Tibet poses some unique and particular risks to your health, mostly associated with altitude. There is no need to be overly worried: very few travellers are adversely affected by altitude for very long, and greater risks are present in the form of road accidents and dog bites.
Make sure you’re healthy before you start travelling. If you are going on a long trip, make sure your teeth are OK. If you wear glasses, take a spare pair and your prescription.
Experienced travellers will rely on their own medical knowledge and supplies. Outside Lhasa and Shigatse there is very little in the way of expert medical care. Make sure you travel with a well-stocked medical kit and knowledge of how to use it.
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Before You Go
Tibet is a remote location, and if you become seriously injured or very sick, you may need to be evacuated by air. Under these circumstances, you don’t want to be without adequate health insurance. Be sure your policy covers evacuation.
China doesn’t officially require any immunisations for entry into the country (apart from a yellow fever vaccination certificate for travellers arriving from countries with risk of yellow fever transmission); however, the further off the beaten track you go, the more necessary it is to take all precautions.
Plan well ahead (at least eight weeks before travel), as some vaccinations require more than one injection. Discuss requirements with your doctor and check with your national health provider for up-to-date recommendations before departure.
A rabies vaccination is recommended for those spending more than a month in Tibet. The vaccine requires three injections spread over one month. If you are prevaccinated and then bitten, you need only get two further shots of vaccine, as soon as possible, three days apart. If not prevaccinated, you require a Rabies Immuno Globulin (RIG) injection, plus five shots of vaccine over the course of 28 days.
The influenza vaccine is recommended for travellers to China and Tibet, and is good for up to one year.
Carry a good supply of all medications and prescriptions with you, including a note of their active ingredients rather than the brand names. It can be useful to have a legible prescription or letter from your doctor to show that you legally use the medication.
It's a good idea to carry a well-supplied first-aid kit to Tibet. If you plan on trekking, be sure your kit includes comprehensive supplies.
You may find it useful to bring the following:
- Diamox – to aid with the prevention of altitude sickness
- Homeopathic medicines like gentiana for altitude sickness
- Diarrhoea and dysentery medicines
- Pain relievers
- Cold and flu tablets, throat lozenges and nasal decongestant
- Water-purification tablets or iodine
Medicine for Mountaineering & Other Wilderness Activities by James Wilkerson is still the classic text for trekking first aid and medical advice.
Pocket First Aid and Wilderness Medicine by Jim Duff and Ross Anderson is a great pocket-size guide that’s easily carried on a trek or climb.
The High Altitude Medicine Handbook by Andrew J Pollard and David R Murdoch is a small-format guide full of valuable information on prevention and emergency care.
Travellers’ Health by Richard Dawood is comprehensive, easy to read, authoritative and highly recommended, although it’s rather large so consider the ebook version.
Availability & Cost of Health Care
Outside Lhasa and Shigatse health-care advice is patchy at best and nonexistent at worst. Self-diagnosis and treatment can be risky, so you should always seek medical help where possible.
Standards of medical attention are so low in most places in Tibet that, for the worst ailments, the best advice is to go straight to Lhasa, or in extreme cases, Kathmandu or Chéngdū.
CIWEC Clinic Travel Medicine Center Kathmandu-based clinic in operation since 1982. Staff members are mostly foreigners and a doctor is on call around the clock. Credit cards are accepted and the centre is used to dealing with insurance claims.
Global Doctor Chéngdū Clinic In Chéngdū. Offers pre-Tibet medical examinations and a Tibet Travellers Assist Package that can be useful if you are worried about an existing medical condition.
Rabies is a fatal viral infection found in Tibet, carried in the saliva of animals (such as dogs, cats, bats and monkeys). Any bite, scratch or even lick from an animal should be cleaned immediately and thoroughly. Scrub gently with soap and running water, and then apply alcohol or iodine solution. Prompt medical help should be sought to receive a course of injections to prevent the onset of symptoms and save the patient from death.
If you have any potential exposure to rabies, seek medical advice in Lhasa (or ideally Kathmandu, Chéngdū or Běijīng) as soon as possible. If you need treatment you will likely have to travel to Bangkok or Hong Kong.
Dysentery & diarrhoea
Dysentery, cholera and giardiasis are common ailments in Tibet that cause diarrhoea. Ask your doctor for a course of antibiotics to take with you in the event of infection (especially if travelling in high mountain areas or trekking). You should seek medical advice if you think you have giardiasis or amoebic dysentery, but where this is not possible, tinidazole or metronidazole are often-recommended drugs.
Upper respiratory tract infections (like the common cold) are very frequent ailments all over China, including Tibet, where the high altitude aggravates symptoms. High pollution levels in Kathmandu and China can cause complications at the beginning or end of your trip.
Any upper respiratory tract infection, including influenza, can lead to complications, such as bronchitis and pneumonia, which may be treated with antibiotics.
Acute mountain sickness (AMS; also known as altitude sickness) is common at high elevations; relevant factors are the rate of ascent and individual susceptibility. The former is the major risk factor. On average, one tourist a year dies in Tibet from AMS. Any traveller who flies to where the elevation is around 3600m is likely to experience some symptoms of AMS.
AMS is a notoriously fickle affliction and can also affect trekkers and walkers accustomed to walking at high altitudes. It has been fatal at 3000m, although 3500m to 4500m is the usual range. High altitude can also aggravate upper respiratory tract infections (like the common cold).
It’s very easy to get sunburnt at high altitudes, so bring a wide-brimmed hat and bring high-SPF sunblock with you.
AMS is linked to low atmospheric pressure. Those who travel up to Everest Base Camp, for instance, reach an altitude where atmospheric pressure is about half of that at sea level.
With an increase in altitude, the human body needs time to develop physiological mechanisms to cope with the decreased oxygen. This process of acclimatisation is still not fully understood, but it is known to involve modifications to breathing patterns and heart rate induced by the autonomic nervous system, and an increase in the blood’s oxygen-carrying capabilities. These compensatory mechanisms usually take one to three days to develop at a particular altitude. You are unlikely to get AMS once you are acclimatised to a given height, but you can still get ill when you travel higher. If the ascent is too high and too fast, these compensatory reactions may not kick into gear fast enough.
Mild symptoms of AMS usually develop during the first 24 hours at altitude. These will generally disappear through acclimatisation in several hours to several days.
Symptoms tend to be worse at night and include headache, dizziness, lethargy, loss of appetite, nausea, breathlessness and irritability. Difficulty sleeping is another common symptom, and many travellers have trouble for the first few days after arriving in Lhasa.
AMS may become more serious without warning and can be fatal. Symptoms are caused by the accumulation of fluid in the lungs and brain, and include breathlessness at rest, a dry, irritative cough (which may progress to the production of pink, frothy sputum), severe headache, lack of coordination (typically leading to a ‘drunken walk’), confusion, irrational behaviour, vomiting and eventually unconsciousness.
The symptoms of AMS, however mild, are a warning: be sure to take them seriously! Travellers and trekkers should keep an eye on each other, as those experiencing symptoms, especially severe symptoms, may not be in a position to recognise them. One thing to note is that while the symptoms of mild AMS often precede those of severe AMS, this is not always the case. Severe AMS can strike with little or no warning.
The best way to prevent AMS is to avoid rapid ascents to high altitudes. If you are travelling by car to Tibet from Nepal, or by train from China, you will experience rapid altitude gain. An itinerary that takes you straight up to Everest Base Camp is unwise; plan to see it well after you've acclimatised. If you fly into Lhasa, take it easy for at least three days; this is enough for most travellers to get over any initial ill effects.
To prevent AMS:
- Ascend slowly. Have frequent rest days, spending two to three nights at each rise of 1000m. If you reach a high altitude by trekking, acclimatisation takes place gradually and you are less likely to be affected than if you fly or drive directly to high altitude.
- Trekkers should bear in mind the climber’s adage of ‘climb high, sleep low’. It is always wise to sleep at a lower altitude than the greatest height that’s reached during the day.
- Once above 3000m, care should be taken not to increase the sleeping altitude by more than 400m per day.
- Drink extra fluids. Tibet’s mountain air is cold and dry, and moisture is lost as you breathe. Evaporation of sweat may occur unnoticed and result in dehydration.
- Avoid alcohol, as it may increase the risk of dehydration, and don’t smoke.
- Avoid sedatives.
- When trekking, take a day off to rest and acclimatise if feeling overtired. If you or anyone else in your party is having a tough time, make allowances for unscheduled stops.
- Don’t push yourself when climbing up to passes; rather, take plenty of breaks. You can usually get over the pass as easily tomorrow as you can today. Try to plan your itinerary so that long ascents can be divided into two or more days. Given the complexity and unknown variables involved with AMS and acclimatisation, trekkers should always err on the side of caution and ascend mountains slowly.
Treat mild symptoms by resting at the same altitude until recovery, which usually takes a day or two. Take paracetamol or acetaminophen for headaches. If symptoms persist or become worse, however, immediate descent is necessary. Even 500m can help.
The most effective treatment for severe AMS is to get down to a lower altitude as quickly as possible. In less severe cases the victim will be able to stagger down with some support; in other cases they may need to be carried down. Whatever the case, any delay could be fatal.
AMS victims may need to be flown out of Tibet as quickly as possible, so make sure you have adequate travel insurance.
The drug acetazolamide (Diamox) is recommended for the prevention of AMS – take 125mg twice a day as a preventive dose. Be aware that even when you are on Diamox, you should not ignore any symptoms of AMS. Diamox should be avoided in those with a sulphur allergy.
Drug treatments should never be used to avoid descent or to enable further ascent (although they can help get people well enough to descend).
Several hotels in Lhasa sell a Tibetan herbal remedy that locals use to ease the symptoms of mild altitude sickness. The remedy is known as solomano in Tibetan and hóngjīngtīan (红景天) in Chinese. Locals also recommend a Chinese herbal medicine called gāoyuānníng (高原宁) and the drug gāoyuánkāng (高原康; dexamethasone). A box of vials costs ¥35 to ¥50. Always consult with your doctor before taking any remedy or medication.
Hypothermia & Frostbite
Tibet’s extreme climate must be treated with respect. Sub-freezing temperatures mean there is a risk of hypothermia or frostbite, even during the summer season, when high areas around western Tibet and the northern Changtang can be hit without warning by sudden snow storms. Exposed plains and ridges are prone to extremely high winds and this significantly adds to the cold. Always be prepared for cold, wet or windy conditions if you’re out walking at high altitudes.
Hypothermia occurs when the body loses heat faster than it can produce it and the core temperature of the body falls. It is surprisingly easy to progress from very cold to dangerously cold through a combination of wind, wet clothing, fatigue and hunger, even if the air temperature is above freezing.
Symptoms of hypothermia are exhaustion, numb skin (particularly toes and fingers), shivering, slurred speech, irrational or violent behaviour, lethargy, stumbling, dizzy spells, muscle cramps and violent bursts of energy. Irrationality may take the form of sufferers claiming they are warm and trying to take off their clothes.
To treat mild hypothermia, first get the person out of the wind and rain, remove their clothing if it’s wet and replace it with dry, warm clothing. Give them hot liquids (not alcohol) and some high-energy, easily digestible food. Do not rub victims; instead, allow them to slowly warm themselves. This should be enough to treat the early stages of hypothermia. The early recognition and treatment of mild hypothermia is the only way to prevent severe hypothermia, which is a critical condition.
Signs and symptoms of frostbite include a whitish or waxy cast to the skin, or even crystals on the surface, plus itching, numbness and pain. Temporary precautions include warming the affected areas by immersing them in warm (not hot) water or with blankets or clothes, only until the skin becomes flushed. Note: frostbitten areas should only be rewarmed if there is not a likelihood they will be frostbitten again prior to reaching medical care. Frostbitten parts should not be rubbed. Pain and swelling are inevitable. Blisters should not be broken.
The basic teachings of Tibetan medicine share much with those of other Asian medical traditions, which, according to some scholars, made their way to the East via India from ancient Greece. These traditions look at symptoms as indications of an imbalance in the body and seek to restore that balance.
The theory of Tibetan medicine is based on an extremely complex system of checks and balances between what can be broadly described as three ‘humours’ (related to state of mind), seven ‘bodily sustainers’ (related to the digestive tract) and three ‘eliminators’ (related to the elimination of bodily wastes). There is also the influence of harmful spirits to consider: 360 harmful female influences, 360 harmful male influences, 360 malevolent naga (water spirits) influences and, finally, 360 influences stemming from past karma. All these combine to produce 404 basic disorders and 84,000 illnesses!
How does a Tibetan doctor assess the condition of a patient? The most important skill is pulse diagnosis. A Tibetan doctor is attuned to 360 ‘subtle channels’ of energy that run through the body’s skin and muscle, internal organs, and bone and marrow. The condition of these channels can be ascertained through six of the doctor’s fingers (the first three fingers of each hand). Tibetan medicine also relies on urine analysis as an important diagnostic tool.
Yuthok Yongten Gonpo (1182–1251), the physician of King Trisong Detsen, who was born near Ralung Monastery, is credited as the founder of the Tibetan medical system. For more on Tibetan medicine, see www.tibetan-medicine.org.
If you get sick, you can get a diagnosis from Lhasa’s Mentsikhang, opposite the Barkhor. Two English-speaking doctors attend to foreigners on the 3rd floor.
The number-one rule is don’t drink the tap water, including ice. Most hotels provide a kettle or thermos of boiling water, which is safe to drink. While trekking you should boil your own water or treat it with water-purification tablets, as livestock contaminate many of the water sources. Tea is always safe to drink. In rural areas, locally brewed beer (chang) is sometimes made with contaminated water and there is always some risk in drinking it. Large 5L bottles of drinking water are available in most supermarkets. Vegetables and fruit should be washed with purified or bottled water or peeled where possible.
The simplest way to purify water is to boil it thoroughly. At Tibet’s high altitude, water boils at a lower temperature and germs are less likely to be killed, so boil water for at least 10 minutes.
Total water filters are more environmentally friendly than buying bottled water, and they take out all parasites, bacteria and viruses, making water safe to drink.
Chlorine tablets will kill many pathogens, but not giardia and amoebic cysts. Iodine is more effective for purifying water but is hard to find in tablet form these days.