Health & safety
Before you go
If you require a particular medication take an adequate supply with you; it may not be available locally. Take the original prescription specifying the generic rather than the brand name; this makes getting replacements easier. It's also wise to have the prescription with you to prove you're using the medication legally. you can register online with the International Association for Medical Assistance to Travelers (IAMAT; www.iamat.org).
Insurance
Buying a travel insurance policy to cover medical problems is recommended. There is a wide variety of policies and your travel agent will have recommendations.
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Medical checklist
Colombian pharmacies stock all kinds of drugs, and medication can be cheaper than in Western countries. There are few restricted drugs; almost everything is sold over the counter. Many drugs are manufactured locally under foreign license. Be sure to check expiry dates.
antibiotics
antidiarrheal drugs (eg loperamide)
acetaminophen (Tylenol) or aspirin
anti-inflammatory drugs (eg ibuprofen)
altitude sickness pills (acetazolamide or dexamethasone)
antihistamines (for hay fever and allergic reactions)
motion sickness pills (eg Dramamine)
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, tweezers
pocket knife
DEET-containing insect repellent for the skin
permethrin-containing insect spray for clothing, tents and bed nets
sun block
oral rehydration salts
iodine tablets (for water purification)
Immunizations
Yellow fever vaccine is required for visitors to the national parks along the Atlantic coast. No other vaccines are legally mandated, but the following are strongly recommended.
VaccineRecommended for Dosage Side effects
hepatitis Aall travelers1 dose before trip; soreness at injection site; booster 6-12 months headaches; body aches later
typhoidall travelers4 capsules by mouth, abdominal pain; 1 taken every other daynausea; rash
yellow feverall travelers, except for 1 dose lasts 10 yearsheadaches; body aches; those limiting their trip to thesevere reactions are rare western edge of the country
hepatitis Blong-term travelers in close 3 doses over 6-month soreness at injection site; contact with the local populationperiodlow-grade fever
rabiestravelers who may have contact 3 doses over 3-4 week soreness at injection site; with animals and may not have periodheadaches; body aches access to medical care
tetanus-diphtheriaall travelers who haven't had 1 dose lasts 10 yearssoreness at injection site booster within 10 years
measlestravelers born after 1956 who've 1 dosefever; rash; joint pains; had only one measles vaccinationallergic reactions
chickenpoxtravelers who've never 2 doses 1 month apartfever; mild case of had chickenpoxchickenpox
Dangers & annoyances
Colombia definitely isn't the safest of countries, and you should be careful at all times. In fact, it was only a few years ago that Colombia was regarded as the 'world's most dangerous country' and the 'kidnapping capital of the world.' The situation has vastly improved over recent years but there are still inherent dangers. Whatever you do, don't let the rumors and urban legends scare you off. Within a day of arriving in Colombia you'll feel your confidence in the security situation quickly growing.
Theft & robbery
Theft is the most common travelers' danger. In general, the problem is more serious in the largest cities. The more rural the area, the quieter and safer it is. The most common methods of theft are snatching your day-pack, camera or watch, pickpocketing, or taking advantage of a moment's inattention to pick up your gear and run away.
Distraction is often part of the thieves' strategy. Thieves often work in pairs or groups; one or more will distract you, while an accomplice does the deed. There are hundreds, if not thousands, of possible ways to distract you, and new scams are dreamt up every day. Some thieves are even more innovative and will set up an opportune situation to separate you from your belongings. They may begin by making friends with you, or pretend to be the police and demand to check your belongings.
If you can, leave your money and valuables somewhere safe before walking the streets. In practice, it's good to carry a decoy bundle of small notes, the equivalent of US$5 to US$10, ready to hand over in case of an assault; if you really don't have a peso, robbers can become frustrated and, as a consequence, unpredictable.
Armed hold-ups in the cities can occur even in some more upmarket suburbs. If you are accosted by robbers, it is best to give them what they are after, but try to play it cool and don't rush to hand them all your valuables at once - they may well be satisfied with just your decoy wad. Don't try to escape or struggle - your chances are slim. Don't count on any help from passers-by.
Be careful when drawing cash from an ATM as some robberies have been reported. Criminals may watch you drawing money, then assault you either at an ATM or a convenient place nearby. It may be safer to get an advance from the cashier inside the bank, even if this takes a while.
Police
While the Colombian military is highly trustworthy (we would trust them with our lives), and the federal police have a reputation as untouchables, local cops have more of a mixed reputation. They don’t get paid a lot of money, and incidents of bribe-taking and bullying of tourists are commonplace.
Always carry a photocopy of your passport with you, including your entry stamp, and never carry drugs of any kind, on the street or when traveling. If your papers are in order and they can’t squeeze you for a bribe, they have no excuse to bother you.
In tourist areas, there are an increasing number of so-called tourist police; many speak some English. They are uniformed and easily recognizable by the Policía de Turismo labels on their arm bands. Go to them first if you can.
If your passport, valuables or other belongings are stolen, go to the police station and make a denuncia (report). The officer on duty will write a statement according to what you tell them. It should include the description of the events and the list of stolen articles. Pay attention to the wording you use, include every stolen item and document, and carefully check the statement before signing it to ensure it contains exactly what you’ve said. Your copy of the statement serves as a temporary identity document and you’ll need to present it to your insurer to make a claim. Don’t expect your things to be found, as the police are unlikely to do anything about it.
If you happen to get involved with the police, keep calm and be polite, and always use the formal ‘usted.’ Keep a sharp eye out when they check your gear.
Be wary of criminals masquerading as plainclothes police. They may stop you on the street, identify themselves with a fake ID, then ask to inspect your passport and money. Under no circumstances should you agree to a search. Call a uniformed police officer, if there happens to be one around, or decent-looking passersby to witness the incident, and insist on phoning a bona fide police station. By that time, the ‘officers’ will probably walk discreetly away.
Drugs
Cocaine and marijuana are cheap and widely available in Colombia. Purchasing and consuming drugs, however, is not a good idea. Never travel with drugs (strip searches are not uncommon), and if you insist on purchasing drugs be very careful who you buy from. Most police aren’t interested in busting you, but rather shaking you down for a bribe (though this can’t be said of every policeman). The standard bribe for possession hovers between COP$500,000 and COP$1,000,000, although we’ve known people who had to cut their trip short after forking over US$3500.
Sometimes you may be offered drugs on the street, in a bar or a disco, but never accept these offers. The vendors may well be setting you up for the police, or their accomplices will follow you and stop you later, show you false police documents and threaten you with jail unless you pay them off.
There have been reports of drugs being planted on travelers, so keep your eyes open. Always refuse if a stranger at an airport asks you to take their luggage on board as part of your luggage allowance. Needless to say, smuggling dope across borders is a crazy idea. Have you ever seen the inside of a Colombian prison?
Burundanga
This is another security risk. Burundanga is a drug obtained from a species of tree widespread in Colombia and is used by thieves to render a victim unconscious. It can be put into sweets, cigarettes, chewing gum, spirits, beer - virtually any kind of food or drink - and it doesn't have any noticeable taste or odor.
The main effect after a 'normal' dose is the loss of will, even though you remain conscious. The thief can then ask you to hand over your valuables and you will obey without resistance. Cases of rape under the effect of burundanga are known. Other effects are loss of memory and sleepiness, which can last from a few hours to several days. An overdose can be fatal.
Burundanga is not only used to trick foreigners - Colombians have been on the receiving end too, losing their cars, contents of their homes, and sometimes their life. Think twice before accepting a cigarette from a stranger or a drink from a new 'friend.'
In transit
Deep vein thrombosis (dvt)
Blood clots may form in the legs during plane flights. Most are reabsorbed uneventfully, but some may break off and travel through the blood vessels to the lungs, where they could cause complications.
The chief 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.
To prevent the development of DVT 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.
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 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. Their main side-effect is drowsiness. An herbal alternative is ginger, which works like a charm for some people.
While you're there
Availability & cost of health care
Adequate medical care is available in major cities, but may be difficult to find in rural areas. For an online guide to physicians, dentists, hospitals and pharmacies in Colombia, go to the US Embassy website at usembassy.state.gov/bogota/wwwfm edl.pdf. Most doctors and hospitals will 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. For air ambulance service in Colombia, call Aeromedicos (Ambulancia Aerea, El Dorado International Airport, Entrance 2, Int 1, Of 105; 1-413 9160, 413 8915; fax 1-413 9550). Since this may cost tens of thousands of dollars, be sure you have insurance to cover this before you depart.
Cholera
Cholera is an intestinal infection acquired through ingestion of contaminated food or water. The main symptom is profuse, watery diarrhea, which may be so severe that it causes life-threatening dehydration. The key treatment is drinking oral rehydration solution. Antibiotics are also given, usually tetracycline or doxycycline, though quinolone antibiotics such as ciprofloxacin and levofloxacin are also effective. In recent years, only a small number of cholera cases have been identified and a cholera vaccine is no longer required.
Dengue fever
Dengue fever is a viral infection and the number of cases reported from Colombia has risen sharply in recent years, especially in Santander, Tolima, Valle del Cauca, Norte de Santander, Meta and Huila. Dengue is transmitted by Aedes mosquitoes, which bite preferentially during the daytime and are usually found close to human habitations, often indoors. Dengue is especially common in densely populated, urban environments.
Dengue usually causes flulike symptoms, including fever, muscle aches, joint pains, headaches, nausea and vomiting, which are often followed by a rash. The body aches may be quite uncomfortable, but most cases resolve uneventfully in a few days.
There is no treatment for dengue fever. The only thing to do is 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.
Hepatitis A
Hepatitis A is the second most common travel-related infection (after traveler's 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. And if you get a booster six to twelve months later, it lasts for at least 10 years. Because the safety of hepatitis A vaccine has not been established for pregnant women or children under age 2; 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.
Hepatitis B vaccine is safe and highly effective. However, a total of 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.
HIV & AIDS
Infection with the human immunodeficiency virus (HIV) may lead to acquired immune deficiency syndrome (AIDS), which is a fatal disease. Any exposure to blood, blood products or body fluids may put the individual at risk. The disease is often transmitted through sexual contact, and in Colombia it's primarily through contact between heterosexuals.
HIV and AIDS can also be contracted through infected blood transfusions, and you should be aware that not all the hospitals screen blood supplies. The virus may also be picked up through injection with an unsterilized needle. Acupuncture, tattooing and body piercing are other potential dangers.
Intestinal worms
These parasites are common in humid, tropical areas. They can be present on unwashed vegetables or in undercooked meat, or you can pick them up through your skin by walking barefoot. Infestations may not show up for some time and, although they are generally not serious, can cause further health problems if left untreated. A stool test on your return home is not a bad idea if you think you may have contracted them. Medication is usually available over the counter and treatment is easy and short.
Malaria
Malaria is transmitted by mosquito bites, usually 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 of malaria may involve the central nervous system and lead to seizures, confusion, coma and death.
Taking malaria pills is strongly recommended for all rural areas below 800m. Risk is highest in the departments of Amazonas, Chóco, Córdoba, Guainía, Guaviare, Putumayo and Vichada. There is no malaria risk in or around Bogotá.
There is a choice of three malaria pills, all of which work about equally well. Mefloquine (Lariam) is taken once weekly, starting one to two weeks before arrival and continuing through the trip and for four weeks after return. The problem is that a certain percentage of people develop neuropsychiatric side effects, which may range from mild to severe. Atovaquone/proguanil (Malarone) is a newly approved combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure. Side effects are typically mild. Doxycycline is a third alternative, but may cause an exaggerated sunburn reaction.
In general, Malarone seems to cause fewer side effects than mefloquine and is becoming more popular. The chief disadvantage is that it has to be taken daily.
Protecting yourself against mosquito bites is just as important as taking malaria pills, since none of the pills are 100% effective.
If you may not have access to medical care while traveling, 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. However, Malarone should not be used for treatment if you're already taking it for prevention.
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. In Colombia, a rabies outbreak caused by large numbers of bat bites was reported in May-June 2004 from Birrinchao, along the Purricha river in the Choco region.
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.
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.
Sexually transmitted diseases
Sexual contact with an infected partner can result in you contracting a number of diseases. While abstinence is the only 100% effective prevention, the use of condoms lessens the risk of infection considerably.
The most common sexually transmitted diseases are gonorrhea and syphilis, which in men first appear as sores, blisters or rashes around the genitals and a discharge or pain when urinating. Symptoms may be less marked or not present at all in women. Syphilis symptoms eventually disappear, but the disease continues and may cause severe problems in later years. Gonorrhea and syphilis are treatable with antibiotics.
Typhoid fever
Typhoid 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, typhoid vaccine is a good idea.
The drug of choice is usually a quinolone antibiotic such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), which many travelers carry for treatment of traveler's 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 may be indistinguishable.
Tetanus
This potentially fatal disease is difficult to treat, but is easily prevented by immunization. Tetanus occurs when a wound becomes infected by a germ that lives in soil in the feces of horses and other animals. It enters the body via breaks in the skin, so the best prevention is to clean all wounds promptly and thoroughly and use an antiseptic. Use antibiotics if the wound becomes hot or throbs or pus is seen. The first symptom may be discomfort in swallowing or stiffening of the jaw and neck; this can be followed by painful convulsions of the jaw and whole body.
Typhus
This is spread by ticks, mites and lice. It begins as a severe cold followed by a fever, chills, headaches, muscle pains and a body rash. There is often a large and painful sore at the site of the bite, and nearby lymph nodes become swollen and painful.
Yellow fever
Yellow fever is a life-threatening viral infection transmitted by mosquitoes in forested areas. The illness begins with flu-like symptoms, which may include fever, chills, headache, muscle aches, backache, loss of appetite, nausea and vomiting. These symptoms usually subside in a few days, but one person in six enters a second, toxic phase characterized by recurrent fever, vomiting, listlessness, jaundice, kidney failure and hemorrhage, leading to death in up to half of the cases. There is no treatment except for supportive care. The vaccine is highly recommended for visitors to the country's national parks along the Atlantic coast.
The vaccine should be given at least 10 days before any potential exposure to yellow fever and remains effective for approximately ten 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 have been described but are extremely rare.
Traveler's 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 antidiarrheal 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.
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