The following information is not intended to be a comprehensive medical guide; neither will medications and their use be discussed in any detail. There are number of excellent first aid manuals, specifically written for use by trekkers in the Himalaya, available in Kathmandu. The chances of becoming seriously unwell while trekking in Nepal are probably no worse than in any other part of the developing world. Provided a few simple precautions are taken it is unlikely that anything will occur that will spoil your overall enjoyment of your trek. Remember, however, that you are traveling through a remote and undeveloped country where modern medical facilities are often few and far between. Good advice is to make sure that you are well prepared for the trek since lack of fitness can often lead to discomfort or illness. Something as simple as a foot blister can totally ruin a trek, not only for you but also for your companions.

Stomach Upsets

One of the most common complaints suffered by visitors to Nepal is stomach disorder. Whether they are caused by a simple change of diet, drinking contaminated water or by lack of hygiene on the part of a cook or more likely yourself or one of your companions and attack of "Kathmandu quickstep" is not an uncommon ailment. The problems can range from mild discomfort for a day or so, to a more serious onset of vomiting and diarrhea, which may need treatment to enable the trekker to continue. In order to avoid, or minimize, the risk of falling prey to stomach problems trekkers should follow the following rules.

• Drink only bottled drinks with the seals intact, boiled/filtered water or water that has been treated with iodine. Tea and coffee are usually safe since the water used to make them should have been boiled.
• Pay particular attention to personal hygiene with frequent washing of hands, especially before eating.
• The hygiene of those you come into contact with is obviously harder to control.
• Avoid very spicy food if you are unused to it.
• Avoid eating any uncooked vegetables or fruits that cannot be peeled before consumption.

In the case of a persistent stomach upset ensure that you keep the body hydrated. Drink plenty of fluids preferably including a re-hydration mixture, such as the locally available Jeevan Jal or Gatorade, and seek medical advice if the symptoms persist. It is likely that persistent stomach upsets will require medication in the form of antibiotics.

Coughs, colds sore throats and chest infections

They dry air of the mountains combined with close contact with locals and fellow trekkers will often lead to upper respiratory tract problems. These can range from mild inconvenience to debilitating infections. How serious the complaints get depends on how quickly action is taken. No amount of precautions, however, can fully protect you from the chance of a sore throat or a cough or cold.

Sore throats can best be avoided by attempting not to breathe cold air directly through the mouth. Try to breathe through the nose or use a scarf over your mouth to warm up the air. This is often easier said than done when climbing hills at altitude when you tend to be gasping for air. If you do get a sore throat, suck lozenges or try a chewable vitamin C tablet. Gargling with a warm water and salt solution can sometimes give relief. If the problem persists, or worsens, then treatment with antibiotics may be indicated.

Colds and flu are impossible to avoid completely whether you are trekking in Nepal or sitting in your office. The consequences of catching a cold while you are trekking are likely to have a more serious affect, however, since you will be exerting yourself more than normal and breathing may become more difficult. The problem may also make sleeping more difficult. If you do catch a cold try to avoid passing it on to your companions and limit the discomfort by the use of aspirin or paracetamol. Beware of a cold or flu developing into a chest infection, which would then require the use of antibiotics to affect a cure.

Coughs are another one of those complaints that are common amongst trekkers, especially those trekking at the higher altitudes. The causes are cold dry air coupled with smoky atmospheres in teahouses. A cough can be more than just a nuisance as it will invariably lead to a sore throat and often will keep the sufferer, and his companions, wake at night. The treatment is similar to that for sore throats but, in addition, one of the proprietary cough expectorants may help. Avoid smoking.

Joint and Muscle strains

Trekkers who are not used to walking day after day will often suffer mid joint and muscle pains for the first few days on the trail. These symptoms will generally disappear as you get used to the daily routine of trekking. What are more serious, however, do torn or strained ligaments cause actual injuries? Such injuries can often mean that a trekker has to curtail their trek or at least travel more slowly than planned.

Prevention is obviously better than cure and using appropriate footwear and walking carefully on uneven stretches of trail can avoid many strains. If you find your balance is a problem on steep sections of the trail, use a walking stick. A stick will also help you avoid "sahib's knee", that very common complaint amongst trekkers who suffer knee pains when they are descending steep slopes.

The obvious signs of strains or torn ligaments are local pain and swelling around the joint, usually the ankle or knee. Application of cold water (or snow or ice) will usually reduce the swelling and the joint should then be supported with a crepe bandage and the limb elevated. Aspirin or paracetamol will reduce the pain and swelling. If the victim must continue walking. Use a stick to keep as much weight off the joint as possible. Consider having a porter help to support the victim or, in an emergency, carry him.

Remember, what may appear to be a strain or sprain may, in fact, be a broken bone. If the pain persists, or worsens, then seek medical advice as soon as possible or evacuate the victim if necessary.

Foot problems
If you are walking all day for several days it makes sense to look after your feet. The mot likely problems you will have are blisters. Wearing well broken-in footwear will go a long way to avoiding such problems. If you do feel sore hot spots on your feet while walking stop immediately and apply protective plasters to the affected area. Another common way that blisters form is from wearing unwashed socks. After a few days of use without washing, the socks will become hard with dirt and sweat and this can cause blisters.

If you are unfortunate enough to develop blisters, try to relieve the pressure on them by the use of adhesive plasters or special blister pads. Avoid bursting the blister as this could lead to infection, which will make walking almost impossible. If blisters do burst be particularly careful to keep them clean and apply antiseptic cream regularly.