Photo credit: markhorrell via Foter.com / CC BY-NC-SA
Make sure that you’re up-to-date with your standard set of childhood vaccinations including Diphtheria, Tetanus, Polio, Measles, Mumps, Hepatitis A and Rubella.
TB and Meningococcal Meningitis are recommended if you are working closely with the local population.
Hepatitis B is recommended for healthcare workers.
Rabies is recommended. However it does not provide complete protection and urgent medical attention is still required.
Japanese Encephalitis is recommended if you are planning to spend more than three weeks in rural areas, especially after dusk when infection is more likely.
Influenza and Pneumococcal vaccines are recommended for elderly travellers.
Malaria prophylaxis is recommended is you travel to lowlands and jungle areas.
For up-to-the-minute advice on vaccinations see Nepal International Clinic and Travel Medicine Center sites.
Although there are a small number of hospitals in Lukla these have only a limited range of facilities. Whilst they may be useful for treating minor ailments, major injuries and illnesses are best dealt with in Kathmandu. The following clinics and hospitals are able to offer a high standard of care: Nepal International Clinic and CIWEC Clinic.
In the event of a serious injury or illness it is possible to arrange a helicopter evacuation. When organising this it is vital to have insurance documents and credit card details available. Without these, rescue may be refused! Importantly, it’s worth remembering that helicopters have a number of limitations:
 The altitude a helicopter can reach is limited. Above 5000m rescue may be impossible. Therefore casualties above the Mera La will need to be brought down to a lower altitude first.
 Delays due to bad weather are common. These not only occur high on the mountain but also in the Hinku Valley too. Here, low lying cloud can settle in for several days making rescues impossible. Helicopters will not leave Kathmandu unless the weather is good at the landing site.
 Ensure that any victim is warm and comfortable. Once airborne the temperature in the helicopter will fall rapidly. Do not assume that luggage will be allowed onboard. At high altitude the pilot may not be able to transport anything more than the weight of the casualty. If supplemental oxygen is being used this should be taken onboard.
 It is possible to assist the pilot by identifying a landing zone (LZ) prior to the arrival of the helicopter. This should be a flat area at least 150m downwind of residential areas and free of any obstacles such as cables, wires or rocks. The wind direction should be highlighted. This can be done by using pieces of material attached to poles. Lights may be placed in each corner of the LZ. They should be bright enough to be visible by day but not so bright that they blind the pilot.
 Do not approach the helicopter until the pilot or crew have indicated you to do so. Due to the steep and often broken trail over the Zangmu La, it is rarely possible for yaks or horses to carry the sick or injured. Instead a group of porters, taking it in turns, are needed to carry individuals in an adapted carrying basket. The journey from the Hinku Valley to Lukla in this way may take 24 hours or more to complete.
Transport of Equipment
Apart from what you can carry yourself, your personal equipment and group supplies will be carried by porters. These men and women travel to Lukla from low altitude during the spring and autumn climbing seasons in search of work. Unlike Sherpas and other ethnic groups living at high altitude, these people have no genetic advantages over their clients. Since they carry enormous loads (40 kg or more) at a rapid pace they are prone to HAI’s, especially during their first few weeks at altitude. Be aware of this and provide treatment wherever necessary.
Although a rescue post is currently being established in Khare for much of the route you will be a long way from medical services. For the majority of the time you will be relying upon other team members and the guiding staff who accompany you. It is important to check that your guides can communicate fluently with you, that they have experience of mountaineering at 6000m and importantly, know how to treat any medical problems that may arise.
A limited number of lodges can be found along the route. These can provide a room, food and a warm communal area to eat in. During the busiest times, these can fill up quickly, so to avoid disappointment its worth arriving early or sending porters ahead to reserve spaces. The safety and cleanliness of lodges can vary. Therefore, it’s important to inspect the room and communal area first. Whilst the vast majority of lodges are clean and hospitable, it will be obvious which ones aren’t. Look out for animal droppings and evidence of food remains.
A few important points on staying in lodges:
 Check that you know where the fire exits are. Most lodges are wooden constructions heated with stoves. Therefore, there is a real risk of fire.
 Take your time on the stairs, often these are steep and uneven. Injuries are common!
 Watch your head! Lodges are not designed with tall Westerners in mind!
 Don’t get too close to the stove. After a day spent out in the rain, it’s tempting to get as close to the stove as possible. Unfortunately, the stove and chimney are very hot and burn easily.
If you have tented accommodation below the Mera La this gives you enormous flexibility allowing you the option of using either tents, lodges or a combination of both. A popular option is to sleep in tents and use lodges to eat and socialise in. This gives you the advantage of having a warm and well lit space for relaxing and eating after a hard day’s efforts.
Some networks provide mobile telephone coverage in Lukla, however this can be very unpredictable. Landline and satellite telephones are available in Khote, Tangnag and Khare. You can expect to pay between $5 and $10 per minute for your call.
From March to May and September to November.
Above 5000m in the Himalayas the weather conditions are often unpredictable and prone to rapid changes. A night of heavy snow can transform a benign path into a steep and impassable snow slope. Lower down the mountain, freezing conditions are common at night, however daytime temperatures can exceed 25 degrees C. It is therefore essential to be prepared for all conditions – down jackets and trousers at night and lightweight trekking clothes for use during the day.
At lower altitudes heavy rain storms are common. Umbrellas are invaluable and can be bought cheaply in Kathmandu and Lukla. A waterproof cover for your daypack is also very useful. Porters will normally wrap your luggage in plastic sheeting, however this is no guarantee that the contents will remain dry. Therefore its worthwhile ensuring that clothes and sleeping bag are stowed in a dry bag inside your luggage before they disappear up the trail!
Above 5000m: -20 degrees C to 20 degrees C
Below 5000m: -10 degrees C to 30 degrees C
Normally, snow and ice are not encountered until Khare. If dry, the trail up to this point is straightforward and only trekking poles and approach shoes are required. However in the wet, conditions can turn slippery and awkward on steep sections.
Once on the glacier, crampons, ice axe and harness are required. Since crevasses are common, it makes sense to rope together despite the dozens of porters who criss cross the glacier alone!
On summit day the route rarely exceeds angles of more than 30-40 degrees, however the last 100 to 200m of vertical ascent may be steeper after heavy snowfall. Parties may therefore need to use fixed ropes for this final section.
Leeches can be found along many of the trails leading to Mera. These are especially common in the monsoon months. The good news is that they don’t transmit infection. However, they can cause considerable bleeding since they inject a small dose of anticoagulant shortly before drawing blood. In order to control the bleeding apply constant firm pressure with a clean dressing for at least five minutes. Once the bleeding has stopped apply a sticking plaster “band aid” for 12-24 hours. To prevent leeches attaching to the skin, wear a hat, pull your socks up to your shin, wear long trousers and button shirts to the wrist. Whenever you leave or enter your tent ensure that it is zipped up.
For much of the time yaks and mules will be sharing the trails with you. Although both are passive and sure-footed creatures injuries can occur. On steep trails make sure you stand closest to the slope and give them as much space as possible!
River crossings are notorious for being sites of accidents in the mountains. Take special care in wet conditions since rivers can be high and slips and falls are common. Most crossings on the Mera trail are clearly marked. If in doubt wait for a porter or local guide and follow them!
Gastroenteritis is common in the popular areas of the Himalayas. The vast majority of infections can be prevented by following a series of simple steps:
Meticulous Hand Hygiene – As a minimum, it is essential to wash hands prior to eating and following going to the toilet. This should be done with clean water and an anti-bacterial soap.
Boil or sterilise water before use.
Avoid uncooked fruit or vegetables.
Meat needs to be thoroughly cooked before eating. Many opt to eat a vegetarian diet on Mera. After seeing the way raw meat is stored in the neighbouring villages, this is highly recommended!
Ensure that all cooking equipment and eating utensils are thoroughly cleaned before use.
The treatment for gastroenteritis is similar regardless of the cause:
Replace fluids with oral rehydration fluids
Avoid using loperamide (immodium) unless symptoms limit the ability of the casualty to be evacuated
Use paracetamol (acetaminophen) if in pain or a high temperature is present
The use and timing of antibiotics is controversial. One approach that is popular, is to use ciprofloxacin (1g initially, followed by 500mg twice a day for three days) if diarrhoea persists for 12 hours or more.
For further details see Traveller’s Diarrhoea
Although minor, superficial injuries caused by ill fitting boots can ruin an attempt on Mera. For many, it will be the first time plastic mountaineering boots have been worn. Ideally these should be tried out at home in winter conditions first. At the very least, wear them on the glacier during a rest day first. Any areas of soreness can then be quickly identified and covered with a protective dressing. Long, warm socks should be worn and boots laced so that the foot is held in place and the ankles have a good degree of flexibility. These can be tightened for descending.
Paper by Jeremy Windsor and George Rodway, members of the UIAA Medical Commission
Acknowledgements: The authors wish to thank David Hillebrandt, Buddha Basnyat and all those at the guiding company Jagged Globe for their help in the preparation of this article.