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Contents

Before You Go

On The Journey

On The Track

The risk of dying while trekking was calculated in the 1980s to be only 14 in 100,000— mostly from falls rather than disease. By comparison, the risk of dying in a car accident in the United States was 24 in 100,000, and the risk of being murdered in New York City was 20 in 100,000. So it may be safest to spend the rest of your life trekking. That said, there are a number of precautions to take.

BEFORE YOU GO

Talk to your doctor, who should know your own particular problems and weaknesses. We recommend immunization against typhoid, tetanus, diphtheria and polio—and whooping-cough, measles and mumps, if you have not had them. Cholera vaccine is only 50 percent effective and may have quite severe side-effects, so is not always recommended. Some doctors suggest a gamma globulin injection a few days before departure. This gives 80 percent protection for five months against hepatitis, which is prevalent in Pakistan.

Malaria exists year round in the whole of Pakistan below 2,000 meters. As Islamabad is in the malaria belt and it takes a few days to reach a malaria-free altitude, malarial prophylactics are recommended. Some doctors suggest that you do not take daily or weekly pills if you are in the danger zone for only a short period, recommending instead that you carry larium to be taken only if you have an attack of malaria.

Government regulations require yellow fever and cholera vaccination certificates if you are coming from an infected area.

ON THE JOURNEY

Your main medical problem on holiday is likely to be travellers' trots—an upset stomach. The chief risk is from water-born organisms, either cysts, bacteria or viruses. Beware of all water i, whether served on your  flights, drawn from the tap in the  or taken from a clear spring in the mountains. Ignore claims of purity.

Giardia lambia is a troublesome parasite now infesting many rivers in Europe and America as well as Asia. It lies dormant in cyst form, waiting to be ingested by a new host. The cysts and bacteria can be killed by boiling or with one drop of iodine per liter, or filtered out by a filter with a pore size of 0.2 microns.

Viruses can be killed by iodine or boiling. You do not need to boil the water for long, even at high altitudes, to kill all cysts, bacteria and viruses. However, as fuel is always a problem, it is easier just to treat the water with water purification tablets and then add a drop of iodine. Water purification tablets are unstable, so buy a new supply each season.

Carry your water bottle and purification tablets at all times. Use them on  flights and all public transport, in all hotels and even when visiting friends. Beware of ice, which is made with tap water.

Safe bottled water and soft drinks are available in all  towns and many smaller ones. Ask for a glass and be sure it is clean, dry and uncracked—or use your own cup. Tea is usually safe if the cup as Pakistanis boil milk, making it safe in your tea.

Contaminated food can be as much a problem as water. Seasoned travelers in Asia may have developed some immunity and know by experience what they can and cannot eat, but new arrivals should avoid eating anything that has not been freshly cooked, especially salads, sliced tomatoes and even sliced, raw onion. Remember the motto: 'Boil it, bake it, peel it or forget it.'

Buffet meals in first-class hotels pose a special risk, as food kept warm for long periods is likely to be contaminated.

Food from roadside stalls is usually safe, but make sure it is served from a boiling pot onto a clean, dry plate. Chapattis and daal are available in most stalls and make a good, cheap, high-protein meal. Fresh yogurt is usually safe; if flies have been sitting on it, dig some out from underneath. The best rule for roadside stalls is to eat where the crowds are, as the most popular stalls have the best—and freshest—food.

Fruit is particularly good in Pakistan, but, peel it with a clean knife. Cut fruit, mixed fruit juices and ice cream sold in the bazaar spell danger to all but the most seasoned of Asian travelers.

Be fastidious about washing your hands. Pakistanis eat with their right hand, and you will too when you get the hang of it (or you can keep a spoon handy in your bag).

ON THE TREK

To help avoid diarrhoea, set up a bar of soap and a water container with a tap or long handled spoon on the edge of camp. Be sure hand washers do not contaminate the clean washing water. If you are cooking for yourself you are unlikely to get sick, but if you have hired a cook he will need careful supervision. 

If, despite your precautions, you still get diarrhoea, drink plenty of water to avoid becoming dehydrated. It is essential to take rehydration salts and to follow the directions exactly, or they will dehydrate you more. Imodium will help clog you up and prevent too much water loss; it provides some relief, especially for bus journeys, but is not a cure.

Altitude sickness can be fatal. Read up on it before you leave home, so you know how to recognize and treat it. It is caused by a lack of oxygen above 2,500 metres. The usual signs are a combination of any of the following: headache, nausea or vomiting, irregular breathing, dry cough, loss of appetite, lassitude and fatigue, loss of coordination and loss of judgment. Another symptom is oedema, which results in swollen face and hands, reduced urine output (you should produce at least one pint of urine a day) and, in severe cases, pneumonia and waterlogged brain. These symptoms should be taken seriously. The cure is to go to a lower altitude and rest. The best preventative is to gain altitude slowly; the height at which you sleep should not increase by more than 300 to 400 meters per day, though it is all right to climb higher and return.

Some people take Diamox 250 milligrams to reduce altitude sickness. We found it made our fingers and toes tingle, forced us to pee every hour and did nothing to help us acclimatize. Discuss it with your doctor.
Some people are more prone to strep throat (an infection caused by the bacteria Streptococcus) and chest infections than others. A treatment for chest infection and cough is ciprofloxacin antibiotic.
A good patent treatment for a blister is to prick it and cut off some of the loose skin. Add a blob of zinc oxide ointment and cover with Spenco second skin. Surround the spot with a lint ring and tape in place with surgical tape. When walking in bright sunlight on snow, put sun cream inside your nose, as reflected rays can badly bum your nostrils.