Health & Safety

Altitude sickness, also known as Acute Mountain Sickness (AMS), poses a significant consideration for travelers in Bhutan. 

Many popular trekking routes and even major towns like Thimphu and Paro are situated at high altitudes, with initial adaptation difficulties potentially appearing as low as 2500 meters. 

It is crucial to understand that vulnerability to AMS is universal; anyone can be affected at altitudes above 3500 meters, irrespective of their physical fitness level. 

This dispels the common misconception that only unfit individuals are at risk, emphasizing the physiological nature of AMS and the universal need for precautions.

Symptoms to Watch For

AMS typically manifests as a rapid and dramatic onset of symptoms, rather than a slow, gradual worsening of minor issues. Symptoms often begin to appear 12-24 hours after ascending to a higher altitude. Vigilance for these signs is paramount:

• Common Symptoms: Headaches, nausea, dizziness, difficulty walking, rapid heartbeat or fast pulse, shortness of breath, insomnia (altitude adjustment problems), and a severe cough.
• Severe Forms of Altitude Sickness:
  • Low Oxygen Saturation: At high altitudes, the reduced atmospheric pressure means each breath takes in less oxygen, leading to poorly saturated blood. This can cause fatigue and breathlessness. In severe cases, it can impair mental functions and reduce decision-making ability. Guides on organized treks are often equipped with pulse-oximeters to monitor oxygen saturation daily.
  • Cerebral Oedema: This is an extremely serious medical emergency where reduced air pressure causes fluid to accumulate in the sinuses and air cavities of the skull. It may initially present as a mild headache but can rapidly progress to disorientation, coma, and even death. Cerebral oedema can appear very suddenly.
  • Pulmonary Oedema: This condition results from reduced air pressure in the lungs, causing fluid to seep from lung tissues into the air spaces, making breathing significantly more difficult. It often resembles pneumonia and is most likely to occur during sleep.

Key Prevention Strategies

The most effective prevention strategy for altitude sickness is a tranquil and slow approach to ascent.

• Gradual Ascent & Acclimatization: The most critical principle is to maintain a slow and steady pace. Travelers should increase their elevation gradually, aiming for a maximum gain of 300-500 meters per day, particularly once above 3000 meters. Incorporating planned rest days into the itinerary, especially after significant altitude gains, allows the body crucial time to adjust and recover. If rapid transportation to high altitudes (e.g., by flight or bus) occurs, it is advisable to remain at that sleeping altitude for at least three days to facilitate acclimatization. The widely recommended motto “Climb high, sleep low” advises ascending to a higher point during the day but returning to a lower altitude for sleeping.
• Hydration & Nutrition: Adequate fluid intake is paramount for preventing dehydration, which can mimic or worsen AMS symptoms, and for aiding acclimatization. Travelers should aim to drink at least three liters of water daily; a general guideline is one liter of fluid per 1,000 meters of altitude. Tea, juices, or soups are excellent hydrating options. Consuming a balanced diet rich in carbohydrates is also beneficial, as the body metabolizes carbohydrates more efficiently at high altitudes.
• Avoid Alcohol & Caffeine: Limiting or completely avoiding alcohol and caffeine, especially during the initial days at altitude, is important as they can dehydrate the body and impede the acclimatization process.
• Pacing & Monitoring: Travelers should walk slowly enough to maintain a normal conversation without panting or breathing hard; if heavy breathing occurs, the pace must be slowed down. Continuous self-monitoring of pulse and heart rate is advised, and any symptoms should be taken seriously and reported to a guide immediately.
• Medication (Prescription Only): The prescription drug Diamox (acetazolamide) can be helpful in preventing AMS. However, it is essential to consult with a doctor before taking it. A significant danger lies in unsupervised use of medications like Aspirin and Diamox, as they can suppress symptoms and mask true acclimatization. This can lead to a false sense of security, causing dangerous delays in recognizing severe AMS and potentially turning a manageable situation into a life-threatening one. Therefore, adherence to professional medical guidance is crucial.
• Physical Preparation: While a good fitness level is advantageous, it does not guarantee immunity to AMS. Engaging in regular cardiovascular exercises and strength training prior to the trip, and practicing hiking on trails with elevation changes, will help prepare the body for the demands of high-altitude trekking.

Immediate Treatment Protocols

Prompt and appropriate action is critical upon the onset of altitude sickness symptoms.

• No Further Ascent: If any symptoms of acute altitude sickness appear, it is critical to halt further ascent immediately.
• Immediate Descent: If adaptation problems do not improve noticeably, or if symptoms worsen, immediate descent to a lower altitude is mandatory. In extreme cases, seeking rescue without hesitation is necessary.
• Never Leave Alone: Individuals exhibiting signs of altitude sickness should never be left alone, as their health condition can change rapidly and unpredictably.
• Monitoring by Guides: Reputable trekking guides are trained to monitor clients for AMS. They will check oxygen saturation levels (e.g., if below 80%, retesting is required; if it doesn’t rise to at least 75%, immediate descent is necessary) and use assessment tools like the Lake Louise Scale to evaluate symptom severity and guide decisions on continuing the trek or initiating descent.
• Rest: A rest day can be beneficial for initial discomfort. When resting or sleeping, elevating the upper body in a well-ventilated tent is advised.