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The Medical Kit
A basic medical kit
proposed here that can be purchased quite cheaply in
Kathmandu will help trekkers be reasonably prepared for
most problems and can be considered a kind of insurance.
In most developed countries, prescriptions are required
for some of the drugs. An understanding physician should
give you these if you carefully explain why you need
them. Do not use these medications when medical
assistance is available nearby. When you are sick and
there are appropriate treatments, it makes sense to use
them. By following the suggestions given below, the
chances are excellent that you will recover, and the
benefits of treatment far outweigh the risks. If you are
not getting better in spite of self-treatment, then
consider other alternatives, especially if the situation
seems grave.Names of drugs are always
dilemma. While the official or generic names are
generally the same throughout the world, the advertising
or brand names vary greatly from place to place. The
generic names are used here where possible.
The recommended
medical kit- enough for a party of two- includes the
following:
Moleskin.
Felt or foam (molefoam) padding (about 1mm thick for
felt, 2or 3 mm for foam) with adhesive backing, used for
the prevention of blisters. About half a square foot per
person should be enough. It is not available in
Kathmandu, but adhesive tape or zinc oxide strapping can
be used as a substitute.
Bandages.
One roll of 2-in. adhesive tape, and five to ten
adhesive bandages per person for small wounds.
Elastic Bandage.
One 3-in. roll for relief of strains and sprains.
Thermometer.
One that reads below normal temperatures (for diagnosis
of hypothermia) as well as above (for fever).
Miscellaneous.
Scissors, needle, or safety pin, and forceps or
tweezers.
Plastic Dropper
Bottles. One-ounce (30ml) size for iodine. This
is best brought from home. If your pharmacy no longer
carries empty plastic dropper bottles for dispensing
compounded ear, eye, or nose drops, buy a plastic
dropper bottle of nose drops and dump the contents.
Water
Purification Chemicals. Tetraglycine
hydroperiodide or iodine in various forms. Vitamin C
powder masks the taste.
Nose Spray or
Drops (optional). Phenylephrine HCL (0.25%) for
stuffed noses and sinuses. Put two drops in each nostril
two or three times a day when symptomatic and when
changing altitude. An alternative is oxymetazoline, used
no more than twice a day.
Nasal
Decongestant (optional). For those accustomed
to taking these tablets for colds.
Antihistamine
(optional). For treating symptoms of colds and hay
fever. If you do not have a favorite, try
chlorpheniramine maleate tablets (4mg). Terfenadine and
astemizole are expensive, non sedating antihistamines
you could try.
Aspirin or
Similar Drug. Twenty-five tablets (5grain,
325mg) of aspirin for relief of minor pain, for lowering
temperatures, and for symptomatic relief of colds and
respiratory infections. Ibuprofen (200mg) or
acetaminophen (paracetamol)are appropriate substitutes
for those who can't tolerate aspirin.
Codeine.
Fifteen tablets (30mg) for relief of pain, cough, and
diarrhea. A good multipurpose drug. It is customarily
compounded with acetaminophen tablets in the U.S.A.
Anti-motility
Agents. Codeine, as already mentioned, or
loperamide (2mg), or diphenoxylate compound tablets.
Take twenty.
Antibiotic.
The current trekkers' wonder drug is probably
ciprofloxacin, in 500mg tablets. Expensive, but adequate
for most of the infectious bacterial causes of illnesses
that might befall the trekker. Take twenty capsules at
least; the dose is one capsule twice a day. An
alternative is norfloxacin, 400mg tablets, taken three
times a day. A related cheaper drug, nalidixic acid, has
been used successfully in Nepal and is the drug of
choice for children for diarrhea. Other choices would
best require that two different ones should be carried,
a cephalosporin (cefaclor, cefuroxime, and cefadroxil
are choices in the United States) and co-trimoxazole.
Carry a 10-day supply of a 250-mg cephalosporin. The
dose for the cephalosporin is either one or two every
8hours (cefaclor) or 12hours (cefuroxime or cefadroxil).
If allergic to penicillin, you might also be allergic to
a cephalosporin, but this is relatively rare.
Erythromycin (250mg capsule) would be the best choice
for allergic individuals. Take forty. Bring co-trimoxazole
(trimethoprim 160mg and sulfamethoxazole 800mg) in
so-called double-strength tablets if not allergic to
sulfa drugs. Bring twenty of these tablets. Be aware
that there may be resistance to this drug in Nepal.
Antiprotozoan.
Tinidazole is the best drug to self-treat presumed
Giardia or Amoeba infections while trekking. It is not
available in the United States but can be purchased in
Nepal. Take twenty 500mg tablets.
Antiheminth
(worm medicine). Six 100-mg tablets of mebendazole. one
tablet taken morning and evening for 3days will take
care of most worm infestations in porters. You won't be
there long enough to require treatment in Nepal.
Oral Rehydration
Solution (ORS, Jeevan Jal). A mixture of salts
and glucose, this powder is added to a liter of water to
provide the appropriate drink to rehydrate in almost any
situation, but especially from diarrhea. Not easily
available in the United States- buy it in Nepal.
Altitude
Medicines. Acetazolamide (DiamoxTM), 250mg
tablets, take twenty, and also dexamethasone, 4-mg
tablets, take five. The first is to treat symptoms of
mild altitude illness, and the second is to take if
someone has the serious, cerebral symptoms. The first
drug is appropriate to use for prevention in suitable
situations.
Gamow BagTM.
A hyperbaric chamber for treatment of serious altitude
illness. Enquire to Chinook Medical Gear, P.O. Box 1736,
Edwards, CO 81632, phone 1-800-766-1365 or (970)
926-9277, fax (970) 926-9660. Recommended for parties in
a group trek to significant altitudes.
Anti-inflammatory
Agent. To be considered if you are prone to
arthritic conditions or tendonitis. Aspirin or ibuprofin
are good choices; acetaminophen is not meclofenamate.
The latter is a good all-purpose pain medicine.
Sunscreen
Preparation. One with a sun protection factor
(or SPF) of at least 15 in order to get adequate
protection from the sun on snow slopes at high
altitudes. Sunscreens are best applied 1or2 hours before
exposure and reapplied after heavy sweating. Be sure to
apply them over all areas that can receive direct or
reflected sunlight, especially under the nose, chin, and
eyebrows. Lip balms containing effective sunscreens
should also be used.
Topical
Ophthalmic Antibiotic. Good choices of
ophthalmic antibiotics are those that contain bacitracin,
gentamicin, polymyxin, or tobramycin. Avoid any that
contain steroids such as betamethasone, cortisone,
dexamethasone, hydrocortisone, prednisolone, or others.
If you wear contact lenses trekking, be sure to bring
antibiotic eye drops.
Malaria
Suppressant (optional). Chloroquine, for
instance, if you and your doctor think it is necessary. |
