HEALTH

Tap water in Bishkek is in our view perfectly safe though some tour guides, erring in favour of caution, advise you to stick to bottled water, and you can freely buy cheap mineral waters if you wish. Almost all travellers anywhere in the world suffer from diarrhea at some stage: bring some medicine for this, or buy it here, and to cut down on the risk it is best to wash fruits and to eat well-cooked hot food. But generally, Kyrgyzstan is much more health-conscious than many other Asian destinations. Possible exceptions are when you eat in roadside cafes, where standards are not up to those in the cities.

Innoculations — if you are already in the hotel reading this, then maybe it is too late. But for the record: Technically, at the time of writing, none are required … however, you should certainly have considered tetanus, diphtheria and cholera innoculations to be on the safe side. However, please ask your doctor about this and other possibilities, we are not doctors and cannot advise properly.

There is reportedly rabies in mountain areas, and most hospitals carry stocks of vaccine. We have never heard of a tourist (or, for that matter anyone else) getting this disease but it does exist apparently, in Kyrgyzstan and neighbouring countries including China.

Remember that even in Kyrgyzstan you may travel at over 10,000 feet (3000 metres) and at even higher altitudes in some places. There should be no problem if you are in a vehicle or even while walking gently at 3000 m. But we advise that you consult your doctor and ask about altitude sickness particularly if you are elderly or have breathing problems, asthma, etc. You will not be at the very high altitude for very long, and you will not have to do anything strenuous if you do not want to. At altitudes over 4000 metres, even our younger and more athletic staff quickly feel tired after running short distances. We are not doctors and we cannot advise you, but to the best of our knowledge, very few people suffer from altitude sickness while travelling in vehicles and if they do, the best cure is a prompt return to lower altitudes. A 48 year old and quite asthmatic passenger felt a little uncomfortable when travelling with Celestial Mountains Tour Company on the 4700 meter pass, but no more than a little uncomfortable and aware of the height at which he was travelling.

If you go to places like the Ala Archa National Park then you should aware that there have been reported incidences of tick borne encephalitis. You should try to cover exposed areas of the skin and take a form of insect repellent.

It is unlikely to affect guests in the hotel but you should be aware that there are occasionally press reports about the incidence of widespread TB, venereal disease in the country.

If you fall ill, there are reasonable hospitals in the region, but your insurance should — we strongly recommend — cover repatriation for serious illness.

DOCTORS — MEDICAL ASSISTANCE

Doctors in Kyrgyzstan are often well trained and professional but in some specialties medical practice may lag behind the West. Doctors and hospitals sometimes lack the latest equipment and medicines and the physical facilities of hospitals are somewhat run down and below Western standards. However, facilities are now being improved and Westerners can obtain a good standard of care and treatment, especially in Bishkek, though at a price. There is a Diagnostic Centre in the city, near the Tsum Store and central post-office, which offers a good range of diagnostic services at reasonable prices (blood tests, other kinds of analyses, ECGs, cardiovascular exercise tests, ultrasound, etc.)

ALTITUDE SICKNESS.

There are inherent risks in travelling at high altitude. High altitude is generally reckoned to be above 2438m (8000 feet) so that includes places like the Ala Archa, the Dolon Pass, Naryn, Son Kul and Tash Rabat. Very High altitude is considered to start at 3658m (12000 feet) and that would include the Torugart Pass. Anything over 18000feet (5500 m) is considered extreme altitude — but it is unlikely that our tours will ever go this high.

There is no way of telling who may be affected by altitude. There are no simple factors such as age, sex, or physical condition which can be used as indictors. Most people are able to go to 2500m and feel no affect — whereas others are taken ill very quickly. For people unaccustomed to travelling at altitude, caution is the best advice. Even for those who have been — proper acclimatization is important.

Altitude sickness arises because there is less oxygen in the air — and to get enough oxygen into the bloodstream, the body has to adjust and the rate of breathing increases (even when at rest). The main cause of altitude sickness is going too high, too fast. Given time to adapt, the body is able to cope with the changes necessary to copy with the changed conditions — this process is known as acclimatization and usually requires between 1 to 3 days at a given altitude. It is important to remember that different people acclimatize at different rates — so it is important to consider the group as a whole — and not to be guided by the first few individuals to acclimatize.

Over 10000 feet (3048 m) — most people will experience some symptoms. The onset of symptoms is normally delayed for about 12—24 hours after arrival at altitude. Symptoms include headache, dizziness, fatigue, shortness of breath, loss of appetite, nausea, disturbed sleep, and a general feeling of malaise. They tend to be more marked at night because the body activity is decreased and more relaxed. It is important that any symptoms are reported by clients as soon as they become apparent.

Although some medications are available to help prevent altitude sickness — they should only be taken under medical supervision — and the only cure for altitude sickness is descent. Medication may help to relieve symptoms but they cannot resolve the overall issue.

If possible, travellers should not drive or fly to high altitudes. It is best to start at below 10000 feet, (3048 m) and walk up. It is important not to over-exert yourself — and if possible to remain at the same altitude for about 24 hours. Ideally further ascents should be at the rate of about 1000 feet, (305m) per day, with a days rest at that altitude. It is best NOT to sleep at the maximum height reached that day (although at places like Son Kul this might be difficult to achieve). If symptoms develop, then no further attempt should be made to go any higher — indeed the advice is to descend. Every person in the group should keep hydrated — drink copious amounts of water and avoid alcohol (also tobacco and other depressant drugs — including sleeping pills). The diet should be high in carbohydrates.

If we are informed beforehand that altitude sickness may be an issue for a particular group of individual, then arrangements can be made to carry oxygen cylinders. These should only be used by people that have received proper training and are in possession of the appropriate certificates. It should be remembered that these are only an aid — and cannot solve the problem. The only cure for altitude sickness is descent.

Remember:

DESCEND, DESCEND, DESCEND!!!

SUN RELATED PROBLEMS

From sandy beaches by Lake Issyk Kul to lofty mountain summits, sun protection is an essential.

Skin cancer caused by overexposure to the sun has emerged as a major health issue around the world and is by far the most common cancer in the United States. At the very least, a bad sunburn causes pain, discomfort and dehydration — and has ruined many holidays in the sun.

Kyrgyzstan experiences many sunny days — and in the summer the days can be very hot, and the sun can be very strong.

Preventing Sun Related Problems:

UV Rays — What You Don’t See Can Hurt You. Sun-related problems are among the most preventable of outdoor illnesses and injuries. Here are some tips to help youdo so:

• The first line of defense is what you wear. Tight-weave clothing blocks a large amount of ultra violet radiation, especially if it stays reasonably dry. Choose darker colored fabrics because they tend to block more ultra violet rays than lighter-colored clothing.
  
• A full-brimmed hat will shade face and neck, and a floppy brim breaks up scattered ultra violet better than a rigid brim.
  
• Sunscreens dramatically reduce the chance of skin problems. Although most experts agree that screens with a sun protection factor (SPF) of 15 sufficiently protect most skin, recent studies show that higher SPF numbers offer additional protection, especially in the first few hours of exposure. Sunscreens are most effective if applied when the skin is warm and allowed to soak in for about half an hour before extreme exposure. People with very susceptible skin types might do better to completely block ultra violet radiation from exposed skin with an opaque substance such as zinc oxide.
  
• Limit your time in the sun. ultra violet A bombards the earth at an almost constant rate throughout the day, but approximately 80 percent of ultra violet B rays strike between 10 a.m. and 3 p.m. For minimum exposure, plan to be in the sun early and late in the day.
  
• Smoke absorbs ultra violet radiation, but clouds do not. Cool, overcast days in the summer are dangerous because ultra violet radiation penetrates the densest cloud cover, while heat-carrying infrared waves are filtered out. People feel cool, fail to take precautions, and often get severe sunburns.
  
• Wind will dry skin, removing the natural skin protection. Wind does not truly burn skin, but it makes skin more susceptible to sunburn and irritates already sunburned skin, a problem often called "windburn."
  
• Activities associated with water increase the risk of serious sunburn since sunlight bouncing off the water's surface attacks exposed skin. The more directly the sun is overhead, the more the reflectivity. Rough, choppy water is much more reflective than calm water. Snow is also highly reflective, reflecting as much as 85 percent as much light as water.
  
• Altitude is another factor. For every 1,000 feet above sea level, ultra violet radiation increases about five to six percent.
  
• Consult your doctor or chemist about medications that make skin more sensitive to sun: tetracyclines, antihistamines, sulfa drugs, diuretics, and some oral contraceptives.
  
• Wear sunglasses that absorb or reflect ultra violet light. Ultra violet light damages eyes as well as skin. The conjunctiva can swell from ultra violet exposure, sun-induced cataracts can form from repeated exposure, and direct ultra violet radiation will burn the retina.
  
• Teach children about the dangers of sunlight. According to some research, 80 percent of lifetime exposure to skin-damaging ultra violet light occurs during the first 18-20 years of life.
  

Using Sunscreen

The most important rule when playing, working or sitting in the sun is to use a sunscreen. Choose a sunscreen with a Sun Protection Factor (SPF) of 15 or higher. Following these guidelines should help you enjoy the sun:

• Use sunscreen for protection, not in place of it.
  
• Choose a water-resistant sunscreen that will not wash off as easily.
  
• Reapply sunscreen every two hours or after swimming or rigorous activity.
  
• Sunscreens work best if applied liberally on warm, dry skin and allowed to soak in 15-30 minutes prior to sun exposure.
  
• Protect your lips, nose and face with a sunscreen.
  
• When venturing into areas of higher insect infestation, apply sunscreen under insect repellent or use a combination sunscreen/insect repellent such as Repel Sun & Bug Stuff.
  

INSECT PROTECTION

Mosquitoes and other biting insects have done more to ruin a wilderness experience than anything else known to man or woman. But mosquitoes and other blood-feeding insects are more than a minor annoyance. According to the Centre for Disease Control and Prevention (CDC), diseases transmitted by mosquitoes, ticks, biting flies, fleas, gnats, and other biting insects are becoming a major public health problem. Mosquitoes can carry such serious diseases as Encephalitis, Yellow Fever, Malaria, and Dengue Fever.

Tick borne Encephalitis, and malaria both occur in Kyrgyzstan.

Methods of Protection

• Use an insect repellent.
  
• Carefully read and follow all label directions for safe application.
  
• Dress in light-coloured clothing to spot ticks more easily. Wear collared long-sleeved shirts and long pants/trousers with cuffs for maximum protection. Tuck your shirt into your pants and pants into your socks or boots.
  
• Dress in loose clothing to help prevent bites from bugs that can reach their biting apparatus through tight clothing.
  
• Look for ticks several times during the day or before you return indoors. Check especially around the scalp, nape of the neck, behind the ears and knees, and under the armpits.
  
• Remove ticks completely with tweezers or tick remover. Grasp the tick close to the skin, as close as possible to the tick's mouth and pull outward without twisting until the mouthpart is released. Avoid the tick's bloated abdomen, which can act like a syringe if squeezed.
  
• Don't use heat or suffocation methods. Petroleum jelly, nail polish, rubbing alcohol, cigarettes, or lighted matches will only serve to sicken the tick and may increase the chance of a host tick injecting you with dangerous bacteria.
  
• If bitten by an insect or tick, treat the area with a bite relief formula for relief of pain, itching, and swelling. It symptoms persist, consult a doctor.
  
• Some insects, especially mosquitoes, feed primarily at dawn and dusk, and sometimes throughout the night. To sleep more comfortably, use a tent with adequate insect netting or sleep under a mosquito net.

Proper Application of insect repellents

• Always follow the label directions carefully.
  
• Apply only to exposed skin and/or clothing as directed on the product label. Do not use under clothing.
  
• Never use repellents over cuts, wounds, or irritated skin.
  
• Do not apply to eyes and mouth.
  
• Do not apply to the hands of young children who are prone to putting hands in their mouth. Also, use a lower concentration product for children.
  
• Use just enough repellent to cover exposed skin and/or clothing. Saturation is unnecessary for effectiveness.
  
• After returning indoors, wash treated skin with soap and water.
  
• Always keep insect repellents out of reach of small children.