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Guatemala

Health & safety

Before you go

Further reading

For further information, see Healthy Travel Central & South America, also from Lonely Planet. If traveling with children, Lonely Planet’s Travel with Children may be useful. The ABC of Healthy Travel, by E Walker et al, and Medicine for the Outdoors, by Paul S Auerbach, are other valuable resources.

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Insurance

If your health insurance does not cover you for medical expenses abroad, strongly consider getting supplemental insurance. Check the Travel Services section of this website for more information. See also the US State Department website (www.travel.state.gov) for a list of medical evacuation and travel insurance companies. 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 available on the internet. A superb book called International Travel and Health, which is revised annually and is available online at no cost, is published by the World Health Organization (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.

Australia (www.smartraveller.gov.au)

Canada (www.hc-sc.gc.ca)

UK (www.doh.gov.uk)

United States (www.cdc.gov/travel/)

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Medical checklist

antibiotics

antidiarrheal drugs (eg loperamide)

acetaminophen/paracetamol (Tylenol) or aspirin

anti-inflammatory drugs (eg ibuprofen)

antihistamines (for hay fever and allergic reactions)

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

thermometer

pocket knife

DEET-containing insect repellent for the skin

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

sunblock

oral-rehydration salts

iodine tablets (for water purification)

syringes and sterile needles

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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.

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Recommended vaccinations

The only required vaccine is yellow fever, and that’s only if you’re arriving in Guatemala from a yellow fever–infected country in Africa or South America. However, a number of vaccines are recommended. Note that some of these are not approved for use by children and pregnant women – check with your physician.

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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.

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Dangers & annoyances

No one could pretend that Guatemala is a very safe country. There are just too many stories of robbery, often armed robbery, for that. Rapes and murders of tourists have also happened. The two most frequently reported types of nasty incident involving tourists are highway robbery, when a vehicle is stopped and its occupants relieved of their belongings, and robberies on walking trails. For a scary litany of recent incidents, visit the website of Guatemala City’s US embassy (guatemala.usembassy.gov) and click on ‘Recent Crime Incidents Involving Foreigners.’ Further, marginally less alarming, information is on the website of the US Department of State (travel.state.gov) and the website of the UK Foreign and Commonwealth Office (www.fco.gov.uk).

Vehicles carrying tourists, such as shuttle minibuses and buses, along heavily touristed routes seem to be a prime target for highway robbery. On this basis, some people argue that chicken buses are the most risk-free way to travel, but chicken buses are certainly not exempt from holdups. No road in the country is exempt from this risk, but those that are most frequently mentioned include the Interamericana (Hwy 1) between the Antigua and Panajachel turnoffs and near the Salvadoran border, Carretera al Pacífico (Hwy 2) near the Salvadoran and Mexican borders, and Hwy 13 between the Belizean border and the Puente Ixlú (El Cruce) junction.

Robberies against tourists on walking trails tend to occur in isolated spots on well-known walks. Some trails around the Lago de Atitlán and on Volcán Agua outside Antigua are particularly notorious. The Tikal archaeological site, Volcán Pacaya and Cerro de la Cruz (Antigua), all the scenes of several incidents in the past, have become, for now, safer because of increased police and ranger presence designed to protect tourism.

Other potential dangers are pickpocketing, bag-snatching, bag-slitting and the like in crowded bus stations, buses, streets and markets, but also in empty, dark city streets.

It is impossible to remove the element of risk from traveling in Guatemala, but it is possible to reduce that risk by always staying alert to the behavior of people around you (watch out for people who get unwarrantedly close to you in any situation) and by following a few simple precautions:

Only carry on your person the money, cards, checks and valuables that you have immediate need of. Leave the rest in a sealed, signed envelope in your hotel’s safe, and obtain a receipt for the envelope. If your hotel doesn’t have a safe, it is usually safer to secrete your money and valuables in three or four different stashes among your locked luggage in your room than to carry them with you.

Be aware that any purse or bag in plain sight may be slashed or grabbed. At ticket counters in bus stations, keep your bag between your feet.

Don’t flaunt jewelry, cameras or valuable-looking watches. Keep your wallet or purse out of view.

On buses keep your important valuables with you, and keep a close hold on them.

Don’t wander alone in empty city streets or isolated areas, particularly at night.

When using ATMs (cash machines), keep alert to people nearby. Don’t accept help from strangers when using ATMs.

Keep informed by talking to travelers, hotel staff and others, and consulting official information sources such as the US and UK government websites, your country’s embassy in Guatemala City, and Inguat.

Hiking in large groups and/or with a ­police escort reduces the risk of robbery.

Resisting or trying to flee from robbers usually makes the situation worse.

Hiking on active volcanoes obviously has an element of risk. Get the latest story before you head out. In the wet season, go up volcanoes in the morning before rain and possible thunderstorms set in. A Canadian tourist was killed by lightning on Volcán Pacaya in 2002.

There have been a few bizarre incidents in which foreign visitors have been unjustly suspected of malicious designs against Guatemalan children. Be careful not to put yourself in any situation that might be misinterpreted.

Any crowd can be volatile, especially when drunk or at times of political tension.

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The number of guards and rangers at Tikal has been stepped up since several robberies and rapes happened there a few years ago. On our visit it seemed safe and secure enough, but when visiting the more isolated parts of the site, such as the Templo de las Inscripciones, it still pays to be on your guard and not to go alone. If in doubt, you can always ask a guard whether it is safe to go there.

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Scams

One common scenario is for someone to spray ketchup or some other sticky liquid on your clothes. An accomplice then appears to help you clean up the mess and robs you in the process. Other methods of distraction, such as dropping a purse or coins, or someone appearing to faint, are also used by pickpockets and bag snatchers.

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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. 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.

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Jet lag & motion sickness

Jet lag is common when crossing more than five time zones, and can result 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 or 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.

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While you're there

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 postexposure 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.

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Mosquito bites

To prevent mosquito bites, wear long sleeves, long pants, hats and shoes (rather than sandals). Make sure you bring along a good insect repellent, preferably one that contains 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. Compounds containing DEET 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. Repellents containing DEET 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 an accommodation that allows 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.

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Snake bites

Snakes are a hazard in some areas of Central America. In Guatemala the chief concern is Bothrops asper, the Central American or common lancehead, also called the ­fer-de-lance and known locally as barba amarilla (yellow beard) or terciopelo (velvet skin). This heavy-bodied snake reaches up to 2m in length and is commonly found along fallen logs and other small animal runs, especially in the northern provinces.

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.

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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.

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Water

Tap water in Guatemala is not safe to drink. 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 1 quart or liter of water (five drops to clear water, 10 drops to cloudy water) and let 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, those 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.

Safe-to-drink, inexpensive purified water (agua pura) is widely available in hotels, shops and restaurants. Salvavida is a universally trusted brand.

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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.

Cholera outbreaks occur periodically in Guatemala, but the disease is rare among travelers. Cholera vaccine is no longer required, and is in fact no longer available in some countries, including the US, because the old vaccine was relatively ineffective and caused side effects. There are new vaccines that are safer and more effective, but they’re not available in many countries and are only recommended for those at particularly high risk.

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Dengue fever (breakbone fever)

Dengue fever is a viral infection found throughout Central America. Thousands of cases occur each year in Guatemala. Dengue is transmitted by aedes mosquitoes, which bite predominantly during the daytime and are usually found close to human habitations, often indoors. They breed primarily in artificial water containers, such as jars, barrels, cans, cisterns, metal drums, plastic containers and discarded tires. As a result, dengue is especially common in densely populated, urban environments.

Dengue usually causes flu-like symptoms, including fever, muscle aches, joint pains, headaches, nausea and vomiting, often followed by a rash. The body aches may be quite uncomfortable, but most cases resolve uneventfully in a few days. Severe cases usually occur in children under the age of 15 who are experiencing their second dengue infection.

There is no treatment for dengue fever 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 protecting against insect bites.

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Hepatitis A

Hepatitis A occurs throughout Central America. 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 all over the world, but the incidence is higher in developing nations. Symptoms may include fever, malaise, jaundice, nausea, vomiting and abdominal pain. Most cases resolve uneventfully, 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 the initial vaccination, it lasts for at least 10 years. You really should get it before you go to Guatemala or any other developing nation. Because the safety of 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.

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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 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.

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Malaria

Malaria occurs in every country in Central America. It’s 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 may involve the central nervous system and lead to seizures, confusion, coma and death.

Taking malaria pills is strongly recommended for all rural areas in Guatemala except at altitudes greater than 1500m. The risk is high in the departments of Alta Verapaz, Baja Verapaz, El Petén and San Marcos, and moderate in the departments of Escuintla, Huehuetenango, Izabal, Quiché, Retalhuleu, Suchitepéquez and Zacapa. Transmission is greatest during the rainy season (June through November). There is no risk in Antigua or Lago de Atitlán.

For Guatemala, the first-choice malaria pill is chloroquine, taken once weekly in a dosage of 500mg, starting one to two weeks before arrival and continuing through the trip and for four weeks after departure. Chloroquine is safe, inexpensive and highly effective. Side effects are typically mild and may include nausea, abdominal discomfort, headache, dizziness, blurred vision and itching. Severe reactions are uncommon.

Protecting yourself against mosquito bites is just as important as taking malaria pills, since no 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 undergo 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. If you start self-medication, you should try to see a doctor at the earliest possible opportunity.

If you develop a fever after returning home, see a physician, as malaria symptoms may not occur for months.

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Rabies

Rabies is a viral infection of the brain and spinal cord that is almost always fatal if not treated. 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 Central American countries. In Guatemala the risk is greatest in the northern provinces along the Mexican border. Most cases are ­related to dog bites.

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, you should consider asking for the vaccine if you 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 rabies vaccine with rabies immune globulin. It’s effective, but must be given promptly. Most travelers don’t need rabies vaccine.

All animal bites and scratches must be promptly and thoroughly cleansed with large amounts of soap and water and local health authorities must be contacted to determine whether or not further treatment is necessary.

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Typhoid

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, 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 the age of two.

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 may be indistinguishable.

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Yellow fever

Yellow fever no longer occurs in Central America, but many countries in this region, including Guatemala, require yellow fever vaccine before entry if you’re arriving from a country in Africa or South America where yellow fever is known to occur. If you’re not arriving from a country with yellow fever, the vaccine is neither required nor recommended. Yellow fever vaccine is given only in approved yellow fever vaccination centers, which provide validated international certificates of vaccination (also known as yellow booklets). The vaccine should be given at least 10 days before departure and remains effective for approximately 10 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.

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Chagas’ disease

This is a parasitic infection that is transmitted by triatomine insects (reduviid bugs), which inhabit crevices in the walls and roofs of substandard housing in South and Central America. The triatomine insect lays its feces on human skin as it bites, usually at night. A person becomes infected when he or she unknowingly rubs the feces into the bite wound or any other open sore. Chagas’ disease is extremely rare in travelers. However, if you sleep in a poorly constructed house, especially one made of mud, adobe or thatch, you should be sure to protect yourself with a bed net and a good insecticide.

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Histoplasmosis

Caused by a soil-based fungus, histoplasmosis is acquired by inhalation, often when the soil has been disrupted. Initial symptoms may include fever, chills, dry cough, chest pain and headache, sometimes leading to pneumonia. Histoplasmosis has been reported in European travelers returning from Mazatenango.

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HIV/AIDs

This has been reported in all Central American countries. Be sure to use condoms for all sexual encounters.

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Leishmaniasis

This occurs in the mountains and jungles of all Central American countries. The infection is transmitted by sandflies, which are about one third the size of mosquitoes. Leishmaniasis may be limited to the skin, causing slowly growing ulcers over exposed parts of the body, or (less commonly) disseminate to the bone marrow, liver and spleen. The disease may be particularly severe in those with HIV. In Guatemala, most cases of cutaneous leishmaniasis are reported from the northern parts of the country at elevations less than 1000m. The greatest risk occurs in the forested areas of El Petén. The disseminated form may occur in the semiarid valleys and foothills in the east central part of the country. There is no vaccine for leishmaniasis. To protect yourself from sandflies, follow the same precautions as for mosquitoes, except that netting must be of finer mesh (at least 18 holes to the linear inch).

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Leptospirosis

This is acquired by exposure to water contaminated by the urine of infected animals. Outbreaks often occur at times of flooding, when sewage overflow may contaminate the water sources. The initial symptoms, which resemble a mild flu, usually subside uneventfully in a few days, with or without treatment, but a minority of cases are complicated by jaundice or meningitis. There is no vaccine. You can minimize your risk by staying out of bodies of fresh water that may be contaminated by animal urine. If you’re visiting an area where an outbreak is in progress, as occurred in Guatemala after flooding in 1998, you can take 200mg of doxycycline once weekly as a preventative measure. If you actually develop leptospirosis, the treatment is 100mg of doxycycline twice daily.

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Onchocerciasis (river blindness)

Onchocerciasis is caused by a roundworm that may invade the eye, leading to blindness. The infection is transmitted by black flies, which breed along the banks of rapidly flowing rivers and streams. In Guatemala, the disease occurs in heavily forested areas between 500m and 1500m, chiefly the Pacific slope of the Sierra Madre and in Escuintla along the Verde and Guachipilín rivers.

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Typhus

This may be transmitted by lice in scattered pockets of the country.

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Children & pregnant women

In general, it’s safe for children and pregnant women to go to Guatemala. However, because some of the vaccines are not approved for use in children and pregnant women, these travelers should be particularly careful not to drink tap water or consume any questionable food or beverage. Also, when traveling with children, make sure they’re up-to-date on all routine immunizations. It’s sometimes appropriate to give children some of their vaccines a little early before visiting a developing nation. You should discuss this with your pediatrician. Lastly, if pregnant, you should bear in mind that should a complication such as premature labor develop while abroad, the quality of medical care may not be comparable to that in your home country.

Since yellow fever vaccine is not recommended for pregnant women or children less than nine months old, these travelers, if arriving from a country with yellow fever, should obtain a waiver letter, preferably written on letterhead stationery and bearing the stamp used by official immunization centers to validate the international certificate of vaccination.

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Availability & cost of health care

Good medical care is available in Guatemala City, but options are limited elsewhere. In general, private hospitals are more reliable than public facilities, which may experience significant shortages of equipment and supplies. Many travelers use Hospital Herrera Llerandi (2384 5959; 6a Av 8-71, Zona 10; www.herrerallerandi.com). For an online list of hospitals and physicians in Guatemala, go to the US embassy website (guatemala.usembassy.gov/medical_information.html).

Many 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.

Many pharmacies are ­well-supplied, but important medications may not be consistently available. Be sure to bring along ­adequate supplies of all prescription drugs.

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Traditional medicine

The following are some traditional remedies for common travel-related conditions.

Jet lag – melatonin

Mosquito-bite prevention – oil of eucalyptus or soybean oil

Motion sickness – ginger

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Traveler’s diarrhea

To prevent diarrhea, avoid tap water unless it has been boiled, filtered or chemically disinfected; 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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