Healthy Trekking

The Medical Kit

A basic medical kit, proposed here, that can be purchased quite cheaply in Kathmandu will help trekkers be reasonably prepared for most problems and can be considered a kind of insurance. In most developed countries, prescriptions are required for some of the drugs. An understanding physician should give you these if you carefully explain why you need them. Do not use these medications when medical assistance is available nearby. When you are sick and there are appropriate treatments, it makes sense to use them. By following the suggestions given below, the chances are excellent that you will recover, and the benefits of treatment far outweigh the risks. If you are not getting better in spite of self-treatment, then consider other alternatives, especially if the situation seems grave.

Names of drugs are always a dilemma. While the official or generic names are generally the same throughout the world, the advertising or brand names vary greatly from place to place. The generic names are used here where possible. The recommended medical kit - enough for a party of two - includes the following:

• Moleskin. Felt or foam (molefoam) padding (about 1mm thick for felt, 2 or 3 mm for foam) with adhesive backing, used for the prevention of blisters. About half a square foot per person should be enough. It is not available in Kathmandu, but adhesive tape or zinc oxide strapping can be used as a substitute.
• Bandages. One roll of 2-in. adhesive tape, and five to ten adhesive bandages per person for small wounds.
• Elastic Bandage. One 3-in. roll for relief of strains and sprains.
• Thermometer. One that reads below normal temperatures (for diagnosis of hypothermia) as well as above (for fever).
• Miscellaneous. Scissors, needle, or safety pin, and forceps or tweezers.
• Plastic Dropper Bottles. One-ounce (30ml) size for iodine. This is best brought from home. If your pharmacy no longer carries empty plastic dropper bottles for dispensing compounded ear, eye, or nose drops, buy a plastic dropper bottle of nose drops and dump the contents.
• Water Purification Chemicals. Tetraglycine hydroperiodide or iodine in various forms. Vitamin C powder masks the taste.
• Nose Spray or Drops (optional). Phenylephrine HCL (0.25%) for stuffed noses and sinuses. Put two drops in each nostril two or three times a day when symptomatic and when changing altitude. An alternative is oxymetazoline, used no more than twice a day.
• Nasal Decongestant (optional). For those accustomed to taking these tablets for colds.
• Antihistamine (optional). For treating symptoms of colds and hay fever. If you do not have a favorite, try chlorpheniramine maleate tablets (4mg). Terfenadine and astemizole are expensive, non sedating antihistamines you could try.
• Aspirin or Similar Drug. Twenty-five tablets (5grain, 325mg) of aspirin for relief of minor pain, for lowering temperatures, and for symptomatic relief of colds and respiratory infections. Ibuprofen (200mg) or acetaminophen (paracetamol)are appropriate substitutes for those who can't tolerate aspirin.
• Codeine. Fifteen tablets (30mg) for relief of pain, cough, and diarrhea. A good multipurpose drug. It is customarily compounded with acetaminophen tablets in the U.S.A.
• Anti-motility Agents. Codeine, as already mentioned, or loperamide (2mg), or diphenoxylate compound tablets. Take twenty.
• Antibiotic. The current trekkers' "wonder" drug is probably ciprofloxacin, in 500mg tablets. Expensive, but adequate for most of the infectious bacterial causes of illnesses that might befall the trekker. Take twenty capsules at least; the dose is one capsule twice a day. An alternative is norfloxacin, 400mg tablets, taken three times a day. A related cheaper drug, nalidixic acid, has been used successfully in Nepal and is the drug of choice for children for diarrhea. Other choices would best require that two different ones should be carried, a cephalosporin (cefaclor, cefuroxime, and cefadroxil are choices in the United States) and co-trimoxazole. Carry a 10-day supply of a 250-mg cephalosporin. The dose for the cephalosporin is either one or two every 8 hours (cefaclor) or 12hours (cefuroxime or cefadroxil). If allergic to penicillin, you might also be allergic to a cephalosporin, but this is relatively rare. Erythromycin (250mg capsule) would be the best choice for allergic individuals. Take forty. Bring co-trimoxazole (trimethoprim 160mg and sulfamethoxazole 800mg) in so-called double-strength tablets if not allergic to sulfa drugs. Bring twenty of these tablets. Be aware that there may be resistance to this drug in Nepal.
• Antiprotozoan. Tinidazole is the best drug to self-treat presumed Giardia or Amoeba infections while trekking. It is not available in the United States but can be purchased in Nepal. Take twenty 500mg tablets.
• Antiheminth (worm medicine). Six 100-mg tablets of mebendazole. one tablet taken morning and evening for 3days will take care of most worm infestations in porters. You won't be there long enough to require treatment in Nepal.
• Oral Rehydration Solution (ORS, Jeevan Jal). A mixture of salts and glucose, this powder is added to a liter of water to provide the appropriate drink to rehydrate in almost any situation, but especially from diarrhea. Not easily available in the United States - buy it in Nepal.
• Altitude Medicines. Acetazolamide (DiamoxTM), 250mg tablets, take twenty, and also dexamethasone, 4-mg tablets, take five. The first is to treat symptoms of mild altitude illness, and the second is to take if someone has the serious, cerebral symptoms. The first drug is appropriate to use for prevention in suitable situations.
• Anti-inflammatory Agent. To be considered if you are prone to arthritic conditions or tendonitis. Aspirin or ibuprofin are good choices; acetaminophen is not meclofenamate. The latter is a good all-purpose pain medicine.
• Sunscreen Preparation. One with a sun protection factor (or SPF) of at least 15 in order to get adequate protection from the sun on snow slopes at high altitudes. Sunscreens are best applied 1 or 2 hours before exposure and reapplied after heavy sweating. Be sure to apply them over all areas that can receive direct or reflected sunlight, especially under the nose, chin, and eyebrows. Lip balms containing effective sunscreens should also be used.
• Topical Ophthalmic Antibiotic. Good choices of ophthalmic antibiotics are those that contain bacitracin, gentamicin, polymyxin, or tobramycin. Avoid any that contain steroids such as betamethasone, cortisone, dexamethasone, hydrocortisone, prednisolone, or others. If you wear contact lenses trekking, be sure to bring antibiotic eye drops.
• Malaria Suppressant (optional). Chloroquine, for instance, if you and your doctor think it is necessary.