The CIWEC Clinic Newsletter – August 2011

Staff News

We have said farewell to our very popular doctors Dr. Ravi Vadlamudi and Dr. Robin Ramsay who have returned to their home countries. We have been joined by Dr. William Elson, a general practitioner doctor from the United Kingdom with expertise in Travel Medicine. Dr. William Elson along with Drs Prativa Pandey and Rashila Pradhan will be working with an excellent team of subspecialists at the clinic. Our nursing pool continues to grow.

CIWEC expansion project

Construction is going full swing at the clinic. We have tried to minimize the noise but some days it is noisier than other days. We had hoped to have everything ready by the end of 2011 but we will be lucky if we can have the new wing operational before spring 2012. We hope to provide extra services on site once the new wing is completed.

As the BIG holiday season is approaching in Nepal, we would like to let everyone know that the clinic is open 24 hours a day 7 days a week. We DO NOT CLOSE FOR HOLIDAYS. It is business as usual for us during the holiday season. Also, would like to remind you that we are much more than a clinic since we have an active inpatient service, laboratory, radiology on site and an ambulance service.

Influenza outbreak

Recently there was a small outbreak of influenza in the valley and we had several Influenza A confirmed cases. The main influenza season in Nepal is in the winter months of December/ January. We have seasonal flu vaccine available at the clinic. The 2011-2012 flu vaccine contains the swine flu component. We recommend flu vaccine to any one >6 months old for prevention of the flu. You can walk in any day of the week to receive this vaccine.

Diarrheal illnesses

There will be diminishing diarrhea risk as we head into the cooler months. But it will remain a significant problem for new arrivals into the country. If symptoms of diarrhea or vomiting start, it is important to replace fluid and electrolytes to prevent dehydration. This can be done fairly easily with an electrolyte solution mixed in a liter of boiled and filtered water or one liter of mineral water. Some commercially available products are Nava Jeevan and Jeevan Jal. Other fluids that can supplement the oral rehydration solution are: coca-cola/sprite without the bubbles, herbal teas, clear soup, tang solution, Gatorade or weak tea. Alcohol and heavily caffeinated products should be avoided. It is important to urge young children with diarrhea to drink liquids frequently since they can get dehydrated quickly from seemingly small fluid losses. Adults should drink 3 liters or more fluids per day depending on the amount lost as diarrhea or vomiting.

Bowel paralyzers, such as loperamide (eldoper locally), can give temporary relief of abdominal cramps and diarrhea, but do not shorten the illness or treat the cause. The use of bowel paralyzers is justified, however, when there is severe watery diarrhea or when facing a long bus or plane trip, or when you are trying to trek. To treat with loperamide, take 2 pills to start, and 1 pill after each loose stool (not to exceed 6-8 pills a day) until the diarrhea stops. Do not use loperamide alone if you have bloody diarrhea or fevers unless if you take an antibiotic with it.

Planning for a trek: Many persons will go trekking in the Nepali mountains in the fall season. Any person who is mentally prepared to trek and is reasonably fit, can safely do so. If you are taking high blood pressure medication and are not sure what to do, please continue to take your medication while you trek. Blood pressure tends to go higher at high altitudes. It is important to have a first-aid kit in case you encounter health problems like diarrhea, cough/cold and altitude illness while trekking. Use of birth control pills including the continuous use oral contraceptive pills is considered OK during trekking.

Altitude illness can start to occur at 2500 metres but serious symptoms are rare below 3000 metres. The early symptoms are headache, nausea, loss of appetite, fatigue and poor sleep. Serious symptoms are mental confusion, ataxic or drunken gait, cough with gurgling sound in the chest, extreme fatigue or shortness of breath at rest. Mild symptoms can resolve while you stay at the same altitude and you can continue your trip. Serious symptoms require that you descend immediately by helicopter or by walking/getting carried. It is important to know that there is great individual susceptibility to altitude illness and you may be the only person in a group to have symptoms.

Diamox (acetazolamide) can be used for prevention of altitude illness if you know that you have been susceptible to altitude on a previous trip or if you are flying/driving directly to high altitude places like Lhasa. It is not recommended for sulfa allergic people. The dose of diamox is ½ of a 250mg tablet twice daily for adults. For children, a dosage of 5mg/kg/day can be divided into 2 doses. There will be tingling noted around the mouth, fingers and toes in most people taking diamox. It is slightly uncomfortable but not a worrisome side effect.

If you are taking children to high altitude or if you have any medical condition that you are concerned about, we suggest that you see us before your high altitude trek. Detailed information on altitude illness and on the topic “trekking with children” can be found on the CIWEC Clinic website at: A handout on altitude illness and its prevention is also available in the clinic waiting room. A first aid kit with an instructional booklet prepared by the clinic doctors is available at the clinic.

Thank you.
The CIWEC Team