Staying well on a luxury trip in India and Nepal

Most health problems on a well-planned journey in India and Nepal are minor and avoidable: an upset stomach, a headache at altitude, too much sun. Serious illness is uncommon, but good medical care outside the large cities can be hours away, so planning matters more than it would in Europe or North America. The essentials are simple. See a doctor or travel clinic six to eight weeks before you go, take out insurance that covers your whole itinerary, drink only sealed or filtered water, and respect the time your body needs at altitude.

This article is general travel advice, not medical advice. We are travel planners, not doctors, and everything below should be checked with your own physician, who knows your history. What we can describe is how we build journeys to reduce risk: the pace we set, the hotels we choose, the drivers we use and the plans we make in case something goes wrong. Vaccination advice and entry health rules can change, so check current status before you travel.

Book an appointment with your doctor or a travel clinic at least six weeks before departure, with your full itinerary to hand. Some vaccinations need several weeks to take effect, and the advice differs between, say, a Rajasthan palace tour in February and a monsoon journey through Assam. The clinic will usually review routine immunisations, discuss travel vaccines such as hepatitis A and typhoid, and advise whether malaria precautions are needed for parts of the North East or the Nepal Terai.

If you are going above 3,000 m, ask specifically about altitude: whether any condition or medication you have affects it, and whether a preventive medicine is appropriate for you. That decision belongs to your doctor. Bring enough of every prescription for the trip plus a week, in original packaging with a copy of the prescription, and keep it in hand luggage. A small kit with your usual painkiller, rehydration salts, plasters and any stomach remedy your doctor suggests covers most minor needs.

Altitude is the main health consideration on our mountain journeys. Leh sits at about 3,500 m and you arrive by air in about 75 minutes from Delhi, so the first two days are for rest. Symptoms of acute mountain sickness, such as headache, nausea, poor sleep and breathlessness, are common on the first day and usually ease with rest and water. If they worsen, the standard advice is to go no higher and to descend if needed. Every vehicle on our Ladakh journeys carries medical oxygen, a pulse oximeter and a first-aid kit, and we change plans without hesitation.

The pattern differs by land. Sikkim's high points, Tsomgo Lake at about 3,750 m and Yumthang at about 3,560 m, are day trips from lower bases. Tawang in Arunachal, at about 3,050 m, follows a night at Dirang. In Nepal, Kathmandu is only about 1,400 m; the altitude questions arise on Everest helicopter flights, which can land briefly well above 3,500 m, and on walks to Namche Bazaar at about 3,440 m. Anyone with a heart or lung condition, anyone pregnant, and families with young children should discuss these trips with a doctor before booking.

Indian and Nepali food is one of the best reasons to travel here, and you do not need to avoid it. The luxury hotels we use serve filtered or bottled drinking water and run careful kitchens, and our guides choose restaurants they know. The common advice still holds: drink sealed bottled or filtered water, including for brushing teeth if you are cautious, avoid ice outside good hotels, and prefer food that is freshly cooked and served hot. Fruit you peel yourself is safer than cut salads from a roadside stall.

Street food is part of the experience in Old Delhi, Lucknow, Jaipur and Kochi, and we include it on many journeys, but our guides take you to busy stalls where food is cooked in front of you. If your stomach does protest, rest, drink rehydration salts and eat plain food such as rice and curd. Most upsets pass within a day or two. A fever, blood, or symptoms lasting more than 48 hours mean it is time to see a doctor, and we will arrange one.

• Drink only sealed or filtered water; carry a refillable bottle that the hotel fills for you.
• Wash or sanitise your hands before eating.
• Go easy on rich food and alcohol in the first days.
• At altitude, drink plenty of water through the day and limit alcohol.

From April to June, Rajasthan, Agra and Varanasi regularly pass 40 °C, which is why we rarely plan journeys there in those months. In any season the sun is strong, and at altitude in Ladakh it is stronger still: wear a hat, high-factor sunscreen and sunglasses with UV protection, and drink more than you feel you need. Mosquitoes carry dengue in many parts of India and Nepal, especially during and after the monsoon, so use repellent on exposed skin and sleep in screened or air-conditioned rooms.

Air quality is a winter issue in the north. From November to January, smog over Delhi, Agra, Lucknow and Varanasi can reach levels that trouble anyone with asthma or a heart condition. If that applies to you, keep time in the Gangetic plain short in those months, carry your inhaler, and consider a well-fitted mask. Kerala, Goa, Ladakh and the North East hills have much cleaner air. The sea needs respect too: currents off Goa and Kerala are strong from June to September, and swimming where there are no lifeguards is never wise.

Comprehensive travel insurance is a condition of travelling with us. Read the policy closely: many exclude travel above a set altitude, often 3,000 or 4,000 m, and some exclude helicopter evacuation. For Ladakh, Sikkim, Arunachal and the Everest region, you need cover that names your highest point and includes air evacuation. Declare existing conditions honestly, or the insurer may not pay. Keep the emergency number and policy number on paper and on your phone, and send a copy to us.

Medical access varies widely between our lands. The table gives our general picture; it is not a ranking of hospitals, and we brief each guest on the nearest facilities for their own route before departure.

Road safety is the largest practical risk on any trip in India or Nepal, larger than most illnesses. Every journey we plan uses a private car with an experienced driver who knows the route, and we avoid driving mountain roads after dark. We keep daily drives within reason, break long sectors with a night halfway, and fly where the road would take more than a day. Please use the rear seatbelts, and tell us before travel if you need a particular vehicle for comfort or mobility.

If you feel unwell, tell your guide straight away, however minor it seems. They can call the hotel doctor, change the day's plan or drive you to the nearest clinic, and they speak the local language. We give every guest an emergency contact for the whole journey. Our seven-night family journey in Ladakh, from ₹2,50,000 per person, keeps a gentle pace with no nights higher than Leh for exactly these reasons, and we can shape any journey the same way.