Health and Safety Issues while Trekking in Nepal

Insurance for Trekking in Nepal

The most important thing with travel insurance is the fine print. Pore over the finer things no matter who you approach. It has to cover the highest altitude in your itinerary and for the Himalayas, it is advisable to make sure that the insurance covers up to 6,000 meters. But most importantly it has to cover helicopter evacuations. Air Ambulance coverage out of Kathmandu is not necessary as hospitals here have all the facilities you will need. Before you go shopping for one, check up with insurance companies you are already connected with. It might be your bank, your health insurance provider or if you are Donald Trump, your hair insurance provider. They might have the goods and might cut you a better deal. If not, you will find many options online. Remember the bit about the fine print though.

Let us hope you will never get to claim your insurance. But if you have to evacuate, make sure you keep all your receipts and signed medical reports. Also remember, helicopter companies in Nepal will not send in a chopper unless they are completely assured of payment and they will not deal with your insurance company. You will have to provide the cash guarantee and later file a claim with your insurer. The guarantee can be provided through credit card, your trekking agency or your embassy.

It is also important that not only you but the porters and guides you use are insured too. And you might be in for big trouble if something happens and there is no insurance. One of the perks of going through a travel agency is that they will take care of the porter/guide insurance for you.

Pre-existing Conditions to consider before Trekking in Nepal

The following list is not exhaustive and it is certainly no replacement for a thorough consultation with a trained professional. It is simply presented as a reminder to formulate a personalized plan in consultation with a specialist.

When you plan for the mountains with a pre-existing medical condition hope for the best, but be ready for the worst. Have enough medications and some more. Make a kit with clear labels and keep it in your hand-carry during flights. Have an official letter from your doctor about your condition, medication and emergency contact. Also, if you intend to travel in a group through a travel agency, consider the fact that there is very limited scope for changes in the original itinerary. You might be better off traveling with your own close circle who understand your condition and are open to itinerary revisions. Also, make sure you are frank about your condition with your travel agency and insurance provider.

Avoid High Altitude if you have these pre-existing conditions

1. Sickle cell Disease- Increased risk of sickle cell crisis.

2. Pregnancy- First three months puts the fetus at high risk.

3. Pulmonary hypertension- High risk of High Altitude Pulmonary Edema (HAPE)

4. Obesity Hypoventilation Syndrome- High risk of Acute Mountain Sickness, High Altitude Pulmonary Edema (HAPE) and heart failure.

5. Carotid Surgery- Difficulty/Disability to increase airflow in response to low oxygen content. It might be possible to undertake a trek depending upon the kind of surgery. Thorough consultation required.

6. Congenital Heart Problems- High risk of High Altitude Pulmonary Edema (HAPE).

Take Extreme Precautions if you have these pre-existing conditions

1. Obstructive Sleep Apnea- Travel with a CPAP machine. Supplemental Oxygen required.

2. Diabetes- Take readings more often and manage blood sugar level religiously. Make sure your glucose meter will work in extreme cold and high altitudes. Dosage changes might be necessary. Make sure you know the guidelines.

3. Chronic Obstructive Pulmonary Disease- Supplemental oxygen might be required. Severe cases should not travel to high altitudes. Bronchodilators are helpful.

4. Neuromuscular Diseases- Depends upon the exact nature of the disease.

5. Chronic Kidney Disease- Makes it hard to maintain fluid, electrolyte content. Hard to acclimate to low oxygen content. Increased susceptibility to HAPE.

6. Cystic fibrosis- Supplemental oxygen, antibiotics, and physiotherapy will help. Depends upon the severity.

Take Precautions if you have these pre-existing conditions

1. Radial Keratotomy- Carry corrective glasses. While laser surgery doesn’t cause problems, avoid high altitudes for 6 months after the surgery. Carry corrective glasses.

2. Heart Diseases- Depends upon the type and severity of the problem. Ascend slow and acclimatize well. Take extra days if required. Use Diamox preventively.

3. Arrhythmia- Supplemental Oxygen might be required. Avoid exertion.

4. High Blood Pressure- Regularly check blood pressure. Take regular medication and do not change the dosage without consultation.

5. Anemia- Reduction of physical fitness. Iron supplements might help in certain cases. High altitude performance highly dependant on type and severity of anemia.

6. Obesity- Slightly higher risk of AMS.

7. Epilepsy- Make sure members of your group know what to do in case of a fit.

8. Peptic Ulcer- Increase in gastrointestinal bleeding. Avoid alcohol, smoking, caffeine at high altitudes. People with peptic ulcer should avoid dexamethasone unless for treatment of HACE/HAPE.

Don’t worry about these pre-existing conditions

1. Asthma- Continue with usual treatment. You might actually do better at high altitudes.

2. Migraine- Frequency and severity can go up. Continue with regular medication.

Immunizations to consider before coming to Nepal

Being a very welcoming country, nobody will bother with your immunizations before issuing a visa to Nepal. But the good gesture might not always work out for your benefit. Nobody in their right mind imagines that they will get bit by a rabies infected dog while planning a trip to Nepal. But a clinic in Nepal took care of 118 such cases among travelers over a seven-year period. And that is just 1 clinic. The bottom line- shit happens and it is better to think, ‘That could be me’ rather than ‘Oh Lord, Why me?’.

Important immunizations to get before trekking in Nepal

1. Hepatitis A- For the love your liver, and sake of your life.

2. Typhoid Fever- Salmonella might sound like salmon, but you sure as hell don’t want it.

3. Chickenpox- Unfortunately yes chickenpox is still a nuisance in Nepal. And if you have never had this disease and intend to keep it that way, get that vaccine before coming to Nepal.

Missing these can not only ruin your vacation but also that of others who accompany you. Skipping these vaccines speaks for your general disregard of good advice and while statistically, you will most likely get away in this case, just make sure you don’t bring the same attitude to altitude related risks. The mountains can be pretty heartless.

Recommended Immunizations to get before trekking in Nepal

1. Measles-Mumps-Rubella- In the unlikely event that your parents skipped you on this one, it comes highly recommended.

2. Influenza- This vaccine is updated annually and is highly recommended. Nepal has had its share of Swine Flu and Bird Flu in the past.

3. Tetanus- If you can’t remember the last time you had a booster dose, get one just in case. It is good for a decade.

4. Rabies- Dogs are generally not raised for companionship in Nepal, and stray dogs have it worse. Because of the traumatic upbringing, some of them develop serious anger issues. Be especially careful around monasteries and if you bring kids along, invest in an Anti-Dog Whistle. And of course, do not forget to get the pre-exposure series of the rabies vaccine.

An Immunization List for hypochondriacs ;)

1. Hepatitis B- Get 3 shots for this if your itinerary involves lots of blood work and casual sex.

2. Japanese Encephalitis- Only if you intend to stay more than a month in Nepal during Aug-Oct.

3. Meningococcal meningitis.

4. Cholera- Unless you intend to drink the filthiest water you can find, you can pass on this one.

5. Polio.

If social media and the internet haven’t eroded your patience yet, you might consider going through the following detailed treatment at from CIWEC.

Water Safety and Diarrhea in Nepal

What percent of travelers you think will contract diarrhea while in Nepal? 20%? 40%? 50%? Couldn’t be higher than that now, could it? Unfortunately, an exit poll at Kathmandu’s international airport reported that a good 68% suffered from some form of diarrhea. Yes, 68%!! That’s like if you are traveling with your spouse and a kid, two of you will get sick. But there is a silver lining to this grim tale. Diarrhea is preventable and in most cases easily treatable.

The most important rule is that all water is suspect unless you have personally seen it boil. Bottled water you buy in regular tourist establishments are usually good but do not expect all bottled water to be safe. What are you supposed to drink then, right? Invest in a portable water filter. These days they come in really handy sizes and that ‘handy’ is meant to be taken literally. And they aren’t all that expensive. Water filters are exceptional against all diarrhea-causing pathogens but are pretty toothless against viruses. Drink boiled water as far as possible and have the filter as a backup, is. Or alternatively just stick to beer.

Also, Nepal is no place for salad lovers. Avoid it. You will also be better off without peeled fruits especially melons. And at all costs avoid lassi, a yogurty fruit shake, no matter how delicious they sound or look.

Water Safety in Nepal

Bottled Water

Not only are a good proportion of bottled water in Nepal suspect, but they also have a huge ecological footprint. Despite the convenience, it is highly recommended to BYOB and drink boiled water. While this isn’t possible in the urban areas, it is very much doable during a trek.

Boiling

Boiling is perhaps the greatest invention when it comes to water purification. Bacteria, protozoa, giardia, amoeba, viruses you name it, they are no match for boiled water. And in the cold of the mountains, hot water is just that much more awesome. Also, access is not a problem along the popular routes. There will be a nominal cost though. But remember that all the great things boiling does to water will go to waste if you don’t have water bottles that can take hot water. Get two.

Water filters

Water filters are getting smaller real fast. And by smaller, we are not just referring to their physical size, but also to their pore size. Smaller physical size means portability and sometimes compatibility with camelbaks while smaller pore size translates to better filtration. There are even some filters in the market that claim to filter away viruses. This claim is only partly true. As for non-viral pathogens, you can rest assured with water filters. Anything smaller than 0.2-micron pore size will do the job. In order to get rid of viruses, consider a hybrid system which in addition to a water filter employs some form of iodine-based treatment.

Water filters have an advantage over boiling in that they are much more convenient to use with camelbaks.

Safe Drinking Water Stations

Along the trail in Annapurna and lower stretches of Everest, there are safe drinking water stations that sell ozone treated water for Rs 40-100 per liter. Use of these as far as possible.

UV purifier

UV purifiers are good against all pathogens if the water being purified is clear of particulates. Also, make sure you read the instructions very carefully as correct contact time and power delivery might be necessary to achieve best results. Something that is overlooked is that UV purified water cannot be left in direct light for an extended period because of pathogen reactivation. They are also not cheap and require batteries. If you can manage that, UV purifiers are hands down the way to go in terms of their efficacy.

Iodine/Chlorine

We suggest iodine/chlorine-based treatment be used only when no other alternatives exist. Their efficacy is dependent upon temperature and lighting. They are not effective against all pathogens and also have about half an hour incubation time. Iodine-based water treatment should be avoided by pregnant women and people with thyroid problems. If you intend to carry iodine/chlorine-based chemicals with you, we suggest tetraglycine hydroperiodide or chlorine dioxide based products. Read the instructions very carefully.

Water-borne Diseases

If in spite of your best efforts, you do manage to contract diarrhea, the first thing to worry about is rehydration. Getting ORS will not be a problem in Kathmandu and we suggest you carry at least a couple of packets during the trek. Even if you do not get diarrhea, they are great for rehydration at high altitudes.

Now let's have a look at some prime suspects of diarrhea and ways to deal with these buggers. However, please note that this is only a rough guide to be used in case you do not have access to a specialist.

Bacterial Diarrhea

More likely than not, bacteria is your culprit, for they cause 80% of diarrhea seen in travelers. While it may pass on its own quickly, as many well-meaning people will no doubt tell you, it is also likely that your restroom runs will last for 2 weeks. If you are okay with that, read no further, but why walk with the ball and chain when you can get rid of it within a few days?

Symptoms: Bacterial infections are characterized by an abrupt onset of diarrhea. Nausea, vomiting, and fever may occur.

Treatment: Ciprofloxacin 500 mg twice daily for three days. 1 hour before a meal. If symptoms do not withdraw within 2 days consider adding Azithromycin 500 mg once per day for 3 days, 1 hour before a meal. Antimotility agents such as loperamide can be used to reduce the runs, but should not be used if you have a fever or bloody stool. Remember to rehydrate yourself sufficiently for a couple of days even after the symptoms have passed.

If that doesn’t take care of your diarrhea, we suggest you go out of your way to seek expert medical help.

Giardia

Giardia is a kind of protozoa which is the second most common cause of diarrhea in Nepal.

Symptoms: First let's debunk the myth of sulfurous burps and farts as indicators of giardia. Also keep in mind that if you contract diarrhea within 2 days of coming to Nepal from your home country, in all likelihood it isn’t giardia. That ‘home country’ bit is important because if you are coming from an extended stay in say Bangkok or Delhi, it might be a different story. Symptoms of diarrhea caused by giardia have considerable overlap with diarrhea caused by bacteria and the only way to be sure is a stool test. However, one way to tell is that giardia never starts abruptly.

Treatment: Tinidazole 2 g single dose after an evening meal. While you shouldn’t be drinking alcohol anyways, avoid alcohol even if it’s your 21st birthday while taking tinidazole.

Amoebic Diarrhea

While diarrhea caused by amoeba is rare, it is nevertheless the hardest to diagnose even within a lab setting and is potentially the deadliest.

Symptoms: Amoebic diarrhea is characterized by toilet runs which might last for a couple of days and all of a sudden stop, only to start again a few days later. You might experience constipation as the diarrhea alternates. Pus cells and blood are often present in stool. Self-medication is not suggested and immediate medical help and perhaps even hospitalization is necessary because of the possibility of liver damage.

Treatment: Tinidazole 2 g once per day for three days after an evening meal. Also remember alcohol creates an unholy mixture with tinidazole and is to be avoided at all costs. Even after treatment, a follow-up lab assessment and consultation is a must.

Cyclospora

This protozoan is active during the rainy season and diarrhea caused by this guy peaks around June-July. If you are traveling outside May-Aug, you can rest assured this is not your guy.

Symptoms: It is characterized by extreme tiredness and diarrhea that comes and goes. Expert medical help is highly recommended.

Treatment: Bactrim, 1 tablet twice a day with or without food for 10 days. People with a sulfa allergy should avoid this drug, however.

For more details we present the following web resources from two hospitals in Kathmandu:

http://ciwec-clinic.com/health-information/understanding-diarrhea-in-travelers/

http://www.nepalinternationalclinic.com/diarrhoeal-diseases-in-nepal/

Altitude Illness while Trekking in Nepal

Would you get in an airliner if you knew that it has a broken cabin pressurization system? That’s just utterly stupid, right? In spite of the obvious, every year Himalayan Rescue Association’s Pheriche Aid Post sees a steady stream of people who manage to pull off something similar. Their reward? A helicopter ride to a hospital in Kathmandu and a chance to exchange love letters with an insurance company.

Just like cruising at 10,000 meters requires cabin pressurization, walking to 5,000 meters requires a spacesuit, or more realistically acclimatization, your body’s very own cabin pressurization system. We don't want that broken now, do we?

So, unless you have the genes of the extinct Denisovans, which give Sherpas their unmatched capacity at high altitudes, you are better off taking it slowly along with the use of preventive medication. We will get into the details, but for now, let’s give in to some statistical fear mongering: 40-50% people get sick with altitude illness upon trekking to 4,000m in Nepal; 7.7/100,000 people die of altitude related illness every year in Nepal and despite the availability of rescue services, the number is increasing.

Acclimatization:

We will get into the intricacies of acclimatization shortly, but let's get down to business first:

What to do for Acclimatization?

1. Above 2,500 meters limit your daily ascent to 500 meters between night stops.

2. Have a rest day every 3 days or 1,000 meters ascent, whichever comes first.

3. Drink 4 liters of fluid every day. ORS is highly recommended. Yes, you will be urinating much more frequently, but remember you would be peeing almost as much even without the 4 liters.

4. For the Everest trek starting at Lukla, preventive use of acetazolamide (Diamox) must be considered in addition to the aforementioned points. Dosage: 125 mg twice daily initiated a day before the climb and continued until descent starts or after 3 days at target altitude for an extended stay. For children below 16, the suggested dose is 2.5mg/kg twice daily.

5. In the case of allergic reaction to acetazolamide, dexamethasone can be used. Dosage: 4 mg every 12 hours starting with the day of ascent and continued until descent begins. Dexamethasone should not be used for more than 10 days and should not be used for children.

6. If prior history of High Altitude Pulmonary Edema is present, nifedipine must be used preventively. Dosage: 60 mg daily, divided into smaller doses for sustained release, starting the day before ascent and continued until descent begins or 5 nights at target elevation.

7. Make sure you are warmly clothed at all times. Carry a fleece in your day pack and make use of your Windstopper.

What NOT to do for Acclimatization?

1. Do not continue ascent with a headache or any other sign of altitude illness.

2. Avoid alcohol at all costs.

3. Do not take sleeping pills, period.

4. Do not sleep during the day and generally stay active.

5. Avoid heavy exertion.

The fact that there is about half the amount of oxygen at 5,000 meters above sea level, gives your body a long to-do list, so you can continue to enjoy your vacation. And simply put, the things that your body does for you is called acclimatization. Help it by doing your part, you know it is your body after all.

1. Your body will increase the pulse rate and breathing rate/depth. Given that your heart is already working harder, do not push it by exerting yourself.

2. Your body will let go of non-vital fluids by increasing urination. Do your part by replenishing the fluids.

3. Your body will thicken blood through fluid loss and increased red cells production. This increases the danger of internal blood clots. Do your part by drinking enough and remaining active during the day.

4. Your body might go through a phase of periodic breathing which will disturb sleep. This is normal. Do your part by not suppressing this response through sleeping pills.

5. However, nothing will acclimate you above 5,500 meters unless you are Reinhold Messner. Do your part by limiting the length of stay and/or use supplemental oxygen.

Above everything else, remember that acclimatization is a process that takes time and depends on a wide variety of factors. And the single most important factor that causes sickness has got to be cockiness. The fact that you are an ultra-athlete or in the SAS is irrelevant to the mountains. Be kind to your body by giving it time and listen carefully to what your body is telling you. And we cannot stress this more but DO NOT ever think of ascent with any symptoms of altitude sickness.

Acute Mountain Sickness (AMS) and High Altitude Cerebral Edema (HACE)

AMS is basically a bloody ‘hangover’ that can quickly progress to HACE, a fancy term for a lot of water in your brain. And just in case the ‘water in your brain’ part wasn't scary enough, yes HACE can kill.

AMS presents itself as a headache along with one or more of the following: nausea/vomiting, fatigue, dizziness or sleeplessness. These will show after your ascend to an altitude your body isn’t comfortable with. That is the reason why you have to take it slow and listen to your body. Now look at the symptoms, there are various factors that might be causing them other than the altitude. A ‘hangover’ may be an actual hangover or dehydration or possibly a lack of essential salts. That is why drinking enough water/ORS and avoiding alcohol is important. Fatigue and dizziness can be the result of exhaustion or exposure. Hence the need to avoid exerting oneself and proper clothing. AMS is that much easier to come to terms with once you have ruled out confounding causes through proper prevention.

Mild AMS

AMS usually develops slowly, almost imperceptibly. If all you have is a mild headache along with one or the other symptoms also of mild intensity, this is just a warning shot. Heed it. Stop ascent, rest, drink water/ORS and maybe some snacks. Also, take a mild analgesic (paracetamol or ibuprofen) or antiemetic (ondansetron) if needed and see how it goes for the night. Do not climb until all symptoms have resolved.

Moderate-Severe AMS

If however, you have a severe headache along with one or more of the accompanying symptoms of moderate-severe intensity, it is time to get into treatment mode. And the most effective treatment is immediate descent. Even a 500-meter drop can be helpful, but sometimes a 1,000 meters might be necessary. It will be easier on the patient if given dexamethasone 4 mg every 6 hours during the descent. Supplemental oxygen and use of portable Gamow Bag chambers might be necessary depending upon the severity.

Ascent can be initiated after symptoms resolve completely.

HACE

In extreme cases, severe AMS can give way to HACE which is characterized by ataxia, confusion and altered consciousness. It is now time to say goodbye to the mountains and go into rescue mode. Descend immediately at least 1,000 meters. 8 mg dose of dexamethasone followed by 4 mg every 6 hours will be very helpful. Supplemental oxygen and Gamow Bag chambers must be used until evacuation helicopter arrives.

High Altitude Pulmonary Edema (HAPE)

HAPE means water in your lungs and while uncommon, it is fatal, much more so than AMS and HACE. It is characterized by difficulty of breathing at rest, cough, rapid heart rate, rapid shallow breathing and possibly blue skin color. Immediate evacuation is necessary and the patient needs to descend at least 1,000 meters. Supplemental oxygen and Gamow Bag chambers must be used if available, but should not be used as a replacement for a descent. 60 mg of Nifedipine daily divided into sustained release dosage should be used in conjunction with descent and other treatment.

The Himalayan Rescue Association runs lectures on altitude illnesses at its Thamel Information Centre, Pheriche Aid Post and Manang Aid Post at 3 pm every day. It will be time well spent. For more information contact:

http://www.himalayanrescue.org/

Environmental Hazards while Trekking in Nepal

Khumbu Cough

As you go higher, you will cough that much more and at times the coughing can get so violent that it hurts like hell. Surprising as it might sound, there is no consensus on the cause or treatment of this problem. Bronchial irritation due to the cold dry air perhaps has something to do with it. Breathing through the mouth is also thought to exacerbate the situation. The best way to avoid the Khumbu cough is to breathe humidified air by using a mask of some sort. A buff is great for this purpose and a handkerchief will do just fine. Just make sure it isn’t too tight. Also, make sure to dress warmly and remember to protect your neck and head from the cold. Candies or cough drops will help.

Knee problems

Use trekking poles. You will walk much better.

Another very important thing is to descend slowly. After the labors of an uphill climb, even a small stretch of downhill seems like a godsend sign to walk faster and reclaim some of the lost ego. But do not fall for it (pun intended). Please go downhill only a little bit faster than your uphill pace. Your knees will love you for it.

Sunburn

We had no intention of writing about this one until we saw a trekker walk down with two buffs covering her face. Serious sunburn not only looks but must be treated as a second-degree burn. And that was what the buffs were covering.

But as we all know it is easily preventable. There is, however, a susceptible group which should be cautious: redheads, blue-eyed blondes, individuals of northern European descent and children. Another susceptible group seems to be those that are used to seeing snow and mountains in their home country and usually get by without much prevention there.

The main difference in the Himalayas is the altitude which results in that much more UV rays and your usual regimen might not cut it here. Let us suggest one:

Choose an SPF 30 sunscreen that is effective against UVA. 30 might sound like a small number given that there are sunscreens with SPF ratings of 100, but believe it will be more than adequate. If you feel like it, push it to 50 but beyond that, it is just a waste of money. The UVA bit, however, is very important, not to avoid sunburns but to avoid long-term skin damage. Your money is better spent on UVA protection than high SPF ratings.

Make sure you are done applying your sunscreen by the time you sit for breakfast as it is very important to do so at least half an hour before exposure. And don’t forget your ears and neck. However, the skin above your eyes is better off without sunscreen because sweat will wash the cream into your eyes causing irritation. Leave it to your sunglasses to protect that bit of skin.

Later on, before you sit for lunch wash your face and apply the sunscreen again. Since sweat will wash off sunscreen anyways reapplication is very important while SPF rating isn’t. If you have been sweating too much consider a more frequent application.

Other ways to protect against sunburn are creams based on titanium dioxide and zinc oxide. Also a sun hat is great.

Snow Blindness

The term snow blindness is misleading. While snow is important, it is the amount of UV that is the deciding factor. This is perhaps one of the reasons why some people who come from lowland areas that see a lot of snow, usually make light of this. And the high amount of UV in the Himalaya takes its toll. Hence, sunglasses with good UV protection is necessary and you should put them on even on overcast days. Also, make sure the glasses offer sung and complete protection for the eyes. Straps that hold the glasses are highly recommended as it makes the job of losing the glasses very hard if not impossible. If you have a penchant for misplacing things, consider getting an extra pair. And if you ever find yourself without one, improvise by slitting a dark fabric or if you have an inclination for the exotic, go Tibetan style with woven yak hair.

In case you are blinded, know that it will pass on its own in a few days. Meanwhile, avoid exposure to light and do not rub your eyes. Painkillers and eye drops will give some relief. Localized anesthetics, however, must be avoided.

Blisters

Make sure your boots are a good fit and break them back home. A thin inner sock is also very helpful for preventing blisters. Check your feet at the earliest sign of a hotspot, and cover the area with tape or moleskin.

If you are judicious, you will never have to go through the hassle of breaking, sterilizing and bandaging a blister.

Chafing is another problem that is encountered by many. The most suspect parts are inner thighs and collarbone area. Moleskin will work great if you are susceptible to inner thighs chafing and a pair of socks tucked under the strap of your bag will take care of your collarbone. Calamine lotion works wonders in healing the skin once chafing has developed.

Avalanches

The Annapurna Base Camp Trek is one of the few treks in Nepal in which avalanche is an issue. While relatively rare, there have been incidents. Precautionary measures are perhaps the most important reason why the casualty rate is so low. Unlike media depictions which might have given the impression that avalanches can occur anywhere anytime, there are certain avalanche gullies that funnel avalanches and most of them usually occur after 10 am. The most active area for avalanches in the Annapurna Base Camp Trek is the section between Dobhan and Machhapuchhre Base Camp. And even within this section, there are certain gullies that are most dangerous. The easiest rule of thumb is that when you see an awesome waterfall or a stream on your side of the trail, do not loiter around that area. Snow gets funneled in the same way as water and hence streams and avalanches generally follow the same route. It is also a good idea to cross avalanche prone areas before 11:00 am. This is especially important if there has been fresh snow or rain recently. In case you personally face an avalanche there are certain things you can do increase your chances of surviving:

1. Create an air pocket around your face by holding your arms in front of your face. No matter what the situation is going to be, you will need air.
2. If you are near the surface, swim, or at least try to. You will stay near the surface that way.
3. When the whole action stops, take a deep breath and try to raise your arms, before the snow hardens. Once the snow hardens, it will be as hard as concrete, restricting all movement.
4. Stay as calm as possible. Don't yell. No one will hear you. Also, unless, you are very near the surface, it will be impossible to dig yourself out. So keep your fingers crossed until help arrives.

Frostbite

Frostbite is irreparable and mountain weather is unpredictable. Get a good pair of boots. Running shoes will not cut it. Make sure to put on warm clothing and ensure that they are dry. Be sure to update yourself on the weather from lodges and other trekkers. If the terrain is heavily snowed over it might make sense to wait for other groups to pass through. Once the trail is broken, it will make both walking and navigation easier.

Frostbite is the body’s response to protect vital organs in the face of rapid heat loss, by limiting the amount of blood circulation to the peripheries. As such, the signs of frostbite will first appear in the parts furthest from the heart: toes, fingers, nose, cheeks, and ears. If you feel a numbness in fingers and toes you can increase blood circulation to these parts by moving them. Also adding a layer of clothing might help. Cover your ears, nose, and cheeks. But your primary objective should be to find warm shelter of a lodge as fast as possible. Immersing the extremity in lukewarm water (about 40 degrees C or 105 degrees F) will be very helpful. This treatment is especially important if the numb parts have started to turn whitish and waxy. Do not rub such parts. Continue with the treatment until the whitish parts start to turn red. It can be very painful though.

In severe cases, evacuation must be considered.

Carbon Monoxide Poisoning

While it doesn’t happen often, there have been cases of carbon monoxide poisoning. Ensure proper ventilation before using a heater in your hotel room. Ditto with heaters used inside tents. Dining halls in lodges are rather porous and usually safe.

Hypothermia

It is colder in the mountains than your body’s capacity to cope. Hypothermia results when your body cannot compensate for heat loss and results in shivering and mental confusion in mild cases to a silent heart in more severe ones. Hypothermia also exacerbates many other altitude and cold-related illnesses.

Follow the dress code for mountains and you can leave all dangers behind. And the dress code is layers. Synthetic thermal underwears work great as a base layer. Avoid cotton like the plague for once wet from sweat, it makes things really uncomfortable by losing its insulating properties and increasing heat loss through evaporation.

A light fleece works great as the next layer and tops it off with a wind and waterproof jacket. Have a down for evenings and mornings at night stops. The great thing about layering, in addition to insulation, is the ease with which you can shed and add clothes. This is very important as it gets hot while walking and the moment you rest you will feel cold. Add to this the drastic fluctuations in temperatures that are the hallmark of the mountains.

As such the dress code is not just suggestive but necessary.

Animals

While animals are not much of a danger along trekking routes, there are a couple of things to keep in mind. Be careful around monasteries, as there might be ferocious Tibetan Mastiffs. They are used for security of the monastery and are huge and ill-tempered. Do not get cuddly with street dogs about the villages for all it takes is a friendly scratch or an innocent bite to get infected. Think of investing in an Anti-Dog Whistle if you will be traveling with kids. They are also least likely to report a small scratch or bite, so be careful and vigilant.

In case you do get bit by a dog, wash the wound immediately with soapy water. Be liberal with the soap and apply an antiseptic immediately afterward. Seek expert medical help for post-exposure vaccination.

Horses can bite, mules can kick and yaks can throw you off balance in a trail. Maintain your distance and when these animals approach, stick to the mountainside of the trail as a gentle nudge from the loads they carry can cause you to tumble down if you are on the streamside.

Wild animals will usually maintain their distance and attacks are very rare. The only cases in which they might attack is if they have kids and you are too close. Maintain your distance and avoid sudden movements. The most ill-tempered of them all is perhaps the Himalayan Black Bear. Chances of meeting one if however next to none. If you do have a good fortune of crossing paths with one, avoid eye contact and slowly back away. Both of you will be happier and on your way soon.

Crime/Theft

Nepal is a rather safe country. There are no places which should be avoided due to the high crime rate. Hence, there is very little to worry about in terms of personal safety. Theft, however, can be an issue. As such some precautions are needed:

1. Do not travel alone, period. Even if you come into Nepal alone it will not be hard to find like-minded people in Kathmandu or even along the trail. Pack together. This is helpful in oh so many ways, like getting accommodation in the peak season, for lodges shrink from giving room to small groups. It is also a good idea in case of an accident or other health-related problems. If you are hiring a porter, make sure you padlock your kit bag.

2. Do not leave cameras and other valuables unattended. If you are traveling by bus, take them with you when you go out to get refreshments along the way. Do not put valuables in the stuff that goes on the luggage compartment of buses or planes. And generally stay vigilant, especially around areas with road connectivity.

3. The international airport at Kathmandu is well renowned for baggage theft. Carry valuables in your hand carry.

4. Double check the seats before getting off a taxi or other means of public transportations.

5. It should go without saying, but please lock your rooms before leaving even for a short toilet run. And that is true not just in Kathmandu but also along the trails.

Dealing with Traumatic Injuries while Trekking in Nepal

Injuries resulting from people falling on things and things falling on people are the most common causes of death among trekkers in Nepal. Following a serious injury, there is little you can do until expert help arrives. As such think prevention, rather than test gravity.

1. You are most vulnerable on the first and last day of your trek. The first day you are like look at this, look at that and haven't yet found your rhythm. Such distracted excitability, needless to say, isn’t too great for safety. It sure is great to be among the mountains, but remember safety first. The last day sees people mulling over things they missed or will have to face, again not very conducive to safe walking.

2. Another common scenario is when you are trying to take that profile picture of yours standing on top of a rock with Ama Dablam in the background. Sure it looks badass and all, but you know the risks. Rise above it.

3. As a mule/yak train approaches remember that these guys find it incredibly offensive if you stand on the stream side of the trail as you let them pass and might even give you a gentle nudge to expedite your journey to the stream. Always stand on the side of the mountain when letting these guys pass.

4. Say you took a wrong turn somewhere and realize it sometime later. As it might happen, the correct path may be just 20 feet above or below your current track. Valiant as you are, you decide to scramble for it. You don’t want to hear the end of this story. Just retrace your steps back to where you took the wrong turn.

5. Do not travel alone for obvious reasons. Find like-minded people along the trek or in Kathmandu if you do arrive alone.

6. Nepal is no place to end up as a number in the Rolling Stones’ Greatest Hits. The danger of rolling stones is greatest if there is an open area such as a pasture above you. Be especially cautious if there are animals there. And for god's sake lose those headphones.

God forbid it, but if you do sustain an injury, it might be just a small scratch or it might require an evacuation. However, there are a few things you can do until evacuation arrives. Let us focus on these things. Also, remember that an actual emergency will not accord you the luxury to go through this text. So please make an effort go through the following slowly and carefully.

1. Get to Safety

While your first response on seeing a companion suffer might be to help him/her, your first priority should be to move the person away from dangers such as falling rocks, precarious slopes or avalanche-prone area.

2. Breathing and pulse

The first thing that needs to be done is to check if the person is breathing and if the airway is obstructed. Use CPR if necessary. Once that is taken care of check for the pulse. Given everything is in the order it is now time to contain the bleeding.

3. Check bleeding

The only way to control bleeding is by application of direct pressure. Tourniquets should never be used. While most bleeding will stop after a couple of minutes if an artery is severed it will take longer. Once bleeding has been controlled it is now necessary to attend to shock.

4. Shock

Shock is a medical term for a critical medical condition that results from excess blood loss and can be fatal. Since treatment for shock is most effective immediately after an injury, it is important you know how.

You can tell a person is in shock if s/he appears pale and the skin feels cold first at the peripheries and centrally later on. In extreme cases, the person might act agitated or restless. Pulse goes up and blood pressure goes down and the patient might complain of feeling cold or thirsty. Even if the person has no such signs, it is imperative to treat for shock to be on the safe side if bleeding has occurred or internal bleeding is suspected.

The person should lie down face up while both feet must be lifted up about 12 inches. This will ensure that more blood is available to the vital parts. Blankets and sleeping bags must be wrapped around the person in order to maintain body heat. However, if an external heat source is available it is that much better. Oxygen and IV therapy must be used if available. Avoid food and water if rescue is set to arrive within a few hours.

Congratulations, you might just have made the difference between life and death.

5. Check for Head injuries/Spinal Injuries/Internal Injuries

While evacuation support must be called for serious injuries anyways, it is extremely important for head injuries, spinal injuries, and internal injuries. While head and spinal injuries are easy to ascertain internal injuries can be told by rapid pulse and pale cool skin while very little bleeding has occurred externally. Check for them. In the case of spinal injury, the person should not be moved unless it is absolutely necessary before expert help arrives.

6. Lacerations

In addition to the points that have been mentioned earlier, it might be necessary to control bleeding with sterile gauze wrapped with a bandage. However make sure the bandage isn't too tight, for it might hamper blood circulation to other parts. Immobilization of the injured part might be necessary in order to move the victim. If evacuation is likely to take time, it is extremely important to clean the wound with disinfected water. A syringe comes in very handy for this. Make sure the jet of water removes dried blood and dead tissues in addition to foreign particles.

However, do not attempt to suture the wound under any condition. Doing so outside the sterile conditions of a hospital is likely to cause more harm. It isn’t all that important anyways and can wait for evacuation support.

7. Sprains and Strains

Injured ligaments cause sprains and strains. The pain and other symptoms are very similar to a fracture and it is hard to tell the difference between the two without an X-ray.

However, RICE is great for treating sprains. Rest, Ice, Compression, and Elevation. Rest is self-evident, while ice takes care of bleeding and swelling. A bandage around the sprain will not only immobilize the injured part but will also check swelling. Elevating the injured part will reduce fluid accumulation and hence control swelling.

However, additional immobilization will be necessary for some injuries while for more serious kinds rapid evacuation must be considered.

8. Fractures

Ascertaining a fracture is not necessary for first aid. If a fracture is suspected, immediate steps had to be taken to immobilize the injured part. Make sure both joints above and below the fracture is immobilized. If proper splints are not available, use your imagination. Think metal rod inside your rucksack, backpack strap, towel, newspapers, trekking poles, fleece or cardboard boxes.

In case of open fractures, it is essential to clean the associated wound with disinfected water before attempting to straighten the break. Rapid evacuation is essential for such fractures.

Use painkillers as required for all kinds of fractures.

Health Services in Nepal

Health services for travelers is a well equipped, well experienced and streamlined operation in Nepal. Along the trail are the Lukla Hospital, Khunde Hospital, and Himalayan Rescue Association (HRA) Pheriche/Manang Aid Post. In addition to patient care, HRA is also capable of coordinating search and rescue operations in addition to evacuations. Helicopter rescue services are also one of the best this side of the world. And once in Kathmandu and Pokhara, there is the highly efficient and experienced CIWEC Hospital among others.

The bottom line: You have a pretty strong safety net.

Himalayan Rescue Association (HRA)

http://www.himalayanrescue.org/

The HRA has come a long way from its humble beginnings in 1973 to a fully equipped and efficiently run organization. The one thing that hasn’t changed is its mission to reduce casualties in the Nepal Himalayan. And through its Pheriche Aid Post, Everest Base Camp Medical Clinic, and Manang Aid Post, it has been doing just that.

Go say Hi during their daily 3 pm lectures given by volunteer doctors. More than the facilities, the volunteers who man the post have got to be the biggest asset of the HRA. They come from all around the world to help the HRA and trekkers during the high season (Sep-Dec; Mar-May).

The Pheriche Aid Post is well equipped to a point where calling it a hospital wouldn’t be an exaggeration and in case of an emergency you are guaranteed professional treatment and/or evacuation support.

Khunde Hospital

Khunde Hospital was established by Sir Hillary’s Himalayan Trust and currently provides medical services to locals and tourists alike. Between well trained local doctors and volunteer western doctors, this hospital provides exceptional facilities for its remote location. While X-rays and Ultrasound facilities have been available for some time now, a laboratory is being planned. The hospital has also done exceptional work in establishing various medical clinics and training health staffs in Khumbu.

CIWEC Hospital

http://ciwec-clinic.com/

CIWEC has been in the business of helping travelers for over 30 years now and oversees the bulk of them in Nepal. The seriousness with which they take their job is reflected in the numerous original research papers they have published.

Contact Information for Medical Facilities while Trekking in Nepal

Himalayan Rescue Association (HRA) Contact Information

Phone: +977-1-4440292 / +977-1-4440293 Fax. : +977-1-4411956 E-mail: hra@mail.com.np Dhobichaur, Lazimpat (North Gate of the Royal Palace) P.O. Box No. : 4944, Kathmandu, Nepal Pheriche Aid Post: +977-038-540214; 882687700139 Manang Aid Post: 882687700195

Khunde Hospital Contact Information

Tel: +977-038-540053, +977-038-540113

Lukla Hospital Contact Information

Phone Number: +977-038-550119 http://www.luklahospital.com/ info@luklahospital.com

CIWEC Hospital Contact Information

Kathmandu Phone: +977-1-4424111, +977-1-4424242, +977-1-4435232 Fax : +977-1-4412590 Email: info@ciwec-clinic.com Lazimpat (Opposite British Embassy) Kathmandu, Nepal

Pokhara Branch Phone: +977-61-463082, +977-61-467053 Email: pkradministrator@ciwec-clinic.com Meera Hotel Lane, Lakeside, Pokhara-6, Nepal

Nepal International Clinic Contact Information

Tel: +977-1-4434642, +977-1-4435357 Fax: +977-1-4434713 E-mail: nic@naxal.wlink.com.np, nepalinternationalclinic@gmail.com GPO BOX 3596, Lal Durbar, Kathmandu, Nepal

Contact Information of Law Enforcement Bodies

Everest Region- Contact Information for Law Enforcement Bodies

Namche Law Enforcement

Nepal Army: +977-038-540120, +977-038-540220 Police: +977-038-540099 Sagarmatha National Park Headquarters: +977-038-540114

Lukla Law Enforcement

Police: +977-038-550005 Airport: +977-038-550044

Annapurna Region- Contact Information for Law Enforcement Bodies

Chame Law Enforcement

Nepal Army: +977-066-440322 Police: +977-066-549399 ACAP: +977-061-521102, +977-061-528202

Manang Law Enforcement

ACAP: +977-019-442009 Airport: +977-019-442000

Jomsom Law Enforcement

Nepal Army: +977-069-440018 Police: +977-069-440099 ACAP: +977-069-440102 Airport: +977-069-440006

Lo Manthang Law Enforcement

Police: +977-069-440022 ACAP: 069-446517

Contact Information for Rescue in Nepal

The world’s highest rescue operation happened right here when a mountaineer was picked up at 7,000 meters on the slopes of Everest. Needless to say, you are in safe hands.

A helicopter will be on its way once the helicopter company has been assured of payment. You can do this through your credit card, trekking agency or embassy. HRA and local authorities can aid you with communication.

It usually takes about 24 hours for evacuation support to arrive. Be warned however that all rescues are weather dependent and given inclement weather it might take longer.

Helicopter Services

Fishtail Air Contact Information

24/7 Line: +977-9851062087, +977-9802062087, +977-9751000115, +977-9801000115 Office Phone Number: +977-1-4112217, +977-1-4112230, +977-1-4112463, +977-1-4112464, +977-1-4112465, +977-1-4112466, +977-1-4112467 Email: sales@fishtailair.com Website: http://www.fishtailair.com Address: P.O. Box: 5465, Gairi Gaon, Sinamangal, Kathmandu, Nepal. (Opposite to Air Cargo Division)

Altitude Air Contact Information

For Enquiry: +977-9851036218, +977-9810129861, +977-9801249907 Head Office (Landline): +977-1-4116665, +977-1-4116666 Email: altitude@altitudeheli.com Website: https://altitudeairnepal.com/ Address: P.O Box 4515, Sinamangal, Kathmandu, Nepal

Air Dynasty Contact Information

Phone No: +977-1-4497418, +977-1-4477560, +977-1-4477561, +977-1-4477562 Fax No: +977-1-4468802 Email: assistance@airdynastyheli.com Website: http://www.airdynastyheli.com Address: Post Box No. 10112 Sinamangal, Kathmandu, Nepal

Simrik Air

Lukla Airport : +977-9851010695, +977-9801123824, +977-9801123825 Pokhara Airport: +977-61-467544, +977-9851010694, +977-9801123823 Kathmandu Airport: Tel: +977-1-4483233, +977-9851010698 Other Telephone Numbers: +977-1-4155340, +977-9851010696, +977-9851010697, +977-9851203493 Head Office Phone Number: +977-1-4155341 / +977-1-4155342 / +977-1-4155343 Fax: +977-1-4155345, +977-1-4155346 Address: P.O.Box: 10288 Puspa Marg, Subidhanagar,Tinkune, Kathmandu, Nepal Email: info@simrikair.com.np Website: www.simrikair.com

Manang Air Contact Information

Phone Number: +977-1-4112317, +977-1-4112232 Fax:+977-1-4112214 PO Box:15146. TNT Building, 2nd Floor, Tinkune, Kathmandu, Nepal.

Contact Information for Embassies and Consulates in Nepal

Australia

Registration Services: https://www.orao.dfat.gov.au/orao/weborao.nsf/Homeform?Openform Tel: +977-1-4371678; +977-1-4371076; +977-1-4371678466 Fax: +977-1-4371533 Out of Hours: +977-9851026238 Email: PO Box 879, Bansbari, Kathmandu, Nepal Website: http://www.nepal.embassy.gov.au/

Austria

Tel: +977-1-4434690, +977-1-4434648, +977-1-4434860, +977-1-4434825 Fax: +977-1-4434515 Email. autconktm@wlink.com.np Mr. Laxman Babu Shrestha Honorary Consul Post Box No 4416, Naxal, Nagpokhari, Kathmandu

Bangladesh

Tel: +977-1-4390130, +977-1-4390131 Fax: +977-1-4390132 Email: mission.kathmandu@mofa.gov.bd Basundhara, Chakrapath, Kathmandu Municipality Ward No. 3 (Opposite to NABIL Bank, Dhapashi Branch) Kathmandu, Nepal

Belarus

Tel. +977-1-4258339, +977-1-4258340 Fax. +977-1-4782402

Email: consulate@muktishree.com Mr. Ajeya Raj Sumargi Parajuli Honorary Consul Post Box No. 12557, Sumargi B. Complex Babarmahal

Belgium

Tel: +977-1-4418922; +977-1-4413732 Fax: +977-1-4410330 Email: info@diplobelnepal.org Mr. Ang Tshering Sherpa Honorary Consul Post Box No 3022, Bhagawan Bahal, Thamel-Amrit Marg-643/26, Kathmandu Working Hours: Monday, Tuesday, and Thursday: 1000-1200 hrs Wednesday and Friday: 1400-1600 Hrs

Brazil

Tel: +977-9801032381, 9801032380 Fax: Email: brasemb.katmandu@itamaraty.gov.br (General), consular.katmandu@itamaraty.gov.br (Consular), thadeu.franca@itamaraty.br; thadeu.franca@itamaraty.br POBox 19299 Chundevi Marg, House no. 155 Maharajgunj

Bulgaria

Tel: +977-1-4220245 Ext. 23, +977-1-4229335(direct) Fax: +977-1-4221180 Email. bthapa@president.com.np Mr. Bhola Bikram Thapa Honorary Consul Post Box No 1307, Durbar Marg, Kathmandu Working Hours: Monday-Friday: 1000-1700 Hrs

Canada

Registration Services: http://travel.gc.ca/travelling/registration Tel: +977-1-4441976 Fax: +977-1-4434713 Out of hours: +1-613-996-8885 Email: canadaconsul@mail.com.np Dr. Buddha Basnyat PO Box 3596, 47 Lal Durbar Marg, Kathmandu, Nepal

Chile

Tel. +977-1-4221637, +977-1-4221585, +977-1-4243593 Fax. +977-1-4220178 Email. temtig@mos.com.np Mr. Basant Raj Mishra Temple Tiger Venture Travels, P.O. Box 3968 Kantipath, Kathmandu. Working Hours: Monday to Friday: 0900 hrs–1300 hrs

China

Tel: +977-1-4419389; +977-1-4411740 Fax: +977-1-4414045 Out of hours: +977-9851071888(24 hours) Email: chinaemb_np@mfa.gov.cn http://np.china-embassy.org/eng/ Baluwatar, Kathmandu

Croatia

Tel: +977-1-4228541, +977-1-4225414, +977-1-4015551, +977-1-4373134 Fax: +977-1-4225974, +977-1-4015552 Email. corporate@ugnepal.com; honcroconsulate@ugnepal.com Mr. Amir Pratap JB Rana Honorary Consul Post Box No 3787, Kamaladi, Kathmandu Working Hours: Monday to Friday: 1000 hrs–1300 hrs

Cyprus

Tel. +977-1-4225490, +977-1-4226327, +977-9851020435, Fax. +977-1-4226314 Email. pjyoti@mail.com.np Mr. Padma Jyoti Honorary Consul Post Box No 133, Jyoti Bhawan, Kantipath, Kathmandu Working Hours: Monday to Thursday: 1100 hrs – 1400 hrs

Czech Republic

Tel. +977-1-4259528, +977-1-4261160, +977-1-4261847 Fax. +977-1-4248001, +977-1-425893 Email. kathmandu@honorary.mzv.cz, vka@mawnepal.com Mr. Vishnu Kumar Agarwal Honorary Consul Post Box No 1452, Tripushwor, Teku Road, Kathmandu Working Hours: Monday to Friday: 1000 hrs–1300 hrs

Denmark

Tel: +977-1-4413010 Fax: +977-1-4411409 Email: ktmamb@um.dk Website: http://nepal.um.dk/ P.O. Box 6332 Lazimpat, Kathmandu, Nepal

Egypt

Tel: +977-1-5524640; +977-1-5590166; +977-1-5590544 Fax: +977-1-5592661 Email: embassy.kathmandu@mfa.gov.eg Website: http://www.mfa.gov.eg/kathmandu_Emb Sainbu, Bhaisepati, P.O Box 792, Kathmandu.

Estonia

Tel: +977-1-4436900, +977-1-4436650 Fax: +977-1-4415380 Out of Hours: +977-9851031532, +977-9751031532 Email. navaconsulest@gmail.com, envtrek@wlink.com.np Website: www.estoniaconsulate.org.np Mr. Nava Raj Dahal Honorary Consul Consulate of the Republic of Estonia P.O. Box 25728 Tridevi Marg, Thamel, Kathmandu Nepal

Finland

Tel: +977-1-4416636; +977-1-4417 221 Fax: +977-1-4416703 Emergency Calls: +358916055551 Email: sanomat.kat@formin.fi Website: www.finland.org.np Bishalnagar, G.P.O. Box 2126 Kathmandu Nepal

France

Tel: +977-1-4412332; +977-1-4414734, +977-1-4413839, +977-1-4418034 Fax: +977-1-4419968 Out of hours: +977-9851017201 Email: ambassade@ambafrance-np.org Website: http://www.ambafrance-np.org/ Lazimpat - BP 452 - Kathmandu - Nepal

Germany

Registration Services: https://service.diplo.de/elefandextern/home/registration!form.action Tel: +977-1-4217200 Fax: +977-1-4416899 Out of hours: +977-9851137942, +977-9851137942 Email: info@kathmandu.diplo.de Website: http://www.kathmandu.diplo.de P.O Box 226 Gyaneshwar, Kathmandu, Nepal.

Greece

Tel: +977-1-5545999 Fax: +977-1-5539 900 Email. consulate.office@greecenepal.com Mr. Bikram Pandey Honorary Consul Nuwakott Ghar, Sanepa Chowk (along Shuvatara School Road), Lalitpur - 2 Kathmandu Nepal

Hungary

Tel. +977-1-5527370, +977-1-5522871, +977-1-5526894, +977-1-5521311 Fax. +977-1-5524139, +977-1-5521291 Email. info@nbe.com.np Mr. Chandra Shekhar Gyawali Honorary Consul Oasis 49 Dhara, Patan Dhoka, Lalitpur, GPO Box 1357, Kathmandu Working Hours: Sunday to Friday: 0900 hrs–1700 hrs

India

Tel: +977-1-4410900; +977-1-4414990, +977-1-4411699 Fax: +977-1-4428279 P.O. Box. 292 336 Kapurdhara Marg, Lainchaur, Kathmandu

Indonesia

Tel. +977-1-4002581 Fax: +977-1-4002584 Email: indoconsulate@imeremit.com, indoconsulate@gmail.com Mr. Chandra Prasad Dhakal IME Complex Panipokhari, Kathmandu

Israel

Tel: +977-1-4411811; +977-1-4413419, +977-1-4419103 Fax: +977-1-4413920 Email: info@kathmandu.mfa.gov.il Website: http://kathmandu.mfa.gov.il Bishramalaya House, PO Box 371, Lazimpat, Kathmandu, Nepal

Italy

Tel: +977-1-4252801, +977-1-4252804 Fax: +977-1-4255218 Email. consulateofitaly@mos.com.np Mr. Ravi Bhakta Shrestha PO Box 1097, I. J. Plaza, 1st Floor, Teendhara Pathshala, Durbar Marg, Kathmandu Working Hours: Monday and Thursday: 1000 hrs-1200 hrs

Japan

Tel: +977-1-4426680 Fax: +977-1-4414101 Email: culjpn@mos.com.np Website: http://www.np.emb-japan.go.jp P.O.Box No. 264 Panipokhari, Kathmandu, Nepal.

Korea, North

Tel: +977-1-5521855 Fax: +977-1-5525394 Email: rimnine@wlink.com.np Bakhundole, Lalitpur

Korea, South

Tel:; +977-1-4270172, +977-1-4270417, +977-1-4277391, +977-1-4270058 Fax: +977-1-4272041 Email: konepemb@mofa.go.kr Website: http://npl.mofa.go.kr/english/as/npl/main/index.jsp Rabi Bhawan, Kathmandu, Nepal.

Lithuania

Tel. +977-1-4700275, +977-1-4700276, +977-1-4700274701135 Fax. +977-1-4700045, +977-1-4355074 Email. nepaltur@mos.com.np Website: http://www.urm.lt/ Mr. Rameswor Sapkota Honorary Consul Bld. # 120, Nurshing Chowk, Thamel, P O Box # 2107, Kathmandu

Luxembourg

Tel. +977-1-5007503, +977-1-5007504, +977-1-5549740 (O), +977-1-5525984 (R) Fax. +977-1-5007689 (O) Out of Hours: +977-9851021047 Email. shreeramanju@gmail.com Mr. Shree Ram Lamichhane Honorary Consul Anjushree Building, Gwarko (next to B&B Hospital), P O Box 2354, Kathmandu Working Hours: Monday to Friday: 1000 hrs–1200 hrs

Malaysia

Tel: +977-1-5010004; +977-1-5010005 Fax: +977-1-5010492 Out of Hours: (Emergency Only): +977-9801008000 Email: mwkathmandu@kln.gov.my Website: http://www.kln.gov.my/web/npl_kathmandu/home 2nd Floor, Block B, Karmachari Sanchaya Kosh Bhawan, P.O. Box 24372 Pulchowk, Lalitpur, Kathmandu

Maldives

Tel. +977-1-5525171 Fax. +977-1-5527364 Email. nirvana@chaudharygroup.com Mr. Nirvana Chaudhary, Honorary Consul Chaudhary House, Sanepa Lalitpur, Nepal

Malta

Tel. +977-1-4255687, +977-1-4255842, +977-1-4430413, +977-1-4278721 Fax: +977-1-4256186 Email: maltaconsul.kathmandu@gov.mt; dinesh.shrestha@shresthacompany.com.np, dinesh@pacific-nepal.com Website: pacific-nepal.com Mr. Dinesh Shrestha Honorary Consul P. O. Box No. 1011, Pacific Building Ramshah Path, Kathmandu.

Mongolia

Tel: +977-1-4915373, +977-1-4915432 Fax: +977-1-4915625 Mobile: +977-9851020848 e-mail: mongol_con@wlink.com.np samling@mos.com.np Mr. Tsetan Gyurman Shrestha Boudha Tinchuli K T M.Nepal, G.P.O Box 2534, Nepal

Morocco

Tel. +977-1-4416775, +977-1-4221260 Fax. +977-1-4410959, +977-1-4226293 Email. consul.morocco@chaudharygroup.com

Mr. Basant K. Chaudhary PO Box 648 Thamel, Kathmandu

Myanmar

Tel: +977-1-5592774; +977-1-5592841 Fax: +977-1-5592776 Email: myanmaremb@wlink.com.np NAKHKHU HEIGHT, LALITPUR, KATHMANDU, G.P.O.Box 2437

Netherlands

Tel: +977-1-5523444 Fax: +977-1-5523155 Email. consulate@nlconsulate.org.np Website: www.netherlandsconsulate.org.np Po Box 1966, Bakhundole Height, Lalitpur, Nepal. Working Hours: Monday to Friday, 0830 hrs – 1700 hrs

New Zealand

Tel. +977-1-4426427 Fax: +977-1-4361600 Out of Hours: +977-9849786967 Email: nzconsulate@tigermountain.com.np Ms. Lisa Choegyal P. O. Box 2018, Tiger Mountain Pvt Ltd, Ramalaya, Panipokhari, Kathmandu

Norway

Tel: +977-1-5545307 Fax: +977-1-5545226 Out of hours: +977-1-5545307 (Press 5 after office hours) +977-9851134289; +977-9851022414 Email: emb.kathmandu@mfa.no Website: http://www.norway.org.np/ P.O.Box 20765 Kathmandu, Nepal. Surya Court, Pulchowk, Lalitpur

Pakistan

Tel: +977-1-4374024, +977-1-4374016 Fax: +977-1-4374012 Email: pakembktm@gmail.com Website: http://www.mofa.gov.pk/nepal Pushpanjali, Maharajgunj Chakrapath, Kathmandu (Nepal), P.O. Box No. 202

Peru

Tel: +977-1-4241504, +977-1-4225284 Fax: +977-1-4225538 Email: info@msgroup.com.np Mr. Sumit Kumar Agarwal House No. - 149/13 (Kha), Jhochhen Tole Basantapur, Kathmandu Po Box 556, Shiva Arcade, Basantapur, Kathmandu, Nepal.

Philippines

Tel: +977-1-4478301, +977-1-4478302, +977-1-4372800 Fax: +977-1-4486243 Email. philcongen@voith.com.np Website: www.voith.com.np/philcongen Mr. Suraj Vaidya P O Box 2640, VOITH Complex, Sinamangal, Tinkune, Kathmandu Working Hours: Monday to Friday: 0900 hrs - 1500 hrs

Poland

Tel. +977-1-4249114, +977-1-4250001 Fax. +977-1-4249723 Email. lmg@golchha.com, polishcounsulatenepal@gmail.com Mr. Lokmanya Golchha P.O.Box-363, Golchha House, Ganabahal, Kathmandu Working Hours, Sunday to Friday 10.00 hrs 13.00 hrs

Portugal

Tel: +977-1-4446400, +977-1-4446401, +977-1-4446402 Fax: +977-1-4444443 Email: R@rkhetan.com Mr. Rajendra Kumar Khetan Post Box No 6156, Corporate House, Hattisar, Kathmandu Working Hours: Monday to Friday: 1000 hrs – 1500 hrs

Romania

Tel: +977-1-4446407 Fax: +977-1-4444366 Email. romania@itni.com.np Mrs. Sarika Khetan Laxmi Bank Building, Hattisar, Kathmandu

Russia

Tel: +977-1-4412155; +977-1-4411063 Fax: +977-1-4416571 Out of hours: +977-9801047187 Email: ruspos@info.com.np Po Box 123, Baluwatar, Kathmandu.

Slovakia

Tel.: +977-1-4421541, +977-1-4422656 Fax.: +977-1-4427067, +977-1-4479664 E-mail: skconsulate_sat@wlink.com.np Pasang Dawa Sherpa P. O. Box 1358 Dobichaur, Lazimpat, Kathmandu, Nepal

South Africa

Tel: +977-1-5523957, +977-1-5549876 (O), +977-1-5545075 (R) Fax: +977-1-5526529 Email. honsa@panchakanya.com.np Mr. Pradeep Kumar Shrestha Post Box No. 2743, Panchakanya Bhawan, Krishna Galli, Pulchowk, Lalitpur Working Hours: Sunday to Friday: 0930 hrs–1730 hrs

Spain

Tel. +977-1-4473724, +977-1-4470770 Fax. +977-1-4471379, +977-1-4471378 Email. dwarikas@mos.com.np Mrs. Ambica Shrestha Post Box No 459, Battisputali, Kathmandu Working Hours: Monday to Friday: 0900 hrs–1700 hrs

Sri Lanka

Tel: +977-1-4720623; +977-1-4721389 Fax: +977-1-4720128 Email: lankaemb@wlink.com.np Website: http://www.slembktm.com/ P.O Box No. 8802, Kathmandu, Nepal Shiv Ashish Niwas, Gairi Marg, Chundevi Road, Maharajgunj, Kathmandu

Sweden

Tel: +977-1-4220939, +977-1-4221287, +977-1-4720251 Fax: +977-1-4221826 Email. meerahome@wlink.com.np Mr. Gajendra Bahadur Shrestha Meera Home, Khichapokhari, Kathmandu Working Hours: Monday to Friday: 1000 hrs–1230 hrs

Switzerland

Registration Services: https://www.itineris.eda.admin.ch/home Tel: +977-1-5524927; +977-1-5524928; +977-1-5549225 Fax: +977-1-5525358 Out of hours: +977-9851034617 Email: kathmandu@eda.admin.ch Websites: https://www.eda.admin.ch/countries/nepal/en/home/representations/embassy-kathmandu.html https://www.eda.admin.ch/countries/nepal/en/home/representations/cooperation-office.html Ekantakuna, Jawalakhel P.O. Box 113, Kathmandu, Nepal

Thailand

Tel: +977-1-4371410; +977-1-4371411 Fax: +977-1-4371408; +977-1-4371409 Email: thaiemb@thaiembnepal.org.np Website: http://www.thaiembnepal.org.np/ P.O. Box 3333 167/4 Ward No. 3, Maharajgunj, Bansbari Road

Turkey

Tel: +977-1-4444445, +977-1-4444322, +977-1-4444323 Fax: +977-1-4444443 Email: mgk@khetan.com.np; mtcn@khetan.com.np P.O. Box 4140 Hattisar, Kathmandu, Nepal.

Ukraine

Tel: +977-1-4416544, +977-1-4416767, +977-1-4437901 Fax: +977-1-4421845 Email. vaidya@ccsl.com.np, vaidyamail@gmail.com, info@ukraineconsulatenepal.org Mr. Kiran Vaidya P.O. Box 3843, House No. 122, Bhagwan Marg, Narayan Chour, Naxal, Kathmandu, Nepal Working Hours: Monday to Friday: 1000 hrs–1300 hrs

UK

Tel: +977-1-4410583; +977-1-4414588; +977-1-4411281 Fax: +977-1-4411789, +977-1-4416723 Out-of-hours: +977-1-4422294 Email: BEKathmandu@fco.gov.uk PO Box 106 Lainchaur Kathmandu Nepal

USA

Registration Services: https://step.state.gov/step/ Tel: +977-1-4234000; +977-1-4234500 Fax: +977-1-4007272 Out-of-hours emergency: +977-1-400-7266, +977-1-400-7269 Email: usembktm@state.gov; consktm@state.gov Website: www.nepal.usembassy.gov Maharajgunj, Kathmandu, Nepal.