Health, Safety & Mountain Sickness
Health, Safety & Mountain Sickness - Travelers make sure to be healthy before start the journey to Tibet. Travellers require a particular medication take a good supply, as it may not be available in Tibet. Take along part of the packaging showing the generic name rather than the brand to make getting replacements easier. To avoid problems, it’s a good idea to have a legible prescription or letter from your doctor to show that you legally use the medication.
Insurance: Keep in mind that Tibet is a remote location, and if you become seriously injured or very sick, you may need to be evacuated by air. Under these circumstances, you don’t want to be without adequate health insurance. Be sure your policy covers evacuation.
Recommended vaccinations: China doesn’t officially require any immunizations for entry into the country; however, the further off the beaten track you go, the more necessary it is to take all precautions. The World Health Organization (WHO) requires travellers who have come from an area infected with yellow fever to be vaccinated before entering the country. Record all vaccinations on an International Health Certificate, available from a doctor or government health department.
Plan well ahead and schedule your vaccinations because some require more than one injection, while others should not be given together. Note that some vaccinations should not be given during pregnancy or to people with allergies.
It is recommended that you seek medical advice at least eight weeks before travel. Note that there is a greater risk of all kinds of disease with children and during pregnancy.
Discuss your requirements with your doctor, but vaccinations you should consider for this trip include the following:
Diphtheria & Tetanus Vaccinations for these two diseases are usually combined and are recommended for everyone. After an initial course of three injections (usually given in childhood), boosters are necessary every 10 years.
Hepatitis A - The vaccine for Hepatitis A (eg Avaxim, Havrix 1440 or VAQTA) provides long-term immunity (at least 20 years) after an initial injection and a booster at six to 12 months. Hepatitis A vaccine is also available in a combined form, Twinrix, with hepatitis B vaccine. Three injections over a six-month period are required, the first two providing substantial protection against hepatitis A.
Hepatitis B - China (although not so much Tibet) is one of the world’s great reservoirs of hepatitis B infection, a disease spread by contact with blood or by sexual activity. Vaccination involves three injections, the quickest course being over three weeks with a booster at 12 months.
Polio - This serious, easily transmitted disease is still prevalent in many developing countries, including Tibet’s neighboring countries, India, Pakistan and Nepal. Everyone should keep up-to-date with this vaccination, which is normally given in childhood. One adult booster is then needed (as long as the full childhood course was completed), particularly if travelling to a country with recent polio activity. This should be discussed with your doctor.
Rabies - China has a significant problem with rabies, which is worsening. Rabies is now the most common infectious disease cause of death in China. Only India reports more human cases annually. The vaccination is strongly recommended for those spending more than a month in Tibet, especially if you are cycling, handling animals, caving or travelling in remote areas, and for children. Pretravel vaccination means you do not need to receive Rabies Immuno Globulin (RIG) after a bite. RIG is very unlikely to be available in Tibet, and there is such a worldwide shortage that for the first time the CIWEC Clinic in Kathmandu reports that it cannot source any (at the time of writing). If you are prevaccinated and then bitten, you need only get two further shots of vaccine, as soon as possible, three days apart. If not prevaccinated, you require RIG plus five shots of vaccine over the course of 28 days. Thus the management of any bite or scratch is greatly simplified if you have been vaccinated. Current expert opinion is that the full series of vaccination does not require any boosters unless a bite occurs.
Tuberculosis - The risk of tuberculosis (TB) to travellers is usually very low, unless you’ll be living with or closely associated with local people in high-risk areas. As most healthy adults don’t develop symptoms, a skin test before and after travel to determine whether exposure has occurred may be considered. Recommendations for BCG vaccination vary considerably around the world. Discuss with your doctor if you feel you may be at risk. It is strongly recommended for children under five who are spending more than three months in a high-risk area.
Typhoid - This is an important vaccination to have for Tibet, where hygiene standards are low. It is available either as an injection or oral capsules. A combined hepatitis A-typhoid vaccine was launched recently but its availability is still limited. Check with your doctor to find out its status in your country.
Yellow Fever - This disease is not endemic in China or Tibet and a vaccine is only required if you are coming from an infected area. These areas are limited to parts of South America and Africa.
Measles-mumps-rubella (MMR) - All travellers should ensure they are immune to these diseases, either through infection or vaccination. Most people born before 1966 will be immune; those born after this date should have received two MMR vaccines in their lifetime.
Chickenpox (Varicella) - Discuss this vaccine with your doctor if you have not had chickenpox.
Influenza - The flu vaccine is recommended for anyone with chronic diseases, such as diabetes, lung or heart disease. Tibet has a high rate of respiratory illness, so all travellers should consider vaccination.
Pneumonia - A vaccine is recommended for anyone over 65 or those over 55 with certain medical conditions.
Acute Mountain Sickness: Acute mountain sickness (AMS, also known as altitude sickness) is common at high elevations; relevant factors are the rate of ascent and individual susceptibility. The former is the major risk factor. On average, one tourist a year dies in Tibet from AMS. Make sure that it is not you. Any traveller who flies or buses into Lhasa, where the elevation is just over 3600m, is likely to experience some symptoms of AMS. Take care to acclimatize slowly and take things easy for the first couple of days. Lack of oxygen at high altitudes (over 2500m) affects most people to some extent. The effect may be mild or severe and it occurs because less oxygen reaches the muscles and the brain at high altitude, requiring the heart and lungs to compensate by working harder.
AMS is a notoriously fickle affliction and can also affect trekkers and walkers accustomed to walking at high altitudes. It has been fatal at 3000m, although 3500m to 4500m is the usual range.
Acclimatization: AMS is linked to low atmospheric pressure. Those who travel up to Everest Base Camp, for instance, reach an altitude where atmospheric pressure is about half of that at sea level.
With an increase in altitude, the human body needs time to develop physiological mechanisms to cope with the decreased oxygen. This process of acclimatization is still not fully understood, but is known to involve modifications in breathing patterns and heart rate induced by the autonomic nervous system, and an increase in the blood’s oxygen-carrying capabilities. These compensatory mechanisms usually take about one to three days to develop at a particular altitude. You are unlikely to get AMS once you are acclimatized to a given height, but you can still get ill when you travel higher. If the ascent is too high and too fast, these compensatory reactions may not kick into gear fast enough.
Symptoms: Mild symptoms of AMS are very common in travellers visiting high altitudes, and usually develop during the first 24 hours at altitude. Most visitors to Tibet will suffer from some symptoms; these will generally disappear through acclimatization in several hours to several days.
Symptoms tend to be worse at night and include headache, dizziness, and lethargy, loss of appetite, nausea, breathlessness and irritability. Difficulty sleeping is another common symptom, and many travellers have trouble for the first few days after arriving in Lhasa.
AMS may become more serious without warning and can be fatal. Symptoms are caused by the accumulation of fluid in the lungs and brain, and include breathlessness at rest, a dry irrigative cough (which may progress to the production of pink, frothy sputum), severe headache, lack of coordination (typically leading to a ‘drunken walk’), confusion, irrational behavior, vomiting and eventually unconsciousness.
The symptoms of AMS, however mild, are a warning; be sure to take them seriously! Trekkers should keep an eye on each other as those experiencing symptoms, especially severe symptoms, may not be in a position to recognize them. One thing to note is that while the symptoms of mild AMS often precede those of severe AMS, this is not always the case. Severe AMS can strike with little or no warning.
Prevention: If you are driving up from Kathmandu, you will experience rapid altitude gain. An itinerary that takes you straight up to Everest Base Camp is unwise; plan to see it on your way back if possible. The best way to prevent AMS is to avoid rapid ascents to high altitudes. If you fly or bus into Lhasa, take it easy for at least three days; this is enough for most travellers to get over any initial ill-effects. At this point you might step up your programme by visiting a few sights around town. Within a week you should be ready for something a bit more adventurous, but do not push yourself to do anything that you are not comfortable with.
To prevent acute mountain sickness: Ascend slowly. Have frequent rest days, spending two to three nights at each rise of 1000m. If you reach a high altitude by trekking, acclimatization takes place gradually and you are less likely to be affected than if you fly directly to high altitude.
Trekkers should bear in mind the climber’s adage of ‘climb high, sleep low’. It is always wise to sleep at a lower altitude than the greatest height that’s reached during the day. High day climbs followed by a descent back to lower altitudes for the night are very good preparation for high-altitude trekking. Also, once above 3000m, care should be taken not to increase the sleeping altitude by more than 400m per day. If the terrain won’t allow for less than 400m of elevation gain, be ready to take an extra day off before tackling the climb.
Drink extra fluids. Tibet’s mountain air is cold and dry, and moisture is lost as you breathe. Evaporation of sweat may occur unnoticed and result in dehydration.
Eat light, high-carbohydrate meals to keep up energy.
Avoid alcohol as it may increase the risk of dehydration, and don’t smoke.
When trekking, take a day off to rest and acclimatize if feeling overtired. If you or anyone else in your party is having a tough time, make allowances for unscheduled stops.
Don’t push yourself when climbing up to passes; rather, take plenty of breaks. You can usually get over the pass as easily tomorrow as you can today. Try to plan your itinerary so that long ascents can be divided into two or more days. Given the complexity and unknown variables involved with AMS and acclimatization, trekkers should always err on the side of caution and ascend mountains slowly.
Treatment: Treat mild symptoms by resting at the same altitude until recovery, usually a day or two. Take paracetamol or acetaminophen for headaches. If symptoms persist or become worse, however, immediate descent is necessary. Even 500m can help.
The most effective treatment for severe AMS is to get down to a lower altitude as quickly as possible. In less severe cases the victim will be able to stagger down with some support; in other cases they may need to be carried down. Whatever the case, any delay could be fatal.
AMS victims may need to be flown out of Tibet as quickly as possible, so make sure you have adequate travel insurance.
The drug acetazolamide (Diamox) is recommended for the prevention of AMS – take 125mg twice a day as a preventive dose. Be aware that even when you are on Diamox, you should not ignore any symptoms of AMS.
However, the use Diamox is controversial. It can reduce the symptoms, but may also mask warning signs; severe and fatal AMS has occurred in people taking this drug. Travellers should discuss the use of Diamox with a travel health expert. Diamox should be avoided in those with a sulphur allergy, but you can discuss taking a trial of the medication at home if necessary.
Drug treatments should never be used to avoid descent or to enable further ascent (although they can help get people well enough to descend).
Several hotels in Lhasa sell a Tibetan herbal medicine recommended by locals for easing the symptoms of mild altitude sickness. The medicine is known as solomano in Tibetan and Hongjingtian in Chinese, though locals also recommend Gaoyuanning and Gaoyuankang. A box of vials costs around Y20 to Y35; take three vials a day.