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Health

Treatment for minor injuries and common traveller’s health problems is easily accessed in Bali and to a lesser degree on Lombok. For serious conditions, you will need to leave the islands.

Travellers tend to worry about contracting infectious diseases when in the tropics, but infections are a rare cause of serious illness or death in travellers. Pre-existing medical conditions, such as heart disease, and accidental injury (especially traffic accidents) account for most life-threatening problems. Becoming ill in some way is relatively common, however; ailments you may suffer include gastro, overexposure to the sun and other typical traveller woes.

It’s important to note certain precautions you should take on Bali and Lombok, especially in regard to rabies, mosquito bites and the tropical sun.

The following advice is a general guide only and does not replace the advice of a doctor trained in travel medicine.

Before You Go

Make sure all medications are packed 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 you are carrying syringes or needles, be sure to have a physician's letter documenting their medical necessity. If you have a heart condition ensure you bring a copy of a electrocardiogram taken just prior to travelling.

If you take any regular medication bring double your needs in case of loss or theft. You can buy many medications over the counter without a doctor's prescription, but it can be difficult to find some of the newer drugs, particularly the latest antidepressant drugs, blood-pressure medications and contraceptive pills.

Insurance

Even if you are fit and healthy, don't travel without sufficient health insurance – accidents do happen. If you're uninsured, emergency evacuation is expensive – bills of more than US$100,000 are not uncommon.

Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures.

Recommended Vaccinations

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.

Most vaccines don't produce immunity until at least two weeks after they're given. Ask your doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all the vaccinations you've received.

The World Health Organization recommendations for Southeast Asia include the following:

Hepatitis A Provides almost 100% protection for up to a year; a booster after 12 months provides at least another 20 years' protection. Mild side effects such as headache and sore arm occur in 5% to 10% of people.

Hepatitis B Now considered routine for most travellers. Given as three shots over six months. Lifetime protection occurs in 95% of people.

Measles, mumps and rubella Two doses of MMR are required unless you have had the diseases. Many young adults require a booster.

Typhoid Recommended unless your trip is less than a week and only to developed cities. The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot.

Required Vaccinations

The only vaccine required by international regulations is yellow fever. Proof of vaccination will only be required if you have visited a country in the yellow-fever zone (primarily some parts of Africa and South America) within the six days prior to entering Southeast Asia.

Health Advisories

It's usually a good idea to consult your government's travel-health website before departure, if one is available:

There is a wealth of travel health advice on the internet.

  • World Health Organization (www.who.int/ith) Publishes a superb book called International Travel & Health, which is revised annually and is available online at no cost.

  • Centers for Disease Control & Prevention (www.cdc.gov) Good general information.

Medical Checklist

Recommended items for a convenient personal medical kit (other items can be easily obtained on Bali if needed):

  • antibacterial cream (eg muciprocin)
  • antihistamine – there are many options (eg cetirizine for daytime and promethazine for night)
  • antiseptic (eg Betadine)
  • contraceptives
  • DEET-based insect repellent
  • first-aid items such as scissors, bandages, thermometer (but not a mercury one) and tweezers
  • ibuprofen or another anti-inflammatory
  • steroid cream for allergic/itchy rashes (eg 1% to 2% hydrocortisone)
  • sunscreen and hat
  • throat lozenges
  • thrush (vaginal yeast infection) treatment (eg clotrimazole pessaries or diflucan tablet)

In Bali

Traveller's Diarrhoea

Traveller's diarrhoea (aka Bali belly) is by far the most common problem affecting travellers – between 30% and 50% of people will suffer from it within two weeks of starting their trip. In over 80% of cases, traveller's diarrhoea is caused by bacteria (there are numerous potential culprits), and therefore responds promptly to treatment with antibiotics.

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

Loperamide is just a 'stopper' and doesn't get to the cause of the problem. However, it can be helpful, 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.

  • Stay well hydrated; rehydration solutions such as Gastrolyte are the best for this.
  • Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin will kill the bacteria quickly.

Giardiasis

Giardia lamblia is a parasite that is relatively common in travellers. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. The parasite will eventually go away if left untreated but this can take months. The treatment of choice is Tinidazole, with Metronidazole being a second-line option.

Infectious Diseases

Hepatitis A

A problem throughout the region, this food- and waterborne virus infects the liver, causing jaundice (yellow skin and eyes), nausea and lethargy. There is no specific treatment for hepatitis A; you just need to allow time for the liver to heal. All travellers to Southeast Asia should be vaccinated against hepatitis A.

HIV

HIV is a major problem in many Asian countries, and Bali has one of the highest rates of HIV infection in Indonesia. The main risk for most travellers is sexual contact with locals, prostitutes and other travellers.

The risk of sexual transmission of the HIV virus can be dramatically reduced by the use of a kondom (condom). These are available from supermarkets, street stalls and drugstores in tourist areas, and from the apotik (pharmacy) in almost any town. Don't buy a cheap brand.

Rabies

Rabies is a disease spread by the bite or lick of an infected animal, most commonly a dog or monkey. Once you are exposed, it is uniformly fatal if you don't get the vaccine very promptly. Bali has had a major outbreak dating to 2008 and people continue to die each year.

To minimise your risk, consider getting the rabies vaccine, which consists of three injections. A booster after one year will then provide 10 years' protection. This may be worth considering given Bali's rabies outbreak. The vaccines are often unavailable on Bali, so get them before you go.

Also, be careful to avoid animal bites. Especially watch children closely.

Having the pre-travel vaccination means the post-bite treatment is greatly simplified. If you are bitten or scratched, gently wash the wound with soap and water, and apply an iodine-based antiseptic. It is a good idea to also consult a doctor.

Those not vaccinated will need to receive rabies immunoglobulin as soon as possible. Clean the wound immediately and do not delay seeking medical attention. Note that Bali is known to run out of rabies immunoglobulin, so be prepared to go to Singapore immediately for medical treatment.

Typhoid

This serious bacterial infection is spread via food and water. Its symptoms are a high and slowly progressive fever, headache and possibly a dry cough and stomach pain. It is diagnosed by blood tests and treated with antibiotics. Vaccinations are 80% effective and should be given one month before travelling to an infected area.

Bird Flu

Otherwise known as avian influenza, the H5N1 virus has claimed more than 100 victims in Indonesia. Most of the cases have been in Java.

Hepatitis B

The only sexually transmitted disease that can be prevented by vaccination, hepatitis B is spread by body fluids.

Dengue Fever

This mosquito-borne disease is a major problem. As there is no vaccine available it can only be prevented by avoiding mosquito bites. The mosquito that carries dengue bites day and night, so use insect avoidance measures at all times. Symptoms include high fever, severe headache and body ache (dengue was previously known as 'breakbone fever'). Some people develop a rash and experience diarrhoea. It's vital to see a doctor to be diagnosed and monitored.

Malaria

The risk of contracting malaria is greatest in rural areas of Indonesia. Generally malaria is not a concern on Bali or in the main touristed areas of Lombok. Consider precautions if you are going into remote areas or on side trips beyond the two islands.

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

Travellers are advised to prevent mosquito bites by taking these steps:

  • Use a DEET-containing insect repellent on exposed skin. Wash this off at night, as long as you are 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.

If you are going to an area of Indonesia where there is a malaria problem, consult with a clinic about the various prescription drugs you can use to reduce the odds you'll get it.

Availability & Cost of Health Care

In south Bali and Ubud there are clinics catering to tourists, and just about any hotel can put you in touch with an English-speaking doctor.

International Medical Clinics

For serious conditions, foreigners are best served in the costly private clinic, BIMC, that caters mainly to tourists and expats. Confirm that your health and/or travel insurance will cover you. In cases where your medical condition is considered serious you may be evacuated by air ambulance to Singapore or beyond; this is where proper insurance is vital because these flights can cost more than US$20,000.

BIMC is on the bypass road just east of Kuta near the Bali Galleria. It's a modern Australian-run clinic that can do tests, hotel visits and arrange medical evacuation. Visits can cost US$100 or more. It has a branch in Nusa Dua.

Hospitals

There are two facilities in Denpasar that offer a good standard of care. Both are more affordable than the international clinics.

BaliMed Hospital On the Kerobokan side of Denpasar, this private hospital has a range of medical services. A basic consultation is 220,000Rp.

Rumah Sakit Umum Propinsi Sanglah The city's general hospital has English-speaking staff and an ER. It's the best hospital on the island, although standards are not the same as at those in first-world countries. It has a special wing for well-insured foreigners, Paviliun Amerta Wing International.

Remote Care

In more remote areas facilities are basic – generally a small public hospital, doctor's surgery or puskesmas (community health centre). In government-run clinics and hospitals, services such as meals, washing and clean clothing are normally provided by the patient's family.

The best hospital on Lombok is Rumah Sakit Harapan Keluarga, in Mataram.

Pharmacies

Many drugs requiring a prescription in the West are available over the counter in Indonesia, including powerful antibiotics.

The Kimia Farma chain is recommended. It has many locations, charges fair prices and has staff who are helpful. The Guardian chain of pharmacies has appeared in tourist areas, but the selection is small and prices can be shocking even to visitors from high-priced countries. Elsewhere you need to be more careful as fake medications and poorly stored or out-of-date drugs are common.

Women's Health

In the tourist areas and large cities, sanitary napkins and tampons are easily found. This becomes more difficult the more rural you go.

Birth-control options may be limited so bring adequate supplies of your own form of contraception.

Environmental Hazards

Heat

Most parts of Indonesia are hot and humid throughout the year. It takes most people at least two weeks to adapt to the hot climate. 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. Be careful to avoid the following conditions:

Heat exhaustion Symptoms include weakness, headache, irritability, nausea or vomiting, sweaty skin, a fast, weak pulse and a normal or slightly elevated body temperature. Treatment involves getting out of the heat and/or sun, fanning the victim and applying cool wet cloths to the skin, laying the victim flat with their legs raised, and rehydrating with water containing one-quarter of a teaspoon of salt per litre. Recovery is usually rapid and it is common to feel weak for some days afterwards.

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

Prickly heat A common skin rash in the tropics, caused by sweat being trapped under the skin. The result is an itchy rash of tiny lumps. Treat by moving out of the heat into an air-conditioned area for a few hours and by having cool showers.

Bites & Stings

During your time in Indonesia, you may make some unwanted friends.

Bedbugs These 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 as you sleep. You can treat the itch with an antihistamine.

Jellyfish Most are not dangerous, just irritating. Stings can be extremely painful but rarely fatal. First aid for jellyfish stings involves pouring vinegar onto the affected area to neutralise the poison. Do not rub sand or water onto the stings. Take painkillers, and anyone who feels ill in any way after being stung should seek medical advice.

Ticks Contracted after walking in rural areas, ticks are commonly found behind the ears, on the belly and in 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.

Skin Problems

Fungal rashes There are two common fungal rashes that affect travellers. The first occurs in moist areas that get less air such as the groin, armpits and between the toes. It starts as a red patch that slowly spreads and is usually itchy. Treatment involves keeping the skin dry, avoiding chafing and using an antifungal cream such as Clotrimazole or Lamisil. Tinea versicolor is also common – this fungus causes small, light-coloured patches, most commonly on the back, chest and shoulders. Consult a doctor.

Cuts and scratches These can easily get infected in tropical climates so take meticulous care of any cuts and scratches. Immediately wash all wounds in clean water and apply antiseptic. If you develop signs of infection see a doctor. Divers and surfers should be careful with coral cuts because they become easily infected.

Drinking Water

Never drink tap water in Indonesia.

Widely available and cheap, bottled water is generally safe but check the seal is intact when purchasing. Look for places that allow you to refill containers, thus cutting down on landfill.

Most ice in restaurants is fine if it is uniform in size and made at a central plant (standard for large cities and tourist areas). Avoid ice that is chipped off larger blocks (more common in rural areas).

Avoid fresh juices outside of tourist restaurants and cafes.

Sunburn

Even on a cloudy day sunburn can occur rapidly, especially near the equator. Don't end up like the dopey tourists you see roasted pink on Kuta Beach. Instead:

  • Use a strong sunscreen (at least factor 30).
  • Reapply sunscreen after a swim.
  • Wear a wide-brimmed hat and sunglasses.
  • Avoid baking in the sun during the hottest part of the day (10am to 2pm).

Diving

Divers and surfers should seek specialised advice before they travel to ensure their medical kit contains treatment for coral cuts and tropical ear infections, as well as the standard problems. Divers should ensure their insurance covers them for decompression illness – get specialised dive insurance if necessary.

Divers should note that there is a decompression chamber in Sanur, which is a fast-boat ride from Nusa Lembongan. Getting here from north Bali can take three to four hours.

Alcohol Poisoning

There are ongoing reports of injuries and deaths among tourists and locals due to arak (the local spirits that should be distilled from palm or cane sugar) being adulterated with methanol, a poisonous form of alcohol. Although arak is a popular drink, it should be avoided outside established restaurants and cafes.