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Fiji

Health & safety

Before you go

Further reading

Good options for further reading include: Travel with Children by Cathy Lanigan; Healthy Travel Australia, New Zealand and the Pacific by Dr Isabelle Young; and Your Child's Health Abroad: A Manual for Travelling Parents by Dr Jane Wilson-Howarth and Matthew Ellis.

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Insurance

If your health insurance policy does not cover you for medical expenses abroad, consider taking supplemental insurance. Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. (In Fiji most treatment requires payment in cash, though.)

Really serious illness or injury may require evacuation, eg to Auckland or Sydney; make sure that your health insurance has provision for evacuation. Under these circumstances hospitals will accept direct payment from major international insurers.

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Medical checklist

It is a very good idea to carry a medical and first-aid kit with you, in case of minor illness or injury. The following is a list of items you should consider packing.

acetaminophen (paracetamol) or aspirin*

adhesive or paper tape

antibacterial ointment, eg Bactroban for cuts and abrasions (prescription only)

antibiotic plus steroid eardrops (prescription only), eg Sofradex, Kenacort Otic

antibiotics (prescription only), eg ciprofloxacin (Ciproxin) or norfloxacin (Utinor; Noroxin)

antidiarrhoeal drugs, eg loperamide

antigiardia tablets - tinidazole (prescription only)

antihistamines (for hay fever and allergic reactions)

anti-inflammatory drugs, eg ibuprofen

bandages, gauze, gauze rolls, waterproof dressings

DEET-containing insect repellent for the skin

iodine tablets (for water purification)

oral rehydration salts, eg Gastrolyte, Diarolyte, Replyte

Permethrin-containing insect spray for clothing, tents, and bed nets

pocket knife+

scissors, safety pins, tweezers+

steroid cream or hydrocortisone cream (for allergic rashes)

sun block

syringes and sterile needles (prescription only), and intravenous fluids if travelling in very remote areas

thermometer

+ Do not take on planes in carry-on luggage

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Prevention is the key to staying healthy while abroad. A little planning before departure, particularly for pre-existing illnesses, will save trouble later. See your dentist before a long trip, carry a spare pair of contact lenses and glasses, and take your optical prescription with you. Bring 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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Recommended vaccinations

The World Health Organization (WHO) recommends that all travellers be covered for diphtheria, tetanus, measles, mumps, rubella and polio, regardless of their destination. Since most vaccines don't produce immunity until at least two weeks after they're given, visit a physician at least six weeks before departure. A recent influenza vaccination is always a good idea when travelling. If you have not had chicken pox (varicella) consider being vaccinated.

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Required & recommended vaccinations

If you have been in a country affected by yellow fever within six days of arriving in Fiji, you will need an International Certificate of Vaccination for yellow fever to be allowed entry into the country. Vaccinations are recommended for hepatitis A, hepatitis B and typhoid fever.

All injected vaccinations can produce slight soreness and redness at the inoculation site, and a mild fever with muscle aches over the first 24 hours. These are least likely with hepatitis A and a little more common with hepatitis B and typhoid inoculations. Typhoid inoculation can cause a sensation of nausea within 24 hours and the hepatitis B vaccine can produce temporary joint pains.

An allergy to eggs or poultry is a condition that makes the yellow-fever vaccination inadvisable; an exemption certificate can be issued. Very rarely, an acute allergic (anaphylactic shock) reaction can occur within minutes of any vaccination. More commonly a flulike illness of varying severity may occur at any time up to 10 days after vaccination. In the elderly, encephalitis has been recorded.

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Dangers & annoyances

Fiji is still a pretty safe place for travellers. When you're in Nadi or Suva, though, do not walk around at night, even in a group, as muggings are common. Locals catch cabs after dark in these cities and you should do the same. Don't hitchhike; while it's commonly done by locals, as a foreigner, you're a sitting duck for muggers. As a precaution, use a moneybelt and keep your valuables in a safe place.

While it's unlikely that you'll be robbed, it does happen, so try to keep all valuables out of sight and lock your door while you're out or sleeping. Most resorts have a safe where you can store your moneybelt. You can also avoid becoming utterly destitute by stashing a small amount of cash or a couple of travellers cheques in a separate place to where the bulk is stored.

As you exit customs at Nadi airport, you'll likely be swarmed by touts who will do their best to get you into their shuttle van and on the road to their employer's resort. It's advisable to have at least your first night of accommodation booked, but if you're unsure of where you want to stay and want to avoid these mobs while you consider your options, head to the FVB desk.

Sword sellers are not as common as they used to be, but if anyone becomes overly friendly, wants to know your life story and begins carving your name on a long piece of wood, just walk away, even if they pursue you claiming that you have to pay for the rubbishy item. If you are travelling for an extended period you may tire of being asked where you are staying. While this is often just innocent conversation, it can also be a way of judging how much you're going to be charged for dinner. Male travellers in particular are likely to be approached and asked if they want marijuana.

If you are unlucky enough to be caught in a natural disaster such as a cyclone or flood, ask locals for advice on where to seek protection from the elements.

It’s worth remembering that sodomy and other homosexual acts remain illegal in Fiji and as such, the police have the right to arrest and prosecute on these grounds. Public displays of affection in general are considered offensive in Fiji; as a gay or lesbian couple, the risks of receiving unwanted attention for outwardly homosexual behaviour are high. But gay couples who are relatively private are extremely unlikely to have any trouble in Fiji.

If driving there are some road hazards you should be aware of.

Contrary to Fiji's image promoted overseas, many beaches, especially on the large islands, aren't great for swimming. The fringing coral reefs often become too shallow at low tide. Avoid swimming or snorkelling alone and be very careful of currents and tidal changes. Always seek local advice on conditions.

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Gay & lesbian travellers

Fiji's constitution states that discrimination must not occur on the basis of sexual orientation and, precoup, Chaudhry's government was all for legalising homosexual activity. However, this sentiment evoked a heated reaction from the present conservative and very Christian government. In 2002 the debate of possibly legalising homosexuality was once again sparked when a new Family Law bill was put forward. Sadly, this stirred greater hostility and two prominent gay men (the Red Cross leader John Scott and his partner) were murdered in July 2002.

There is some indication of changing attitudes in the community, though. A large number of openly gay men work in the hospitality industry, and some nightclubs in Lautoka, Nadi and Suva are gay-tolerant. Furthermore, in 2005 the Fijian High Court acquitted two gay men who were previously convicted and sentenced for having a sexual relationship. The Judge who gave the ruling also urged the Fijian Law Commission to address reform in legislation regarding homosexuality in Fiji.

It's important to remember, however, that sodomy and other homosexual acts remain illegal in Fiji and as such, the police have the right to arrest and prosecute on these grounds. Public displays of affection are considered offensive in Fiji in general; as a gay or lesbian couple, the risks of receiving unwanted attention for outwardly homosexual behaviour are high. But gay couples who are relatively private are extremely unlikely to have any troubles in Fiji. Gay singles should exercise some caution; don't give anyone an excuse to even think you are paying for sex, and be very careful not to provide the impression you are after young Fijian men.

The website www.globalgayz.com/g-fiji.html tracks gay developments in Fiji.

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In transit

Deep Vein Thrombosis (DVT)

Blood clots may form in the legs during plane flights, chiefly because of prolonged immobility. The longer the flight, the greater the risk. 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 breathing difficulties. Travellers with any of these symptoms should immediately seek medical attention.

To prevent the development of DVT on long flights you should walk about the cabin, contract the leg muscles while sitting, drink plenty of nonalcoholic fluids and avoid tobacco.

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Jet lag & motion sickness

To avoid jet lag (common when crossing more than five time zones) try drinking plenty of nonalchoholic fluids and eating light meals. Upon arrival, get exposure to natural sunlight and readjust your schedule (for meals, sleep and so on) as soon as possible.

Antihistamines such as dimenhydrinate (Dramamine) and meclizine (Antivert, Bonine) are usually the first choice for treating motion sickness. A herbal alternative is ginger.

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While you're there

Infectious diseases

The realistic risks to visitors from infectious diseases are very low with the exception of dengue fever.

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Dengue fever

Dengue fever is a virus spread by the bite of a day-biting mosquito. It causes a feverish illness with headache and severe muscle pains similar to those experienced with a bad, prolonged attack of influenza. Another name for the disease is 'break bone fever' and that's what it feels like. Danger signs include prolonged vomiting, blood in the vomit and a blotchy rash. There is no preventive vaccine and mosquito bites should be avoided whenever possible. Self-treatment involves paracetamol, fluids and rest. Do not use aspirin. Haemorrhagic dengue fever has been reported only occasionally, manifested by signs of bleeding and shock, and requires medical care.

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Eosinophilic meningitis

Eosinophilic meningitis is caused by a microscopic parasite - the rat lungworm - which contaminates raw food. It's a strange illness manifested by scattered abnormal skin sensations, fever and sometimes by the meningitis (headache, vomiting, confusion, neck and spine stiffness), which gives it its name. There is no proven specific treatment, but symptoms may require hospitalisation. For prevention pay strict attention to advice on food and drink.

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Hepatitis A

This is a virus disease causing liver inflammation spread by contaminated food or water. Fever, nausea, debility and jaundice (yellow coloration of the skin, eyes and urine) occur and recovery is slow. Most people recover completely but it can be dangerous to people with other forms of liver disease, the elderly and sometimes to pregnant women towards the end of pregnancy. Food is easily contaminated by food preparers, handlers or servers, and by flies. There is no specific treatment. The vaccine is close to 100% protective.

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Hepatitis B

Hepatitis B is a virus disease causing liver inflammation but the problem is much more serious than hepatitis A and frequently goes on to cause chronic liver disease and even cancer. It is spread, like HIV, by mixing body fluids, ie sexual intercourse, contaminated needles and accidental blood contamination. Treatment is complex and specialised but preventative vaccination is highly effective.

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Hepatitis C

This is a virus similar to hepatitis B that causes liver inflammation, which can progress to chronic liver disease or result in a symptomless carrier state. It is spread almost entirely by blood contamination from shared needles or contaminated needles used for tattooing or body piercing. Treatment is complex and specialised. There is no vaccine available.

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HIV/AIDS

The incidence of HIV infection is on the rise in the whole South Pacific and is fast becoming a major problem in Fiji. Safe-sex practise is essential at all times. If an injection is needed in a smaller clinic it is best to provide your own needles. Blood transfusion laboratories do tests for HIV.

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Leptospirosis

Also known as Weil's disease, leptospirosis produces fever, headache, jaundice and, later, kidney failure. It is caused by a spirochaete organism found in water contaminated by rat urine. The organism penetrates skin, so swimming in flooded areas is a risky practice. If diagnosed early it is cured with penicillin.

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Typhoid fever

Typhoid is a bacterial infection acquired from contaminated food or water. The germ can be transmitted by food handlers or flies, and can be present in inadequately cooked shellfish. It causes fever, debility and late-onset diarrhoea. Untreated it can produce delirium and is occasionally fatal, but the infection is curable with antibiotics. Vaccination is moderately effective, but care with eating and drinking is equally important.

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Availability & cost of health care

Fiji has readily available doctors in private practice, standard hospital and laboratory facilities with consultants in internal medicine, obstetrics/gynaecology, orthopaedics, ophthalmology, paediatrics, pathology, psychiatry and general surgery. Private dentists, opticians and pharmacies are also available. The further you get from main cities the more basic the services.

Private consultation and private hospital fees are approximately equivalent to Australian costs. Fees for government-provided services vary from modest to negligible but waiting times can be very long. Direct payment is required everywhere except where a specific arrangement is made, eg in the case of evacuation or where a prolonged hospital stay is necessary; you will need to contact your insurer. Although hospitals will accept credit cards, there might be difficulty with the more remote small hospitals. If a credit card is not accepted you should be able to arrange cash on credit through local banks.

Except in the remote poorly staffed clinics, the standard of medical and dental care is generally quite good even if facilities are not sophisticated. The overall risk of illness for a normally healthy person is low; the most common problems being diarrhoeal upsets, viral sore throats, and ear and skin infections - all of which can mostly be treated with self-medication. For serious symptoms, eg sustained fever, chest or abdominal pains it is best to go to the nearest clinic or doctor straight away.

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Family health

Tampons and pads are readily available in main centres but do not rely on getting them if you travel to one of the outer islands. Dengue fever, especially in the first three months of pregnancy, poses a hazard because of fever but otherwise there is no reason why a normal pregnancy should prevent travel to the region. However, unless necessary, immunisation in the first three months of pregnancy is not recommended.

For young children, it is again dengue fever that could be a problem. The disease tends to come in epidemics mainly in the hotter, wetter months so it should be possible to plan holidays accordingly.

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Medications & contraception

Most commonly used medications are available. Private pharmacies are not allowed by law to dispense listed drugs without prescription from a locally registered practitioner, but many will do so for travellers if shown the container or a prescription from home. Oral contraceptives are obtainable without prescription in Fiji, as is the 'morning after' pill. Asthma inhalers and most anti-inflammatories are available over the counter. It is best to have a sufficient supply of a regularly taken drug as a particular brand may not be available and sometimes quantities can be limited. This applies particularly to psychotropic drugs such as antidepressants, antipsychotics, anti-epileptics or mood elevators. Insulin is available even in smaller centres, but you cannot guarantee getting a particular brand, combination or preferred administration method. If you have been prescribed 'the very latest' oral antidiabetic or antihypertensive make sure you have enough for the duration of your travel.

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Traveller's diarrhoea

Diarrhoea - frequent, loose bowel movements - is caused by viruses, bacteria or parasites present in contaminated food or water. In temperate climates the cause is usually viral, but in the tropics bacteria or parasites are more usual. If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution (eg Diarolyte, Gastrolyte, Replyte). 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. Giardiasis is a particular form of persistent, although not 'explosive', diarrhoea caused by a parasite present in contaminated water. One dose (four tablets) of tinidazole usually cures the infection.

To prevent diarrhoea pay strict attention to the precautions regarding food and water.

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