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In India

Environmental Hazards


With temperatures hitting 45°C and over in the summer months, heatstroke and heat exhaustion are serious dangers for travellers used to cooler climes; for most people it takes at least two weeks to adapt.

Swelling of the feet and ankles is common, as are muscle cramps caused by excessive sweating. Prevent these by avoiding dehydration and excessive activity in the heat.

Drink rehydration solution or eat salty food. Treat cramps by stopping activity, resting, rehydrating with double-strength rehydration solution and gently stretching.

Dehydration is the main contributor to heat exhaustion. Symptoms include a feeling of weakness, headache, irritability, nausea or vomiting, sweaty skin, a normal or slightly elevated body temperature, and a fast, weak pulse. Treatment involves getting the sufferer out of the heat and/or sun, fanning them and applying cool wet cloths to the skin. Lay the sufferer flat with their legs raised, and rehydrate them with water containing a quarter of a teaspoon of salt per litre.

Heatstroke is a serious medical emergency. Symptoms come on suddenly and include weakness, nausea, a hot, dry body with a body temperature of more than 41°C, dizziness, confusion, loss of coordination, fits and eventually collapse and loss of consciousness. Seek medical help, and cool the person by getting them out of the heat, removing their clothes, fanning them and applying cool wet cloths or ice to their body, especially to the groin and armpits.

Prickly heat is a common skin rash caused by excessive perspiration getting trapped under the skin. Treat it by moving out of the heat and into an air-conditioned area for a few hours and by having cool showers. Creams and ointments clog the skin, so they should be avoided. Locally bought prickly-heat powder can be helpful.

Insect Bites & Stings

Bedbugs don’t carry disease, but their bites are very itchy. They live in the cracks of furniture and walls, and then migrate to the bed at night to feed on you. You can treat the itch with antihistamines.

Lice inhabit various parts of your body but most commonly your head and pubic area. Transmission is via close contact with an infected person. Lice can be difficult to treat, and you may need numerous applications of an anti-lice shampoo such as permethrin. Pubic lice are usually contracted from sexual contact.

Ticks are contracted after walking in rural areas. They’re commonly found behind the ears, on the belly and in the armpits. If you have had a tick bite and experience symptoms such as a rash at the site of the bite or elsewhere, fever or muscle aches, you should see a doctor. Doxycycline prevents tick-borne diseases.

Bee and wasp stings mainly cause problems for people who are allergic to them. Anyone with a serious bee or wasp allergy should carry an injection of adrenaline (eg an Epipen) for emergency treatment. For others, pain is the main problem – apply ice to the sting and take painkillers.


Eating in restaurants is the biggest risk factor for contracting traveller’s diarrhoea. Ways to avoid it include eating only freshly cooked food, and avoiding shellfish and food that has been sitting around on buffets. Peel all fruit, cook vegetables and soak salads in iodine water for at least 20 minutes (avoid iodine if you are pregnant or have thyroid problems).

Drinking Water

  • Never drink tap water.
  • Bottled water is generally safe – check the seal is intact at purchase.
  • Avoid ice.
  • Avoid fresh juices that have been watered down.
  • Boiling water is the most efficient method of purifying it.
  • The best chemical purifier is iodine. It should not be used by pregnant women or those with thyroid problems.
  • Water filters should also filter out viruses. Ensure your filter has a chemical barrier such as iodine and a small pore size, eg less than four microns.

Air Pollution

Air pollution, particularly vehicle pollution, is an increasing problem in most of India’s major cities. If you have severe respiratory problems, speak with your doctor before travelling to any heavily polluted urban centres.

Infectious Diseases

Traveller’s Diarrhoea

Traveller’s diarrhoea is the most common problem that affects travellers – between 30% and 70% of people will suffer from it within two weeks of starting their trip. In over 80% of cases, traveller’s diarrhoea is caused by a bacteria, and therefore responds promptly to antibiotics. Treatment with antibiotics will depend on your situation – how sick you are, how quickly you need to get better etc.

Traveller’s diarrhoea is defined as the passage of more than three watery bowel actions within 24 hours, plus at least one other symptom such as fever, cramps, nausea, vomiting or feeling generally unwell. Treatment consists of staying well hydrated; rehydration solutions such as Gastrolyte are best for this. Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin will kill the bacteria quickly. Loperamide is just a ‘stopper’ and doesn’t get to the cause of the problem. It can be helpful, though, for example if you have to go on a long bus ride. Don’t take Loperamide if you have a fever, or blood in your stools. Seek medical attention quickly if you do not respond to an appropriate antibiotic.


Considering it’s such a serious and potentially deadly disease, there is an enormous amount of misinformation about malaria. You must get expert advice as to whether your trip will put you at risk. For most rural areas, the risk of contracting malaria far outweighs the risk of any tablet side effects. Before you travel, seek medical advice on the right medication and dosage for you.

Malaria is caused by a parasite transmitted by the bite of an infected mosquito. The most important symptom of malaria is fever, but general symptoms such as headache, diarrhoea, cough or chills may also occur. Diagnosis can only be made by taking a blood sample.

Two strategies should be combined to help prevent malaria – mosquito avoidance and antimalarial medications. Most people who catch malaria are taking inadequate or no antimalarial medication.

Travellers are advised to take to the following steps to prevent mosquito bites:

  • Use an insect repellent that contains DEET on exposed skin. Wash this off at night, as long as you’re sleeping under a mosquito net. Natural repellents such as citronella can be effective but must be applied more frequently than products containing DEET.
  • Sleep under a mosquito net impregnated with permethrin.
  • Choose accommodation with screens and fans (if not air-conditioned).
  • Impregnate clothing with permethrin in high-risk areas.
  • Wear long sleeves and trousers in light colours.
  • Use mosquito coils.
  • Spray your room with insect repellent before going out for your evening meal.

A variety of medications are available:

  • The effectiveness of the Chloroquine and Paludrine combination is now limited in many parts of south Asia. Common side effects include nausea (in 40% of people) and mouth ulcers.
  • Doxycycline is a broad-spectrum antibiotic with the added benefit of helping to prevent a variety of tropical diseases such as leptospirosis, tick-borne disease and typhus. The potential side effects include photosensitivity (a tendency to sunburn), thrush in women, indigestion, heartburn, nausea and interference with the contraceptive pill. More serious side effects include ulceration of the oesophagus – you can help prevent this by taking your tablet with a meal and a large glass of water, and never lying down within half an hour of taking it. It must be taken for four weeks after leaving the risk area.
  • Lariam (Mefloquine) has received much bad press, some of it justified, some not. This weekly tablet suits many people. Serious side effects are rare but include depression, anxiety, psychosis and fits. Anyone with a history of depression, anxiety, any other psychological disorder or epilepsy should not take Lariam. It is considered safe in the second and third trimesters of pregnancy. Tablets must be taken for four weeks after leaving the risk area.
  • Malarone is a combination of Atovaquone and Proguanil. Side effects are uncommon and mild, most commonly nausea and headache. It is the best tablet for beach-goers and for those on short trips to high-risk areas. It must be taken for one week after leaving the risk area.

Availability & Cost of Health Care

  • Most hotels have a doctor on call – if you’re staying at a budget hotel and they can’t help, try contacting an upmarket hotel to find out which doctor they use.
  • Some cities now have clinics catering specifically to travellers and expats. These are usually more costly than local facilities but are worth it, as they offer a superior standard of care. Additionally, staff at these clinics understand the local health system, and can also liaise with insurance companies should you require evacuation.
  • It is difficult to find reliable medical care in rural areas. If you’re seriously ill, contact your country’s embassy, which usually has a list of recommended doctors and dentists.
  • Treatment at public hospitals is generally reliable, though private clinics offer the advantage of shorter queues.
  • Many pharmaceuticals sold in India are manufactured under licence from multinational companies, so you’ll probably be familiar with many brand names.
  • Before buying medication over the counter, always check the expiry date and ensure the packet is sealed.

Before You Go

  • Pack 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 very useful.
  • If you are carrying syringes or needles, be sure to have a physician’s letter documenting their medical necessity.
  • If you have a heart condition, bring a copy of your ECG taken just prior to travelling.
  • If you take any regular medication, bring double the amount you need in case of loss or theft.
  • You’ll be able to buy many medications over the counter in India without a doctor’s prescription, but it can be difficult to find some of the newer drugs.


  • Even if you’re fit and healthy, don’t travel without health insurance – accidents do happen.
  • You may require extra cover for adventure activities such as rock climbing.
  • Make sure you are covered for emergency evacuation.
  • Ask in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. (In many countries doctors expect payment in cash.)
  • If you have to claim later, make sure you keep all documentation.
  • Some policies ask you to call (reverse charges) a centre in your home country, where an immediate assessment of your problem is made.


Specialised travel-medicine clinics are your best source of information; they stock all available vaccines and will be able to give specific recommendations for you and your trip. The doctors will take into account factors such as past vaccination history, the length of your trip, activities you may be undertaking, and underlying medical conditions, such as pregnancy.

Most vaccines don’t give immunity until at least two weeks after they’re given, so visit a doctor 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.

Required & Recommended Vaccinations

Yellow fever is the only vaccine required by international regulations. Proof of vaccination will only be required if you have visited a country in the yellow-fever zone within the six days prior to entering India. If you are travelling to India from Africa or South America you should check to see if you require proof of vaccination. The World Health Organization (WHO) recommends that travellers to India be up to date with measles, mumps and rubella vaccinations. Other vaccinations it recommends:

  • Adult diphtheria and tetanus Single booster recommended if none given in the previous 10 years.

  • Hepatitis A Provides almost 100% protection for up to a year; a booster after 12 months provides at least another 20 years’ protection.

  • Hepatitis B Now considered routine for most travellers. Given as three shots over six months.

  • Polio Only one booster is required as an adult for lifetime protection.

  • Typhoid Recommended for all travellers to India, even if you only visit urban areas. The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot. Tablets are also available; however, the injection is usually recommended as it has fewer side effects.

  • Varicella If you haven’t had chickenpox, discuss this vaccination with your doctor.

Immunisations recommended for long-term travellers (those going away for more than one month) or those at special risk:

  • Japanese B Encephalitis Three injections in all. Booster recommended after two years.

  • Meningitis Single injection. There are two types of vaccination: the quadrivalent vaccine gives two to three years’ protection and the meningitis group C vaccine gives around 10 years’ protection. Recommended for longterm backpackers aged under 25.

  • Rabies Three injections in all. A booster after one year will then provide 10 years’ protection.

  • Tuberculosis (TB) Adult long-term travellers are usually advised to have a TB skin-test before and after travel, rather than vaccination. Only one vaccine needs to be given in a lifetime.

Medical Checklist

Recommended items for a personal medical kit:

  • antibacterial cream, eg Muciprocin
  • antibiotic for skin infections, eg Amoxicillin/Clavulanate or Cephalexin
  • antifungal cream, eg Clotrimazole
  • antihistamine – there are many options, eg Cetrizine for daytime and Promethazine for night
  • antiseptic, eg Betadine
  • antispasmodic for stomach cramps, eg Buscopan
  • contraceptive(s)
  • decongestant, eg Pseudoephedrine
  • DEET-based insect repellent
  • diarrhoea medication – consider an oral rehydration solution (eg Gastrolyte), diarrhoea ‘stopper’ (eg Loperamide) and anti-nausea medication (eg Prochlorperazine); antibiotics for diarrhoea include Norfloxacin and Ciprofloxacin, for bacterial diarrhoea Azithromycin, and for giardia or amoebic dysentery Tinidazole
  • first-aid items such as scissors, Elastoplasts, bandages, gauze, thermometer (but not mercury), sterile needles and syringes, safety pins and tweezers
  • Ibuprofen or another anti-inflammatory
  • indigestion tablets, eg Quick Eze or Mylanta
  • iodine tablets (unless you are pregnant or have a thyroid problem) to purify water
  • laxative, eg Coloxyl
  • migraine medication if you suffer from them
  • paracetamol
  • permethrin to impregnate clothing and mosquito nets
  • steroid cream for allergic or itchy rashes, eg 1% to 2% hydrocortisone
  • sunscreen and hat
  • throat lozenges
  • treatment for thrush (vaginal yeast infection), eg Clotrimazole pessaries or Diflucan tablet
  • Ural or equivalent if you are prone to urine infections


There’s a wealth of travel-health advice on the internet. LonelyPlanet.com (www.lonelyplanet.com) is a good place to start. Some other suggestions:

Centers for Disease Control and Prevention (CDC; www.cdc.gov) Good general information.

MD Travel Health (www.mdtravelhealth.com) Provides complete travel-health recommendations for every country; updated daily.

World Health Organization (WHO; www.who.int/ith/) Its superb book International Travel & Health is revised annually and is available online.

Health Advisories

It’s 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)

New Zealand (www.mfat.govt.nz/travel)

South Africa (www.dfa.gov.za/consular/travel _advice.htm)

UK (www.doh.gov.uk/traveladvice/)

USA (www.cdc.gov/travel/)

Further Reading

Lonely Planet’s Asia & India – Healthy Travel is pocket-sized and packed with useful information about pre-trip planning, emergency first aid, immunisation and disease information, and what to do if you get unwell while on the road. Other recommended references include Traveller’s Health, by Dr Richard Dawood and Travelling Well (which is also online at www.travellingwell.com.au) by Dr Deborah Mills.