Safety Tips in Tibet

Being in Lhasa one does not notice it so much, but Tibet really has quite a lot of beggars (not counting monks' alms here!) - and the more you go to south-west along the Friendship Highway, the more noticeable it is. Kids, men, women, old people - we've seen everybody at it. They can even come into the restaurant while you're eating - anything goes.

In a restaurant, quite unexpectedly, it's often food they want - given the huge (for me) portions people get served, most people will usually be quite happy to give them some of it when approached.

There's plenty of advice out there as to whether one should or should not give money. With kids (who tend to be the most persistent), we've bought some sweets & pens to hand out, which seemed to work well enough. That said, if you'd rather donate to an organised charity and are having a hard time to shake beggars off, the only trick we've found that works is to mention 'Police' - even though people did not speak English, the concept was familiar and we were left alone.

What is it?

Acute Mountain Sickness is a name for a host of symptoms that can appear as the oxygen content in the air is reduced when people ascend to higher altitudes without proper acclimatisation. The level at which AMS can manifest itself differs from person to person, but generally one would have to be above 3,000m to exhibit any noticeable symptoms. Flying into Lhasa is a common trigger, as you get straight to an altitude of ca. 3,500m - often from close to sea level. Most common symptoms would include headaches, lack of appetite, difficulty sleeping, etc.

It's usually difficult to predict how one feels at higher altitude unless one has been there - how fit one is is not always a reliable guide. Even past history can be misleading - both my mother and myself have got AMS once before at an altitude of about 3,000m with prior acclimatisation, but this time we were absolutely fine at 5,200m at the Everest Base Camp without oxygen or anything like that (even though we went up there from ca. 4,050m altitude at Shegar in a day)

What to do?

1. Acclimatise in Lhasa - when first arriving in Lhasa from lower down, it's a good idea to stay in the city for a couple of days at least to get used to the altitude. Whether you will be able to do any sightseeing on day 1 will depend on how well your body adjusts to the altitude. If you see you're not doing so well, starting off at the Potala is not a good idea.

2. Make a gradual ascent - try not to gain more than 400-500m net a day. It's much easier done when hiking, but if you're riding in a Land Cruiser you may not notice the elevation gain before you stop for the night. If you see you're struggling and you're flexible with your schedule - try to remain at the same altitude for another day. You will probably be safe without it, but better safe than sorry, right?

3. 'Climb high, sleep low' - the old mountain climbing principle. AMS symptoms are typically worse at night, so it's considered prudent to go up during the day (possibly by more than 500m net) and then descend a little bit for the night.

4. If symptoms are bad - the only thing to do most often is go down.

One of the very few unpleasant things one encounters in Tibetan cities are packs of feral dogs. There have been clean-up campaigns in Lhasa and Shigatse's centre (which does sound cruel, but if the current situation in other towns is anything to go by - Gyantse springs to mind - things must have been pretty desperate), but in smaller towns and Shigatse's suburbs it's still a problem.

The packs did not feel life-threatening, but it made me seriously consider whether I really wanted to do the Tashilhunpo kora (which was perfectly fine, given it was day-time and the number of people around), and it did feel distinctly uncomfortable when we left the hotel in Gyantse to go for dinner across the road to see 6 dogs on a surface of about 8-9 sq. meters.

To be on the safe side, try to avoid the less frequented roads and be especially vigilant at night (most dogs tend to sleep during the day and don't care much for passers-by). Something to definitely steer clear of are the nomads' dogs, who are guard dogs and as such should be given a very wide berth.

Protesters are not welcome here. We’ve been told that it would be a big problem if we have a book or poster of Dalai Lama or even Richard Gere. They can make you wait or even send you back from airport. If you carry a photo of them, you should leave it behind. And don’t think you are free to protest after the airport. Every place is highly secured. We’ve been warned just because of standing still (we were listening to our guide) in Potala.

The below web site has good information for traveling at high altitude.

Everyone if different. I had very little problems with high altitude. I think I was just lucky and also drank a lot of water. A travel nurse recommended taking multiple vitamins with iron for at least 6 weeks before the trip. I don't know if it helped but I did what she recommended.

But my friend was like an altimeter and had problems every time we went over 4,000 meters. My friend got use to it over time, I think going up and down in the car as we drove to Lhasa helped. We were touring so took about 2 weeks driving up and down at altitude.

The main thing is give your body time to get acclimated to the altitude. Don't fly in to Lhasa and head off to Everest Base Camp (EBC) the next day. EBC is a tourist sight and many people do this.

Drink plenty of water. Just breathing causes a lot of lost of water vapor that you don't even know it's happening. Drinking alcohol will cause problems and I did not.

Please rate this and my other tips when you find useful, interesting, or like the pictures.

As said above , don´t expect any hands on experience from your GP - last time I came out of the university travel clinic with altitude medication and the following note in my journal : "prescribed as per the users experience and knowledge" . This doesn´t mean the doc was a passive rubberstamp , he was very professional in checking out possible interaction with other medicines.

We also went over the documentation from the specialist altitude medicine site together : http://ismmed.org/np_altitude_tutorial.htm#prevention

Some of the points I´ve come to see as important over the last twenty years of travelling in the Himalayas :

* You acclimatize to A altitude , not THE altitude. Having just arrived in Lhasa you´ll match the norm for home oxygen treatment for people with chronic lung disease, and you will improve a lot over the first three days , but full acclimatization takes up to two months. Jump up to 4500 meters and you´ll have to restart the process.

* The key factor both in acclimatization and altitude sickness is where you sleep : longer time with the lower oxygen saturation that comes from horizontal position. Hence start counting nights , not days.

* Many assume that land travel is automatically better , from a gradual approach. Often it´s the opposite : on the Kathmandu-Lhasa run for example Lhasa is the lowest night.

* acclimatization is slow at 2000 meters , and nonexistent below 1500 : the optimal run is going fast to your first acclimatization night near cabin pressure ( like Xining at 2300 ) , and preferably spend two nights there before going higher.

* After your first acclimatization night you can do day visits up to 4000 meters , and this will in fact boost your acclimatization : "climb high , sleep low"

I’ve never seen a brighter sun in my life! Maybe because of being closer to it, sun is too powerful here. It can even cook your brain, if you don’t protect yourself. Bring hat and high factor sun blocks. Select higher factors than your usuals. I would bring UV factored clothing, too, if I was aware.
You can see a strange device people used for boiling water in Tibet in photo. It can give you an idea about the sun’s power.

Lhasa and its airport located in an altitude of 3500m. I live in Istanbul, at sea level. It is quite a way to up. My body couldn’t adjust in 2-3 days; I think you’ll experience the same.
Our guide has warned us about walking slower than usual, drink more water and not to drink alcohol. We have already started taking some pills (Diazomid from Turkey, Diamox is the European version) against altitude sickness before coming. I started to feel dizzy after landing. We reached the first city after a bus ride. It was hard to climb even the stairs to first floor. I was tired but wanted to see the city and left the room while everybody resting. Walking over 3500m was like walking on the moon. I thought that I was drunk. Yet I enjoyed the walk and this helped me to speed up my adjusting period.
Height can affect people in various ways. The most common effect is feeling dizzy. Several people from the group suffered from difficulty in breathing. This is why all hotel rooms have oxygen tubes. Altitude sickness also has dangerous effects. Take the pills I mentioned to prevent it. The pills have side effects like itchy feeling in your hands and feet, urinating more… Since you need to drink more, diuretics cause a gross problem. But if you don’t take the pills, you may have heavy headaches. The problem you’ll face in Tibet is up to your choice.