Minimizing gastrointestinal problems - Since most of Nepal still gets along without modern sanitation, these are endemic. They range from self-limiting attacks of diarrhea where dehydration is the main risk, through intestinal parasites, amoebic dysentery and giardiasis which are chronic without proper medical treatment, to immediately life-threatening infections like cholera and typhoid. Habituation even to common intestinal flora generally takes about a year and many unpleasant bouts of stomach problems, so tourists contemplating shorter stays should take extensive precautions. Filter or treat your own water, use bottled water, checking to make sure lid is sealed (limit use of bottled water since there's no place to dispose of the used bottles) or stick with beverages made from water that has been thoroughly boiled and filtered. Tea or coffee from cafes catering to tourists are 'generally' safe.
When trekking carry iodine or other chemical means of treating water and be sure to follow directions, i.e. don't drink the water before the specified time interval to ensure that resistant cysts are deactivated. In trailside teashops, although glasses may be washed in questionable water, tea is made by pouring boiling water through tea dust into your glass. The chances of disease-causing organisms surviving that are small but not zero.
Brush teeth with prepared drinking water and avoid water entering the mouth when showering.
Wash hands regularly and especially before eating.
Thoroughly wash fruit and vegetables for raw consumption using boiled and filtered water. Also consider peeling them.
Salads, especially in the wet season, should be treated as a suspect.
Look for freshly-cooked food and avoid anything that has been cooked and then left sitting around without refridgeration (which can expose you to a buildup of bacterial toxins), or without protection from flies (which can transfer disease organisms and parasite eggs to the food).
Get vaccinated and consider prophylactic treatment. You may be exposed to typhoid, cholera, hepatitis malaria, and possibly even rabies. Read the article on Tropical diseases and review travel plans with your health care provider.
Practice safe sex or do without. Nepali women are sought after in India and the Middle East and so there is human trafficking. Victims may be allowed to return home when health issues become a liability, then continue 'working' as long as possible. The incidence of STDs is rising and the government has not always been proactive about treatment and promoting awareness. Unless your Nepali is extremely fluent, your chances of finding out about a prospective partner's sexual history are slim.
Altitude sickness Permanent snow lines are between 5,500 m and 5,800 m (18,000 ft and 19,000 ft), so base camps and passes in the Himalaya are usually higher than Mount Blanc or Mount Whitney. This puts even experienced mountain climbers at risk of altitude-related medical conditions that can be life-threatening. Risks can be minimized by choosing routes that don't go high, such as Pokhara-Jomosom, or routes and trekking companies where gamow bags or other treatment are available, and by sleeping not more than 300 m (1,000 ft) higher per day. According to the "climb high, sleep low" mantra, it is good to take daytime conditioning hikes that push acclimation, then to return to a more reasonable elevation at night.
Hypothermia is a risk, especially if you are trekking in spring, autumn or winter to avoid heat at low elevations. When it is a comfortable 30°C (85°F) in the Terai, it is likely to be in the teens Fahrenheit or -10°C (14°F) at that base camp or high pass. Either be prepared to hike and sleep in these temperatures (and make sure your comrades, guides and porters are equally prepared), or choose a trek that doesn't go high. For example, at 3,000 m (10,000 ft) expect daytime temperatures in the 40s Fahrenheit or 5 to 10°C.
Dogs are not vaccinated and catch this fatal disease from other dogs or wild animals with some regularity. All mammals are potentially vulnerable. Dogs are considered ritually polluting and are widely abused, so it can be impossible to know whether a dog bit you because it is paranoid about people or because it is rabid. You should be vaccinated against rabies before going to Nepal, but this is not absolute protection.
Be on the lookout for mammals acting disoriented or hostile and stay as far away as possible. Do not pet dogs, cats or pigs no matter how cute. Keep a distance from monkeys, especially in places like the Monkey Temple in Kathmandu. If bitten or exposed to saliva, seek medical attention. You may need an extended series of injections that provides a higher level of protection than routine vaccination.
The risk is greatest in warm weather and at elevations below 1,500 m (5,000 ft). Poisonous snakes are fairly common and cause thousands of deaths annually. Local people may be able to differentiate poisonous and non-poisonous species.
Cobras raise their bodies in the air and spread their hoods when annoyed; itinerant snake charmers are likely to have specimens for your edification.
Vipers have triangular heads and may have thick bodies like venomous snakes in North America.
Kraits may be the most dangerous due to innocuous appearance and extremely potent neurotoxin venom. Kraits are strangely passive in daylight but become active at night, especially around dwellings where they hunt rodents. Krait bites may be initially painless, causing only numbness.
However without proper antivenin numbness can progress to deadly paralysis, even with bites from small, seemingly harmless specimens. Wearing proper shoes and pants rather than sandals and shorts provides some protection. Watch where you put your feet and hands, and use a flashlight when walking outside at night. Sleeping on elevated beds and on second stories helps protect against nocturnal kraits.
There are strikes ("bandas") and demonstrations to contend with. Businesses close and transportation halts. Ask about strikes at your hotel and make sure you have enough money to last. Food and water are still available in hotels, and much business goes on behind closed doors. Rallies and demonstrations are routinely charged by police wielding laathis or long sticks. Tourists should keep a low profile, and to avoid confrontations.
The Maoist insurgency ended in 2006 after they signed comprehensive peace agreement with the government. Their combatants are still in camps (as of September 2008) with their future to be decided by the government. The former rebels are now leading the government and their activists on the ground have not harassed the tourists. The trekking routes and other tourist destinations are safe for travel If your country has an embassy or consulate in Nepal, let them know your whereabouts and plans, and at least listen seriously to any cautionary advice they offer. IT is advised not to take long haul buses through the Eastern Terai, particularly overnight as there have been reports of Maoist takeovers on these buses.
Nepal's cities are safer than most. Even pickpockets are rare. Still, don't flash cash or make ostentatious displays of wealth, out of respect for the non materialistic reality of the people.
Be cautious about transportation. Roads are narrow, steep, winding and frequently crowded. Seatbelts are an aberration. If you read the papers regularly, you may notice articles about busloads of people falling into gorges. The Eastern Terai is not the place to be taking buses between destinations. There have been reports of takeovers by Maoist rebels, robberies and buses burnt (although, typically they let passengers off the bus first). Domestic flights with a private company are much safer.
Scheduled flights are safer than the roads, but planes occasionally fly into clouds and find mountains. The risks are greatest before and during the monsoon season when the mountains are usually clouded over. Helicopters may be better at avoiding this, but sometimes crash due to mechanical complexity and dubious maintenance. If you are flying with a company that has no pilots older than 30, you might wonder why. Aviation was already fairly well developed by the 1960s; where have all the old pilots gone?
Nevertheless if you should be seriously injured or sick out where there are no motorable roads or airports, medical evacuation by helicopter may be your last best chance. This can get very expensive. If there is no firm guarantee that the bill will be paid, companies offering these services may demur, so look into insurance covering medical evacuations. Also ask if your embassy or consulate guarantees payment; another reason for introducing yourself, even if they seem a bit stuffy.