Diarrhea

Hemorrhoid sufferers all over the world will be flocking to Nepal.

Look at your food, the change is commonly the problem.
Live on McD and Subway for a few days, and see if that clears it up.
Avoid spicy and veggie, both will worsen the problem.

Drink bottled water (coffee and tea ) instead of tap water.  Also cook with bottled water, wash your fruit and vegetables with this water too.
If you get the problem,  use a solution of salt and glucose to prevent from dehydrating. These comes in powder form so you can always carry with you.   Or drink cola.

In the beginning I had the same problem,  took weeks before my body adjust to it. I realised that it has to do with the tap water.  They make tea of it and didn't boiled long enough. After spending two months at the inlaws, I moved two our own house. On the moment I use bottled
water,  the problem solved.  I use tap water for
cooking.


Not very handy with squd toilets, I can tell you.

The government doesn't inspect the branded water and a lot of them come from india and not actually anything but river water. They even say it on the label, 'spring water.' This is a tip from my book, Nepal: A Tourist's Manual: Ask your guest house manager to send out for a blue jug for your room. The government inspets it and they all have Reverse Osmosis water filters, which is what I have in my home. So, for 350 NRs. you get a jug. The refill of water is 50 NRs. with a 20 NRs. charge for delivery. When you move out you can deduct the deposit from your room charges and go on.

Although this will save you a lot of money, the best part is that you will be able to drink more clean water and not have all those plastic bottles to worry about-environmentally.

To prevent stomach issues you need to be sure to wash your hands before each meal with soap, an alcohol or fitkuri (get it from the market). My theory is that when you get it you can keep contaminating yourself and it keeps going from hand to mouth and back to hand. Fitkuri is a natural, white stone that you can find in the market where they sell rock salt and things for Hindu worship. Just put a drop of water in the palm of your hand and rub well with the stone.

If you must brush your teeth with tap water just be sure to use the hot, solar faucet. Otherwise, you will get one of those critters from the nasty black tanks that sit on the roofs and never get scrubbed or chlorinated.

Ask your guest house manager if someone could take a stole specimen to the lab for you. It will cost less than $5 for the entire thing. You need to find out if it's just a normal thing or the protazoa that the doctors in the West won't even know to look for. Some will stay with you for years and cause organ damage. You can also take Apple Cider Vinegar with charcoal/burned toast in the beginning to see if you can get the buggers to pass. I think a lot of people with 'irritable bowel syndrome' actually have one of these guys in their gut. (These are tips from my eBook, Nepal: A Tourist's Manual)

Thanks for all the replies. The stomach issue seems to have resolved for now  ( took about a week or so without any medications).  I didn't know that use for Fitkuri. I will definitely get some and use it.
Stay healthy, y'all.

With the last post two years ago, here goes...with my personal experience!
After coming down with hepatitis in Nepal, and being laid up for 2-3 months in bed, believe me, I began to take all possible precautions, starting with potable drinking water.
1. First, let's talk about Expats, namely people who live in Nepal on a regular basis, and those who are likely to live and work in the capital of Kathmandu
a. To avoid taking any risks, I would advise not drinking the tap water. It is possible that nepalese people are able to drink it with no resulting stomach problems, But then it is also quite possible if not likely that the local population  have what I would call a "built-in" immunity system (anti-bodies) that we, foreigners/visitors, do not have.
b. Some people will tell you, just boil that water and it will be okay.  True enough, but what if the purified/boiled water is poured into a cup or recipient which is contaminated? The answer is that immediately that water in turn becomes contaminated.
Personal note;  as from the day I understood that, I made the personal choice and strict decision  never to accept a cup of tea which is offered to visitors umpteen times a day, in shops etc  The reason is simple:  how do I know if the shopkeeper, as nice as he may be, has washed his hands, and what water did he use to make that tea....and so forth?  To be on safe side, I always very politely but firmly declined offers of tea in or about the city shops etc.
c. In restaurants, at least one can chose bottled water and often the brand, which is so important. But make no mistake about it, and other contributors have written quite rightly about this:
NOT ALL BOTTLED WATER IS SAFE FOR DRINKING IN NEPAL.
How do I know this?  Here is the answer:
d.  One day, I heard about the existence in Nepal of a very reputable and highly professional organization by the name of ENPHO.ORG with connections to Helvitas Nepal, Tribhuwan University, with three doctors on their Board, etc. who are in fact a Public Health Organization. So my point is that rather than listening to this one person or that other one......about whether water is safe or not in Nepal ...tap and/or bottled, and which brand is best etc. I can only but strongly advise that you - the expat - do your own testing as follows:
- At a cost of 50 nrs or so, buy from Enpho a Tap Water test bottle/kit and test your water in home or other. Their web site in Kathmandu is easy to find and this test is called "Coliform presence/absence test"
- If you have spring water to test, buy from Enpho their Spring Water Kit which costs a bit more, around 455 nrs at last report
- if you have a dug well, buy the Enpho test for that, which is around 957 nrs as advertised
- finally, if you have a dug well and tube well to test, get their test for that at some 1377 nrs.
What I did, personally, was to buy half a dozen test bottles, I remember, and I went ahead and tested the big 5 or 10 gallon plastic jug the people in the office were drinking.....Result:  the water the staff was drinking was polluted!!! It was a known brand, but the reason I know -- the specimen from that large jug - the water - turned BLACK in the Enpho test bottle after 48 hours...which proved that particular brand of water was no good.
After that, I tested the tap water in the same office in the center of town:  same result after the water was allowed to settle after 48hrs in the Enpho test kit. The water turned BLACK
I tested the water in a small resort near Kirtipur;  polluted as well, as per Enpho test kit.
On the other hand, the Aqua 100 one liter water in the plastic bottle I regularly purchased in Kathmandu at that time back, was perfectly safe to drink according to Enpho test. Color stayed the same!  So I have no idea if that particular brand is still as good now in 2017 but rely on Enpho, do your own testing, and you will know for sure is the best advice I can give!!  Maybe you will find that Everest water is okay, or some other brand...Let Enpho do the professional and reliable testing!!
All I know is that you do not have to pay 100 to 300 nrs to get a bottle of good drinking water in the capital of Kathmandu! It is quite possible that some lesser known brands are ok, ...so it is not a question only of price....It is a question of quality which you can determine yourself at a cost of 50 rupees plus tax.
2. As for people who are not expats, but trekkers and/or people who travel around the country, spend time in villages, I have little advice to give. I know tablets exist, but suffice it to say that it is no fun to get sick on water, and one cannot be careful enough....even when water is boiled.....The recipient that you pour it into must also be clean and germ free as previously stated...And what if the person who is tendering has not washed his hands properly after going to the toilet....e-coli or worse....So yes, wash your own hands....fair enough.... but what about the other guy?  Are HIS/HER hands clean....and how do you/we know???     ONE CANNOT BE CAREFUL ENOUGH.
Avoid water borne diseases. No one wants to see his stay in the mountains cut short...with stomach ills or worse...and let's face it, good (proven/tested) bottled water is not always available in every shop and anywhere out country. The only thing we can do is take the maximum of precautions, and take the best advice you can get from your doctor before you embark on your expedition or trek or whatever.  In Kathmandu, admittedly it is easier to test water along the lines I have suggested.

Note; Comes to mind that there is a new type of bottle in plastic on the market which comes with a filter built in. Cannot recall the name of it, but this might be an answer or at least a partial solution? Other contributors may know how effective it is?

I lived in Nepal through the 1980s and worked as a guide around the world, so I was in the city and in the country and got intestinal diseases fairly regularly. For giardia, probably the most common type of diarrhea, TINIBA works well and is cheap at the pharmacies. I recommend you get some potassium permanganate crystals to make "pinky water" for hand washing and in your dishwashing water. Don't use it in your drinking or cooking water, it is too hard to control the concentration.

https://bootstrapadventure.com/potassium-permanganate/

Other than that, the best way to purify your drinking water is a pricey ceramic pump style device, such as the new and fabulous MSR Guardian, which filters out bacteria and viruses. You can add a bit of iodine (crystal form) to your filtered water to ensure all microorganisms have been killed.

http://www.outdoorgearlab.com/Backpacki … er-Reviews

Hope that helps.

Actually, the blue jar water is the best you can buy in Nepal. The government inspects the filters and other equipment and the little bottles are not inspected, at all. Sometimes they are imported from India. I got sick one time by brushing my teeth with tap water. Another time I got sick from taking a samosa home to eat later.

I put this trick in my book, Nepal: A Tourist's Manual. When you get to a guest house that you will stay at for a few days ask the manager to bring you a blue jar of water. It will cost 350-400 nrs. but you will get all be 50 NRs. back in the deposit.

I recently wrote a blog post about this issue: http://frugaltravelsnepal.blogspot.com/ … aving.html

I use alum stone to sanitize my hands when I'm out to eat. They are called fitkuri in Nepal and you can easily find them in the marketplace where they sell things like Himalayan rock salt.

I tell my friends when I visit that I have allergies and ask them not to prepare anything for me. I bring my own water. The Nepali are extremely kind and understanding.

It's interesting to understand that Nepali get sick, too. But what they don't realize is that they are contagious until they get the bug out of them, not just when the symptoms leave.

What antiboticas work the best and can you get them there

I recently found out it's more difficult than I thought to get a sleeping pill in Nepal. I also found out benedrel (anti-histamine) isn't here, at all. That being said, you can still go to a pharmacy and ask the pharmacist for something for what you seem to have and they will usually just cut some off of a strip of pills and make something like this on the back:  00-00-00 which would indicate you should take 2 pills 3 times a day.

Bottom line is you have to make some rules for yourself to live by while in Nepal. I see people contaminate themselves all the time. Never touch your face with your hands. Do not use the handrails if you don't need to. Wash your hands well before you eat anything. Do not eat street food. Do not complain at a restaurant and send the food back. Do not eat anything that isn't piping hot. Do not eat from any buffets. Never take a 'doggy bag' home unless you have a dog. My blog has several other tips. I haven't gotten dirreaha in about 4 years and I've lived here for 6 years. http://frugalTravelsNepal.blogspot.com

It depends upon what bug you have. If you have giardia, you will have suphur smelling burps and bad smelling gas, along with diarrhea. For that, Tiniba is a good medication.

If you have access to a local clinic, take a stool sample in and have them tell you what bug you have. When you know that, you will know what antibiotic to ask for.

Not all diarrheal diseases are bacterial or amoebic, many are viral. Antibiotics do not kill viruses.

If you have a respiratory infection, it is most likely viral, but if it goes on for a while and you are coughing up yellowish greenish stuff, you may have a secondary bacterial infection. There are plenty of local clinics. No reason to avoid making a visit to the doctor. Don't let a respiratory infection go on for a long time, you could end up with pneumonia.

Awesome post, Whiteumbrella. I have a funny story that illustrates the need to see a doctor/healthpost.

After the earthquakes we had many volunteers here helping. One guest came down with something and I told him he needed to walk up to the healthpost or give us a specimen to have it checked. Your guest house should have someone availble to take it for less than $5 tip. Handling poo carries a premium. Well, the diarrhea had let up after 24 hours or so; he refused. A few days later he mentioned it again that he had another problem. I told him it was the same problem and the eggs had hatched. He still refused to give up a bit of poo for the lab.

Again, he had an issue and this time he gave a sample, but by this time it was clear as water. Our guy took it, but when he was asked about it, 'urine?' he just nodded. Of course they tested it for kidney, etc. all of which came back normal-they were testing for the wrong thing entirely. Our guest went onward with his travels all the while being a carrier for this little friend he continues to carry. Little does he know that he is leaving 'friends' on door handles, stair railings, dinnerware, etc. These critters can even crawl into various organs, like the kidneys or brain.

How many people have been to India, Nepal, or some other developing country only to return to the west with a diagnosis of Crone's disease or irratable bowl syndrome. This is why I wrote the blog post about it and what to do on your last few days in Nepal. http://bit.ly/2dto8aA

Take only positive suveniours home with you.

The question has been asked about which medicine (antibiotics were singled out) work best and whether they were available in Nepal.
Personally, I cannot recommend highly enough that visitors to Nepal bring their own medicine from their home country, in sufficient quantity, and to the fullest extent humanly possible. Obviously, it is impossible to foresee each and every need or contingency  but - do your best - is my advice. The reason is this. None other than the WHO (World Health Organization) estimates that 1 in 5 drugs made in India are fake. For anyone left in doubt, and requiring further proof, they can read Wikipedia, citing none other than the European Commission,  which says that 75% of counterfeit drugs supplied to worldwide have their origins in India. And when you know that  about 70% of Nepal's imports of medicines are met by Indian imports, there is cause for concern.
Referring therefore to those medicines/drugs one can buy in Nepal or generally speaking any pharmacy in or outside the capital of Kathmandu, the question one can legitimately ask is this;
How does one know - anyone really - if the antibiotic or ANY other product bought at the pharmacy in Nepal is real or fake?
The hard fact and sad truth is that it is VIRTUALLY IMPOSSIBLE to differentiate between fake and counterfeit medications WITHOUT PROPER TESTS. (one cannot tell from simply looking at the outer packaging - and this goes for the consumer as well as the pharmacist who sells it to you)
Returning therefore to the question which was asked about amoxycillin, one can only applaud and heartily welcome the initiatives taken by the Authorities who seized those products made by Adip Labs of Kalol in India (source: Nepal Times) some years ago. That supply of amoxycillin was all fake, Adip Labs never existed at all and it was widely reported at the time that the amoxycillin which found itself on the shelf of the pharmacies in Nepal was white powder.

There is a simple way to get good meds in Nepal. Go to a pharmacy attached to an international hospital. You can also look at the package and see if they have a hologram/quality packaging, etc. I've always gotten good meds here, and so cheap. Bringing a medicine chest would cost a fortune.

I haven't been sick with diarrhea in over 4 years. Wash your hands, eat hot food, no street food.

I've even been quite ill and got excellent medical care here. You can check out my blog posts at frugaltravelsnepal.blogspot.com

I try to be careful and avoid situations where you're bound to catch some belly bug. Does not always work though, and sometimes I do come home with diarrhea. Usually it's out of my system in a few days, but what I watch out for is recurring diarrhea and amoebic diarrhea.

Amoebic diarrhea is easy to resolve, but you do need to catch the indicators and get the proper medication. Indicators are (next to diarrhea) bad burping (sulfuric smell and taste - think burping bad eggs) and similar bad smelling gas.
Solution is simple: Tinidazole, 2000 mg. in a single dose for 3 consecutive days. Readily available from any medical shop I walked into in Kathmandu so far. I am not a medical doctor, so don't take my word for it, but it works for me. If you're under 70kg. weight, you would probably have to adjust the dose. Ask a professional for your specific situation.

Recurring diarrhea as it says comes and goes by itself. But it just keeps coming back. Usually in combination with a mild fever. In these situations I ask in a medical shop attached to a big hospital for antibiotics, and just take what they give. Hasn't failed me so far ...

And although the blue water jars are not per definition clean, they usually don't give me diarrhea. And that water I drink untreated.
Usually I get diarrhea after visiting the tourist hub of Thamel, enjoying a nice but probably not too clean meal, or a bear from a glass that was washed but not dried carefully enough. Something stupid like that...

But then... living in Nepal has its advantages and its disadvantages. I guess diarrhea is just one of those things I sometimes have to deal with. Say maybe twice a year or so ...

Could I please ask a Kathmandu resident to check a pharmacy next time you are there for the following meds that are too expensive to bring from home?

Chloroquin/Primaquine (malaria prophylaxis)
Pramipexole (a neurological med) in immediate release and extended release form
Armodafinil (another neurological med, and I need to know if an Rx is required and if I can get that from a Nepali doc or need to bring an Rx...could substitute Modafinil)
Rifaximin (an antibiotic)

Thank you very much.

I got the runs 3 times in thailand but never in Nepal going on 10 months. Maybe my body got used to the new bacteria in Thailand. Even so, i don't drink the nepal tap water. I only use the water from the 5gal bottle for cooking use. I don't open my mouth when i shower. And i place my toothbrush in a glass with bottle water and calcium hypochlorite between brushings and use a mouth rinse from a liter bottle of water with a pinch of calcium hypochlorite in it. It kills all bacteria but tastes a little like swimming pool water. Very good for you actually. The pharmas sell anti diarrrhea meds and codeine works good too. I never had giardia but i have another mineral solution that would take care of that. It kills all parasites like malaria also. Kills all pathogens over time including replicating ones.

I have been living here for a while now, eating everything in a row - in local places, street food and have never got sick.

Have some turmeric with luke warm water every morning and evening, it will kill all the gems in your body and boost your immunity.

Personally, I think it is very difficult to avoid diarrhea in Nepal, and sooner or later, one is bound to get the runs and some form of medicine may indeed be required, particularly if the symptoms last more than a day or two and are accompanied by vomiting. Only a lab test can determine the exact nature of the ailment. Based on the stool test you would then be wise to go at the nearest clinic to protect your health, let the doctors tell you whether it is due to an amoeba/bacteria or a virus, the result of food poisoning, or something else. Antibiotics cannot kill a virus. If problem is due to amoeba/bacteria lab results will reveal which antibiotic works and which doesn't. One cannot take just any antibiotic, as your body may be resistant to it. Doctor will advise. The term diarrhea has been defined by medecinenet as more than five bowel movements a day or liquid stools. Over a 20 year period in Nepal, I got ill countless times. About two years ago, I even stopped buying mangoes in the street/shops after learning that they had been injected with some form of acid in India to make them ripen faster. (if you detect the acid in your mouth...spit it out..it has a horrid taste)  Those imported ones systematically upset my intestines.  Same for the larger size bananas. On the other hand, I found that the much smaller and sweeter home-grown nepalese bananas were fine, so I ate those only, to the relief of my intestines! (and don't forget to carefully wash every fruit you buy, to get rid of any chemicals)
Turning to the larger picture, those of you who are interested can consult CDC - Center for Disease Control and Prevention - www.cdc.gov -  with Hq in Washington. This official agency makes these points:
1. Travelers' diarrhea (TD) is the most predictable travel-related illness and their statistics show that rates of TD range from 30% to 70% of travelers, depending on destinations.
2. CDC writes that the most important determinant of risk is travel destination. They go on to divide the world into 3 grades of risk:
a. Low risk countries (USA, Canada, Australia, Japan etc.)
b. Intermediate risk countries (Eastern countries, South Africa etc.)
c. High risk countries (Asia, Middle East, Africa, etc)
In the CDC Section "Risk for TD" one will read that "An 'episode' can occur in a single trip..... A cohort of expatriates residing in Kathmandu experienced an average of 3.3 episodes of TD per person in their first year."       (Note: this is pretty consistent with my own/personal experience)
3. And worth taking note, they add "Traditionally it was thought that TD could be prevented by following simple recomendations such as "boil it, cook it, peel it or forget it" but studies have found that people who follow these rules may still become ill. Poor hygiene in local restaurants is likely the largest contributor to the risk for TD....bacterial pathogens are the predominant risks, thought to account for 80-90% of TD. Viruses 5-8%
If you are interested in Prevention, I refer you to CDC website where, notably, they warn that "no vaccines are available for most pathogens that cause TD"

Bad hygiene in restaurants is a big factor. Sneezing toward food is not considered a big deal.

Bobby,
Since you wrote in, situation has not improved one bit, judging by article published in today's paper: 

Himalayan Times: 66 per cent Water consumed in Valley contaminated
Himalayan News Service: Even purified bottled water contains deadly microbes, E coli and coliform
July 14: About 66 per cent of the water being consumed in households of Kathmandu Valley is contaminated with hazardous bacteria, a study conducted by District Public Health Office, Kathmandu, shows. 
The Kathmandu DPHO said it found the presence of microbes, E coli and coliform in the water used in households of Kathmandu, Lalitpur and Bhaktapur Districts. 

Talk of diarrhea, as they point out, E coli is a bacteria species that lives in the digestive tracts of humans and animals, and their microbes cause bad diarrhoeal infections. Not safe to drink is an under-statement. Boy oh boy, like they also recommend, better ensure people boil their water before drinking.....Clear from their findings, can't rely either on "purified bottled water" which comes in bottles or larger jugs. Let's hope people follow that advice.

I never drink tap water and just drink the popular brands of bottled water. I also put a touch of pool shock in my bathroom liter of water for rinsing out my mouth after brushing. You could use tap water to fill a liter bottle but it would have to be treated. A touch of pool shock(calcium hypochlorite)will do that. Tap water quality will vary depending upon the region. Pokhara tap water seems better and there are also many free filling stations in lakeside with spring water. If you get an apartment just get a 5 gallon filtered water bottle. I never had tummy troubles from water in nepal but i did get sick from food a couple times. People sneezing on your food or handling it with poo fingers could happen. I never ate meat at a local place due to refrigeration issues.

WhiteUmbrella, I just saw your request. Do you still need to know about these meds? IM me if you do and I will have someone check on these drugs.

I used the blue jar for years and never had a problem from it. This is excellent water, RO filtration. The problem is most likely that the person who opened the bottle didn't wash their hands or the bottle wasn't sanitized properly, or the filters haven't been changed. I just bought a good RO system for myself when I had my own apartment.

The blue jar water is inspected by the government, but maintenance is always a problem.

Could not agree more with you, Beadwindow. I buy immodium whenever I can find it!
Here's my take on the subject, because to me and most people, the issue of health - including avoiding nepali runs - is on high priority list:
1. As we all know, the "Blue Jug" is not a brand and there are countless brands of water here in Nepal which range from good, to bad, to downright contamination. NOT all brands of blue jugs are safe.  Can't believe that. Price is no guarantee of quality either. (Besides, word of caution: if you see the seal is broken, DO NOT BUY. This happens in Nepal too)
2. The blue jug in question contains 20 liters or 5 gallons of water and each jug weighs 40 lbs or 19 kilos. So my point is that, yes, it is suitable for home or office but totally useless to tourists, visitors or trekkers to Nepal.
3. Because of weight and bulk, all my friends have these jugs delivered to their place - only practical way - Che garne? Experience shows that some local distributors of these water jugs are reliable for home/office delivery, and others not so much.
4. Let's be honest, brand name is meaningless in Nepal because NO ONE consumer can possibly really know how good or how bad the water inside the blue jug in this country really is - UNLESS one has had it personally tested.
That's what I did. I followed the good piece of information and advice given right here by this other contributor in this column on Expat.  Back in March 2017, he provided expats with the name of this nepalese non-profit public health organization called Enpho, a pioneer in SAFE WATER and Sanitation with more than 25 years in the field, and working not only in Nepal with with half a dozen other countries, benefiting more than 2.7 million people. For details, click:
www.enpho.org       and visit Laboratory section, where you will see they provide SAMPLE COLLECTION SERVICES.
or more detailed info on:     www.enpho.org/research-and-development/analysis/
I just went over to them and bought the little kit bottle for 50nrs from Enpho and did my own testing of the "blue jug" we had at home. And guess what? I had exactly the same bad experience and bad results this other expat had....After two days, the sample from my water jug I had bought turned black - meaning that the blue jug water I had purchased was contaminated, and I had the proof of that.  Since, I have changed brands.....
Who claimed that water in these blue jugs are inspected by the Government? Bit puzzled there in the light of above?

This is a very serious issue. Many people ignore it or don't understand the dangers from these little parasites and various other kinds of critters. I suggest going to the doctor/hospital to have the stool specimen tested at a lab. It's really cheap. You just go to a hospital with an international INGO presence. You'll get about the same care as in that country that's sponsoring them. I like the Kathmandu Teaching Hospital. They have a brand new hospital in Dhulikhel, just outside the Kathmandu Valley. Cost will be about like this:
20 nrs. to see the doctor
400 nrs. for the poo specimen
20 nrs. for follow-up doctor  apt.
200 nrs. for the medicine

You should take a Nepali friend, a worker at your guest house will be eager to accompany you. You can pay him about 500 nrs. for taking you. He will crowd in to pay at the cashier. Unless you are really big and agressive you will have a hard time getting to the front of the line. This is where your Nepali friend comes in. He knows how to manage the system and will be a godsend. You should plan to be there at about 10:30 am because all the Nepali get there at 7 am so by mid morning you won't have to wait so long.

You really have to do this if it comes back after the initial problem. I'm not a doctor, but I've been here awhile and haven't had food poisoning for over 5 years.

Anyone planning on trekking and comes down with food poisoning, I would hydrate, take vitamins and wait at least a week before going to the high country. Take the high altitude sickness issue very seriously if you are getting over an illness like this.

I've written a few blog posts about this subject here: http://frugaltravelsnepal.blogspot.com/ … nepal.html

Very, very serious issue indeed, the risks of illnesses remaining omnipresent when taken in the context of conditions which continue to plague Nepal. Bad water, or no water depending, situation is critical according to Trupti Rai, Country Representative of Water Aid Nepal, who ranks the country 2nd worst in Asia with having the greatest percentage of urban dwellers, still lacking safe private toilets - 43% according to them, with no access to toilets. They did not publish the percentage for the population located outside of urban areas, but it would not be surprising if the situation in the out country was worse.  If 1 out of 2 don't have toilets in higher developed India, it's hard to believe that Nepal would fare better for the nation as a whole. Like Water Aid is quick to remark, in that kind of situation, people have no choice but to defecate out in the open. And in cases of no washing of hands or anything, Water Aid points to the risks of diseases like cholera or typhoid which can spread so quickly without proper sanitation and hygiene practices, and turn into an epidemic.
None of us can be careful enough, as has been pointed out.

Monica, Sounds like people shit in the street in Kathmandu. I've been here almost 7 years and I've never seen human waste in the street-well, a couple times from children. Seriously, it's not like that. Those statistics refer to 'flush-able' toilets, which would give a Westerner the idea of an outhouse or corner of poo in various places.

Reality of the situation is that most of the buildings have the traditional, squat toilet. They do not always flush and often there is no water in the pipes, anyway. But there is a bucket in the corner with water. One should use the bucket to flush the toilet. Yes, it's still a bit gross, but people are not dying from disease all over Kathmandu. It's just the way it is in Nepal and you won't die if you use a smelly, nonflush-able toilet.

One trick tourists use is to buy Tiger Balm from the street venders and put a little under your nose so you won't smell it so badly. There are ways to find nice clean toilets, too. Please don't let such statistics stop you from coming to Nepal.

Here's a blog post about how to find a good, clean toilet in Kathmandu. By the way, your guesthouse will almost always have a flush-able toilet (unless you pay $2). http://frugaltravelsnepal.blogspot.com/ … mandu.html

In keeping with this thread, diarrhea is no joke. In nearby India, a country I know well, it kills 200,000 people every year. I can understand why this lady contributor with vested interest in a guesthouse in our beloved Nepal would say that. If I were in her shoes, I would be putting a different spin on things too! But the fact remains that, joking apart, Tiger Balm will not do the trick and the sooner the nepalis clean up their mess, the better. Facts are facts and are revealing. Number of tourist arrivals in this country in 2016 was 753,002 which is still very much lagging behind the 5 year peak of 803,092 of 2012, with good time to re-build and recovery allowance being made after that terrible earthquake - At least in India, Prime Minister Modi there is trying to improve things, notably by pushing up the hierarchy of national concerns in a concerted effort to eliminate open defecation in that country by 2019. PM Modi expressed the view that all schools should have toilets, with separate toilets for girls. But in Nepal, what is being done? Maybe the lack of progress  here has got something to do with the fact that Nepal has had 9 Prime Ministers in the last 10 years. Like a nepali friend was saying the other day "here in Nepal, we seem to have a change of PM every 9 months!" Maybe if they successively stuck around in office a bit longer, they would have more time to implement a similar program for the good sanitation for the millions of their own people here?
Expats and "ferners" in general will always muddle through - members of a privileged class really - but what about the have-nots of the majority?

Stats published not so long ago showed that Nepal as a country ranked no. 177 for most pollution among 180 countries (Pollution Index: 81.76). The capital of Kathmandu fared worse in terms of air and water pollution both, with a ranking of 7th worst on the planet (Pollution Index: 95.73) in a study totaling 290 countries.

Again mark my agreement. Excellent - and timely - suggestions too from Beadwindow as CPN Maoist Chairman Pushpa Kamal Dahal has just urged his fellowmen in the government to provide relief to those suffering from cold wave and diarrhea, in the Tarai districts of Nepal. Sadly, many deaths already reported there. So we can only hope that use of Rx like Eldoper and Cipro and the like will help turn the tide in fighting water borne diseases, and human suffering will end in that area.
In the field of pollution with diseases which are airborne in the  country as a whole,  however (due to burning of fossil fuels, carbon dioxide/Co2, gas and other emissions, nano air particles, etc.), finding solutions may not be quite as simple. That's where the challenge is. Bad air affects the respiratory system - the lungs - and not just the gut - and yes, over a longer period of time, if conditions are left unchecked, those respiratory problems can degenerate to the point of becoming life threatening.

Environmental Expert Bhusan Tuladhar - quoting World Org WHO - now reporting a total of 9,943 deaths in Nepal due to air pollution alone. Suggest that anyone who is planning to visit Nepal any time soon would be well advised to consult the US Embassy Kathmandu website and check the then prevailing air pollution, so-called AQI (PM2.5) readings. Any time values are high-end of 151-200 AQI range, they warn that "anyone may begin to experience health effects. Members of sensitive groups may experience more serious health effects".
Current reading from that source at 1PM, on January 18, 2018:  163

Our worst fears are now confirmed. AIR quality here in Nepal is presently the worst in the world. According to the Kathmandu Post (25/01/18) which cites a global EPI study, Nepal is now ranked at the bottom among 180 countries. Report was released by Yale and Columbia Universities in collaboration with the World Economic Forum. Conclusions of that study, they write, are based on the use of 24 different indicators, used to measure. In same, Nepal's air quality is rated worse than neighboring India (ranked 178th) or China (177th) or Pakistan (176th).
Little to rejoice about. Before one would hear many people saying this about the city of Kathmandu only, but if one is to believe the validity of that study, now it's the whole country that's being put to the test.

How can they rate the entire country based upon one city? Actually, Kathmandu was at at the bottom of a huge lake that covered this entire valley. If you've ever dipped your feet in a lake or pond you would have noticed the dirt is silty, powdery. That's the problem with Kathmandu. What can you do when the dust flies around everywhere? Merchants throw buckets of water all day long, but that dust is not to be controlled. When you buy something, anything, the merchant will take a duster and knock off as much dust as possible, but the item seldom looks new. This issue, plus the water isn't treated; now you have a double minus score.

Does anyone have an idea as to what to do about the situation? There is little industrial waste, but we have a plastic problem that is just now beginning to be addressed. I think with a bit of Western ingenuity and some generous donors Kathmandu can be turned around quite quickly. But to say all of Nepal is polluted is a disservice to this beautiful country. There is tourist plastic, tourist shit left on Mount Everest, and many diseases brought in from the West by tourists. All this dumped at the feet of a population who was all but illiterate.

Our village has waste management and much of the plastic is being recycled. The Nepali are most eager to do whatever needs to be done, but how can the second poorest country outside of Africa take total responsibility when it was the Westerners who thrust this pollution upon a society who missed the Industrial Revolution?

I also just read that article in the Kathmandu Post entitled:

              "Nepal's Air Quality is Worst in the World: EPI Report" 

I think we all wish it were otherwise in our beloved Nepal, but I hope you don't mind my saying that in my view, the press did a perfectly creditable job of reporting when they cited those official findings, which clearly related to a country ranking, and not a city ranking.
To verify, I also double-checked the source by searching on the net, under "EPI air quality report in Nepal". I suggest you do the same.  There again, the information correctly refers to EPI which stands for Environmental Performance Index on a country to country national basis. As reported, the study is based on 24 different indicators across 10 categories or classifications covering ecosystem vitality, environmental health and notably measures household solid fuels, air pollution as a leading threat to public health and other factors you can read about.
Do check it all out. Unfortunately, air pollution will go rampant if not checked, and in this case, I fear the city's bad air does not stop at Kathmandu's Ring Road!

I think like that about air pollution which no doubt can come overhead, through cloud formations, transported by air currents call it what you will and which can originate - who knows - from as far away places as industrialized neighboring countries (India and maybe others?)
What I am trying to say is that Kathmandu has no monopoly on air pollution..nor on the airways overhead!
Like it or not, for me this Environmental EPI report on Air pollution about Nepal seems fully credible, and should be taken seriously.
As for this other contributor' remarks - her points may well be perfectly valid - However, she is writing about water, industrial s.........and other waste material visible or more than evident on the ground. With all due respect, I think she is missing the point - Air and Water not quite the same! Let's all hope for an AIR of change!

Is this report saying the air quality of all Nepal is bad? I don't think so. I think once you get outside the city of Kathmandu the air is fine. Yes, there will be some particles of pollution, but not bad, at all. The rest of it is because the country isn't developed.

I've seen pictures of Beijing and you can hardly see across the street. It isn't like that in Nepal, unless you are standing behind a bus. They are also working hard to turn it around. Each week many volunteers help to clean the Bagmati and it's looking a lot better in many parts. We even have garbage pickup here in our village.

I've been to many places and Nepal seems more pristine and beautiful than any other place I've been, including Europe. Could it be that Nepal hasn't caught up to the West yet? I just found that article to be misleading. Yes, we need to drink filtered water, but that's the same even in the US and they have things like lead in a large part of the water, not just in Flint, MI. Many parts of Oklahoma and other states where they are fracking has undrinkable water. And Nepal just has a valley where 5 million people live and drive and the water isn't treated and the people got Western plastic without a manual as to how to deal with the mess. But a polluted capitol city and a lack of infrastructure shouldn't make it the most polluted country.

You can duck the issue all you want but we should be thankful to the press (Kathmandu Post) to have reported this alarming situation in the first place, because the official report they cite is based on scientific findings, not fiction. It's all verifiable information for anyone who can read english. In that sense, the facts establishing that the air pollution in Nepal is the worst in the world is a great public service, really. Now that the word is out, with no place to hide, what will those in charge and planners do about it? Nepal's leaders have never impressed me with their skills to plan anything ahead.  We can therefore ask ourselves; what will they do to minimize the health risks, respiratory diseases and all the rest of it, for the people of this country...in the decades ahead? If nothing is done, it's just going to get worse and worse, that's for sure. Time is not on their side in this case. Let's hope they get on their horses and move....for once. It's that serious. Action is called for NOW, not later (or never) Human health is at stake.

Any long term project in our country takes decades to tackel here in Nepal. Take Melamchi water project which is to solve chronic water shortage in our capital as an example. That project was started almost 20 years ago. Within the last couple of months, the government announced the project was now, in 2018, 80% complete!! One day, that project will surely be completed. But hard tings like air polution here in Nepal - even harder to solve? Here lots and lots of patiense is always required. 
We'll talk about it in 2068!