The best way to avoid developing diarrhea during your visit to Nepal is to avoid eating raw vegetables and unpeeled fruits and to drink only treated water, hot drinks, or bottled drinks (avoid ice). Plenty of soft drinks are available, as well as bottled water (mineral water), sparkling water (soda), beer, and juices. You will find that any restaurant in Kathmandu that caters to tourists will claim to use boiled and filtered water and will also claim to treat its vegetables with a sterilizing solution.

This is usually true and you can usually get away with eating salads and drinking iced drinks at these establishments. However, there are still risks involved. Why take a chance on getting diarrhea just so you can eat a pile of shredded cabbage and a slice of tomato (this is what most salads consist of in Nepal)? If you're at the start of a trip, it pays to be cautious. Remember that almost no one leaves Nepal without having some sort of stomach problems, so plan a few sick days into your schedule if you can. Though you may be tempted, you should also avoid cheesecakes and meringue pies while in Nepal. Salmonella bacteria favor these two items.

The next-most-important thing to remember is to wash your hands before you eat. This may sound simple, but it is not always easy, especially when you're trekking. Nepalis always wash their hands, or at least rinse them, before eating because they eat with their fingers. Moist towelettes or sterilizing gel will be invaluable.

Unfortunately, what is commonly contracted in Nepal is not always the simple traveler's diarrhea that goes away after a few days. Doctors in Nepal clinics have found that the majority of cases of diarrhea require treatment with antibiotics. If you develop diarrhea, it is very important to drink enough fluids to avoid dehydration. Packets of oral rehydration salts added to drinking water will help to replenish salts and electrolytes lost by your body. These packets are readily available for only a few cents per package all over Nepal. In the West, the same salts are difficult to find and are often very expensive.

Here are a number of ways to deal with diarrhea, depending on its severity. The first line of defense should be Pepto-Bismol tablets, which are unavailable in Nepal, so be sure to bring some from home. If the diarrhea becomes so severe that it is difficult to stay hydrated, an antidiarrheal drug such as Imodium, Lomotil, or codeine can be taken. Such drugs are not antibiotics and only treat symptoms, but they're particularly helpful if travel is necessary. If diarrhea is due to food poisoning, though, these drugs can be harmful. Remember, too, that codeine is a narcotic and can become addictive if taken over a long period.

Food Poisoning. Salmonella is the most common cause of food poisoning in Nepal. It is caused by a bacteria found in chickens and therefore in egg products. Fresh-cooked eggs are rarely a problem, but dishes such as cheesecake and meringue pie commonly support the growth of salmonella. It's best to avoid these two treats. The symptoms of salmonella are severe stomach cramps, diarrhea, vomiting, fever, and chills. Luckily, these all pass within 24 hours. Antidiarrheal drugs such as codeine, Imodium, and Lomotil should never be taken if salmonella poisoning is suspected. To treat salmonella, drink as much liquid as possible.

Bacterial Diarrhea. Of all the possible causes of diarrhea, bacterial infection is by far the most common. This is caused by a proliferation of a usually harmless form of E. coli bacteria. Because E. coli in Nepal has developed a resistance to the antibiotic sulfamethoxazole-trimethoprim (SMZ-TMP), which is marketed in the United States under the trade names of Septra and Bactrim, the most common way to treat bacterial diarrhea in Nepal is with Norfloxacin or Ciprofloxacin (both readily available).

Amoebic Dysentery. Though this is one of the most dreaded of diseases among travelers to the tropics, amoebas can be easily treated if diagnosed. The problem is that amoebas are often difficult to detect. If left untreated, they will migrate to the liver and cause damage, so it is very important that you let your doctor know that amoebic dysentery is a possibility should you develop diarrhea after leaving Nepal. Symptoms of amoebic dysentery include abdominal pain, diarrhea (frequently with blood or pus in the stool), lethargy, and fever. In Nepal, the recommended treatment for amoebic dysentery is tinidazole (marketed in Nepal as Tiniba). In the United States, where tinidazole is not available, Flagyl is the recommended drug.

Giardiasis. Another cause of long-term diarrhea, giardiasis is caused by a protozoan and is quite common in Nepal. Giardiasis is spread by water and food that has been contaminated with the cysts of the giardia organism; it has an incubation period of 7 days. Therefore, if you develop diarrhea on your second or third day in Nepal, giardiasis is not the cause. Common symptoms of giardiasis are a violent bubbling in the intestines accompanied by pain in the upper part of the abdomen. Diarrhea may come and go and often occurs only in the morning. Should you develop diarrhea after returning home, it is important that you tell your doctor that giardiasis is a possibility. In the United States, giardiasis is usually treated with the drug Flagyl, but in Nepal, the recommended treatment is tinidazole (marketed as Tiniba).

 All of the immunizations for the various diseases listed below are available at either of these clinics, and both use disposable needles and vaccines manufactured in Europe or North America.
 

The majority of illnesses in Nepal are spread by unsanitary conditions, particularly contaminated water. Consequently, it is important to take special precautions to ensure that your drinking water is safe. The best precaution is not to drink any water unless you have purified it yourself, or know that it has been boiled. Do not drink tap water; even bottled water in Nepal is suspect because bottles, especially out on the trekking routes, are sometimes refilled with unsafe water.

Water purification can be done in a number of ways, but boiling it for 20 minutes is the most common method. This is generally not something you can do yourself, and not something you can count on a Nepali to do for you-boiling water for 20 minutes will seem like a waste of precious fuel. Milk tea is the most common drink in Nepal and it's made with boiled water, though whether it has been boiled long enough to kill bacteria and other organisms is never certain. There is a risk with drinking tea, but a relatively low one.

A much better method of purifying water is with iodine, though some people don't like the taste of iodized water. Iodine, which is a poison and should never be taken internally at its full strength, comes in solutions of varying strengths. Use 8 drops of tincture of iodine (a 2% solution) or 4 drops of Lugol's solution (the most common form of iodine in Nepal) to sterilize a quart or liter of water.

Water-purification tablets are another option. There are two types available, but only one of them, tetraglycine hydroperioiodide, is effective for purifying water in Nepal. Chlorine tablets, which are the most common form of water-purification tablets, are not effective at killing amoebic cysts.

Portable water filters, which have become popular among backpackers in the United States, will filter out bacteria, amoebas and their cysts, and giardia and their cysts, but not the hepatitis virus. With this limitation, these filters are useless in Nepal, where hepatitis is prevalent. However, a two-stage filter which filters and iodinizes water is effective against the hepatitis virus. Look for these filters at large camping-supply stores.

GOLDEN RULE # 1

If you feel unwell at Altitude, it is Altitude Sickness until proven otherwise.

GOLDEN RULE # 2

Never ascend with symptoms of AMS

GOLDEN RULE # 3

If you are getting worse or have (HACE or HAPE), go down at once !!!

The concentration of oxygen at sea level is about 21% and the barometric pressure averages 760 mmHg. As altitude increases, the concentration remains the same but the number of oxygen molecules per breath is reduced. At 12,000 feet (3,658 meters) the barometric pressure is only 483 mmHg, so there are roughly 40% fewer oxygen molecules per breath. In order to properly oxygenate the body, your breathing rate (even while at rest) has to increase.

Since the amount of oxygen required for activity is the same, the body must adjust to having less oxygen. In addition, for reasons not entirely understood, high altitude and lower air pressure causes fluid to leak from the capillaries which can cause fluid build-up in both the lungs and the brain. Continuing to higher altitudes without proper acclimatization can be life-threatening

The major cause of altitude illnesses is going too high too fast. Given time,  your body can adapt to the decrease in oxygen molecules at a specific altitude.  This process is known as acclimatization and generally takes 1-3 days at that  altitude. For example, if you hike to 10,000 feet (3,048 meters), and spend  several days at that altitude, your body acclimatizes to 10,000 feet (3,048  meters). If you climb to 12,000 feet (3,658 meters), your body has to  acclimatize once again.

Prevention of altitude illnesses falls into two categories, proper acclimatization and preventive medications. Below are a few basic guidelines for proper acclimatization.

• If possible, don't fly or drive to high altitude.
• Start below 10,000 feet (3,048 meters) and walk up.
• If you do fly or drive, do not over-exert yourself or move higher for the first 24 hours.
• If you go above 10,000 feet (3,048 meters), only increase your altitude by 1,000 feet (305 meters) per day and for every 3,000 feet (915 meters) of elevation gained, take a rest day.
• "Climb High and sleep low." This is the maxim used by climbers. You can climb more than 1,000 feet (305 meters) in a day as long as you come back down and sleep at a lower altitude.
• If you begin to show symptoms of moderate altitude illness, don't go higher until symptoms decrease (&quotDon't go up until symptoms go down"). If symptoms increase, go down, down, down! Keep in mind that different people will acclimatize at different rates.
• Make sure all of your party is properly acclimatized before going higher. Stay properly hydrated. Acclimatization is often accompanied by fluid loss, so you need to drink lots of fluids to remain properly hydrated (at least 3-4 quarts per day).
• Urine output should be copious and clear. Take it easy; don't over-exert yourself when you first get up to altitude.
• Light activity during the day is better than sleeping because respiration decreases during sleep, exacerbating the symptoms.
• Avoid tobacco and alcohol and other depressant drugs including, barbiturates, tranquilizers, and sleeping pills. These depressants further decrease the respiratory drive during sleep resulting in a worsening of the symptoms.
• Eat a high carbohydrate diet (more than 70% of your calories from carbohydrates

Mild AMS. The only cure is either acclimatization or descent. Symptoms of Mild AMS can be treated with pain medications for headache and Diamox. Both help to reduce the severity of the symptoms, but remember, reducing the symptoms is not curing the problem. Diamox allows you to breathe faster so that you metabolize more oxygen, thereby minimizing the symptoms caused by poor oxygenation. This is especially helpful at night when respiratory drive is decreased.

Since it takes a while for Diamox to have an effect, it is advisable to start taking it 24 hours before you go to altitude and continue for at least five days at higher altitude. The recommendation of the Himalayan Rescue Association Medical Clinic is 125 mg. twice a day (morning and night).  Possible side effects include tingling of the lips and finger tips, blurring of vision, and alteration of taste. Side effects subside when the drug is stopped.

Contact your physician for a prescription. Since Diamox is a sulfonamide drug, people who are allergic to sulfa drugs should not take Diamox. Diamox has also been known to cause severe allergic reactions to people with no previous history of Diamox or sulfa allergies.

Moderate AMS includes severe headache that is not relieved by medication, nausea and vomiting, increasing weakness and fatigue, shortness of breath, and decreased coordination (ataxia). Normal activity is difficult, although the person may still be able to walk on their own. At this stage, only advanced medications or descent can reverse the problem. Descending even a few hundred feet (70-100 meters) may help and definite improvement will be seen in descents of 1,000-2,000 feet (305-610 meters). Twenty-four hours at the lower altitude will result in significant improvements.

The person should remain at lower altitude until symptoms have subsided (up to 3 days). At this point, the person has become acclimatized to that altitude and can begin ascending again. The best test for moderate AMS is to have the person "walk a straight line" heel to toe. Just like a sobriety test, a person with ataxia will be unable to walk a straight line. This is a clear indication that immediate descent is required. It is important to get the person to descend before the ataxia reaches the point where they cannot walk on their own (which would necessitate a litter evacuation).

• Acclimatization. There are no specific factors such as age, sex, or physical condition that correlate with susceptibility to altitude sickness.
• Causes. The major cause of altitude illnesses is going too high too fast.
• Prevention. "Climb High and sleep low." This is the maxim used by climbers.
• Prevention. Avoid tobacco, alcohol and other depressant drugs including, barbiturates, tranquilizers, and sleeping pills.
• Diamox allows you to breathe faster so that you metabolize more oxygen, thereby minimizing the symptoms caused by poor oxygenation.
• Dexamethasone (a steroid) is a prescription drug that decreases brain and other swelling reversing the effects of AMS.
• Basic Treatment. The only cure is either acclimatization or descent. Symptoms of Mild AMS can be treated with pain medications for headache and Diamox. Both help to reduce the severity of the symptoms, but remember, reducing the symptoms is not curing the problem.
• Moderate AMS. Moderate AMS includes severe headache that is not relieved by medication, nausea and vomiting, increasing weakness and fatigue, shortness of breath, and decreased coordination (ataxia).  At this stage, only advanced medications or descent can reverse the problem.
• Severe AMS. Severe AMS requires immediate descent to lower altitudes (2,000 - 4,000 feet [610-1,220 meters]).
• HAPE. Anyone suffering from HAPE must be evacuated to a medical facility for proper follow-up treatment.
• HACE. Severe instances can lead to death if not treated quickly. Immediate descent is a necessary life-saving measure

There are two distinct seasons: the rainy monsoon season and the dry season. The monsoon begins as early as late April or early May in the Kathmandu Valley, and as late as mid-June in the Terai. Rains, though not as torrential as farther south in India, are constant and steady.

This is the main growing season in Nepal and the time of year with the fewest visitors. The rains continue until mid-October with a gradual slacking off beginning as early as late September. With the end of the monsoon, the cool, dry season begins.

Mid-October to mid-December is the prime time to visit Nepal, whether you're trekking or simply sightseeing. The sky is a clear blue, and the mountains are visible almost daily. Temperatures even at 13,000 feet rarely go below freezing during the day, and in the Kathmandu Valley it can be warm enough for shorts and T-shirts.

From mid-December to late January, there is a slight chance of frost in the Kathmandu Valley, and it can get well below freezing higher up in the mountains. There is still good trekking at lower elevations, and fewer people visit at this time. This is my favorite time to visit, though the country is quite dry and brown by November.

 From February to March, the weather begins to warm up, and the skies are sometimes cloudy, although there are still quite a few clear days.

March to April is the second-most-popular time for trekking, though haze often obscures the mountains and it can be much too hot to trek at lower elevations. In May the weather even in Kathmandu or Pokhara can be uncomfortably hot, and in the Terai temperatures it can reach more than 110°F.

Nepal is the country of extremes. The low-land plains of the Terai can have tropical temperatures and also the mosquitoes. The Himalayas can get to sub-zero temperatures, but the sun blaze can bring some warmth during the day, even in the mountains. The temperature of Kathmandu goes below 1 Degree Celsius (34 Degree Fahrenheit) in winter and rises to an average of 25 Degree Celsius (77 Degree Fahrenheit) in summer.

During the rainy monsoon season between June to August, it rains to an average between   200-375 millimeters in Kathmandu. There is occasional rainfall during the other seasons too.     In an average, 1300 millimeters of rain falls in Kathmandu every year.

Monsoon in Nepal is not the typical monsoon of Asia. Rains usually occur during the night-time leaving the sky clean and clear by the morning making the Himalayan view even more dramatic. Some parts of the Himalayas in Manang, Mustang and Dolpo are in rain-shadow areas; the mountains are high enough to block the clouds. Tibet's high travel season also corresponds to Nepal’s monsoon.

General Conditions

Environment
We use Kerosene-burning brass stoves or Gas and we adhere to strict environmental policies as well as cultural codes on all of our trips.

Prices
Prices are based on known costs at the present year.

Price changes
The prices quoted by Mount Meru Treksl are based on airfares, exchange rates and costs in effect on the date shown. We reserve the right to alter our prices if these rates change substantially. We may also apply surcharges in the event of significant changes in airfare, government regulations and taxes. Mount Meru Treks cannot make refunds to travelers/trekkers who are adversely affected by changes in exchange rates.

Passports & Visas
A passport valid for all countries to be visited must be carried.

Accident or loss
We have no liability for loss, damage, delay, inconvenience, or direct or consequential loss, however caused, unless due to our employees' negligence, in which case our liability is limited (except for death or personal injury) to a maximum of the refund of the tour cost. We do not own or manage the vehicles, accommodation, and restaurants used and we have no liability for loss or damage caused by the proprietors or operators thereof.

Extra cost
Extra cost due to unforeseen expenses that may arise due to factors beyond our control like landslides, political unrest, personal illness are not our responsibility.
Breaking of tours & trekking
Any tour or trekking can be broken at the wish of our client(s) or in the case of sickness, accident, landslides, and other factors beyond our control. No refund will be made and clients should bear his/her expenses for the remaining days.

What the cost includes and excludes
This is specifically stated on each itinerary.

Responsibility

Mount Meru Treks reserves the right to refuse to continue to carry any client causing inconvenience or annoyance to other travelers/trekkers, or creating difficulties that would hamper the smooth running of a trip.

We shall not be liable for any loss or damage to baggage or personal possessions, or any consequential losses incurred as a result. If a traveler/trekker is injured or becomes ill, all evacuation and hospital expenses, doctors' fees and repatriation costs are the traveler/trekker's responsibility, and Mount Meru Treks shall not be liable for any refund of the cost of the treks or tours.

It is the traveler/trekker's responsibility to have valid passports and all visas and equipment that may be required on the selected tour. We do not accept responsibility for failure to obtain these visas for any reason, and we do not accept responsibility for any passports or documents left with us for this purpose.

Assumption of risk

The traveler/trekker understands that during the course of the trip, certain risks and dangers may occur, including, but not limited to, the hazards of traveling in mountainous terrain, accident or illness in remote places without medical facilities, and the forces of nature.

 The traveler/trekker agrees to assume all risks associated with the journey, and agrees that no liability will be attached to the company or its outfitters, employees or agents, or to any member of the tour group in respect to death, personal injury, illness or delay of traveler/trekker, or for any loss or damage to the property of the traveler/trekker during the course of the trip, howsoever caused.

Liability

1)Mount Meru Treks aims for the fulfilment of your every desire. In this connection, we perform our duties honestly and seriously to make your experience smooth and pleasant.

However, Mount Meru treks will not take any responsibility regarding changes and alternations in the itinerary due to unavoidable circumstances such as land-slides, road blockage, flood, snow, political unrest, cancellation of flight, delay arrival, sickness or accidents. Any extra cost incurred thereof shall be borne by the clients on the spot.

 All clients are advised to take out their own insurance to adequately cover against medical and personal accident risk.

2)Mount Meru Treks, while undertaking tours, transportation, hotel accommodation and other services only acts as an agent on the clear understanding that it shall not be, in any way, responsible or liable for any accident, damages, loss, delay, international flight cancellation/delays, or inconvenience caused in connection with the travel facilities arranged by the company, its employees or agents.

All bookings are accepted and executed with utmost care, yet no responsibility is undertaken for any change or deviation on account of factors beyond our control. .Mount Meru Treks reserves the right to modify any arrangements required by and made on behalf of the clients and to cancel the same without prior notice.

Insurance

It is a condition while booking treks and tours with Mount Meru Treks that travelers/trekkers must be protected by insurance themselves that covers cancellation, accidents, health, emergency evacuation, and loss of items, theft of or damage to baggage and personal effects.

All costs for emergency evacuation must be paid in cash in Nepal unless an insurance company has agreed to pay the costs on your behalf. It is important that any insurance policy issued to cover emergency evacuation for trek/tour does not exclude alpinism or mountaineering.
Read more
 

Health, fitness and safety

We strongly recommend a visit to your doctor and dentist before your holiday. Your doctor will advise current inoculation requirements. If a doctor has recommended against travel or indicated travel may be inconvenient then inform us of the details.

 On all trekking and exploratory trips our staff have been trained to strict hygiene standards. We carry extensive medical kits and, if the need should ever arise, we are able to evacuate seriously ill group members by helicopter. We run regular first aid courses for all trekking guides.

Note
Mount Meru Treks can facilitate optional emergency helicopter rescue insurance.
(If selected on the booking form)

Booking & payment

Booking
Reserve your trek by making a preliminary booking on this web site. A preliminary booking is not a final booking and does not require any pre-payment or financial commitment.

Note
You will receive final confirmation of your booking via email after we receive a copy of your international flight ticket by email or fax.

Please remember to write your booking-ID on the international flight confirmation. You will find your booking-ID on the preliminary summary booking which you will receive by email after submitting your online booking at www.mountmerutreks.com.

International flight confirmation:
By email: click here
By fax: +1-503-646-1962


Payment Options
- Pay upon arrival in Nepal with cash (USD, AUD or Euros)
- Pay prior to arrival by wire transfer or credit card (PayPal)
- Pay by check (U.SCanada residents) 14 days prior to arrival

ATMs are available in Kathmandu to obtain local currency. Currency exchanges will also accept credit cards for cash advances in western and local currency.

Delays and itinerary changes

The traveler/trekker specifically agrees that MountMeru Treks shall not be held responsible for any delays or changes in itineraries caused by an act, omission or other circumstances on the part of domestic airlines or helicopter companies in Nepal; the trekkers/travelers understand that such situations may occur, and that we will not be able to inform them of each possible problem.

The itinerary, highlights and excursions as set out in the itinerary,s will be adhered to as far as possible, but these are to be used as a guide only. The company or trek staff may make omissions or alterations to the itinerary, highlights, and excursions as they deem it to be necessary. Some highlights or excursions may be inaccessible for any number of reasons.

Internal transport within Nepal.
This is as indicated by the itinerary and includes domestic flights where necessary. Note that bad weather in mountainous regions can cause flight delays. If you are delayed by bad weather prior to trek departure we will meet your accommodation costs.

If the delay is extended by two days it may be necessary for us to re-route the trek, perhaps to an area more accessible by road. If you are delayed by bad weather at the end of the trek we will meet your accommodation and food costs for the basic tour dates

. Unfortunately we cannot accept responsibility for charges incurred as a result of missed international flight connections. However we will help you to organise your ongoing arrangements. In this situation we would recommend that you make a claim against your insurance policy.

Mountain flight delays in Nepal
Bad weather in the mountains can cause flight delays. This mainly applies to Jumla (Simikot), Juphal, Jomsom, Lukla, Tumlingtar and Taplejung in Nepal. Some treks have built-in waiting costs. These are the ones which rely upon the use of rural airstrips where delays are not uncommon due to inclement weather. If you are delayed beyond the printed itinerary including a set number of waiting days, MountMeru Treks will only meet your accommodation and food costs on a normal trek basis.

Helicopter charter flights to Kathmandu are available at your own expense.