Health & safety
Before you go
Insurance
If your insurance doesn’t cover medical expenses abroad, consider supplemental insurance. See the US State Department website (www.travel.state.gov/travel/tips/brochures/brochures_1215.html) for medical evacuation and travel-insurance companies.
Find out if your insurer will pay providers directly or reimburse you later for expenditures. You may prefer a policy that pays doctors or hospitals directly rather than requiring you to pay up front and claim later. If you have to claim later, keep all documentation. Some policies ask you to call collect to a center in your home country, where an assessment of your problem is made.
Check that the policy covers ambulances and an emergency flight home. Some policies offer lower and higher medical-expense options; the higher ones are for countries such as the USA, which have extremely high medical costs. There is a wide variety of policies available, so check the small print.
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Recommended vaccinations
Since most vaccines don’t produce immunity until at least two weeks after they’re given, visit a physician four to eight weeks before departure. Ask your doctor for an International Certificate of Vaccination (also known as a yellow booklet), which will list all the vaccinations you’ve received. This is mandatory for countries that require proof of yellow-fever vaccination upon entry, but it’s a good idea to carry it wherever you travel. Note that some of the recommended vaccines are not approved for use by children and pregnant women; check with your physician.
The only required vaccine for Belize is yellow fever, and that’s only if you’re arriving from a yellow fever–infected country in Africa or South America. However, a number of vaccines are recommended.
Medical checklist
It is a very good idea to carry a medical and first-aid kit with you, in the case of minor illness or injury. Following is a list of items you should consider packing.
antibiotics
antidiarrheal drugs (eg loperamide)
acetaminophen/paracetamol (Tylenol) or aspirin
anti-inflammatory drugs (eg ibuprofen)
antihistamines (for hay fever and allergic reactions)
antibacterial ointment (eg Bactroban) for cuts and abrasions
steroid cream or cortisone (for poison ivy and other allergic rashes)
bandages, gauze, gauze rolls
adhesive or paper tape
scissors, safety pins and tweezers
thermometer
pocketknife
insect repellent containing DEET for the skin
insect spray containing permethrin for clothing, tents and bed nets
sunblock
oral rehydration salts
iodine tablets (for water purification)
syringes and sterile needles
Bring medications in their original containers, clearly labeled. A signed, dated letter from your physician describing all 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.
Internet resources
There is a wealth of travel-health advice on the internet. The Lonely Planet website at lonelyplanet.com is a good place to start. The World Health Organization publishes a superb book, International Travel and Health, which is revised annually and is available free online at www.who.int/ith.
It’s a good idea to consult your government’s travel-health website before you depart:
Australia (www.smarttraveller.gov.au)
Canada (www.hc-sc.gc.ca/hl-vs/travel-voyage/index_e.html)
UK (www.dh.gov.uk)
USA (wwwn.cdc.gov/travel)
Further reading
For more information, see Lonely Planet’s Healthy Travel Central & South America. If you’re traveling with children, Lonely Planet’s Travel with Children may be useful. ABC of Healthy Travel, by Eric Walker et al, and Medicine for the Outdoors, by Paul S Auerbach, are other valuable resources.
Dangers & annoyances
Belizeans on the whole are remarkably easygoing and travelers experience little hassle, though extra care should be taken when in Belize City. Local men can be very direct about making advances to women, and ganja peddlers in tourist spots can be over-persistent, but these guys do take ‘no’ for an answer.
Nationwide emergency numbers for the police are 90 and 911.
Belizean police are not always cooperative if you try to report a crime. They may try to discourage you with, for example, stories of how long you’ll have to stay in the country to see a matter resolved. If you want to report a crime, be persistent and if necessary seek help from locals (eg your hotel) or from your embassy or consulate.
Some specific areas of concern:
Theft
Occasional incidents of armed robbery and rape of tourists happen in regularly visited but isolated spots; mostly in the west, not far from the Guatemalan border. In 2006 there was a spate of armed robberies against tourist buses on the road to Caracol. The national park service has since implemented a convoy system, whereby all tourist vehicles meet up at Douglas D’Silva (Augustine) ranger station and make the journey on the remote road together, accompanied by armed guards. These precautionary measures seem to be doing the trick.
Armed robberies have also been reported against vehicles on the Hummingbird Hwy and on country roads in the west of Belize.
Such incidents are the exception rather than the rule. The vast majority of visitors to Belize have trouble-free trips and it’s impossible to tell where the next incident will crop up. What you should do is keep your ear to the ground, talk to other travelers and locals, check bulletin boards such as Belize Forums (www.belizeforum.com) and look at the travel advisories issued by your own and other governments. A few foreign embassies in Belize maintain websites with useful information.
The other main trouble spot is Belize City, where some tourists fall victim to muggers and hustlers. You can greatly reduce this risk by a few straightforward steps.
To avoid becoming a victim of petty theft, take normal travelers’ precautions:
Don’t make a big display of obvious signs of wealth (such as an expensive camera, computer equipment or jewelry).
Don’t flash thick wallets or wads of cash.
Don’t leave valuables lying around your room or in a car, especially in plain view.
Keep an eye on your bags when you’re traveling by bus.
In transit
Deep vein thrombosis (DVT)
Blood clots may form in the legs during plane flights, chiefly because of prolonged immobility. The main symptom of DVT is swelling or pain of the foot, ankle or calf, usually but not always on just one side. When a blood clot travels to the lungs, it may cause chest pain and difficulty breathing. Travelers with any of these symptoms should immediately seek medical attention.
To prevent DVT developing on long flights, you should walk about the cabin, contract your leg muscles while sitting, drink plenty of fluids and avoid alcohol.
Jet lag & motion sickness
Jet lag is common when crossing more than five time zones and causes insomnia, fatigue, malaise or nausea. To avoid jet lag, drink plenty of nonalcoholic fluids and eat light meals. Upon arrival, get exposure to natural sunlight and readjust your schedule (for meals, sleep etc) as soon as possible.
Antihistamines such as dimenhydrinate (Dramamine) and meclizine (Antivert, Bonine) are usually the first choice for treating motion sickness. The main side effect is drowsiness. A herbal alternative is ginger, which works like a charm for some people.
While you're there
Availability & cost of health care
Most doctors and hospitals in Belize expect payment in cash, regardless of whether you have medical insurance. If you develop a life-threatening medical problem, you’ll probably want to be evacuated to a country with state-of-the-art medical care. Since this may cost tens of thousands of dollars, be sure you have insurance to cover this before you depart.
Many pharmacies in Belize are well supplied, but important medications may not be consistently available. Be sure to bring along adequate supplies of all prescription drugs. While most prescription medications are available in Belize, they might be relatively expensive. You can obtain prescriptions from general practitioners, who will provide this service for a small fee. Some pharmacists, especially in smaller pharmacies, will dispense medications without a prescription.
Medical facilities in Belize are extremely limited and the number of doctors is quite small. Routine care is readily obtainable in Belize City and the larger towns, but facilities for complicated problems may be difficult to find. In rural areas, medical care may be unavailable. In Belize City the private hospital Belize Medical Associates (223-0302/3/4; 5791 St Thomas St, Belize City) provides generally good care. In San Ignacio, La Loma Luz Hospital (off Map p197; 804-2985, 824-2087; Western Hwy) offers primary care as well as 24-hour emergency services. For divers, there is a hyperbaric chamber on Ambergris Caye.
In Belize, the phone number for an ambulance is 90 but this service is not available in many communities. For a private ambulance in Belize City, call 223-3292.
Chagas’ disease
Chagas’ disease is a parasitic infection that is transmitted by triatomine insects (reduviid bugs), which inhabit crevices in the walls and roofs of traditional housing in South and Central America. In Belize, Chagas’ disease occurs in rural areas. The triatomine insect lays its feces on human skin as it bites, usually at night. A person becomes infected when he or she unknowingly rubs the feces into the bite wound or an open sore. Chagas’ disease is extremely rare in travelers. If you sleep in a poorly constructed house, especially one made of mud, adobe or thatch, be sure to protect yourself with a bed net and a good insecticide.
Dengue
Though relatively uncommon in Belize, dengue fever is a viral infection found throughout Central America and transmitted by aedes mosquitoes, which bite mostly during the daytime and are usually found close to human habitations, often indoors. They breed primarily in artificial water containers such as jars, barrels, cans, cisterns, metal drums, plastic containers and discarded tires. As a result, dengue is especially common in densely populated, urban environments.
Dengue usually causes flu-like symptoms, including fever, muscle aches, joint pains, headaches, nausea and vomiting, often followed by a rash. The body aches may be quite uncomfortable, but most cases resolve uneventfully in a few days. Severe cases usually occur in children under the age of 15 who are experiencing their second dengue infection.
There is no treatment available for dengue fever except to take analgesics such as acetaminophen/paracetamol (Tylenol) and drink plenty of fluids. Severe cases may require hospitalization for intravenous fluids and supportive care. There is no vaccine. The cornerstone of prevention is protection against insect bites.
Hepatitis A
Hepatitis A occurs throughout Belize. It’s a viral infection of the liver that is usually acquired by ingestion of contaminated water, food or ice, though it may also be acquired by direct contact with infected persons. The illness occurs all over the world, but the incidence is higher in developing nations. Symptoms may include fever, malaise, jaundice, nausea, vomiting and abdominal pain. Most cases will resolve uneventfully, though hepatitis A occasionally causes severe liver damage. There is no treatment.
The vaccine for hepatitis A is extremely safe and highly effective. If you get a booster six to 12 months later, it lasts for at least 10 years. Vaccination is recommended for travelers visiting Belize. Because the safety of hepatitis A vaccine has not been established for pregnant women or children under age two, they should instead be given a gamma-globulin injection.
Hepatitis B
Like hepatitis A, hepatitis B is a liver infection that occurs worldwide but is more common in developing nations. Unlike hepatitis A, the disease is usually acquired by sexual contact or by exposure to infected blood, generally through blood transfusions or contaminated needles. The vaccine is recommended only for long-term travelers (on the road more than six months) who expect to live in rural areas or have close physical contact with the local population. Additionally, the vaccine is recommended for anyone who anticipates sexual contact with local people or the need for medical, dental or other treatments while abroad, especially transfusions or injections.
Hepatitis B vaccine is safe and highly effective. Three injections are necessary to establish full immunity. Several countries added hepatitis B vaccine to the list of routine childhood immunizations in the 1980s, so many young adults are already protected.
Leishmaniasis
Leishmaniasis occurs in the mountains and jungles of Belize. The infection is transmitted by sand flies. To protect yourself, follow the same precautions for mosquitoes, except that netting must be finer (at least 18 holes to the linear inch) and you should stay indoors during the early evening. There is no vaccine.
In Belize, the disease is generally limited to the skin, causing slow-growing ulcers over exposed parts of the body; less commonly, it may disseminate to the bone marrow, liver and spleen.
Leptospirosis
Leptospirosis is acquired by exposure to water that has been contaminated by the urine of infected animals. Outbreaks may occur as a result of flooding, when sewage overflow contaminates water sources. The initial symptoms, which resemble a mild flu, usually subside uneventfully in a few days, with or without treatment, but a minority of cases are complicated by jaundice or meningitis. There is no vaccine. Minimize your risk by staying out of bodies of fresh water that may be contaminated by animal urine. If you’re engaging in high-risk activities in an area where an outbreak is in progress, you can take 200mg of doxycycline once weekly as a preventative measure. The treatment for leptospirosis is 100mg of doxycycline twice daily.
Malaria
Malaria occurs in every country in Central America. It’s transmitted by mosquito bites, which usually occur between dusk and dawn. The main symptom is high, spiking fevers, which may be accompanied by chills, sweats, headache, body aches, weakness, vomiting or diarrhea. Severe cases may affect the central nervous system and lead to seizures, confusion, coma and death.
For Belize, malaria pills are recommended for travel to all areas except Belize City. The risk is highest in the western and southern regions.
The malaria pill of choice is chloroquine, taken once weekly in a dosage of 500mg, starting one to two weeks before arrival and continuing during the trip and for four weeks afterwards. Chloroquine is safe, inexpensive and highly effective. Side effects are typically mild and may include nausea, abdominal discomfort, headache, dizziness, blurred vision or itching. Severe reactions are uncommon.
Since no pills are 100% effective, protecting yourself against mosquito bites is just as important as taking malaria pills.
You may not have access to medical care while traveling, so you should bring along additional pills for emergency self-treatment, which you should take if you can’t reach a doctor and you develop symptoms that suggest malaria, such as high, spiking fevers. One option is to take four tablets of Malarone once daily for three days. If you start self-medication, you should try to see a doctor at the earliest possible opportunity.
If you develop a fever after returning home, see a physician, as malaria symptoms may not occur for months.
Rabies
Rabies is a viral infection of the brain and spinal cord that is almost always fatal. The rabies virus is carried in the saliva of infected animals and is typically transmitted through an animal bite, though contamination of any break in the skin with infected saliva may result in rabies.
Rabies occurs in all Central American countries. The greatest risk is in the triangle where Belize, Guatemala and the Yucatán region meet. Most cases are related to bites from dogs or bats.
Rabies vaccine is safe, but requires three injections and is quite expensive. Those at high risk for rabies, such as spelunkers (cave explorers), should certainly be vaccinated. The treatment for a possibly rabid bite consists of vaccine with immune globulin. It’s effective, but must be given promptly. Most travelers don’t need to be vaccinated against rabies.
All animal bites and scratches must be promptly and thoroughly cleansed with large amounts of soap and water, and local health authorities should be contacted to determine whether or not further treatment is necessary.
Typhoid
Typhoid fever is caused by the ingestion of contaminated food or water. Outbreaks sometimes occur at times of flooding, when sewage overflow may contaminate water sources. The initial symptoms, which resemble a mild flu, usually subside uneventfully in a few days, with or without treatment, but a minority of cases are complicated by jaundice or meningitis. Fever occurs in virtually all cases. Other symptoms may include headache, malaise, muscle aches, dizziness, loss of appetite, nausea and abdominal pain, and either diarrhea or constipation.
Unless you expect to take all your meals in major hotels and restaurants, vaccination for typhoid is a good idea. It’s usually given orally, but is also available as an injection. Neither vaccine is approved for use in children under the age of two.
The drug of choice for typhoid fever is usually a quinolone antibiotic such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), which many travelers carry for treatment of traveler’s diarrhea. If you self-treat for typhoid fever, you may also need to self-treat for malaria, since the symptoms of the two diseases may be indistinguishable.
Yellow fever
Yellow fever no longer occurs in Central America. Belize, Guatemala and Mexico require yellow-fever vaccination before entry only if you’re arriving from an infected country in Africa or South America. The vaccine is given only in approved yellow-fever vaccination centers, which provide validated International Certificates of Vaccination (‘yellow booklets’). The vaccine should be given at least 10 days before leaving and remains effective for about 10 years.
Reactions to the vaccine are generally mild and may include headaches, muscle aches, low-grade fevers or discomfort at the injection site. Severe, life-threatening reactions are extremely rare. Vaccination is not recommended for pregnant women or children less than nine months old.
Traveler’s diarrhea
To prevent diarrhea, avoid tap water unless it’s been boiled, filtered or chemically disinfected (with iodine tablets); only eat fresh fruit or vegetables if cooked or peeled; be wary of dairy products that might contain unpasteurized milk; and be highly selective when eating food from street vendors.
If you develop diarrhea, be sure to drink plenty of fluids, preferably an oral rehydration solution containing salt and sugar. A few loose stools don’t require treatment, but if you start having more than four or five stools a day, you should start taking an antibiotic (usually a quinolone drug) and an antidiarrheal agent (such as loperamide). If diarrhea is bloody, persists for more than 72 hours or is accompanied by fever, shaking chills or severe abdominal pain, you should seek medical attention.
Animal bites
Do not attempt to pet, handle or feed any animal, with the exception of domestic animals known to be free of infectious diseases. Most animal injuries occur when people try to touch or feed animals.
Any bite or scratch by a mammal, including bats, should be promptly and thoroughly cleansed with large amounts of soap and water, and an antiseptic such as iodine or alcohol applied. The local health authorities should be contacted immediately for possible post-exposure rabies treatment, whether or not you’ve been immunized against rabies. It may also be advisable to take antibiotics, since wounds caused by animal bites and scratches frequently become infected. One of the newer quinolones, such as levofloxacin (Levaquin), which many travelers carry in case of diarrhea, would be an appropriate choice.
Mosquito bites
To avoid mosquito bites, wear long sleeves, long pants, hats and shoes (rather than sandals). Pack insect repellent, preferably one containing DEET, which should be applied to exposed skin and clothing, but not to eyes, mouth, cuts, wounds or irritated skin. Products containing lower concentrations of DEET are as effective, but for shorter periods of time. In general, adults and children over 12 should use preparations containing 25% to 35% DEET, which last about six hours. Children between two and 12 years of age should use preparations containing no more than 10% DEET, applied sparingly, which will usually last about three hours.
Neurologic toxicity has been reported from using DEET, especially in children, but is extremely uncommon and is generally related to overuse. DEET-containing compounds should not be used on children under age two.
Insect repellents containing certain botanical products, including eucalyptus and soybean oil, are effective but last only 1½ to two hours. DEET-containing repellents are preferable for areas where there is a high risk of malaria or yellow fever. Products based on citronella are not effective.
For additional protection, you can apply permethrin to clothing, shoes, tents and bed nets. Permethrin treatments are safe and remain effective for at least two weeks, even when items are laundered. Permethrin should not be applied directly to skin.
Don’t sleep with windows open unless there is a screen. If sleeping outdoors or in accommodations that allow entry of mosquitoes, use a bed net, preferably treated with permethrin, with the edges tucked in under the mattress. The mesh size should be less than 1.5mm. If the sleeping area is not otherwise protected, use a mosquito coil, which will fill the room with insecticide through the night. Repellent-impregnated wristbands are not effective.
Snake bites
Snakes are a hazard in Belize. The chief concern is Bothrops asper, the Central American or common lancehead, usually known in Belize as the yellow-jaw tommygoff and also called the fer-de-lance, barba amarilla (yellow beard) or terciopelo (velvet skin). This heavy-bodied snake reaches up to 6.5ft in length and is found mostly in the northern region. It is earth-toned and has a broadly triangular head with a pattern of Xs and triangles on its back. Others snakes to watch out for are the brightly striped coral snake and the tropical rattlesnake. All three snakes are deadly, though the coral snake is shyer than the irritable rattlesnake.
In the event of a venomous snake bite, place the victim at rest, keep the bitten area immobilized, and move the victim immediately to the nearest medical facility. Avoid tourniquets, as they are no longer recommended.
Tick bites
To protect yourself from tick bites, follow the same precautions as for mosquitoes, except that boots are preferable to shoes, with pants tucked in. Be sure to perform a thorough tick check at the end of each day. You’ll generally need the assistance of a friend or a mirror for a full examination. Remove ticks with tweezers, grasping them firmly by the head. Insect repellents based on botanical products have not been adequately studied for insects other than mosquitoes and cannot be recommended to prevent tick bites.
Sun exposure
To protect yourself from excessive exposure to the sun, you should stay out of the midday sun, wear sunglasses and a wide-brimmed hat, and apply sunscreen with SPF 15 or higher, with both UVA and UVB protection. Sunscreen should be generously applied to all exposed parts of the body approximately 30 minutes before sun exposure and should be reapplied after swimming or vigorous activities. Travelers should also drink plenty of fluids and avoid strenuous exercise when it is hot. Dehydration and salt deficiency can cause heat exhaustion, which can then progress to heatstroke.
Symptoms of this serious condition include a general feeling of unwellness, not sweating very much (or not at all) and a high body temperature (39°C to 41°C, or 102°F to 106°F). Severe, throbbing headaches and lack of coordination can also occur. Hospitalization is essential, but in the interim get victims out of the sun, remove their clothing, cover them with a wet sheet or towel and fan continually. Give fluids if they are conscious.
Water
Tap water is not safe to drink in Belize. Vigorous boiling for one minute is the most effective means of water purification. At altitudes greater than 3630ft, boil for three minutes.
Another option is to disinfect water with iodine pills. Follow the instructions carefully. Alternatively, you can add 2% tincture of iodine to one quart or liter of water (five drops to clear water, 10 drops to cloudy water) and let stand for 30 minutes. If the water is cold, longer times may be required. The taste of iodinated water may be improved by adding vitamin C (ascorbic acid). Iodinated water should not be consumed for more than a few weeks. Pregnant women, those with a history of thyroid disease and those allergic to iodine should not drink iodinated water.
Water filters with smaller pores (reverse osmosis filters) provide the broadest protection, but they are relatively large and are readily plugged by debris. Those with somewhat larger pores (microstrainer filters) are ineffective against viruses, although they remove other organisms. Follow manufacturers’ instructions carefully.
Safe, inexpensive agua pura (purified water) is widely available in hotels, shops and restaurants.
Children & pregnant women
In general, it’s safe for children and pregnant women to go to Belize. However, because some of the recommended vaccines are not approved for use in children and during pregnancy, these travelers should be particularly careful not to drink tap water or consume any questionable food or drink. Also, when traveling with children, make sure they’re up to date on all routine immunizations. It’s sometimes appropriate to give children some of their vaccines a little early before visiting a developing nation – discuss this with your pediatrician. If pregnant, bear in mind that should a complication, such as premature labor, develop while abroad, the quality of medical care may not be comparable to that in your home country.
Yellow-fever vaccine is not recommended for pregnant women or children less than nine months old. Therefore, these travelers, if arriving from a country with yellow fever, should obtain a waiver letter, preferably written on letterhead and bearing the stamp used by official immunization centers to validate the International Certificate of Vaccination.
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