualify. If you’re not sure, check with your physician. Our mountain treks much more physically demanding than our cultural tours, but they are still designed for anyone who is reasonably fit and active. To ascertain your level of fitness (especially for treks) take the Harvard Step Test online at http://www.brianmac.demon.co.uk/havard.htm

Pre-Trip Conditioning

The better shape you are in, the more you will enjoy your trip. While much of the travel is by vehicle, there is a considerable amount of walking in cities, villages, museums and monasteries. Consult your doctor if you have any questions about exercise. If you are going on a Mandala Adventures trek, we recommend regular aerobic exercise sessions during the weeks prior to your trip. If you supplement these workouts with long training walks during the weekends you’ll be better prepared for your trip. Sustained aerobic exercise may involve cycling, swimming, running, dancing or any other activity which builds heart and lung capacity. Try to build increased activity into your daily life: walk up stairs whenever possible, and walk or bicycle to work. In addition to cardiovascular workouts, you may want to concentrate on strengthening quadriceps (THIGH) muscles, helping you prevent knee problems.

Medical Examination & Insurance

We strongly recommend getting a medical examination. Discuss the extent of your adventure with your physician and some of the potential health problems that could arise. The physical exam should be conducted more thoroughly than a routine checkup. Be sure any abnormalities, chronic problems or special medications are noted. This may be helpful to your trip leader if you begin to exhibit any symptoms during the trip. We also recommend that you visit your dentist prior to your Asia trip departure date.

Recommended Immunizations

Although proof of various immunizations is not required for entry into Mandala Adventures’s destination countries, we strongly recommend that you get all major vaccinations appropriate for the areas you will visit. Begin your series of immunizations early.

For the most up-to-date information on recommended immunizations for each country/region, visit the US Centers for Disease Control website at www.cdc.gov

Your Public Health Department can often give you the best practical and current information on immunizations and prevention, and many can administer vaccinations. Keep in mind that some shots may be given simultaneously, but shots within a series (like TwinRix, the Hepatitis A & B combo vaccine) must be administered several weeks or even months apart. Allow at least eight weeks for the entire process. It is useful to record your past immunizations and the date you received them on the official yellow immunization card obtained from your place of immunization. Vaccinations are not cheap, so be sure to check with your health insurance provider about which ones they will cover, if any.

Note: The following immunizations are typically recommended for travel to Asia, but be sure to check with your physician and/or the Centers for Disease Control at www.cdc.gov for the most current recommendations.

  • Hepatitis A & B – TwinRix vaccine covers Hep A & B together; Havrix is the vaccine for Hep A only.
  • Thyphoid – oral or injection
  • Tetanus-diphtheria – booster needed every ten years
  • Polio – booster as adult

Your Personal Medical Kit

Aside from any prescription medications you ordinarily take, we strongly recommend you take responsibility for bringing your own medical kit. Here are some items you’ll want to include:

  • Moleskin, adhesive bandages, gauze, tape, and other products (Spenco “Second Skin” is good) to treat blisters and sore spots
  • 3” Ace bandages
  • Antibiotic ointment (such as Neosporin)
  • Hand sanitizer (such as Purell)
  • Lomotil or Immodium for emergency treatment of diarrhea
  • Pepto-Bismol (tablets are best) or other indigestion/antiacid remedy
  • Mild laxative
  • Cold medication (such as Actifed), decongestant (such as Sudafed) and/or antihistamine (such as Benadryl).
  • Cough drops or sore throat lozenges
  • Aspirin, Tylenol, Ibuprofen, or Ketoprofen
  • Natural Tears or other eye drops (such as Visine)
  • Motion sickness pills (for long drives)
  • Anbesol (to relieve minor toochache)

Recommended Prescriptions

Speak with your doctor about prescriptions. The following have proven useful in relieving a variety of symptoms. Speak to your physician about your particular requirements.

Ciprofloxin: (therapeutic) Works dramatically to limit the symptoms and duration of suspected bacterial diarrhea and also works well for urinary tract infections.

Azithromycin or Clarithromycin: (therapeutic) Penicillin-related antibiotics for treatment of suspected internal ear infections, sinus infections, or urinary tract infections. People allergic to penicillin must not use it. Potential side effects: include rash and diarrhea.

Lomotil: (symptomatic) A prescription drug closely related to Immodium, which is available over-the-counter. These are derived from narcotics that paralyze the bowel for the symptomatic relief of diarrhea. Should not be used casually, but can be quite useful for bus or airplane travel. Do not use in the presence of fever or bloody stool unless you are also taking the appropriate antibiotic. Potential side effects: constipation.

Tinidazole or Metronidazole: (therapeutic) An antibiotic effective against giardia and amoebae. It can be used to treat a suspected infection. The potential side effects are fatigue, queasiness, and a metallic taste in your mouth (Tinidazole is not available in North America, and can be found only in Asia.) Metronidazole, a related antibiotic, can be obtained in the United States. Alcohol should not be used with either medication.

Ambien or other sleep aid: International travel can wreak havoc with your sleep schedule, so having a few sleeping pills on hand may help on long plane rides and for adjusting to a new time zone for the first night or two. Sleep aids can be addictive so use them sparingly.

Melatonin is a natural supplement that can hasten sleep and ease jet lag, without the hazards or side effects of prescription sleeping pills. Please note – it is not recommended to take any sleeping aid while on a high altitude trek.

High Altitude

If you’re going to be traveling to high altitude––in Nepal, Tibet, Bhutan, Ladakh, and Pakistan––visit the appropriate page here:

  • Nepal
  • Tibet
  • Bhutan
  • Ladakh
  • Pakistan

Malaria

The risk of malaria may be high in parts of Southeast and South Asia. See your health care provider for a prescription antimalarial drug. For details concerning risk and preventive medications visit www.cdc.gov.

Water, Food and Stomachs

Unpurified water or contaminated food can cause stomach problems and diarrhea. This risk can be minimized if you follow a few basic precautions. The Centers for Disease Control website located at www.cdc.gov is a good resource for additional traveling advice.

Drink only bottled water

Bottled soft drinks, beer and liquor are safe; although beer and liquor dehydrates the body. Drinking tea is generally safe since it has been boiled.

  1. Avoid local home-brewed liquor. Alcohol itself does not kill all nasties. These are not boiled or distilled. It may be suspect. (Of course, the benefits could outweigh the risks. You may decide occasionally to sample a bit.).
  2. Wash your hands frequently with soap and sanitized water, or a waterless hand sanitizer
  3. In the cities, eat at tourist hotels or restaurants. Do not eat food from street vendors. On the trail, you can trust the meals the staff prepares.
  4. Avoid food that is not freshly cooked and may have been contaminated by flies or dust.
  5. Wash, dry and peel fruits; avoid uncooked vegetables and salads.

Drinking Water Precautions

Drink only boiled, bottled or treated water. Never drink tap water. Don’t even use it for brushing your teeth! To be absolutely safe, avoid the water (and ice) served in restaurants and hotels and stick to bottled water, which is available in cities for a modest charge. Have the vendor crack the seal on commercial bottled water while you watch.

On trek, our kitchen staff will both filter and boil drinking water and water for meal preparation.

Though not necessary, you may decide to carry your own means of water treatment (filter or iodine).If you elect to treat your own water, we highly recommend doing extensive research on the latest water treatment technology online or at your local outdoor retailer.

Common Illnesses

Upset stomach and diarrhea are probably the most common problems encountered in Asia, and may appear in varying degrees of severity. Mild diarrhea is often caused by unfamiliar organisms entering the digestive tract. Medication is unnecessary. Replace lost fluids and minerals such as sodium and potassium to avoid dehydration. Eat a mild diet, drink caffeine-free beverages that are in factory-sealed containers and avoid dairy products. For mild cases of non-bloody diarrhea, Pepto Bismol may decrease the symptoms but should be limited to 48 hours at most. More severe diarrhea — three or more loose or bloody stools in an eight-hour period possibly accompanied by nausea, vomiting, cramps and fever — is most often caused by bacteria. Antibiotics are effective. See “Recommended Prescriptions” above and speak with your doctor.

Respiratory infections are not uncommon at high altitude. Cold, dry mountain air can aggravate coughs and colds. We suggest you bring non-prescription medications if you will be traveling in the Himalaya.

Medical Care and Emergencies

Make sure you purchase trip evacuation insurance to cover the costs associated with early trip termination and/or emergency evacuation.