When an article titled Diarrhoea at the Summit appeared in a medical journal, some doctors thought it was about climbers having diarrhoea on top of Mt Everest. However, the article was about a summit meeting of diarrhoea in travellers. Still many involved in wilderness medicine felt the title was relevant for Nepal.

It is said that when western travellers and trekkers return home from Nepal, there are two questions that are asked in quick succession for which the answers are usually "yes". Did you have a good time, and did you get sick? Sick usually means having the runs (Delhi belly, Montezuma's revenge are other colorful terms, although for the victim these may not be very funny).

Diarrhoea at the summit is a relevant topic in this spring trekking and climbing season because many trekkers and climbers on the way to the summit will suffer from gastroenteritis, another more scientific term for diarrhoea. Many of these trekkers are fully compliant with the precautions which need to be taken in order to avoid diarrhoea. These measures include frequent hand-washing with soap and water or using the alcohol-based, hand-cleaning solution, drinking only boiled or reliable bottled water, eating steaming, hot food and generally avoiding raw salad. But these measures may not be enough.

Food handlers who will be involved in the preparation and serving also need to adhere to these stringent guidelines. Indeed, the decline in the rate of travellers' diarrhoea in countries like Nepal may have plateaued. One explanation is that the traveller is doing all he or she can for prevention, but for the decrease in diarrhoea rates to be sustained, food handlers too may need to take proper precautions including storage and refrigeration of food supplies. With rampant power cuts in Nepal, adequate refrigeration will continue to be a problem, especially in Kathmandu where the traveller may need to spend a few days to make arrangements for the climb or trek.

Helicopter rescues are often necessary for travellers with severe gastroenteritis on the trail. Many climbers' dream of summiting has remained unfulfilled because diarrhoea is so severe and uncomfortable that the climb has to be abandoned.

The most important improvement would be for the traveller to go home and say "yes, I had a good time", and "no, I did not fall sick".