How to not get sick in Kathmandu. Challenge level: Health Anxiety
April 26, 2024 5:16 AM Subscribe
I'm travelling to Kathmandu for a three week stay in June. I've never really travelled to this part of the world and my health anxiety is starting to kick off in anticipation. Looking for some advice for things I can do to prepare the best I can to avoid sickness, especially of the stomach kind.
My biggest concern at the moment is with food and water, and I've heard many stories that getting sick in Nepal is pretty much unavoidable. I'm vegetarian, and have an incredibly sensitive stomach, so much that I typically eat the same (healthy) western diet every day. When I introduce new foods my stomach doesn't love it, and upset stomach seems to also lead to big general anxiety spikes for me. I'm planning on taking lots of energy bars and other stuff in my luggage, but at the same time I also wouldn't mind sampling some of the local foods. I just very, very, very, much do not want to get sick. Any tips on how to best avoid this, or how to handle it if the inevitable happens?
My secondary concerns relate to things like altitude, pollution, and malaria. (I've gotten all necessary vaccinations and shots, but have been advised that malaria pills would be overkill given we're pretty much going to just be in the Kathmandu valley for most of the trip). Of course, if anyone wants to give me something else to worry about, I'm all ears! I've always had moderate to severe health anxiety and hypochondria. It's pretty under control when I'm in my home base or familiar environment, but this is definitely going to be a big departure for me.
I feel a bit sheepish even asking this, as I know it reflects a pretty privileged and sheltered position, but if anyone has any helpful words of wisdom to share to help put my mind at ease it would be most appreciated. Thank you!
My biggest concern at the moment is with food and water, and I've heard many stories that getting sick in Nepal is pretty much unavoidable. I'm vegetarian, and have an incredibly sensitive stomach, so much that I typically eat the same (healthy) western diet every day. When I introduce new foods my stomach doesn't love it, and upset stomach seems to also lead to big general anxiety spikes for me. I'm planning on taking lots of energy bars and other stuff in my luggage, but at the same time I also wouldn't mind sampling some of the local foods. I just very, very, very, much do not want to get sick. Any tips on how to best avoid this, or how to handle it if the inevitable happens?
My secondary concerns relate to things like altitude, pollution, and malaria. (I've gotten all necessary vaccinations and shots, but have been advised that malaria pills would be overkill given we're pretty much going to just be in the Kathmandu valley for most of the trip). Of course, if anyone wants to give me something else to worry about, I'm all ears! I've always had moderate to severe health anxiety and hypochondria. It's pretty under control when I'm in my home base or familiar environment, but this is definitely going to be a big departure for me.
I feel a bit sheepish even asking this, as I know it reflects a pretty privileged and sheltered position, but if anyone has any helpful words of wisdom to share to help put my mind at ease it would be most appreciated. Thank you!
I think trying to avoid sickness, while understandable, will keep you anxious. I also have health anxiety and hypochondria, and try extremely hard not to get sick on vacation. It doesn't always work, but I've still enjoyed the vacations where I did get sick. For anxiety relief, it would work better for me to come up with a plan for enjoying my vacation anyway if I do get sick.
posted by wheatlets at 6:01 AM on April 26 [5 favorites]
posted by wheatlets at 6:01 AM on April 26 [5 favorites]
Best answer: I study enteric diseases but am not a doctor. I travel a lot in places with variable hygiene infrastructure; I have been to Kathmandu and was not sick. I take preventive Pepto (the pills), starting when I get on the plane, daily for 3-5 days when I get somewhere new. I sometimes bring a short course of antibiotics with me, but they're only for use if I'm stomach-sick more than three days in a row. Drink bottled or otherwise filtered water (widely available). If you get sick, stay hydrated and get rest. A Coke is great for the salt and sugar if you are just mildly ill, but I've brought nuun with me for more rural trips. There's plenty of clinics and doctors in the city; if you are in a dire situation, you will have access to care.
The food in Nepal is great - one thing to consider for an easy dish that is very common is dal bhat (lentils + rice). This is a staple in Nepali cuisine and if you are comfortable with that, you'll be quite happy. You can get more Euro/American food (pizzas, etc) in the city without much trouble, especially in Thamel.
Malaria is very unlikely if you're in the higher altitude parts of the country, including Kathmandu; the relevant mosquito can't make it up there. June is monsoon, so the pollution in Kathmandu is often lower thanks to the rain. It can be nice to have a face mask if the pollution feels high; I think I wore one a few times in dusty situations.
posted by quadrilaterals at 6:22 AM on April 26 [2 favorites]
The food in Nepal is great - one thing to consider for an easy dish that is very common is dal bhat (lentils + rice). This is a staple in Nepali cuisine and if you are comfortable with that, you'll be quite happy. You can get more Euro/American food (pizzas, etc) in the city without much trouble, especially in Thamel.
Malaria is very unlikely if you're in the higher altitude parts of the country, including Kathmandu; the relevant mosquito can't make it up there. June is monsoon, so the pollution in Kathmandu is often lower thanks to the rain. It can be nice to have a face mask if the pollution feels high; I think I wore one a few times in dusty situations.
posted by quadrilaterals at 6:22 AM on April 26 [2 favorites]
Best answer: Here's a 2016 article by former NY Times medical writer, Jane Brody, about staying well on international trips. She also recommends daily Pepto Bismol and cites a study about it.
posted by Elsie at 7:11 AM on April 26 [1 favorite]
posted by Elsie at 7:11 AM on April 26 [1 favorite]
Best answer: We generally take dukoral, which is an oral vaccine against "cholera and tourist diarrhea" before we travel. If I were concerned I would also bring a lifestraw personal water filter just in case.
posted by Iteki at 7:23 AM on April 26 [2 favorites]
posted by Iteki at 7:23 AM on April 26 [2 favorites]
Best answer: I haven’t traveled to Nepal but have been to a lot of other destinations in Asia where stomach upset for travelers is a possible concern.
You may already be conscious of this, but be mindful of water in all its forms and raw foods like fruit and vegetables. This means you must brush your teeth, rinse your mouth, and so on with bottled or boiled water, which might take some mental adjustment since it’s easy to go on autopilot with a task like brushing your teeth. So the same goes for rinsing fruit and veggies, whatever doesn’t get cooked afterwards. I would personally just avoid raw vegetables like salads, and always avoid ice in drinks. I had a moment in India once when I ordered a fresh sugar cane juice and the process started with them rinsing out the juicing machine with tap water and I wondered if I was going to get sick if I drank the juice (it looked too tempting, I drank it anyway, I was fine.)
I personally would not have a huge concern about cooked foods aside from any particular sensitivities you might know of, and no concerns about packaged foods. So you should be able to find something mild and safe to eat no matter what.
Could you prime your system (and mind) for novelty by trying a few bites of a new food per week at home in the months leading up to the trip, so it’s less of a shock to go from always eating the exact same meal to trying a million new things?
I love trying new foods while traveling, I hope you can enjoy it without incident!
posted by music for skeletons at 8:57 AM on April 26
You may already be conscious of this, but be mindful of water in all its forms and raw foods like fruit and vegetables. This means you must brush your teeth, rinse your mouth, and so on with bottled or boiled water, which might take some mental adjustment since it’s easy to go on autopilot with a task like brushing your teeth. So the same goes for rinsing fruit and veggies, whatever doesn’t get cooked afterwards. I would personally just avoid raw vegetables like salads, and always avoid ice in drinks. I had a moment in India once when I ordered a fresh sugar cane juice and the process started with them rinsing out the juicing machine with tap water and I wondered if I was going to get sick if I drank the juice (it looked too tempting, I drank it anyway, I was fine.)
I personally would not have a huge concern about cooked foods aside from any particular sensitivities you might know of, and no concerns about packaged foods. So you should be able to find something mild and safe to eat no matter what.
Could you prime your system (and mind) for novelty by trying a few bites of a new food per week at home in the months leading up to the trip, so it’s less of a shock to go from always eating the exact same meal to trying a million new things?
I love trying new foods while traveling, I hope you can enjoy it without incident!
posted by music for skeletons at 8:57 AM on April 26
Best answer: I recommend bringing a familiar electrolyte mix/ tablet / powder with you.
Consider bringing your own water purifier (not filter) with you.
Consider eating Nepali cuisine before you go. Determine your new favorites!
posted by oceano at 1:21 PM on April 26 [1 favorite]
Consider bringing your own water purifier (not filter) with you.
Consider eating Nepali cuisine before you go. Determine your new favorites!
posted by oceano at 1:21 PM on April 26 [1 favorite]
Best answer: Kathmandu gets a LOT of tourists, so bottled water is everywhere. Nepali food is not particularly spicy, and you can easily find a wide variety of other familiar southern asian vegetarian foods. The city itself is only 1600 m or so above sea level, so you'll acclimate very quickly or not even notice if you've been at any kind of altitude before.
Enjoy yourself. Kathmandu is a cool place to hang out in, and has a very old- school busy southern asian city vibe.
posted by OHenryPacey at 5:14 PM on April 26 [1 favorite]
Enjoy yourself. Kathmandu is a cool place to hang out in, and has a very old- school busy southern asian city vibe.
posted by OHenryPacey at 5:14 PM on April 26 [1 favorite]
Best answer: There's a book on this!
It's called "Shitting Pretty" and it's a guidebook on avoiding food poisoning while you travel. It also explains how to use different forms of commode around the world.
I found the book very useful in my expat years.
posted by champers at 4:00 AM on April 27
It's called "Shitting Pretty" and it's a guidebook on avoiding food poisoning while you travel. It also explains how to use different forms of commode around the world.
I found the book very useful in my expat years.
posted by champers at 4:00 AM on April 27
Best answer: You do not need a water filter if you are going to a city. There will be plenty of bottled water available, you will not need to filter puddle water to stay hydrated, I promise.
Malaria is not an issue at altitude, as the mosquitoes can't survive there. You may notice the altitude may be difficult for you to adjust to, so take some ibuprofen and drink plenty of water if you start feeling its effects. Stairs and hills will be harder than you think they should be so pace yourself.
posted by ananci at 5:35 AM on April 27 [1 favorite]
Malaria is not an issue at altitude, as the mosquitoes can't survive there. You may notice the altitude may be difficult for you to adjust to, so take some ibuprofen and drink plenty of water if you start feeling its effects. Stairs and hills will be harder than you think they should be so pace yourself.
posted by ananci at 5:35 AM on April 27 [1 favorite]
Best answer: Just returned from Kathmandu this week. There is plenty of bottled water. I ate salad, fruit, etc. and had no problems in the week I was there. Bring bars and snacks if you’re worried. You can get western food if you like without problem. Local food is mostly not spicy. If you’re really worried you can always find rice.
I happened to forget the second week of my medication at home and found a pharmacy — he had all three things I asked for and it cost $5 USD OTC. I point that out to say that if you do need medicine it’s available. They probably get it from India, where a lot of the medicine in the world is made (then shipping and marked up in the West). DM me if you have more specific questions.
posted by Bunglegirl at 5:56 PM on April 27 [1 favorite]
I happened to forget the second week of my medication at home and found a pharmacy — he had all three things I asked for and it cost $5 USD OTC. I point that out to say that if you do need medicine it’s available. They probably get it from India, where a lot of the medicine in the world is made (then shipping and marked up in the West). DM me if you have more specific questions.
posted by Bunglegirl at 5:56 PM on April 27 [1 favorite]
Best answer: If staying in Kathmandu and the surrounding area only I’d take care of your throat above all. It’s very polluted. I was careful to always have at least a Buff or multi layered silk scarf on when walking around and if I’d been there for longer I’d have considered a mask underneath it too. Have plenty of honey/thyme/menthol sweets to keep your throat well coated.
For food, I’d think about getting used to eating something close to dal bhat (ie mild lentil curry ). In Kathmandu itself you can get all kinds of western food in well prepared hygienic restaurants, which you can find in the usual ways. However assuming you will be at least travelling around the nearby areas eg Bhaktapur, Nagarkot etc, you may find yourself in places that have fewer tourists and in these places it’s always safest to go for the Dal Bhat because it will be much more likely to be made freshly by someone who knows how to make it, using clean equipment. So it’s good to know if it agrees with you. Momos are widely available and also generally a safe choice.
As a data point I’m vegetarian and I’ve been 4 times to Kathmandu and only got sick once, and that was when I really craved protein and had some fish goujons in a hotel. I think you’re pretty low risk if you don’t eat meat. I did eat salad but was very cautious about where. Also I know quite a lot of people who go there a lot and almost all of them avoid meat when they are there, or only have it in a few places on the last nights.
It is a wonderful city, enjoy! I recommend treating yourself to dinner at the Garden of Dreams and Dwarika. :)
posted by tardigrade at 2:25 AM on April 28 [1 favorite]
For food, I’d think about getting used to eating something close to dal bhat (ie mild lentil curry ). In Kathmandu itself you can get all kinds of western food in well prepared hygienic restaurants, which you can find in the usual ways. However assuming you will be at least travelling around the nearby areas eg Bhaktapur, Nagarkot etc, you may find yourself in places that have fewer tourists and in these places it’s always safest to go for the Dal Bhat because it will be much more likely to be made freshly by someone who knows how to make it, using clean equipment. So it’s good to know if it agrees with you. Momos are widely available and also generally a safe choice.
As a data point I’m vegetarian and I’ve been 4 times to Kathmandu and only got sick once, and that was when I really craved protein and had some fish goujons in a hotel. I think you’re pretty low risk if you don’t eat meat. I did eat salad but was very cautious about where. Also I know quite a lot of people who go there a lot and almost all of them avoid meat when they are there, or only have it in a few places on the last nights.
It is a wonderful city, enjoy! I recommend treating yourself to dinner at the Garden of Dreams and Dwarika. :)
posted by tardigrade at 2:25 AM on April 28 [1 favorite]
I took dukarol before a trip to India and did not get sick. But I have since read that it's efficacy for traveler diarrhea is unproven. But I don't think it has any side effects, so it might be worth the peace of mind.
If the doctors are saying no to anti malaria drugs then for sure don't take them. Some of them can cause psychosis. Not good.
Honestly, I wonder if traveler diarrhea isn't reducing generally as better access to clean water is growing.
Hope you have a good trip.
posted by Senescence at 2:35 AM on April 29 [1 favorite]
If the doctors are saying no to anti malaria drugs then for sure don't take them. Some of them can cause psychosis. Not good.
Honestly, I wonder if traveler diarrhea isn't reducing generally as better access to clean water is growing.
Hope you have a good trip.
posted by Senescence at 2:35 AM on April 29 [1 favorite]
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posted by genmonster at 5:34 AM on April 26 [2 favorites]