Health & safety
Before you go
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.
Insurance
If your health insurance does not cover you for medical expenses abroad, consider supplemental insurance (check the Travel Services section on this website 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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Internet resources
There is a wealth of travel health advice on the Internet. The World Health Organization (WHO; www.who.int/ith/) publishes a superb book called International Travel and Health, which is revised annually and is available online at no cost. 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.
Australia (www.dfat.gov.au/travel/)
Canada (www.travelhealth.gc.ca)
UK (www.doh.gov.uk/traveladvice/index.htm)
United States (www.cdc.gov/travel/)
Recommended immunizations
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 (otherwise known as the 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.
No vaccines are required for Chile, but several are recommended.
Further reading
For further information see Healthy Travel Central & South America, also from Lonely Planet. If you're traveling with children, Lonely Planet's Travel with Children may be useful. The ABC of Healthy Travel, by E Walker et al, is another valuable resource.
Medical checklist
Acetaminophen (Tylenol) or aspirin
Adhesive or paper tape
Anti-inflammatory drugs (eg ibuprofen)
Antibacterial ointment (eg Bactroban) for cuts and abrasions
Antibiotics
Antidiarrhea drugs (eg loperamide)
Antihistamines (for hay fever and allergic reactions)
Bandages, gauze, gauze rolls
DEET-containing insect repellent for the skin
Iodine tablets (for water purification)
Oral rehydration salts
Permethrin-containing insect spray for clothing, tents and bed nets
Pocket knife
Scissors, safety pins, tweezers
Steroid cream or cortisone (for poison ivy and other allergic rashes)
Sunblock
Syringes and sterile needles
Thermometer
Dangers & annoyances
Chile is a remarkably safe country. Its violent crime rate is one of the lowest in South America (and much lower than the US). Though, it still has a healthy nonviolent crime rate. It's a good idea to take certain precautions, especially against pickpocketing, which is on the rise. Avoid carrying large amounts of money in vulnerable spots. Money belts and leg pouches are two secure means of carrying cash and other important documents.
An annoyance rather than a danger are 'students' who hand out poems with a sob story about their financial status and inability to study. They're rarely students, and the poems are rarely theirs.
Oh, and if you're clearly gringo, you may get charged by the odd maverick park attendant to get into free parking areas.
Photographing military installations may lead to getting the film confiscated or a visit to jail.
Natural hazards
Earthquakes happen here: it's a fact of life for most Chileans. Local construction often does not meet seismic safety standards; adobe buildings tend to be especially vulnerable. If you're hyper-safety conscious, make contingency plans for safety or evacuation before going to sleep.
Volcanoes are less likely to threaten safety, since they usually give some warning before blowing their top. However, a few popular resorts are potentially vulnerable, including Pucón, nestled at the base of Volcán Villarrica.
Many of Chile's finest beaches have dangerous offshore rip currents, so ask before diving in and make sure someone on shore knows your whereabouts. Many beaches post signs that say apto para bañar (swimming okay) and no apto para bañar (swimming not okay) or peligroso (dangerous).
In the winter, the smog in Santiago can become a health risk. The city declares 'pre-emergency' or 'emergency' states when the level of smog is dangerously high and takes measures to limit emissions. Children, senior citizens and people with respiratory problems should avoid trips to downtown Santiago at these times.
In transit
Deep vein thrombosis
Blood clots may form in the legs (deep vein thrombosis) during flights, chiefly because of prolonged immobility. The longer the flight, the greater the risk. Though most blood clots are reabsorbed uneventfully, some may break off and travel through the blood vessels to the lungs, where they could cause life-threatening complications.
The chief symptom of deep vein thrombosis 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 the development of deep vein thrombosis on long flights you should walk about the cabin, perform isometric compressions of the leg muscles (ie contract the leg muscles while sitting), drink plenty of fluids, and avoid alcohol and tobacco.
Jet lag & motion sickness
Jet lag is common when crossing more than five time zones, resulting in insomnia, fatigue, malaise or nausea. To avoid jet lag try drinking plenty of fluids (nonalcoholic) and eating light meals. Upon arrival, get exposure to 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. Their 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
There are two modern facilities in Santiago that offer 24-hour walk-in service for urgent problems, as well as specialty care (by appointment) and inpatient services: Clínica Las Condes (210-4000; Lo Fontecilla 441, Las Condes) and Clínica Alemana (212-9700; Av Vitacura 5951, Vitacura). For a list of additional phys- icians, dentists and laboratories in Santia- go, go to the US Embassy website (santiago.us embassy.gov).
The medical care in Santiago and Valparaíso is generally good, but it may be difficult to find assistance in remote areas. Most doctors and hospitals expect payment in cash, regardless of whether you have travel health 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. You can find a list of medical evacuation and travel insurance companies on the US State Department website at www.travel.state.gov/medical.html.
Most pharmacies in Chile are well-stocked and the pharmacists are fully trained. The quality of medications is generally comparable to that found in industrialized countries. Many drugs that require a prescription elsewhere are available over the counter in Chile. If you're taking any medication on a regular basis be sure you know its generic (scientific) name since many pharmaceuticals go under different names in Chile.
Medical care on Easter Island is extremely limited. There is a hospital but the quality of care is unreliable and supplies are often inadequate. Serious medical problems require evacuation to the mainland.
Hepatitis A
Hepatitis A is the second most common travel-related infection (after travelers' diarrhea). 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 throughout the world, but the incidence is higher in developing nations. Symptoms may include fever, malaise, jaundice, nausea, vomiting and abdominal pain. Most cases resolve without complications, 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 after your first, it lasts for at least 10 years. You really should get it before you go to Chile or any other developing nation. Because the safety of the hepatitis A vaccine has not been established for pregnant women or children under the age of two, they should instead be given a gammaglobulin 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 the local inhabitants or a possible need for medical, dental or other treatments while abroad, especially if a need for transfusions or injections is expected.
Hepatitis B vaccine is safe and highly effective. However, a total of three injections is 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.
Typhoid fever
This fever is caused by ingestion of food or water contaminated by a species of Salmonella known as Salmonella typhi. Fever occurs in virtually all cases. Other symptoms may include headache, malaise, muscle aches, dizziness, loss of appetite, nausea and abdominal pain. Either diarrhea or constipation may occur. Possible complications include intestinal perforation, intestinal bleeding, confusion, delirium or (rarely) coma.
Unless you expect to take all your meals in major hotels and restaurants, a typhoid vaccine 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 two years of age.
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 travelers' diarrhea. However, if you self-treat for typhoid fever you may also need to self-treat for malaria, since the symptoms of the two diseases can be indistinguishable.
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 South American countries.
The rabies vaccine is safe, but a full series requires three injections and is quite expensive. Those at high risk for rabies, such as animal handlers and spelunkers (cave explorers), should certainly get the vaccine. In addition, those at lower risk for animal bites should consider asking for the vaccine if they might be traveling to remote areas and might not have access to appropriate medical care if needed. The treatment for a possibly rabid bite consists of the rabies vaccine with rabies immune globulin. It's effective, but must be given promptly. Most travelers don't need the rabies vaccine.
All animal bites and scratches must be promptly and thoroughly cleansed with large amounts of soap and water and local health authorities contacted to determine whether or not further treatment is necessary.
Anthrax
Anthrax is an occupational hazard among those working with farm animals. The infection begins as a small raised area on the skin that ulcerates and turns black. (The name anthrax is derived from the Greek word for coal.) When untreated the illness may be complicated by high fevers, swelling of the area around the ulcer and enlargement of nearby lymph nodes. Anthrax usually responds well to treatment with either doxycycline or ciprofloxacin (Cipro).
Bartonellosis (oroya fever)
This is carried by sandflies in the arid river valleys on the western slopes of the Andes, between altitudes of 800m and 3000m. (Curiously, it's not found anywhere else in the world.) The chief symptoms are fever and severe body pains. Complications may include marked anemia, enlargement of the liver and spleen, and sometimes death. The drug of choice is chloramphenicol, though doxycycline is also effective.
Brucellosis
An infection of domestic and wild animals that may be transmitted to humans through direct animal contact or by consumption of unpasteurized dairy products from infected animals. Symptoms may include fever, malaise, depression, loss of appetite, headache, muscle aches and back pain. Complications may include arthritis, hepatitis, meningitis and endocarditis (heart-valve infection).
Cholera
Cholera is extremely rare in Chile. An outbreak occurred in the northern part of the country in January 1998, but no cases have been reported since that time. The cholera vaccine is not recommended.
Dengue fever
This fever was reported for the first time in March 2002 from Easter Island, but has not been observed in the years since then. Dengue is a flulike illness that is sometimes complicated by hemorrhage or shock. The disease is transmitted by Aedes mosquitoes, which bite primarily in the daytime and favor densely populated areas, though they also inhabit rural environments. There is no treatment for dengue 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 insect protection measures.
Echinococcus
Echinococcus is a parasite that infects the liver, usually in people who work with sheep.
Fascioliasis
Fascioliasis is a parasitic infection that is typically acquired by eating contaminated watercress grown in sheep-raising areas. Early symptoms may include fever, nausea, vomiting and painful enlargement of the liver.
Hantavirus pulmonary syndrome
A rapidly progressive, life-threatening infection acquired through exposure to the excretion of wild rodents. An outbreak was reported from rural areas in the southern and central parts of Chile in late 2001. Sporadic cases have been reported since that time. The disease occurs in those who live in close association with rodents and is unlikely to affect most travelers, though campers in forest areas may be at risk.
HIV/AIDS
HIV/AIDS has been reported from all South American countries. Make sure that you use condoms for all sexual encounters.
Louse-borne typhus
This infection occurs in mountain areas.
Travelers' diarrhea
To prevent diarrhea, avoid tap water unless it has been boiled, filtered, or chemically disinfected (iodine tablets); only eat fresh fruits 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 lots of 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 antidiarrhea agent (such as loperamide). If diarrhea is bloody or persists for more than 72 hours or is accompanied by fever, shaking chills or severe abdominal pain you should seek medical attention.
Altitude sickness
Altitude sickness may develop in those who ascend rapidly to altitudes greater than 2500m. Being physically fit offers no protection. Those who have experienced altitude sickness 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 altitude sickness is descent. If you are exhibiting symptoms, do not ascend. If symptoms are severe or persistent, descend immediately.
One option for prevention of altitude sickness is to take acetazolamide (Diamox). The recommended dosage ranges from 125mg (twice daily) to 250mg (three times daily). It should be taken 24 hours before ascent and continued for 48 hours after arrival at altitude.
Possible side effects include increased urinary volume, numbness, tingling, nausea, drowsiness, myopia and temporary impotence. Acetazolamide should not be given to pregnant women or anyone with a history of sulfa allergy. For those who cannot tolerate acetazolamide, the next best option is 4mg dexamethasone taken four times daily. Unlike acetazolamide, dexamethasone must be tapered gradually upon arrival at altitude, since there is a risk that altitude sickness will occur as the dosage is reduced. Dexamethasone is a steroid, so it should not be given to diabetics or anyone for whom steroids are contraindicated. A natural alternative is gingko.
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.
Animal bites
Do not attempt to pet, handle or feed any animal, 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 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. One of the newer quinolones, such as levofloxacin (Levaquin), which many travelers carry in case of diarrhea, would be an appropriate choice.
Cold exposure
Cold exposure is a significant problem in the Andes, particularly at night. Dress warmly, stay dry, keep active, consume plenty of food and water, get enough rest, and avoid alcohol, caffeine and tobacco. Watch out for the 'umbles' - stumbles, mumbles, fumbles, and grumbles - which are important signs of impending hypothermia.
Mosquito bites
To prevent mosquito bites, wear long sleeves, long pants, hats and shoes (rather than sandals). Bring along a good 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 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 generally related to overuse. DEET-containing compounds should not be used on children under the age of two.
Insect repellents containing certain botanical products, including oil of 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 the window 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 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 and leeches are a hazard in some parts of South America. 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, which are no longer recommended. There are no snakes on Easter Island.
Sun
To protect yourself from excessive sun exposure, you should stay out of the midday sun, wear sunglasses and a wide-brimmed sun 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 activity. Travelers should also drink plenty of fluids and avoid strenuous exercise when the temperature is high.
Water
The tap water in Chile's cities is generally pretty good but has a high mineral content that can cause stomach upsets; bottled water is a good idea for delicate stomachs and in rural areas.
Vigorous boiling for one minute is the most effective means of water purification. At altitudes greater than 2000m, boil for three minutes.
Another option is to disinfect water with iodine pills. Instructions are usually enclosed and should be carefully followed. Or 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 it 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, people with a history of thyroid disease and those allergic to iodine should not drink iodinated water.
A number of water filters are on the market. Those 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. Manufacturers' instructions must be carefully followed.
Traveling with children
When traveling with young children, be particularly careful about what you allow them to eat and drink, because diarrhea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever are not approved for use in children under the age of two. It's sometimes appropriate to give children some of their routine vaccines a little early before visiting a developing nation. You should discuss this with your pediatrician.
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