Health & safety
Canada offers some of the finest health care in the world. The problem is that, unless you are a Canadian citizen, it can be prohibitively expensive. It’s essential to purchase travel health insurance if your regular policy doesn’t cover you when you’re abroad.
Bring any medications you may need clearly labeled in their original containers. A signed, dated letter from your physician that describes all your medical conditions and medications, including generic names, is also a good idea.
If your health insurance does not cover you for medical expenses incurred abroad, it is worth considering taking out supplemental insurance. Check the website of Lonely Planet (www.lonelyplanet.com/travel_services/insurance/travel_insurance.cfm) for more information. Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures.
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There is a wealth of travel health advice available on the internet. The World Health Organization publishes a superb book called International Travel and Health, which is revised annually and is available online at no cost at www.who.int/ith. Another website of general interest is MD Travel Health (www.mdtravelhealth.com), which provides complete travel health recommendations for every country, updated daily, also at no cost.
It’s usually a good idea to consult your government’s travel health website before departure, if one is available.
United Kingdom (www.dh.gov.uk/policyandguidance/healthadvicefortravellers/fs/en)
United States (www.cdc.gov/travel/)
acetaminophen (eg Tylenol) or aspirin
anti-inflammatory drugs (eg ibuprofen)
antihistamines (for hay fever and allergic reactions)
antibacterial ointment (eg Neosporin) 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, tweezers
DEET-containing insect repellent for the skin
permethrin-containing insect spray for clothing, tents and bed nets
Canada is overall a safe place to live and travel. Violent crime does occur, of course; Saskatchewan posts Canada’s highest rates, Québec posts its lowest. But all rates are much lower than in the USA. While smash-and-grab thefts are uncommon, it’s always wise to keep valuables out of view in your parked car, especially in the cities.
Availability & cost of health care
For immediate medical assistance in most provinces and territories, call 911.
In general, if you have a medical emergency, the best bet is to find the nearest hospital and go to its emergency room. If the problem isn’t urgent, you can call a nearby hospital and ask for a referral to a local physician, which is usually cheaper than a trip to the emergency room.
Pharmacies are abundant, but you may find that some medications that are available over the counter in your home country require a prescription in Canada, and if you don’t have insurance to cover the cost of prescriptions, they can be shockingly expensive.
In addition to more common ailments, there are several infectious diseases that are unknown or uncommon outside North America. Most are acquired by mosquito or tick bites, or environmental exposure.
This parasitic infection of the small intestine occurs throughout North America and the rest of the world. Symptoms may include nausea, bloating, cramps and diarrhea, and may last for weeks. To protect yourself from giardia, you should avoid drinking directly from lakes, ponds, streams and rivers, which may be contaminated by animal or human feces. The infection can also be transmitted from person to person if proper hand washing is not performed. Giardiasis is easily diagnosed by a stool test and is readily treated with antibiotics.
Most documented cases of Lyme disease occur in the southern parts of Canada, especially in areas bordering the USA. Lyme disease is transmitted by deer ticks, which are only 1mm to 2mm long. Most cases occur in late spring and summer. The first symptom is usually an expanding red rash that is often pale in the center, known as a bull’s-eye rash. However, in many cases, no rash is observed. Flu-like symptoms are common, including fever, headache, joint pain, body aches and malaise. When the infection is treated promptly with an appropriate antibiotic, usually doxycycline or amoxicillin, the cure rate is high. Luckily, since the tick must be attached for 36 hours or more to transmit Lyme disease, most cases can be prevented by performing a thorough tick check after you’ve been outdoors. The US-based Centers for Disease Control and Prevention has an informative website about Lyme disease (www.cdc.gov/ncidod/dvbid/lyme).
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. In Canada, most cases of human rabies are related to exposure to bats. Rabies may also be contracted from raccoons, skunks, foxes and unvaccinated cats and dogs.
If there is any possibility, however small, that you have been exposed to rabies, you should seek preventative treatment, which consists of rabies immune globulin and rabies vaccine and is quite safe. In particular, any contact with a bat should be discussed with health authorities, because bats have small teeth and may not leave obvious bite marks.
Severe acute respiratory syndrome (SARS)
In 2003 the world’s attention was drawn to the outbreak of a new respiratory illness that became known as SARS. Since the outbreak, there have been just over 300 probable or suspect cases of SARS reported in Canada, resulting in 24 confirmed deaths. The majority of these cases were reported in Ontario, mostly in the greater Toronto area. At the time of writing, SARS appeared to have been brought under control in Canada, and the World Health Organization did not recommend any travel restrictions, as the risk of contracting SARS was extremely low. For the latest on SARS, go to the website of the Public Health Agency of Canada (www.phac-aspc.gc.ca/sars-sras-gen).
The symptoms of SARS are identical to many other respiratory infections, particularly influenza. Symptoms include a high fever over 38°C and a cough, often accompanied by chills, headaches, muscle aches, a sore throat and diarrhea. The case definition of SARS is a person with fever and cough who has traveled to an infected area or been in close contact with an infected person within the previous 10 days. There is no specific quick test for SARS, but certain blood test and chest X-ray results offer support for the diagnosis. There is no specific treatment available and death from respiratory failure occurs in around 10% of patients. Fortunately it appears that it is not as easy to catch SARS as was initially thought. The disease is spread through close personal contact with someone already infected with the SARS coronavirus. Wearing masks has a limited effect and is not generally recommended.
West Nile virus
Cases of West Nile virus were unknown in Canada until a few years ago, but have now been reported in many provinces, including Ontario, Québec, Nova Scotia, New Brunswick, Saskatchewan, Manitoba and Alberta. The virus is transmitted by Culex mosquitoes, which are active in late summer and early fall and generally bite after dusk. Most infections are mild or asymptomatic, but the virus may infect the central nervous system leading to fever, headache, confusion, lethargy, coma and sometimes death. There is no treatment for West Nile virus. For the latest update on the areas affected by West Nile, go to the website of the Public Health Agency of Canada (www.phac-aspc.gc.ca/wn-no).
Acute Mountain Sickness (AMS), aka ‘Altitude Sickness, ’ may develop in those who ascend rapidly to altitudes greater than 2500m. Being physically fit offers no protection. Those who have experienced AMS in the past are prone to future episodes. The risk increases with faster ascents, higher altitudes and greater exertion. Symptoms may include headaches, nausea, vomiting, dizziness, malaise, insomnia and loss of appetite. Severe cases may be complicated by fluid in the lungs (high-altitude pulmonary edema) or swelling of the brain (high-altitude cerebral edema).
The best treatment for AMS is descent. If you are exhibiting symptoms, do not ascend. If symptoms are severe or persistent, descend immediately. When traveling to high altitudes, it’s also important to avoid overexertion, eat light meals and abstain from alcohol. If your symptoms are more than mild or don’t resolve promptly, see a doctor. Altitude sickness should be taken seriously; it can be life-threatening when severe.
When traveling in areas where West Nile virus or other mosquito-borne illnesses have been reported, keep covered (wear long sleeves, long pants, hats, and shoes rather than sandals) and apply a good insect repellent, preferably one containing DEET, to exposed skin and clothing. In general, adults and children over 12 should use preparations containing 25% to 35% DEET, which usually lasts 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 DEET, especially in children, but appears to be 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 oil of eucalyptus and soybean oil, are effective but last only 1½ to two hours. 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 the skin.
Ticks are parasitic arachnids that may be present in brush, forest and grasslands, where hikers often get them on their legs or in their boots. Adult ticks suck blood from hosts by burrowing into the skin and can carry infections such as Lyme disease. To protect yourself from tick bites, follow the same precautions as for mosquitoes, except that boots are preferable to shoes and pants should be tucked in.
Always check your body for ticks after walking through high grass or thickly forested areas. If ticks are found unattached, they can simply be brushed off. If a tick is found attached, press down around the tick’s head with tweezers, grab the head and gently pull upwards – do not twist it. (If no tweezers are available, use your fingers, but protect them from contamination with a piece of tissue or paper.) Do not rub oil, alcohol or petroleum jelly on it. If you get sick in the following couple of weeks, consult a doctor.
Do not attempt to pet, handle or feed any mammal, with the exception of domestic animals known to be free of any infectious disease. Most animal injuries are directly related to a person’s attempt to touch or feed the animal.
Any bite or scratch by a mammal, including bats, should be promptly and thoroughly cleansed with large amounts of soap and water, followed by the application of an antiseptic such as iodine or alcohol. 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 start an antibiotic, since wounds caused by animal bites and scratches frequently become infected.
There are several varieties of venomous snakes in Canada, but unlike those in other countries they do not cause instantaneous death, and antivenins are available. First aid is to place a light constricting bandage over the bite, keep the wounded part below the level of the heart and move it as little as possible. Stay calm and get to a medical facility as soon as possible. Bring the dead snake for identification if you can, but don’t risk being bitten again. Do not use the mythic ‘cut an X and suck out the venom’ trick; this causes more damage to snakebite victims than the bites themselves.
Although there are many species of spiders in Canada, the only ones that cause significant human illness are the black widow and hobo spiders. The black widow is black or brown in color, measuring about 15mm in body length, with a shiny top, fat body and distinctive red or orange hourglass figure on its underside. It’s found throughout Canada, usually in barns, woodpiles, sheds, harvested crops and the bowls of outdoor toilets. Hobo spiders are found chiefly in western Canada.
If bitten by a black widow, you should apply ice or cold packs and go immediately to the nearest emergency room. Complications of a black widow bite may include muscle spasms, breathing difficulties and high blood pressure. The milder bite of a hobo spider typically causes a large, inflamed wound, sometimes associated with fever and chills. If bitten, apply ice and see a physician.
Cold exposure may be a significant problem, especially in the northern regions of the country. To prevent hypothermia, keep all body surfaces covered, including the head and neck. Synthetic materials such as Gore-Tex and Thinsulate provide excellent insulation. Because the body loses heat faster when wet, stay dry at all times. Change inner garments promptly when they become moist. Keep active, but get enough rest. Consume plenty of food and water. Be especially sure not to have any alcohol. Caffeine and tobacco should also be avoided.
Watch out for the ‘Umbles’ – stumbles, mumbles, fumbles and grumbles – which are important signs of impending hypothermia. If someone appears to be developing hypothermia, you should insulate them from the ground, protect them from the wind, remove wet clothing or cover them with a vapor barrier such as a plastic bag, and transport them immediately to a warm environment and a medical facility. Warm fluids (but not coffee or tea – noncaffeinated herbal teas are OK) may be given if the person is alert enough to swallow.
Dehydration is the main contributor to heat exhaustion. Symptoms include feeling weak, headache, irritability, nausea or vomiting, sweaty skin, a fast, weak pulse and a normal or slightly elevated body temperature. Treatment involves getting out of the heat and/or sun, fanning the victim and applying cool, wet cloths to the skin, laying the victim flat with their legs raised and rehydrating with water containing a quarter of a teaspoon of salt per liter. Recovery is usually rapid but it’s common to feel weak for some days afterwards.
Heatstroke is a serious medical emergency. Symptoms come on suddenly and include weakness, nausea, a temperature over 41°C, dizziness, confusion, loss of coordination, fits and eventually collapse and loss of consciousness. Seek medical help and commence cooling by getting the person out of the heat, removing their clothes, fanning them and applying cool wet cloths or ice to their body, especially to the groin and armpits.