The itinerary for the Sikkim trek has been organised in such a way as to enable those students and adults to enjoy the trip and avoid unnecessary health hazards. However altitude sickness in its various forms, intestinal problems, and blisters etc. are hazards which do arise from time to time. The trek will have a trained member of staff with mountain leadership certificate and first aid qualifications and two experienced local guides. With five staff on this trek we have a good staff to pupil ratio and staff will be on the lookout for any possible signs of illness or altitude sickness. We are in the process of planning some weekend walks for the New Year to help increase fitness and to enable the group to work together as a team. This should, however, not be considered all that is necessary to avoid physical fatigue, aching muscles or blisters spoiling the treks. In addition, those taking part should undertake a personal conditioning programme and with the exams over in January, for those doing modular exams, an increasing amount of time should be spent building up fitness. Running a few miles per day, or working out regularly on one of the school's ergonometers is probably the best single physical activity which will help. Hiking with a heavy backpack, cycling and swimming are all useful. Break in the footwear you intend to use before the weekend walks with long hikes and apply white spirit to pressure points on the feet to harden the skin at least two weeks before walking.

The following immunisation programme is necessary before visiting India. You should consult your own General Practitioner who will usually be pleased to organise the necessary immunisations, and will provide a timetable that is considered appropriate.

POLIO - Booster within 10 years. Usually will have been given at age 15 with Diptheria and Tetanus.

TETANUS - Booster within 10 years. Again you should have received a booster at age 15.

HEPATITIS A - Anti-hepatitis A vaccine can be given, with two doses before the trek and a third dose at 6 to 12 months on return from the trek which will then give protection for up to 10 years instead of just three years with the two doses. This is a sensible option to take up. There is no need to check for antibody levels before vaccination in students.

MENINGOCOCCAL MENINGITIS - Within 3 years

There is a current significant risk. The West Berkshire Health Authority vaccine only covers meningitis C, and the epidemic strain in India is meningitis A. Therefore even if students have received the new vaccine at school they will also need to receive the meningitis A vaccine from their GPs as part of the vaccination programme. It will not matter if the other C vaccine has been given, and indeed it is likely that two vaccines for meningitis C will boost the resistance to this strain.

TB - BCG immunisation is essential. Before a BCG is given it is necessary to find out if you have immunity against TB already by performing a Heaf test. If the Heaf test is negative (read at one week), you will receive BCG vaccination. If it is positive various things are done depending on which part of the world you come from and how positive it is. Please contact your GP if this has not been given.

Vaccination is not required for India.

The following may be considered optional.

Rabies does exist in India, and if animal bites occur there is a significant risk. Although not mandatory, pre-immunisation prophylaxis with rabies vaccine will make it more simple to treat any cases of bites when in India. Immunisation involves three injections. Rabies immunisation is optional, not compulsory. Your GP will probably have to charge for this and it may cost £60 or more. Please contact your GP for advice. If bitten by a rabid animal it is important to realise that the vaccine does not provide complete protection. It is necessary to clean the wound by scrubbing with soap and water under a running tap (if available) for 5 minutes. The name and dwelling of the owner should be obtained if possible, and the animal observed for 10 days to see if it begins to behave abnormally. Keep well clear of dogs and the monkeys that are often found around temples where food offerings are left.

Cholera inoculation was required in the past, but was not particularly effective and the World Health Authority has withdrawn it.

This is transferred through sex or contact with contaminated blood, needles or syringes. Immunisation is not necessary.

The following immunisation is not required:

There is only malarial risk in India in the lowland parts which include Calcutta. Antimalarial prophylaxis is therefore considered to be necessary with a Paludrine (2 x daily) and Chloroquine (2 x weekly) regime as the recommended prophylaxis. These will be obtained at cost price for the whole group and these will be started one week before and continued for four weeks after the visit as recommended.

The vaccinations should be recorded on an approved vaccination form which will be provided for you by your GP. You may already have a vaccination form, in which case you should take this to your GP when you plan your vaccination course.

AIDS is something which needs to be considered in any Third world country these days, so contact with body fluids of any local person should be avoided.

There may be specific needs of individuals that must be discussed beforehand with a GP. Please consult your GP if there are any concerns about fitness that you may have. Asthma is a particular condition that has been raised as a cause for concern. Experience shows that asthmatics have no more problems than non-asthmatics at altitude, and allergy to dust mite ceases to be a problem because there are none there at altitude*. (*Information from Dr. Richard Lewis, consultant chest physician and asthma specialist at Worcester Hospital by personal contact) .

I will be taking a medical kit but individuals should pack the following personal items:

1. Routine medication which you need to take should be obtained in sufficient amounts for the trek with additional drugs in case of flight delay, damage or loss. If drugs are very important then give an emergency supply to a member of staff.

2.Blister dressings such as Compeed kits large and small, Spenco, Moleskin etc should be taken in adequate quantity.

3.Dressings

Assorted Elastoplasts (or similar) for small wounds (buy your own supply)

Crepe bandage 7.5 cm x 1

Adhesive tape (Micropore type) x1

Mepore x2

4. Sunscreen preparation (with a sun protective factor of at least 15 and preferably 30). Best applied one or two hours before exposure). Be sure to apply them to all areas receiving direct or reflected sunlight (even under the nose, chin, ears and eyebrows). Lip salves containing a sunscreen should also be taken and used regularly. A brimmed hat is also a sensible sun precaution. 100% UV protection sunglasses are essential and should be worn on sunny days at altitude. A cotton scarf would be very helpful to protect the neck from sun, and to act as a dust filter on trek, and pollution filter in town.

5. Paracetamol in sufficient dose for personal use as a mild pain killer.

6.Throat lozenges such as Nirolex for cough and Strepsils for sore throat. Cough at high altitude is extremely common and a real nuisance, therefore take adequate lozenges.

7.Antiseptic wipes to clean cuts and grazes on trek.

The vast majority of diseases affecting the trekker in India are transmitted by food and water contaminated by infected human and animal faeces. You should assume all water and uncooked foods in India are contaminated. This holds true for the main towns and cities as well as along the trek.

Boiling will render drinking water safe. It is only necessary to bring the water to the boil and let it cool before drinking. Iodine will also sterilise water. 8 drops of tincture of iodine per litre of water is all that is needed. I would suggest that you all have a plastic dropper bottle of this available. It is easy to carry the bottle to add to water in restaurants, and to slip a couple of drops to any drinks you may be offered and can't refuse (2 drops per glass, 250ml). The solution is also useful to remove leeches and to disinfect the skin around any wounds (do not put directly into a wound).

Bottled water is widely available in India for tourists. The sale of bottled water to tourists does add to the huge amount of rubbish in parts of India and creates a lot of waste plastic. I would like us as a group to try and avoid buying this for environmental reasons. Another reason is that it is relatively expensive to buy water for a month considering how cheap it is to sterilise water.

Thoroughly cooked foods can be considered safe, but only if they are eaten soon after cooking. Fruits and vegetables that are eaten uncooked must be first washed with sterile water and peeled under sanitary conditions. ie "Peel it", "Cook it" or "Forget it".

Food prepared by the cooks on the trek can be assumed to be safe if it has just been cooked and not allowed to be contaminated by flies. Contamination is possible from the plates it is served on but this is difficult to control.

I strongly recommend avoiding any chicken dishes, salads, pizzas etc. in the days in Calcutta and Darjeeling before the trek to avoid getting dysentery at that stage. Experience tells us that it would be very sensible to be vegetarian in the first week. There will be plenty of safe, well-cooked vegetarian curry to eat. Hands must be washed before eating food at all times.

All trekkers are likely to have a bout of diarrhoea. Dysentery is when the diarrhoea contains blood and mucus. Sufferers from dysentery may also get stomach cramps and fever. All cases of diarrhoea should be reported to a member of staff.

Generally sufferers should take lots of fluids to avoid dehydration, and oral rehydration solutions will be available. An appropriate antibiotic (ciprofloxacin) will be available and another antibiotic (metronidazole). Ciprofloxacin can cause increased sensitivity to sunlight and a sunscreen of at least factor 15 must be used when taking this drug. Some other medication can be affected by ciprofloxacin, and any current self medication should be notified.

Some of the gut diseases can be caught from contaminated dust on trek so please take a large enough handkerchief or scarf to act as a dust mask on trek. Those with respiratory complaints are also advised to take a pollution filtering face mask for the evenings in Calcutta where the level of pollution can be high. These can be bought from chemists or cycle shops.

Problems resulting from the reduced oxygen supply at altitude can affect anyone even at relatively low altitudes such as 8000ft (2450m). Those going to higher altitudes are more likely to be affected. Altitude sickness can be prevented by acclimatisation, and the trek itinerary has been designed to take this into account. There will be a rest day on day 3 during which we will take a walk to higher ground and back down to help acclimatise before going on further. The main treatment for any altitude sickness will be to stop any further climbing and go back down if symptoms persist. Our route doubles back on itself so this does not present a problem if a member of the group is unable to climb further.

A number of other factors as well as a slow rate of ascent may help prevent altitude sickness. The key to prevention is a large fluid intake to ensure good hydration. (4 litres/day). A guide to good hydration is to ensure that urine is kept dilute and appears almost clear. The passing of strong smelling or darker coloured urine is a sign of dehydration and indicates the need to increase fluid intake. It is usual to find that copious quantities of urine are passed about 24 hours after arrival at altitude. Alcoholic drinks should be avoided at altitude.

Proper nutrition is another factor in acclimatisation. Calorie intake should be maintained, with a diet high in carbohydrates, (eg potatoes). Avoid excessive salt intake at altitude. Don't take salt tablets.

Rest is important to avoid altitude problems. Avoid going so fast that you find yourself stopping for breath with your heart pounding. Those who develop symptoms are usually the keen fast walkers who rush ahead at speed. There is nothing to be gained from being the first to arrive at the next village and then to feel awful later on. It is not a good idea to start being very active on arrival at our stop for the night when at altitude. Take this opportunity of getting some rest.

Symptoms of mild altitude sickness- should be looked for and reported to a member of staff.

* headache

* nausea

* loss of appetite

* mild shortness of breath with exertion

* sleep disturbance

* breathing irregularly, usually during sleep

* dizziness or light headedness

* mild weakness

* slight swelling of hands or face

Symptoms of serious altitude sickness - are an indication for immediate descent and treatment.

* marked shortness of breath with only slight exertion

* rapid breathing after resting

* wet, bubbly breathing

* coughing up pinkish sputum

* heart rate > 110 beats per minute after resting

* blue face or lips

* low urine output (< 1 pint per day)

* persistent vomiting

* severe, persistent headache

* gross fatigue or extreme lassitude

* delirium, confusion or coma

* loss of coordination, staggering

In the event of symptoms and signs of altitude sickness the sufferer will not continue climbing and move to a lower altitude with a member of staff and guide. It is much easier to deal with the problem earlier, so please don't delay talking to staff if you have any symptoms, or fear you may be developing problems. The clearest symptoms to watch out for in yourself are:

* breathlessness at rest

* resting pulse over 100 beats per minute

* loss of appetite

* unusual fatigue while walking

Since altitude sickness may affect judgement and be denied by the victim the following symptoms should be looked for in others, and if necessary discussed with staff.

* skipping meals

* antisocial behaviour

* the last person to arrive at the destination

Prevention is better that cure. Well fitting boots are a must. All boots should be broken in at home first. Canvass shoes or light trainers should be taken for wear in the evenings. Any blisters should be treated with early application of felt or adhesive tape. Tincture of benzoin can be applied to the skin to toughen it. When you feel a tender or hot spot, stop to investigate it. Put a generous piece of Compeed or similar over the area. It is important to keep the feet dry, and socks should be changed frequently and washed!

Trekking in the Himalayas is enjoyable, and the detail of possible hazards outlined above is not meant to indicate that these problems are likely to occur. The Goecha La trek is one that is completed successfully each year by many trekkers. Minor ailments are frequent, major problems are rare and with those taking part having trained prior to departure I envisage a safe and enjoyable time for all and the experience of a lifetime.

The risks of developing thromboses whilst sitting for long periods on international flights have been well documented recently. Whilst the risk is very small, individuals will be given information on how to avoid such problems by carrying out simple exercises on the flight, drinking plenty of fluid and not staying in one seated position for too long.

A. Webster