Bill Hulme has good advice on how to cope at high altitudes

Tibet, which translates as "Land of the snows", is an ancient kingdom considered to be the "roof of the world," bordered by India, Bhutan, Nepal, and Pakistan to the south and east, and by China to the north and west. Its capital, Lhasa, has been hailed as the ancient Shangri-La of legend and is the site of some of the holiest pilgrimage routes of the Buddhist religion.

Geography and people

Tibet consists of vast mountain ranges surrounding the Tibetan plateau that has an average elevation of 3500-5000 metres above sea level. The climate here is extreme, with winter temperatures on the plains plummeting to 250 8 C, but Lhasa is comparatively protected, in the Yarlung valley, with a seasonal variation of 210 8 C in January to +20 8 C in June.

The Tibetans are thought to be the people in the world who are best adapted to the harsh climate that results from high altitude. Tibetan babies in Lhasa thrive at these altitudes, but a proportion of Han Chinese babies born in Tibet have a form of chronic altitude sickness because the oxygen available is only 65% of that at sea level. Some fail to thrive as a result. There are only an estimated 2.3 million people living in the Tibetan Autonomous Region, but the influx of Chinese troops and Han immigrants has steadily increased this number over the past 20 years. Lhasa now has more Chinese than Tibetans, owing to immigration policies giving financial support to businesses set up there, and the city is growing quickly along the valley.

Religion

Tibet is one of the most devoutly Buddhist countries in the world and is steeped in history, as is reflected by the breathtaking religious buildings that remain scattered in the countryside and towns. Before the Chinese invasion in 1951, the Dalai Lama ran the country along with his ministers, but today the monks' powers have been largely removed and handed over to the government of the Tibetan Autonomous Region.

Getting there

In the United Kingdom, a tourist visa can be obtained from the Chinese embassy in London or the consulate in Manchester. This means, however, that you are liable to be charged tourist prices to obtain entry to the region as part of a tour group, and these are roughly double those paid by locals. A working visa enables you to get flights at reduced cost from Chengdu in China to Lhasa, but written invitations from the place of work and a letter from the local employment board are needed before an application can be made. Do not, however, expect to be greeted with open arms by some officials - and be aware that policies are prone to change from week to week.

Life in Tibet

The main languages spoken are Mandarin and Tibetan. Lhasa has a largely Chinese population, and both languages are in use, but outside the city Tibetan is the predominant language spoken, with many regional variations existing.

Vaccinations required for China and Tibet are polio, typhoid, and hepatitis A. HIV risk to date is negligible, with a very low prevalence of the virus in the community. Malaria does not exist at these altitudes, but beware when passing through malarial zones en route to Tibet.

Day to day life in Tibet may pose a few problems. The first noticeable phenomenon is the altitude. Arriving from lower altitudes, you will be short of breath even when walking a few hundred metres, and how severely visitors are affected varies greatly from individual to individual and is not merely down to fitness levels. The sun at this height is very strong, so a sun cream with a high protection factor is needed. Taking it easy for the first few days, drinking plenty of fluids, and perhaps taking some acetazolamide will ensure that most people do not succumb to problems caused by the altitude.

The medical system

There are Western style county hospitals in all major districts in Tibet, but apart from Lhasa these are limited to relatively basic health care. Numerous village hospitals and rural clinics serve vast areas in this sparsely populated country, some run by nurses who have had as little as three weeks' training. Many people, however, cannot travel the huge distances to these clinics and rely on local remedies. Traditional Tibetan medicine is still practised throughout the country, its origins a blend of ayurvedic (ancient Hindu) and traditional Chinese methods. Most medicines are derived from herbs that grow in the foothills and are used to treat a variety of afflictions. There are schools teaching traditional medicine in Tibet, and the practitioners are widely respected throughout the region, working alongside Western methods in some cases.

The emergency medicine system has been undergoing rapid development since the Chinese government invited the Italian government to provide aid and assistance in forming a network of accident and emergency departments, served by ambulances, in the district hospitals. An Italian organisation has so far set up emergency departments in Lhasa and several other locations. Over the next decade it is hoped that a network of departments can be formed to serve the whole of Tibet.