Practical Information

Costs
Tourism in Bhutan is managed through partnership of government regulators and private travel agencies under a policy summed up by the mantra ‘high value, low impact’. There is no restriction on visitor numbers; however, there is a minimum daily tariff fixed by the government. Also your visit must be arranged through an officially approved tour operator, either directly or through an overseas agent. By dealing through an overseas agent you will avoid complicated payment procedures and also have a home-based contact in case of queries or special needs.

The daily tariff for tourists visiting in a group of three people or more is US$200 per day (US$165 per day in the low season of July to August, whether you stay in hotels (a ‘cultural tour’) or go trekking.

To encourage trekkers to make longer treks, the Department of Tourism (DOT) allows a 10% discount on days 11 to 20 and 20% from day 21 on.

The daily tariff includes all of your accommodation, food, land transport within Bhutan, services of guides and porters, supply of pack animals on treks, and cultural programs as appropriate. It also includes a US$65 tax, which is used by the government to fund infrastructure, education, health and other programs.

The tour rate applies uniformly irrespective of location or the type of accommodation asked for or provided (with the exception of several premium hotels). This clause means that if things get busy you may get bumped from a better hotel to one of lesser quality, and you have no recourse.

Individual tourists and couples are subject to a surcharge, over and above the daily rate. The surcharge may also be applied if a member of a group arrives or departs on a separate flight from the rest of the party. The surcharge is US$40 per night for one person and US$30 per night per person for a group of two people. Visitors qualifying for any kind of discount still have to pay this small-group surcharge.

You are expect to pay separately for all drinks, including liquor, beer, mineral water and bottled soft drinks. You’ll also have to pay extra for laundry, riding horses, and cultural splurges such as a Bhutanese hot-stone bath. There are endless potential options that cost extra but provide a means to individualize your itinerary: expert guides, special permits, luxury vehicles, cultural shows and courses, special food and premium accommodation.

Tipping
Tipping is officially discouraged in Bhutan, but it’s becoming a common practice and it’s OK to do so if you want to reward good service.

You will usually be accompanied throughout your visit to Bhutan by the same tour guide and probably the same driver. Though it’s against the official DOT policy, these people expect a tip at the end of the trip. Many leaders on group tours take up a collection at the conclusion of the trip and hand it over in one packet. With a large group this can be a substantial amount and the practice has created high expectations on the part of Bhutanese guides.

If you’ve been trekking, it’s appropriate to tip the guide, cook and waiter. Horsemen also expect tips, but this can be minimal if they are the owners of the horses or yaks and are making money by hiring out their animals. The stakes go up, however, if they have been especially helpful with camp chores and on the trail.

Money
Atms
At the time of research, the few Bhutan National Bank ATMs could only be used by local customers. The bank does have plans, however, for extending the network and providing credit-card facilities.

Cash
If you plan to make a major purchase, for example textiles or art, consider bringing US dollars in cash. Most shops will accept this, and it can save you the hassle of exchanging a large quantity of money in advance and then attempting to change it back if you don’t find the exact piece you were looking for.

Credit cards
You should not count on using a credit card in Bhutan. Credit cards are accepted at the government-run Handicrafts Emporium, a few other handicraft shops and some of the larger hotels in Thimphu, but these transactions do take time. The credit-card companies charge high fees and the verification office is only open from 9am to 5pm. This precludes paying your hotel bill at night or when you check out early in the morning. The Bhutan National Bank has plans for rolling out point of sale credit-card facilities, so check with us for the latest news.

Travellers cheques
You can cash travellers cheques at any bank, most hotels and the foreign-exchange counter at the airport. There are bank charges of 1% for cheque encashment. You should carry only well-known brands such as American Express, Visa, Thomas Cook, Citibank or Barclays. There is no replacement facility for travellers cheques in Bhutan.

Before you go
Pack medications in their original, clearly labelled containers. A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is also a good idea. If carrying syringes or needles be sure to have a physician’s letter documenting their medical necessity. If you have a heart condition, bring a copy of your ECG taken just prior to travelling.

If you take any regular medication, bring double your needs in case of loss or theft. You can’t rely on many medications being available from pharmacies in Bhutan.

Insurance
Even if you are fit and healthy, don’t travel without health insurance – accidents do happen. Declare any existing medical conditions you have – the insurance company will check if your problem is pre-existing and will not cover you if it is undeclared. You may require extra cover for adventure activities such as rock climbing. If you’re uninsured, emergency evacuation is expensive; bills of over US$100, 000 are not uncommon.

Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. (In many countries doctors expect payment in cash.) You may prefer a policy that pays doctors or hospitals directly rather than you having to pay on the spot and claim later. If you have to claim later, make sure you keep all documentation. Some policies ask you to call back (reverse charges) to a centre in your home country, where an immediate assessment of your problem is made.

Vaccinations
Specialized travel-medicine clinics are your best source of information; they stock all available vaccines and will be able to give specific recommendations for you and your trip. The doctors will take into account factors such as past vaccination history, the length of your trip, activities you may be undertaking and underlying medical conditions, such as pregnancy.

Most vaccines don’t produce immunity until at least two weeks after they’re given, so visit a doctor four to eight weeks before departure. Ask your doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all the vaccinations you’ve received.

Recommended vaccinations
The World Health Organization recommends the following vaccinations for travellers to Bhutan (as well as being up to date with measles, mumps and rubella vaccinations) :

Adult diphtheria and tetanus Single booster recommended if none in the previous 10 years. Side effects include sore arm and fever.

Hepatitis A Provides almost 100% protection for up to a year, a booster after 12 months provides at least another 20 years’ protection. Mild side effects such as headache and sore arm occur in 5% to 10% of people.

Hepatitis B Now considered routine for most travellers. Given as three shots over six months. A rapid schedule is also available, as is a combined vaccination with Hepatitis A. Side effects are mild and uncommon, usually headache and sore arm. Lifetime protection occurs in 95% of people.

Polio Bhutan’s last case of polio was reported in 1986, but it has been reported more recently in nearby Nepal and India. Only one booster required as an adult for lifetime protection. Inactivated polio vaccine is safe during pregnancy.

Typhoid The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot. Tablets are also available; however, the injection is usually recommended as it has fewer side effects. Sore arm and fever may occur.

Varicella If you haven’t had chickenpox, discuss this vaccination with your doctor.

These immunisations may be recommended for long-term travellers (more than one month) or those at special risk:

Japanese B Encephalitis Three injections in all. Booster recommended after two years. Sore arm and headache are the most common side effects. Rarely, an allergic reaction comprising hives and swelling can occur up to 10 days after any of the three doses.
Meningitis Single injection. There are two types of vaccination: the quadrivalent vaccine gives two to three years’ protection; meningitis group C vaccine gives around 10 years’ protection. Recommended for long-term backpackers aged under 25.
Rabies Three injections in all. A booster after one year will then provide 10 years’ protection. Side effects are rare – occasionally headache and sore arm.
Tuberculosis A complex issue. Adult long-term travellers are usually recommended to have a TB skin test before and after travel, rather than vaccination. Only one vaccine given in a lifetime.

Required vaccinations
The only vaccine required by international regulations is yellow fever. Proof of vaccination will only be required if you have visited a country in the yellow-fever zone within the six days prior to entering Bhutan. If you are travelling to Bhutan from Africa or South America you should check to see if you require proof of vaccination.

Medical checklist
Recommended items for a personal medical kit:
Antifungal cream, eg Clotrimazole
Antibacterial cream, eg Muciprocin
Antibiotic for skin infections, eg Amoxi­cillin/Clavulanate or Cephalexin
Antibiotics for diarrhoea include Norfloxacin or Ciprofloxacin; for bacterial diarrhoea Azithromycin; for giardiasis or amoebic dysentery Tinidazole
Antihistamine – there are many options, eg Cetrizine for daytime and Promethazine for night
Antiseptic, eg Betadine
Antispasmodic for stomach cramps, eg Buscopa
Contraceptives
Decongestant, eg Pseudoephedrine
DEET-based insect repellent
Diarrhoea – consider an oral rehydration solution (eg Gastrolyte), diarrhoea ‘stopper’ (eg Loperamide) and anti­nausea medication (eg Prochlorperazine)
First-aid items such as scissors, Elastoplasts, bandages, gauze, thermometer (but not mercury), sterile needles and syringes, safety pins and tweezers
Ibuprofen or another anti-inflammatory
Indigestion medication, eg Quick-Eze or Mylanta
Iodine tablets (unless you are pregnant or have a thyroid problem) to purify water
Laxative, eg Coloxyl
Migraine sufferer – take your personal medicine
Paracetamol
Permethrin to impregnate clothing and mosquito nets
Steroid cream for allergic/itchy rashes, eg 1% to 2% hydrocortisone
Sunscreen and hat
Throat lozenges
Thrush (vaginal yeast infection) treatment, eg Clotrimazole pessaries or Diflucan tablet
Ural or equivalent if you’re prone to urine infections

While you’re there
Availability of health care
There are no private health clinics or physicians in Bhutan, but all district headquarters towns have a hospital, and will accept travellers in need of medical attention. The best facility is the Jigme Dorji Wangchuk National Referral Hospital in Thimphu. It has general physicians and several specialists, labs and operating rooms. Treatment is free, even for tourists. If you are seriously ill or injured you should consider evacuation to the excellent medical facilities in Bangkok. It is difficult to find reliable medical care in rural areas. Your embassy and insurance company are good contacts.

Self-treatment may be appropriate if your problem is minor (eg traveller’s diarrhoea), you are carrying the appropriate medication and you cannot attend a recommended clinic. If you think you may have a serious disease, especially malaria, do not waste time – travel to the nearest quality facility to receive attention. It is always better to be assessed by a doctor than to rely on self-treatment.

In most large towns there are shops that sell medicines. Many of these are available without a prescription in these medicine shops.

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