Health & safety:
Before you go: 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. If you require a particular medication take a good supply, as it may not be available in Tibet. Take along part of the packaging showing the generic name rather than the brand to make getting replacements easier. To avoid problems, it’s a good idea to have a legible prescription or letter from your doctor to show that you legally use the medication. Insurance: Keep in mind that 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. Recommended vaccinations: China doesn’t officially require any immunisations for entry into the country; however, the further off the beaten track you go, the more necessary it is to take all precautions. The World Health Organization (WHO) requires travellers who have come from an area infected with yellow fever to be vaccinated before entering the country. Record all vaccinations on an International Health Certificate, available from a doctor or government health department.

Plan well ahead and schedule your vaccinations because some require more than one injection, while others should not be given together. Note that some vaccinations should not be given during pregnancy or to people with allergies.

It is recommended that you seek medical advice at least eight weeks before travel. Note that there is a greater risk of all kinds of disease with children and during pregnancy. Discuss your requirements with your doctor, but vaccinations you should consider for this trip include the following:

Diphtheria & Tetanus Vaccinations for these two diseases are usually combined and are recommended for everyone. After an initial course of three injections (usually given in childhood), boosters are necessary every 10 years.

Hepatitis A: The vaccine for Hepatitis A (eg Avaxim, Havrix 1440 or VAQTA) provides long-term immunity (at least 20 years) after an initial injection and a booster at six to 12 months. Hepatitis A vaccine is also available in a combined form, Twinrix, with hepatitis B vaccine. Three injections over a six-month period are required, the first two providing substantial protection against hepatitis A. Hepatitis B China (although not so much Tibet) is one of the world’s great reservoirs of hepatitis B infection, a disease spread by contact with blood or by sexual activity. Vaccination involves three injections, the quickest course being over three weeks with a booster at 12 months.

Polio: This serious, easily transmitted disease is still prevalent in many developing countries, including Tibet’s neighbouring countries, India, Pakistan and Nepal. Everyone should keep up-to-date with this vaccination, which is normally given in childhood. One adult booster is then needed (as long as the full childhood course was completed), particularly if travelling to a country with recent polio activity. This should be discussed with your doctor.

Rabies: The vaccination is strongly recommended for those spending more than a month in Tibet, especially if you are cycling, handling animals, caving or travelling in remote areas, and for children. Pretravel vaccination means you do not need to receive Rabies Immuno Globulin (RIG) after a bite. RIG is very unlikely to be available in Tibet, and there is such a worldwide shortage that for the first time the CIWEC Clinic in Kathmandu reports that it cannot source any (at the time of writing). 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 RIG plus five shots of vaccine over the course of 28 days. Thus the management of any bite or scratch is greatly simplified if you have been vaccinated. Current expert opinion is that the full series of vaccination does not require any boosters unless a bite occurs.

Tuberculosis: The risk of tuberculosis (TB) to travellers is usually very low, unless you’ll be living with or closely associated with local people in high-risk areas. As most healthy adults don’t develop symptoms, a skin test before and after travel to determine whether exposure has occurred may be considered. Recommendations for BCG vaccination vary considerably around the world. Discuss with your doctor if you feel you may be at risk. It is strongly recommended for children under five who are spending more than three months in a high-risk area.

Typhoid: This is an important vaccination to have for Tibet, where hygiene standards are low. It is available either as an injection or oral capsules. A combined hepatitis A-typhoid vaccine was launched recently but its availability is still limited. Check with your doctor to find out its status in your country.

Yellow Fever: This disease is not endemic in China or Tibet and a vaccine is only required if you are coming from an infected area. These areas are limited to parts of South America and Africa. Measles-mumps-rubella (MMR): All travellers should ensure they are immune to these diseases, either through infection or vaccination. Most people born before 1966 will be immune, those born after this date should have received two MMR vaccines in their lifetime.

Chickenpox (Varicella): Discuss this vaccine with your doctor if you have not had chickenpox.

Influenza: The flu vaccine is recommended for anyone with chronic diseases, such as diabetes, lung or heart disease. Tibet has a high rate of respiratory illness, so all travellers should consider vaccination.

Pneumonia A vaccine is recommended for anyone over 65 or those over 55 with certain medical conditions.

Medical checklist: Following is a list of items you should consider including in your medical kit for travelling – consult your pharmacist for brands available in your country...

Antibiotics – useful for everyone travelling to Tibet to avoid risks of receiving poorly stored local medications; see your doctor, as antibiotics must be prescribed, and carry the prescription with you Antifungal cream or powder – for fungal skin infections and thrush.

Antihistamine – for allergies, eg hay fever; to ease the itch from insect bites or stings; and to prevent motion sickness.

Antiseptic (such as povidone-iodine) – for cuts and grazes.

Bandages, Band-Aids (plasters) and other wound dressings.

Calamine lotion, sting-relief spray or aloe vera – to ease irritation from sunburn and insect bites or stings.

Cold and flu tablets, throat lozenges and nasal decongestant

Homeopathic medicines – useful hom¬eopathic medicines include gentiana for altitude sickness, echinacea for warding off infections, and tea-tree oil for cuts and scrapes.

Insect repellent, sunscreen, lip balm and eye drops.

Loperamide or diphenoxylate – ‘blockers’ for diarrhoea.

Multivitamins – for long trips, when dietary¬ vitamin intake may be inadequate.

Paracetamol (acetaminophen in the USA) – for pain or fever.

Prochlorperazine or metaclopramide – for nausea and vomiting.

Rehydration mixture – to prevent dehydration, which may occur, for example, during bouts of diarrhoea; particularly important when travelling with children.

Scissors, tweezers and a thermometer – note that mercury thermometers are prohibited by airlines.

Sterile kit – in case you need injections in a country with medical hygiene problems; discuss with your doctor.

Water purification tablets or iodine.