1. Travel permits

TTB permit from Tibet Tourism Bureau is a must for a foreign tourist. To get it we need your day-by-day itinerary( when and where to enter, stay and exit), a tour participant list( name in full, date of birth, gender, nationality, occupation and passport number, scanned photo pages and China-visa pages of the passports and a payment proof.
If one travels in remote areas, he/she may need Alien’s Travel Permit from the Public Security, Border Pass from the Border Defence and Military Pass from the army.
It takes Dreams Travel 5 working days to get your permits ready.

2. Acute Mountain Sickness and Treatment
An altitude over 3,000 meters (9,843 feet) is usually defined as high altitude. Since most places in Tibet are higher than this level, Acute Mountain Sickness (AMS), also called Altitude Sickness is the biggest health risk to tourists in Tibet. AMS is common at high altitudes due to the decreasing availability of oxygen. Most people will experience differing degrees of symptoms at high elevation. The occurrence of AMS is dependent on the altitude, the ascent rate and individual physical condition. Symptoms of AMS include headache, nausea, dizziness, fatigue, shortness of breath, loss of appetite and disturbed sleep. Most people will experience one or more AMS symptoms upon their arrival in Tibet. The symptoms will usually gradually decrease in severity during acclimatization. Mild AMS usually will not interfere with mild activity.
However AMS can be very serious, with the most serious symptoms being High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE), which can be fatal. Symptoms of HAPE include weakness, shortness of breath, even at rest, impending suffocation at night, and a persistent productive cough with white, watery, or frothy fluid. Symptoms of HPCE may include headache, ataxia, weakness, hallucinations, psychotic behavior, coma and loss of memory. Both approach and strike at night and can be fatal! Immediate descent is the surest treatment.
Before visiting Tibet, get as fit and healthy as possible, both physically and psychologically. Visitors having record of heart, lung, other organ problems or anemia should consult their doctor before making the decision to visit Tibet.
AMS can be lessened or avoided with proper acclimatization, which will also ease and reduce AMS symptoms. A gradual ascent will allow your body to acclimatize to higher altitudes and the decreased oxygen supply. Go no higher 300 - 400 hundred meters (984 - 1,312 feet) daily and have a rest after each 1,000 meter (3280 feet) ascent. Medication also helps to prevent AMS. Mild AMS symptoms can be treated with proper medication. If medication does not relieve the symptoms, go to hospital or evacuate immediately to safe altitude!
The following precautions may help to prevent or lessen the effects of AMS:

1. Since fluid loss usually accompanies the acclimatization process, drink plenty of fluids (3 - 4 litres daily at least) and eat carbohydrate food to keep the body properly hydrated;
2. Do not over exert and only partake in light activity immediate after your arrival;
3. Don't smoke, drink alcohol or take other depressants such as tranquilizers and sleeping pills. These will depress the respiratory drive and limit oxygen intake. Always keep in mind the following rules which will ensure a smooth and enjoyable trip to Tibet:
4. Any sickness at high altitude is AMS until proven otherwise; · Never go higher with symptoms of AMS;
5. It is significant that you report any symptoms of AMS immediately to other group members in the trip.

How To Avoid Mountain Sickness
Some travelers will get mountain sickness when on the Tibetan plateau. We have some tips for you:
Before you go to Tibet

1. Seek advice from people who have similar experiences. The most important thing is that you should never be nervous or worried about your trip. Regard the trip to Tibet like a trip to any other cities. You should always be optimistic.
2. If you have respiratory problems, we advise you to postpone your trip till you are fully recovered.
3. A thorough physical examination is necessary. If you have problems like anemia or hypertension, or suffer from heart problems and other illness of lungs, liver or kidney, you should not go to Tibet.
4. You need to bring enough water or drinks and fruits. Snacks with high caloric content, like chocolate, will come in handy.
5. What to pack

Pack the minimum wherever you travel! Planning a trip to Tibet is just the same as in any other places. But remember Tibet is on the roof of the world and most part of it is remote area. The things to pack should be in your consideration beforehand.
(1) ID card, the Travel Permit issued by the Tibet Tourism Bureau.
(2) A large backpack and a smaller one. The smaller one can be used for daily activities and can also be put into the big one when necessary.
(3) A waist pack to put property and important documents.
(4) Cold-proof clothes: the temperatures change greatly on the altiplano. In the north part of Tibet, people wear thick coats all year round (including July and August which are the hottest months in most of the areas in China). The highest temperature is 4-5 degrees centigrade in northern Tibet. It also snows in July and August. In Lhasa, the temperature in July arrives at 30 degrees centigrade at daytime, but falls to 10 degrees centigrade at night. Sometimes it will snow or sleet at night, so you’d better take some down garments (those with hats will better), woolen sweaters, warm gloves, warm and wind-proof shoes and socks. Wearing several layers of clothing that can be easily added or removed is the wise choice since temperatures may vary greatly within a single day. A down coat is necessary for those who are traveling beyond Lhasa and Shigatse into more remote areas such as the Everest Camp. A windbreaker plus a sweater will work nicely for strolling around Lhasa in summer. During the peak tourism season, frequent rainfall makes waterproof clothing and raingear absolute necessities. Other essentials to pack include four or five pairs of cotton or woolen underwear, four or five pairs of woolen socks, long sleeve cotton or lightweight wool shirts and T-shirts. Women should avoid skirts or dresses. Sturdy sneakers, walking shoes, or hiking boots are also recommended. Don't forget to bring along a warm hat as well as one or two pairs of warm mittens or gloves.
(5) Protection against sunburn light: as the sunshine is really strong, you’d better take the sunglasses, sunhat and suntan lotion etc. Ladies should take the high SPF sun-cream.
(6) Medicine: medicine is a must for travelers to Tibet. Since the boiling point of water is somewhat lower in Tibet because of the oxygen shortage and low air pressure, it is better to boil water for a longer period of time. Drinking water should be purified with iodine or other purification tablets to prevent intestinal complaints. And when you first arrive, you may have loose bowl, so you should prepare some bitter aloes, berberine and so on. But the water in Tibet is very pure, where most of the water is natural mineral water. Furthermore, take some chrysanthemum tea, sealheal mulberry leaves and gen-seng powders, vitamin C pills, and some pain-killers, and enough medicines for colds, diarrhea, nausea and fever. Some nasal ointment and throat-moistening pills will be of great help for those who are sensitive to chilly or freezing weather conditions. Please consult your doctor prior to your travel to Tibet.
(7) Torches that you can use to take pictures and also in case of power cut. In some areas, the electricity will be cut after 22:00.
(8) Oxygen bag is also necessary, for there are lots of places of high elevation. To avoid anoxic accidents, you can buy some oxygen bags in Tibetan hospitals or some of the hotels. (9) Travel canteen and sleep bag: you should drink much more water to strengthen cycle on the altiplano. You’d better take the down sleepbags, small bucket, little plastic basin and slipper for special lines.
4. Taboos
Taboos on social courtesies

1. Let the guests or the elder people go first when you walk together with them. When you talk, use honorific expressions. When you address somebody, please add "la" behind the name to express respects. When greeting or seeing off a guest, smile at him while you bend your body forward and bend your knees. If you are asked to sit down, please cross your legs, do not stretch your legs forward and face your sole to others. Do not gaze around casually. You should accept the gift with both hands. While presenting the gift, you should bend your body forward and hold the gift higher than your head with both hands. While offering tea, wine or cigarette, you should offer them by both hands and do not tough the inside of the bowl with any of your fingers.
2. When the host presents you a cup of wine, you should dip your ring finger in the wine and flick the wine in the air three times to express your respects to the heaven, the earth and the ancestors before sipping the wine. The host will fill the cup, and you take a sip of the wine again. After the host fills your cup for the forth time, you have to bottom it up.
3. When the host presents you a cup of ghee tea, you should wait until the host holds the cup with both hands to you and take the tea.
4. Do not accept things or give things to others with one hand. When the host fills the cup, you should lower the cup a little with both hands to show respect.

Taboos on behaviors

1. Do not spit or clap your palms behind Tibetan people.
2. Seeing any dagobas, monasteries or Mani piles, please go around them clockwise (not of the Bon). Do not cross any musical instruments used in the Buddhist mass. Do not cross any fire-pans.
3. Do not relieve yourself near any cattle pens, horse stables, or sheepfolds.
4. Do not throw any bones into fire.
5. Do not touch other’s head by hand.
6. Do not use paper with Tibetan characters as tissue or wipe off mess with the paper.
7. Do not step on threshold when entering the tent or house. Do not spit in front of the Tibetan people.
8. In the tent, men sit on the left side, and women on the right side.
9. When there is someone ill or when a woman is giving birth to a baby, Tibetans will make a sign in front of their houses. Some people light a fire in front of their houses. Some place a branch or a red cloth tag in the doorway. Do not enter the house if you see the sign.
10. Tibetan people believe that there are auspicious days and ominous days for everyone. In the ominous days, people can do nothing but stay at home pattering or go to worship the gods and Buddha to avoid the mischance. The Tibetans believe that the end of each Dizhi (the 12 Terrestrial Branches, used in combination with ten Celestial Stems to designate years, months, days and hours) and the beginning of the following Terrestrial Branch in the Tibetan calendar is an ominous year. People should be more careful when they reach their ages of 13, 25, 37 and 49 and so on, which are believed to be one’s ominous years in their life.
11. On the outskirts, you could not drive or disturb the sheep or cows with red, green or yellow cloth strips on because these animals are the Tibetan sacrifice to worship gods. Eagles are the sacred birds in the eyes of the Tibetan people. You should not drive them away or injure them.

Taboos Related to Belief

• Do not whirl round the prayer wheels anticlockwise.
• Do not enter the monastery without permission. No smoke in monasteries. Also it is banned to touch the statue of Buddha and religious articles and scan the sutra books, toll the bells or beat the drums. Do not touch any amulets or the prayer beads that the Lama wears. Be quiet when you are in the monastery, and sit erect. Do not take the seat of the Living Buddha. Do not make noise, hunt or kill any animals near the monastery.
• Do not make a racket when you arrive at a mountain (rackets at the quiet mountaintop are believed possible to cause sudden storm or hailstones).

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