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Health & safety

Before you go

Prevention is the key to staying healthy while abroad. A little planning before departure, particularly for pre-existing illnesses or conditions, will save trouble later. Carry a spare pair of contact lenses and glasses, and take your optical prescription with you. Bring extra 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.

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Citizens of other European Economic Area countries (EU countries plus Norway, Iceland and Liechtenstein) should pick up a European Health Insurance Card (EHIC) before they travel, which entitles you to the same immediate medical treatment available to Bulgarian nationals. However, you should also consider buying a policy that covers you for the worst possible scenario, such as an ­accident requiring an emergency flight home.

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Internet resources

The World Health Organisation’s publication International Travel and Health is revised annually and is available online at www.who.int/ith/. Other useful websites include:

www.ageconcern.org.uk Advice on travel for the elderly.

www.fitfortravel.scot.nhs.uk General travel advice for the layperson.

www.mariestopes.org.uk Providing information on women’s health and contraception.

www.mdtravelhealth.com Travel health recommendations for every country; updated daily.

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Dangers & annoyances

Bulgaria is a modern, peaceful and well-ordered country. If you can handle yourself in the big cities of Western Europe, North America or Australia, you’ll certainly have little or no trouble dealing with the seamier sides of Bulgaria. You’ll be fine if you look purposeful, keep alert and take the usual safety precautions.

Theft is not as much of a problem as it is in some countries, but obviously look after your belongings and watch out for pickpockets in busy markets and on crowded buses. Prime targets for thieves are parked cars, especially those with foreign licence plates and/or rental-agency stickers. Never leave things inside the car; always lock them in the boot, or take them with you.

Bulgarian drivers can be extremely reckless at times, and pedestrians should be very careful when crossing roads, especially in Sofia. Cars regularly park on pavements, blocking them for pedestrians. Inevitably, footpaths in towns throughout Bulgaria are often crumbling and under sporadic repair.

Beggars ply their trade around some churches and larger squares, but most are in real need and are very rarely aggressive or demanding. Be wary, however, of gangs of children who work the streets of big cities such as Sofia and Varna: they’re often professional pickpockets.

Bulgaria has very harsh drug laws, being a common route for drugs (and arms) smuggled in from Turkey, Russia and Armenia and then across the continent. Don’t attempt to buy, sell, transport or use drugs here unless you want an extended stay in Bulgaria’s fearsome prisons.

Foreigners are sometimes set up for minor monetary rip-offs, but these are fairly obvious and easy to avoid: taxi drivers at airports, train stations and beach resorts normally overcharge outrageously, and moneychangers on the street sometimes offer ridiculously high exchange rates. (Changing money on the street is both illegal and unnecessary.)

Bulgaria is a major producer of tobacco, and smoking seems to be the national pastime. Cafés, bars and restaurants are often poorly ventilated, but this is less of a problem in summer when most patrons sit outside.

Construction work along the Black Sea shows no sign of slowing down and many places currently resemble vast, dusty building sites. New hotel and holiday-home developments are springing up at various locations – though the area around Sunny Beach (Slânchev Bryag) accounts for around a third of activity – and concrete and cranes dominate some existing resorts such as Sveti Vlas and parts of Pomorie. The ski resort of Bansko is also undergoing major building development. It’s not easy to know when current work will be finished and where new projects are about to begin, but by law construction should not be taking place during the peak tourist seasons. For now, if you want to avoid the mess completely, you’ll need to scout around for somewhere more to your liking; there are still quiet nooks to be found.

Mosquitoes can be an irritant in some areas during the summer, but sprays, creams and plug-in repellents can be bought cheaply at pharmacies and supermarkets.

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While you're there

Availability of health care

Every city and major town has a government hospital of an acceptable – albeit not excellent – standard, as well as more up-to-date private clinics. Smaller towns and villages may have a clinic, but for serious complaints you should travel to a larger town or ask your embassy/consulate to recommend a hospital, clinic, doctor or dentist. Dental clinics are easy to find in big cities and apteka (pharmacies) are common. Doctors at bolnitsa (government hospitals) are well trained and most speak English and/or German. However, equipment can be lacking and outdated. Staff at the more expensive poliklinika (private clinics), such as in Sofia, are more likely to be fluent in English and German, and equipment is normally of a higher standard.

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Tickborne encephalitis

This is spread by tick bites. It is a serious infection of the brain and vaccination is advised for those in risk areas who are unable to avoid tick bites (such as campers, forestry workers and walkers). Two doses of vaccine will give a year’s protection, three doses up to three years’.

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Typhoid & hepatitis a

These are spread through contaminated food (particularly shellfish) and water. Typhoid can cause septicaemia; Hepatitis A causes liver inflammation and jaundice. Neither is usually fatal but recovery can be prolonged. Hepatitis A and typhoid ­vaccines can be given as a single-dose vaccine, Hepatyrix or Viatim.

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This is a potential concern considering the number of stray dogs running around Bulgaria. If bitten, seek medical attention immediately (most main hospitals will have a rabies clinic), but don’t panic; while rabies is transmitted via the animal’s saliva, the rabies virus is present in saliva only during the final stages of the disease in the animal, often only in the last week of the dog’s life. It is therefore a relatively rarely transmitted disease. Still, do not take any chances and seek medical attention. Any bite, scratch or even lick from an unknown animal should be cleaned immediately and thoroughly. Scrub with soap and running water, and then apply alcohol or iodine solution.

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Traveller’s diarrhoea

If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution (eg Dioralyte). 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 antidiarrhoeal agent (such as loperamide). If diarrhoea is bloody, persists for more than 72 hours or is accompanied by fever, shaking, chills or severe abdominal pain, you should seek medical attention.

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Air pollution

Due to the large number of old, poorly maintained vehicles rattling around the roads in Bulgaria, the build up of traffic fumes can be unpleasant in Sofia and other big cities, and may affect those with respiratory problems. Thankfully, it’s easy enough to escape the urban sprawl and get some fresh air in the country. Cigarette smoke, however, is harder to avoid. Bulgarians are notorious chain-smokers, and restaurants and bars can get particularly fuggy.

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Hypothermia & frostbite

Proper preparation will reduce the risk of getting hypothermia. Even on a hot day in the mountains, the weather can change rapidly, so carry waterproof garments and warm layers, and inform others of your route.

Acute hypothermia follows a sudden drop of temperature over a short time. Chronic hypothermia is caused by a gradual loss of temperature over hours.

Hypothermia starts with shivering, loss of judgment and clumsiness. Unless rewarming occurs, the sufferer deteriorates into apathy, confusion and coma. Prevent further heat loss by seeking shelter, warm dry clothing, hot sweet drinks and shared body warmth.

Frostbite is caused by freezing and subsequent damage to bodily extremities. It is dependent on wind-chill, temperature and length of exposure. Frostbite starts as frostnip (white, numb areas of skin) from which complete recovery is expected with rewarming. As frostbite develops, the skin blisters and then becomes black. Adequate clothing, staying dry, keeping well hydrated and ensuring adequate calorie intake best prevent frostbite. Treatment involves rapid rewarming.

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Tap water is generally considered safe to drink in all major towns and cities, although it might not taste particularly nice. Caution should be taken in smaller villages, and if staying at older or more remote hotels where the water pipes may be as old as the buildings themselves. The fountains in town parks and outside monasteries and churches provide an ideal source of drinkable water. Cheshma (water spouts), often found along main roads, also offer constant supplies of fresh, delicious and safe water.

If in doubt, purify water (with filters, iodine or chlorine) or boil it. At high altitude water boils at a lower temperature, so germs are less likely to be killed. Boil it for longer in these environments.

Easiest, and safest, of all, is to simply buy bottled water, which is inexpensive and sold everywhere. Fill the empty bottles up at public fountains to avoid unnecessary waste.

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Women’s health

Emotional stress, exhaustion and travelling through different time zones can all contribute to an upset in the menstrual pattern. If using oral contraceptives, remember some antibiotics, diarrhoea and vomiting can stop the pill from working and lead to the risk of pregnancy – remember to take condoms with you just in case. Time zones, gastrointestinal upsets and antibiotics do not affect injectable contraceptives. Travelling during pregnancy is usually possible, but always consult your doctor before planning your trip. The most risky times for travel are during the first 12 weeks of pregnancy and after 30 weeks.

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