Your Health while in Nepal Medical health Aussie Action Abroad wants to make sure that you are in good medical condition before the Expedition. Plan to have a check-up about a month before you leave, and make sure you let us know if you are carrying any injuries or medical conditions that require management, eg asthma, diabetes etc that could impact your health & well being in an environment that may make greater than normal demands on your body, such as trekking at high altitudes etc.

Travel Vaccinations These recommendations have been taken from the CSL Travel Vaccines Booklet and are to be used as a guide only. Another good resource is www.tmvc.com.au It is EXTREMELY IMPORTANT for you to seek a pre-travel consultation with your own GP to discuss these recommendations.

See below for vaccinations....

* Cholera * Japanese Encephalitis

SYMBOLS:

+ Typhoid

* Disease occurs in this country

+ Meningococcal Meningitis

+ Vaccination recommended for

+ Hepatitis A # Hepatitis B

protection against disease

# Other options to discuss with your doctor

# Polio (within 10 yrs) # Adult Diphtheria and Tetanus (within 10 yrs) Note: The Terrai regions of Nepal do have some risk of Malaria. The Expedition projects will not be held in these areas, therefore it is not necessary to take Malaria medication unless you are privately travelling to this area of Nepal. You will be notified if any project locations change. REMEMBER: Medication and vaccination options need to be discussed with your GP. NOTE - PLEASE BE PREPARED TO LET OUR STAFF KNOW ANY MEDICATION THAT YOU ARE TAKING AND WHY.

Personal Medication You will need to ensure that you have sufficient quantities of your own personal medication to last you the entire adventure. You need to assume that it will be impossible to re-supply medication whilst in Nepal. Always carry your personal medication with you, along with your personal first aid kit. While there will be medical staff in each group, they cannot be expected to provide personal medications. Doctors from a previous Expedition have put together the following list of recommended medications. Please discuss these options with your own doctor before purchasing. Some can be obtained over the counter, and others will need a doctor’s prescription. • • • • • • • • • • • • •

Antibiotics (one course) Asthmatic medications (if applicable) Fasigyn or Flagyl (for parasites, eg Giardia) Gastrolyte tablets (for rehydration) Lomotil (for stopping diarrhoea) Noroxin (for Urinary Tract Infections and bacterial dysentery) Paracetamol or Nurofen (analgesic/anti-inflammatory) Stemetil or Maxolon (for stopping vomiting) Diamox (for the Everest / Annapurna trekkers) Travelcalm (for travel sickness) Cotton buds, dressings for blisters, elastoplast, bandaids. Antihistamine such as Phenergan OPTIONALS – Claratyne (for respiratory allergy), Medicreme, Multi vitamins

Please be aware that general anti-gastro, Giardia, and pain relief medication is available cheaply in Nepal but DO NOT take this chance with personal medication that is essential to your health.

REMEMBER: AS A MATTER OF SAFETY IT IS ABSOLUTELY IMPERATIVE THAT OUR STAFF KNOW ABOUT ANY MEDICATION THAT YOU’RE PLANNING TO TAKE AND WHY. PLEASE BE READY FOR THIS SITUATION.

Medical Form The second part of our Application Form focuses on your medical needs and we ask that you complete this information and have signed by your GP and post it to the Expedition office. It is a good idea to build this in with your appointment when you discuss the immunizations. At this stage we will ask if you have any medical or psychological condition that will affect your participation in the Expedition. Our duty of care requires that the staff team is fully aware of the medical health of all participants. We are able to accommodate most situations, but only if we know in advance.

When groups have been allocated, we will review everyone’s medical information to ensure your group leader and our medical staff are aware of any issues that may arise and is able to offer you the best possible care. If we contact you requesting further information, please ensure this is forwarded to us as soon as possible. In addition, if there are any other conditions that have arisen since you completed your medical form, please let us know.

Women’s Stuff Girls, as you may or may not be aware travelling can upset your menstrual cycle. Altitude can also cause an early period so you need to be well prepared. Nepal is considered a third world country and so there will be no sanitary bins to place the waste into. We suggest that you use 100% cotton tampons that are made from natural fibre as they are much kinder to the environment and / or fragrance free sanitary pads or liners, as we will need to burn or bury all toiletry waste. But that is not essential. At times there will be no where to do this so you will need to bring some zip lock bags in your day pack to put the waste into until we get back to camp to dispose of it. Carrying baby wipes / and or wet ones (alcohol and fragrance free) will assist you in your daily personal hygiene and keep those areas susceptible to perspiration and chafing clean and dry. Sanitary pads and tampons are available for purchase in Pokhara and Kathmandu, but not in more remote areas. Be prepared for the unexpected and pack extras in your bag when you pack in Australia.

General and Trek fitness You don’t have to be able to run a marathon in Olympic qualifying time, but it is important to the success and enjoyment of the time in Nepal that you are fit enough to meet the challenges that will be presented. The daily routine will often be tiring – when trekking or moving camp you may be breaking camp, walking with full packs, completing project tasks, and then setting up camp again for the night. Or you could be involved in physical community project work, and on the trek will have to be ready for early starts and walking long days. You will have a lot more fun and gain so much more if you are not struggling physically with the daily tasks. From experience, if you are underdone in your fitness, you run the risk of annoying and limiting others who have adequately prepared themselves for the Expedition. Trekking in itself can be quite demanding – throw in some altitude and it can be even more challenging!

If you have not been training regularly or are a bit out of shape, then you may prefer to check with your local GP and get a full physical assessment before you start so that you can work out a realistic plan to improve your overall fitness. To get you to the start of the Expedition in good physical shape, we recommend that you establish a good exercise program now. We recommend that you undertake regular aerobic exercise around 3-4 times per week. Walking briskly on flat ground for around 30 minutes and, when comfortable with that, try some undulating ‘slopes’ - commonly called hills(!) - building up to an hour a day. It is extremely important that you throw some hills into the routine as we will be taking on a few of them and your calves, hamstrings and quads must get used to this movement. Use your lunch hour at work to walk around the block or even throw some stair climbing into the routine, or use your gym membership and use the machines and classes that are available. Doing a ‘step class’ or an aerobic class twice a week is a great start. Step machines are great as well. Ensure you are stretching those muscles thoroughly in the exercise regime to make them more supple and reduce the risk of injuries. Practice walking with your full pack and the boots you will be wearing for the hike. It is important to be comfortable in your boots, and ensure they do not irritate your feet. Ankle strengthening exercises should also be included in your routine. Rope skipping is another excellent form of cardio and leg strength exercise. Each work out should include some moderate warm up, exercise, then muscle stretching during the cool down phase. Build up to a pace that is challenging for you for at least 30 minutes. Don’t overdo it to start with, but don’t hold back either. If in doubt, talk to a qualified instructor at your local gym. Exercise could include cycling, jogging, walking, swimming, aerobics, weight training, and many other sports and activities. Remember it’s much easier to stick to it if you enjoy it. Acclimatisation is a challenge as we are going from summer in Australia to the cold and possibly damp of Nepal. Clearly the fitter you are, the better you will be able to cope with the differing weather conditions. Think of your training as a deposit in your fitness account - everything you do between now and the trek will pay a dividend on the track. You can’t cheat on yourself in preparing for the trek. If you do the work you’ll complete it with ease - although there will be some patches where you might have a bit of self doubt! Remember your own safety, and that of others in the group, will depend on your own level of fitness. Doing all this will stand you in good shape for a comfortable working and trekking journey.

Altitude Sickness (or Acute Mountain Sickness – AMS) The pleasures of trekking the world’s highest mountain ranges cannot be overstated. Neither can the dangers. Altitude Sickness or Acute Mountain Sickness (AMS) can occur in some people as low as 8,000 feet (2500 metres) but serious symptoms do not

usually occur until over 12,000 feet (4000 metres). Even then it is not the height that becomes important, rather the speed in which you ascended to that altitude. It is difficult to determine who may be affected by AMS since there are no specific factors such as age, sex, or physical condition that correlate with susceptibility. Some people get it and some people don’t because some people are more susceptible than others. The main cause of AMS is going too high too quickly. Given enough time your body will adapt to the decrease in oxygen at a specific altitude. This process is known as acclimatisation. Travellers should suspect AMS in themselves if they notice any of the following and should be reported to the group leader for assessment: • • • • • •

Headache Shortness of breath and / or increased heart rate (when body at rest) Loss of appetite Episodes of vomiting Difficulty walking in a straight line Fatigue while walking.

Travellers should suspect AMS in their fellow travellers if they notice any of the following and should be reported to the group leader for assessment: • • • •

Skipping meals Becoming anti-social when normally they are interactive Stumbling Having difficulty with activity.

Aussie Action Abroad Group leaders and Nepali guides are experienced in trekking over the mountain ranges at altitude and take every caution to prevent AMS by going at a slow, steady and sensible walking pace for the group. A further briefing on AMS and signs and symptoms will be given pre-trek in Nepal. (See also www.ismmed.org/np_altitude_tutorial.htm or www.basecampmd.com/expguide/diamox.shtml )

Hydration It is essential during the community project work, the trekking, and the sightseeing, to remain adequately hydrated. It is common to drink copious amounts of chiaa (tea) in Nepal and you will love this custom and sample many different types of teas. However, away from the tea houses or guest houses, you will need to carry water. It is not advisable to drink from the communal taps found in the villages, even if the locals seem to do it with impunity!

In most villages, and along the trekking routes, bottled water can be purchased although the price for these increases with remoteness and altitude and the empty bottles can create litter. Local water can be sanitised by boiling but this is not always convenient and not necessarily the best use of limited fuel. But we would encourage you to endeavour to limit the use of plastic bottles and use your water treatment tablets into boiled water. Our cooks will provide drinking water when groups are based at one location for an extended period, such as the projects.

Attitude/Altitude Finally, remember the old axiom that your ‘attitude’ will determine your ‘altitude’ in life. You are about to consider embarking on a great journey with great people in a new place and for the most part well off the beaten tourist track. You will therefore need to be flexible, respectful, tolerant, and maintain your sense of humour. Do this and you will have a great and memorable time!