Marco polo's nepal

SCHEDULE VALIDITY
DAILY FLIGHTS
October 30, 2008 - March 28, 2009
March 29 – June 30, 2009
July 01 – October 29, 2009
October 30 - December 31, 2009
TOTAL FARE

NOTE: Above prices are the net fares given by Air China without discount or commission.
NOTE: Please note that above flight schedules are subject to change other than Tuesday and Saturday.
Types of Aircraft  Used on regular schedule flight: Airbus  Used on special request and guarantee of pax. Boeing
TIBET VISA
Urgent (Same day)
Semi-Urgent (3days)
Normal (5days)
For US Nationality
Urgent (Same day)
Semi-Urgent (3days)
Normal (5days)

Below are the things that we need before applying visa:
1. 1 passport sized photo without cap/hat.
2. Original Passport of client.
3. Clear information on visa application form
And we also need group names & address in detail, and scanned passport before 15days prior to
arrival in Nepal.


General Information
Tibet, standing at an average elevation of 16,500ft above sea level, till today, still remains one of the most interesting, mysterious, enchanting, remote and in many of the areas still underdeveloped. Besides being the highest plateau in the world; its transformation from a warring and aggressive to a peaceful, pious and gentle people by the influence of Buddhism, is very amazing. Its isolation nearly till the second half of the twentieth century; its diverse climatic and geographical conditions strongly attract people of all types from historians, adventurers, pilgrims and so on. A trip to Tibet is more of an adventurous and spiritual for those who believe Tibet as a Power Place. Due to its high altitude, those travelers with a history of heart, lung or anemic problems should consult their doctor before considering a visit. Overland travel between Kathmandu and Tibet is an incredible journey where you get to see the world’s highest plateau and the Himalayan Ranges in all its glory before you. The trip becomes more wonderful and amazing as you pass through high winding roads and passes. It’s most important that visitors should understand that Tibet was only opened to tourism
since the mid eighties and you should be ready for a bit of adventure regarding hotel
accommodation and other services especially en-route.
Hotels En-Route:
Budget hotels en-route are very basic provide dormitories accommodation and common
toilets. Most of the hotel staff do not speak English. However, many popular deluxe category
hotel of international standard have employed English speaking staffs, many of them are from
Nepal. There are several continental restaurant are available in Lhasa.
Transportation:
We use Land Cruiser 4500 (New Model), van, mini bus, coaster and deluxe coaches as
necessary. All vehicles have air-conditioning.
Photographs:
Taking photographs is prohibited in sensitive areas like in Check Posts/Army Areas. There is
extra charge if you wish to take photographs inside Monasteries, sometimes Monasteries
charge extra for each different section of the same Monastery. If you want to take a
photograph of an individual please ask him or her first, Carry plenty of rolls of films and
batteries.
Road Condition:
The road from Kathmandu to Kodari (Nepal-China Border) is quite narrow but most of it is
tarmac. The driving in central Tibet is much more comfortable since roads from Zhangmmu to
Lhasa are fully pitched except in some area between Nyalam and Zhangmmu which is under
construction and about to be completed. From Zhangmu to Nyalam it is one of the most
mountainous with many twists and turns, you will enjoy breathtaking views including water
falls pouring down to the river Bhotekosi. The landscape changes from green forest to barren
Tibetan plateau or vice versa.
Toilet En-Route:
Toilet en-route Zhangmu to Lhasa during drive is a problem for ladies, you will require going
to toilet often due to required consumption of water, it is best not to use common toilet, we
advise using open air toilet which is available. One can go behind the rock or off the road. We
suggest asking driver to stop the vehicle for toilet in less populated areas before stopping for
a meal in town where clean toilets are not available.



Exchange Rate, ATM and Credit Card:
The exchange rate of - approx. US$1 = Yuan 6. Banks in Tibet/China are closed on Saturday
and Sunday. Regarding the budget for your tour, it is entirely up to you how much you want
to spend with shopping etc, however we advice you to carry at least US$150 per person for a
week. Major currencies such as US Dollar, Euro, UK sterling can be exchanged at the Bank of
China branches in Zhangmu, Shigatse and Lhasa. There are ATM Machines in Lhasa and
Shigatse. Big stores, restaurants and hotels accept major credit cards.
While entering Tibet by overland through Nepal border, you can change with local
moneychanger in Zhangmmu but consult with your guide for reliability of the money changer
in order to avoid any counterfeit notes.
Communication from Tibet:
There are internet centres and private phone booths in Lhasa, Gyantse and Shigatse, it is best
to ask your tour guide, it is usually written INTERNET CENTER on their signboards.
Local Transport:
Taxi is available, charges Yuan 10 within the city centre. There are three wheeler pushbikes
as well for short distances. You will have to make sure you have someone with you who
speaks Chinese while taking taxi or any local transport or you must know the Chinese and
Tibetan name of the your destination.
Electricity: 220 volt.
Passport Size Photographs:
Please make sure that you carry enough passport size photographs; some extras would help in
case it is needed.
Itinerary:
The agency reserves the right to amend the itinerary at the last minute without prior notice
as per the local conditions.
Acclimatization & Altitude Sickness:
Due to the very high altitude - over 12,000 ft, acclimatization is very important. You may be
likely to experience some of the minor symptoms and discomfort of altitude sickness
(headaches, mild nauseas, loss of appetite) until your body adjusts to the elevation. This can
take from a few hours to a couple of days depending on the individual. Do not exert yourself
and drink plenty of non-alcoholic liquids. It is very important to drink at least 4-5 liters of
liquids daily to avoid any altitude sickness; this is probably the best remedy for AMS.


Do not forget - the common effects of altitude such as:

 You may feel breathlessness on exertion; some headache is treatable by aspirin.  May be some difficulty sleeping and a little loss of appetite.  You might also wake up suddenly at night trying to catch your breath. Do not panic!  You may also experience an exaggerated thumping headache, which will not go away, breathless even at rest, extreme nausea.  The lack of oxygen in the system will first affect either the brain (HACE - Height Altitude Cerebral Edema) causing loss of physical and mental coordination OR the lungs (HAPE - Height Altitude Pulmonary Edema), coughing up persistent sputum or both.  Do not drink any alcohol on the outward trek. It seriously impairs the ability to acclimatize, and confuses the symptoms of AMS.
The following medication has been found to be helpful:
Diamox the common name for Acetazolamide originally developed as a diuretic, but
pragmatically found to aid acclimatization available in Kathmandu pharmacies. Some people
feel it is ‘cheating’, but as trekking at altitude is not a competition and you are here to enjoy
it to altitude, not just mask the symptoms. It will make you pee more as intended, and
possibly give you a tingly feeling in your fingers, but is understood to have no more serious
side effects. Taking it is entirely down to personal choice, but if you do decide to use it as a
preventative we have found that a half a 250 mg tablet works just as well as a whole one and
minimizes the side effects, each morning and evening, from the night before the trek through
to the start of the descent from the highest point.
Oxygen Cylinder:
We provide reserve oxygen cylinder in our private tours. There will be minimum charges for
using it.
Drive:
The length of time of drive everyday may vary from 3 hours to 8 hours including lunch, tea
break depending upon the condition of the road; you will notice continuous construction of
road in many places.

Political Situation:
The political situation in Tibet is highly sensitive. You would be well advised not to discuss or
talk or take anything of political with the local people that may aggravate the situation.
Confine yourself to the interests of the tour.

Single Supplement:
Please note that all tours are organized on twin sharing basis. If you want to stay in a single
room than you will be required to pay single supplement, and you must inform us before the
start of the tour so as to enable us to book the room in advance, otherwise it will be difficult
to get rooms. Hotels in Tibet normally do not have triple sharing room.
Guide:
We always use our own Guides employed by our office. Guiding is consider the most
important factor to ensure quality services. Tourism is still consider new to Tibet compare to
many Asian countries, so Guides in Tibet do not get enough exposure, Tibetan Guides have
limited English and you may not expect a fluent explanation about culture and religion or any
other academic topics however Guide will try to do best to their capacity. Your frequent questioning will encourage him/her to explain more in details.
Immigration Formalities:
Zhangmmu Immigration is the main immigration point while entering Tibet from Nepal by
overland. Gonggar airport is the main immigration where you have to go through the
formalities while flying into Tibet.
Tipping:
It is customary to give US$75 each to Guide and Driver per week. It is not compulsory to tip,
only if you believe staff have done remarkably good job putting extra effort to make your trip
enjoyable.
NOTE: We suggest you to buy few prayer flags and Khadas (scarf) from Kathmandu or it can
easily be bought in local market in Lhasa as well to offer in monasteries in Tibet.
Clothing:

Cold Season (September – March)
 Thermal underwear  Down Jacket  Warm Trousers and sweaters  Woollen Shirts full slip  Hat (ear cover)  Gloves water proof  Woollen socks

Warm season (April – August)

 Comfortable trousers  T-shirt  Windproof jacket  Fleece jacket  Scarf
Normal checklist:

 Casual wear and comfortable walking shoes  Sleeping bag (if you are trekking or using guest houses)  Bring all your films  Cosmetics  Personal toilet items that you will need from home  Wind breaker  Sun hat  Food snacks along way (power bars)  Water Bottle  Sunglass  Swiss knife  Sun Cream  Toilet paper  Flash light batteries  Day pack camera and enough film  Mask : roads can be very dusty  Rain Jacket  Personal medical kit  Recommended Guide Book (Foot Print by Gyurme Dorje)  Kathmandu Lhasa Road Map (easily available in Thamel)

Source: http://www.marcopolo.com.np/tibet/pdf/generalinfo.pdf

Curriculum vitae

Robert Owen Newbury, M.D. Curriculum Vitae CURRICULUM VITAE PERSONAL DATA: Canadian, permanent resident of the United EDUCATION: POSTGRADUATE EDUCATION: Resident, Pathology (Anatomic and Clinical Robert Owen Newbury, M.D. Curriculum Vitae PROFESSIONAL EXPERIENCE: Children’s Hospital & Health Center Robert Owen Newbury, M.D. Curriculum Vitae Walw

nhms.org2

Management of Common Opioid-Induced Adverse Effects JOHN M. SWEGLE, PHARM.D., Mercy Family Medicine Residency Program, Mason City, Iowa CRAIG LOGEMANN, PHARM.D., Urbandale Family Physicians, Urbandale, Iowa Opioid analgesics are useful agents for treating pain of various etiologies; however, adverse effects are potential limita- tions to their use. Strategies to minimize adverse effect

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