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Indonesia

Health & safety

Before you go

Further reading

Lonely Planet’s Healthy Travel – Asia & India is a handy pocket-size book that is packed with useful information including pretrip planning, emergency first aid, immunisation and disease information and what to do if you get sick on the road. Other recommended references include Traveller’s Health by Dr Richard Dawood and Travelling Well by Dr Deborah Mills – check out the website www.travellingwell.com.au.

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Insurance

Even if you are fit and healthy, don’t travel without health insurance – accidents do happen. Declare any existing medical conditions you have – the insurance company will check if your problem is pre-existing and will not cover you if it is undeclared. If you’re uninsured, emergency evacuation is expensive; bills of over 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. (In many countries doctors expect payment in cash.) Some policies ask you to call back (reverse charges) to a centre in your home country where an immediate assessment of your problem is made.

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Internet resources

There is a wealth of travel health advice on the internet. The following are good resources:

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

MD Travel Health (www.mdtravelhealth.com) Complete travel health recommendations for every country.

World Health Organization (WHO; www.who.int/ith/) Publishes a superb book called International Travel & Health, revised annually.

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Medical checklist

Consider including the following in your medical kit:

Antibiotics –consider including these if you’re travelling well off the beaten track; see your doctor, as they must be prescribed, and carry the prescription with you

Antifungal cream or powder – for fungal skin infections and thrush

Antihistamine – for allergies, eg hay fever; to ease the itch from insect bites or stings; and to prevent motion sickness

Antiseptic (such as povidone-iodine or Betadine) – for cuts and grazes

Antispasmodic – for stomach cramps, eg Buscopa

Aspirin or paracetamol (acetaminophen in the USA) – for pain or fever

Bandages, Band-Aids (plasters) and other wound dressings

Calamine lotion, sting relief spray or aloe vera – to ease irritation from sunburn and insect bites or stings

Cold and flu tablets, throat lozenges and nasal decongestant

Contraceptives

DEET-based insect repellent

Ibuprofen or other anti-inflammatory

Iodine or other water purification tablets

Loperamide or diphenoxylate – ‘blockers’ for diarrhoea

Multivitamins – consider for long trips, when dietary vitamin intake may be inadequate

Permethrin – to impregnate clothing and mosquito nets

Prochlorperazine or metoclopramide – for nausea and vomiting

Rehydration mixture – to prevent dehydration, which may occur, for example, during bouts of diarrhoea; particularly important when travelling with children

Scissors, tweezers and a thermometer – note that mercury thermometers are prohibited by airlines

Sterile kit – in case you need injections in a country with medical hygiene problems; discuss with your doctor

Sunscreen, lip balm and eye drops

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Travel Alert: Following a number of deaths resulting from the consumption of local arak contaminated with methanol in 2009, travellers to Indonesia are advised to be extremely cautious when consuming local liquor. Most of the fatalities have occurred in Bali, the Gili Islands and Java.

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 also a good idea. If you have a heart condition bring a copy of your ECG taken just prior to travelling.

If you take 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.

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Vaccinations

Specialised travel-medicine clinics are your best source of information. 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 produce 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.

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Recommended vaccinations

The World Health Organization (WHO) recommends the following vaccinations for travellers to Southeast Asia:

Adult diphtheria and tetanus Single booster recommended if none in the previous 10 years. Side effects include sore arm and fever.

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 required unless you have had the diseases. Many young adults require a booster.

Polio Only one booster required as an adult for lifetime protection. Inactivated polio vaccine is safe during pregnancy.

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.

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

These immunisations are recommended for long-term travellers (more than one month) or those at special risk:

Japanese B Encephalitis Three injections in all. Booster recommended after two years. Sore arm and headache are the most common side effects.

Meningitis Single injection. Recommended for long-term backpackers aged under 25.

Rabies Three injections in all. A booster after one year will then provide 10 years’ protection. Side effects are rare – occasionally headache and sore arm.

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

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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 within the six days prior to entering Indonesia. If you are travelling to Indonesia from Africa or South America you should check to see if you require proof of vaccination.

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Dangers & annoyances

Drugs

Indonesia has demonstrated its zero-tolerance policy towards drugs with a spate of high-profile arrests and convictions recently. In 2005 Australian Schapelle Corby captured news headlines around the world when she was arrested in Bali for allegedly smuggling 4kg of marijuana into the country. She received a 20-year prison sentence. In the same year five Australians were caught with several kilograms of heroin strapped to their bodies at Denpasar airport. Along with their accomplices they became known (sensationally) as the ‘Bali Nine’. Seven received life sentences (later reduced to 20 years) and two were sentenced to death by firing squad.

Indonesia has also become something of an Asian centre for ecstasy, which fuels the local rave scenes in Bali, Jakarta and other big cities. In August 2005, the Indonesian government announced random raids of nightclubs in Jakarta and Bali and mandatory urine tests for anyone found with drugs. Several foreigners have consequently been arrested and convicted. There is no differentiation between ‘personal use’ and ‘distribution’ and even one pill is sufficient to land you in jail for many years. Hotel owners are also required by law to report offenders.

In areas where nightclubs are concentrated, such as Bali, you’ll still get plenty of offers. More often than not those ‘buddha sticks’ are banana leaves, ‘hashish’ is boot polish and ‘ecstasy’ is a multicoloured Panadol. But taking any risks is just stupid.

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In the wake of the 2002 and 2005 Bali bombings, Indonesians have made ongoing efforts to revive what was already a suffering tourist industry. There has been an increase in security measures at airports and tourist centres and extremist organisations have been closed down or disbanded. It’s impossible to say where such attacks will or won’t occur, yet the image Indonesia has been tainted with since the bombings – as a terrorism hotspot – has been damaging.

Security issues in Indonesia are often exaggerated by the foreign media, who make it seem like the whole nation is in turmoil. Foreign governments add to the hype with heavy-handed, blanket travel warnings. While it’s true that small sections of Indonesia experience flashes of conflict, overall the archipelago is quite safe. Government travel warnings have the potential to protect travellers from risk, but their impact on local tourism industries is decimating. Maluku in particular is experiencing a burst of growth and calm, and travel there is far easier and safer than ever. Yet the province is still on the ‘do not travel’ list in many travel advisories.

On the other hand, regional and separatist conflicts remain an ongoing problem in Papua. Western mining companies are targeted by frustrated indigenous people here and also in Nusa Tenggara. But most people know the difference between a multi­national and a tourist and conflicts rarely affect travellers.

Of course the best ways to ensure your safety are to keep abreast of the news, plan accordingly and apply common sense. Check official travel advisories. Monitor local and international media reports and seek the advice of other travellers and locals. Lonely Planet’s Thorn Tree (thorntree.lonelyplanet.com) is an online travel forum and another excellent source of information.

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Scams

As in most poor countries, plenty of people are out to relieve you of your money in one way or another. It’s really hard to say when an ‘accepted’ practice like overcharging becomes an unacceptable rip-off, but plenty of instances of practised deceit occur.

Con artists are always to be found. Usually those smooth talkers are fairly harmless guides seeking to lead you to a shop where they receive a commission. Just beware of instant friends and watch out for excessive commissions. Yogyakarta’s batik sales­people fall into this category.

As the main tourist destination, Bali is the home of many scams. Is it possible for a Kuta moneychanger not to short-change you? Then there’s the friendly local who discovers a serious problem with your car or motorbike and urgently gets one of his contacts to fix it for you, for an outrageous amount of money.

An invite to visit a traditional Balinese village from an instant friend may end up with a hard-luck story designed to extract money. It is almost always a con. Indonesia is full of heart-wrenching stories of hardship and poverty, and Bali is better off than most provinces. Most Indonesians suffer in silence and would never ask for money; consider giving to aid programmes if you want to help.

Another scam involves being invited to someone’s house, then introduced to a card game where you can’t lose. Of course, you do lose – big time. These gangs move around.

In Jakarta, police impostors searching foreigners for drugs and trying to extract money have been reported.

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Theft

Theft can be a problem. However, if you are mindful of your valuables and take precautions, the chances of being ripped off are small. Most thefts are the result of carelessness or naivety. The chances of theft are highest in crowded places and when travelling on public bemo, buses and trains.

Pickpockets are common, and their crowded bus and train stations are favourite haunts, as are major tourist areas. Compared to most Indonesians, tourists are rich and this attracts thieves. Bali, particularly Kuta, is No 1 in the thievery stakes, closely followed by the other main tourist areas of Yogyakarta and Lombok. The thieves are very skilful and often work in gangs – if you find yourself being hassled and jostled, check your wallet, watch and bag. The Bahasa Indonesia word for thief is pencuri. In Kuta, the gangs of small children waving necklaces for sale are notorious pickpockets.

Do not leave your valuables unattended, and in crowded places hold your handbag or day pack closely. A money belt worn under your clothes is the safest way to carry your passport, cash and travellers cheques.

Keep an eye on your luggage if it’s stored on the roof of a bus; bag slashing and theft from bags next to you inside the bus are also hazards. Locks on your bags are mandatory – travelling without them is like waving a ‘come and get it’ banner.

Java and Sumatra are the worst places for theft on buses. Organised gangs board the bus and take the seat behind you. If you fall asleep or put your bag on the floor, they will slash it and be gone with your gear before you know it. The chances of this happening are very slight, but the gangs do target tourists. Economy buses are the worst but travelling deluxe is no guarantee.

Always lock your hotel-room door and windows at night and whenever you go out, even if momentarily. Don’t leave valuables, cash or travellers cheques lying around in open view inside your room. It is wise to keep valuables hidden and locked inside your luggage; better hotels have safe storage facilities.

Report any theft to the police, but without witnesses don’t expect action. Bus companies and hotels will automatically deny any responsibility. Reported theft is usually termed kehilangan, or ‘loss’ – you lost it and it is your responsibility to prove theft. Police will provide a report, which is necessary for replacement passports and travellers cheques, and for insurance claims.

Be wary and know where your valuables are at all times – but at the same time remember that the overwhelming majority of Indonesians are honest and will go out of their way to look after a visitor. Out in the villages, far removed from the big cities and tourist areas, theft is a foreign concept.

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While you're there

Air pollution

Air pollution, particularly vehicle pollution, is an increasing problem in major cities. If you have severe respiratory problems speak with your doctor before travelling to any heavily polluted urban centres. This pollution also causes minor respiratory problems such as sinusitis, dry throat and irritated eyes. If troubled by the pollution leave the city for a few days and get some fresh air.

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Food

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 or food that has been sitting around in buffets. Peel all fruit, cook vegetables and soak salads in iodine water for at least 20 minutes. Eat in busy restaurants with a high turnover of customers.

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Heat

Many parts of Indonesia are hot and humid throughout the year. For most people it takes 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. Take it easy when you first arrive. Don’t eat salt tablets (they aggravate the gut) but drinking rehydration solution or eating salty food helps. 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 feeling weak, 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 ¼ teaspoon of salt per litre. Recovery is usually rapid and it is common to feel weak for some days afterwards.

Heatstroke is 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 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 the groin and armpits.

Prickly heat is 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 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.

Tropical fatigue is common in long-term expats based in the tropics. It’s rarely due to disease and is caused by the climate, inadequate mental rest, excessive alcohol intake and the demands of daily work in a different culture.

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Insect bites & stings

Bedbugs don’t carry disease but their bites are very itchy. You can treat the itch with an antihistamine. Lice inhabit various parts of your body but most commonly your head and pubic area. Transmission is via close contact with an infected person. They can be difficult to treat and you may need numerous applications of an antilice shampoo such as Permethrin. Pubic lice are usually contracted from sexual contact.

Ticks are 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. Doxycycline prevents tick-borne diseases.

Leeches are found in humid rainforest areas. They do not transmit any disease but their bites are often intensely itchy for weeks afterwards and can easily become infected. Apply an iodine-based antiseptic to any leech bite to help prevent infection.

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.

Most jellyfish in Indonesian waters are not dangerous, just irritating. 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. Take local advice on whether there are dangerous jelly­fish around and, if so, keep out of the water.

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Parasites

Numerous parasites are common in local Indonesian populations; however, most of these are rare in travellers. The two rules to follow if you wish to avoid parasitic infections are to wear shoes and to avoid eating raw food, especially fish, pork and vegetables.

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Snakes

Always wear boots and long pants if walking in an area that may have snakes. First aid in the event of a snakebite involves pressure immobilisation via an elastic bandage firmly wrapped around the affected limb, starting at the bite site and working up towards the chest. The bandage should not be so tight that the circulation is cut off, and the fingers or toes should be kept free so the circulation can be checked. Immobilise the limb with a splint and carry the victim to medical attention. Do not use tourniquets or try to suck the venom out. Antivenom is available for most species.

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Sunburn

Even on a cloudy day sunburn can occur rapidly. Always use a strong sunscreen (at least factor 30), making sure to reapply after a swim, and always wear a wide-brimmed hat and sunglasses outdoors. Avoid lying in the sun during the hottest part of the day (10am to 2pm). If you become sunburnt stay out of the sun until you have recovered, apply cool compresses and take painkillers for the discomfort. One per cent hydrocortisone cream applied twice daily is also helpful.

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Dengue fever

As there is no vaccine available for this mosquito-borne disease, it can only be prevented by avoiding 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. There is no specific treatment, just rest and paracetamol – do not take aspirin as it increases the likelihood of haemorrhaging. See a doctor to be diagnosed and monitored.

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Filariasis

A mosquito-borne disease that is very common in the local population, yet very rare in travellers. Mosquito-avoidance measures are the best way to prevent this disease.

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Hepatitis A

A problem throughout the region, this food- and water-borne 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 Indonesia should be vaccinated against hepatitis A.

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Hepatitis B

The only sexually transmitted disease that can be prevented by vaccination, hepatitis B is spread by body fluids, including sexual contact. In some parts of Indonesia up to 15% of the population are carriers of hepatitis B, and usually are unaware of this. The long-term consequences can include liver cancer and cirrhosis.

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Hepatitis E

Hepatitis E is transmitted through contaminated food and water and has similar symptoms to hepatitis A, but is far less common. It is a severe problem in pregnant women and can result in the death of both mother and baby. There is currently no vaccine, and prevention is by following safe eating and drinking guidelines.

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HIV

Typically, Indonesia has been considered a relatively safe country with respect to HIV/AIDS, with only a few thousand reported infections per year. However, religious and cultural taboos have likely resulted in a systematic underreporting of the problem throughout the country. According to WHO estimates, anywhere from 50,000 to 200,000 are living with HIV in Indonesia. While this is nowhere near as severe a pandemic as in other parts of Southeast Asia, it is high enough for travellers to exercise caution and vigilance.

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Japanese B Encephalitis

While this is a rare disease in travellers, many locals are infected each year. This viral disease is transmitted by mosquitoes. Most cases occur in rural areas and vaccination is recommended for travellers spending more than one month outside of cities. There is no treatment, and a third of infected people will die while another third will suffer permanent brain damage.

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Malaria

For such a serious and potentially deadly disease, there is an enormous amount of misinformation concerning malaria. Some parts of Indonesia, particularly city and resort areas, have minimal to no risk of malaria, and the risk of side effects from the tablets may outweigh the risk of getting the disease. For most rural areas, however, the risk of contracting the disease far outweighs the risk of any tablet side effects. Remember that malaria can be fatal. 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 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.

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.

There are a variety of medications available:

Artesunate Derivatives of Artesunate are not suitable as a preventive medication. They are useful treatments under medical supervision.

Chloroquine and Paludrine The effectiveness of this combination is now limited in most of Southeast Asia, including Indonesia. Common side effects include nausea (40% of people) and mouth ulcers. Generally not recommended.

Doxycycline This daily tablet is a broad-spectrum antibiotic that has the added benefit of helping to prevent a variety of tropical diseases, including leptospirosis, tick-borne disease, typhus and meliodosis. 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.

Lariam (Mefloquine) Lariam 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 having fits. Anyone with a history of depression, anxiety, other psychological disorder, or epilepsy should not take Lariam. It is considered safe in the second and third trimesters of pregnancy. It is around 90% effective in most parts of Southeast Asia, including Indonesia.

Malarone This drug is a combination of Atovaquone and Proguanil. Side effects are uncommon and mild, most commonly nausea and headache. It is the best tablet for scuba divers and for those on short trips to high-risk areas.

A final option is to take no preventive medi­cation but to have a supply of emergency medication should you develop the symptoms of malaria. This is less than ideal, and you’ll need to get to a good medical facility within 24 hours of developing a fever. If you choose this option the most effective and safest treatment is Malarone (four tablets once daily for three days).

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Measles

This highly contagious bacterial infection is spread via coughing and sneezing. Most people born before 1966 are immune as they had the disease in childhood. Measles starts with a high fever and rash and can be complicated by pneumonia and brain disease. There is no specific treatment.

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Rabies

This potentially fatal disease is spread by the bite or lick of an infected animal – most commonly a dog or monkey. You should seek medical advice immediately after any animal bite and commence postexposure treatment. Having pretravel vaccination means the postbite treatment is greatly simplified. If an animal bites you, gently wash the wound with soap and water, and apply iodine-based antiseptic. If you are not prevaccinated you will need to receive rabies immunoglobulin as soon as possible.

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Schistosomiasis

Schistosomiasis is a tiny parasite that enters your skin after you’ve been swimming in contaminated water – travellers usually only get a light infection and hence have no symptoms. If you are concerned, you can be tested three months after exposure. On rare occasions, travellers may develop ‘Katayama fever’. This occurs some weeks after expos­ure, as the parasite passes through the lungs and causes an allergic reaction; symptoms are coughing and fever. Schistosomiasis is easily treated with medications.

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STDs

Common sexually transmitted diseases include herpes, warts, syphilis, gonorrhoea and chlamydia. People carrying these diseases often have no signs of infection. Condoms will prevent gonorrhoea and chlamydia but not warts or herpes. If after a sexual encounter you develop any rash, lumps, discharge or pain when passing urine seek immediate medical attention. If you have been sexually active during your travels have an STD check on your return home.

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Tuberculosis

While rare in travellers, medical and aid workers, and long-term travellers who have significant contact with the local population should take precautions. Vaccination is usually only given to children under the age of five, but adults at risk are recommended pre- and post-travel TB testing. The main symptoms are fever, cough, weight loss, night sweats and tiredness.

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Typhoid

This serious bacterial infection is also spread via food and water. It gives a high and slowly progressive fever, headache and may be accompanied by a dry cough and stomach pain. It is diagnosed by blood tests and treated with antibiotics. Vaccination is recommended for all travellers spending more than a week in Indonesia, or travelling outside of the major cities. Be aware that vaccination is not 100% effective so you must still be careful with what you eat and drink.

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Typhus

Murine typhus is spread by the bite of a flea whereas scrub typhus is spread via a mite. These diseases are rare in travellers. Symptoms include fever, muscle pains and a rash. You can avoid these diseases by following general insect-avoidance measures. Doxycycline will also prevent them.

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Giardiasis

Giardia lamblia is a parasite that is relative­ly common in travellers. Symptoms include nausea, bloating, excess gas, fatigue and inter­mittent diarrhoea. ‘Eggy’ burps are often attributed solely to giardiasis. 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.

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Availability of health care

It is difficult to find reliable medical care in rural areas, but most capital cities now have clinics catering specifically to travellers and expats. These clinics are usually more expensive than local medical facilities, but are worth utilising, as they will offer a superior standard of care. Additionally they understand the local system, and are aware of the safest local hospitals and best specialists. They can also liaise with insurance companies should you require evacuation.

If you think you may have a serious disease, especially malaria, do not waste time – travel to the nearest quality facility to receive attention.

Buying medication over the counter is not recommended, as fake medications and poorly stored or out-of-date drugs are common.

Local medical care in general is not yet up to international standards. Foreign doctors are not allowed to work in Indonesia, but some clinics catering to foreigners have ‘international advisors’. Almost all Indonesian doctors work at government hospitals during the day and in private practices at night. This means that private hospitals often don’t have their best staff available during the day. Serious cases are evacuated to Australia or Singapore.

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Traditional medicine

Throughout Southeast Asia, traditional medical systems are widely practised. There is a big difference between these traditional healing systems and ‘folk’ medicine, which is dubious and should be avoided.

All traditional Asian medical systems identify a vital life force, and see blockage or imbalance as causing disease. Techniques such as herbal medicines, massage and acupuncture are utilised to bring this vital force back into balance, or to maintain balance. These therapies are best used for treating chronic disease such as chronic fatigue, arthritis, irritable bowel syndrome and some chronic skin conditions. Trad­itional medicines should be avoided for treating serious acute infections such as malaria.

Be aware that ‘natural’ doesn’t always mean ‘safe’, and that there can be drug interactions between herbal medicines and Western medicines. If you are utilising both treatment systems ensure that you inform both practitioners what the other has prescribed.

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Traveller’s diarrhoea

Traveller’s diarrhoea 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 a bacteria (there are numerous potential culprits), and therefore responds promptly to treatment with antibiotics. Treatment with antibiotics will depend on your situation – how sick you are, how quickly you need to get better, where you are 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 like Gastrolyte are the 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, 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.

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Amoebic dysentery

Amoebic dysentery is very rare in travellers but is often misdiagnosed by local poor quality labs. Symptoms are similar to bac­terial diarrhoea, ie fever, bloody diarrhoea and generally feeling unwell. You should always seek reliable medical care if you have blood in your diarrhoea. Treatment involves two drugs; Tinidazole or Metro­niadzole to kill the parasite in your gut and then a second drug to kill the cysts. If left untreated complications such as liver or gut abscesses can occur.

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Women’s health

Pregnant women should receive specialised advice before travelling. The ideal time to travel is in the second trimester (between 16 and 28 weeks), when the risk of pregnancy-related problems are at their lowest and pregnant women generally feel at their best. During the first trimester there is a risk of miscarriage and in the third trimester complications such as premature labour and high blood pressure are possible. It’s wise to travel with a companion. Always carry a list of quality medical facilities available at your destination and ensure you continue your standard antenatal care at these facilities. Avoid rural travel in areas with poor transportation and medical facilities. Most of all, ensure travel insurance covers all pregnancy-related possibilities, including premature labour.

Malaria is a high-risk disease in pregnancy. WHO recommends that pregnant women do not travel to areas with Chloroquine-resistant malaria. None of the more effective antimalarial drugs are completely safe in pregnancy.

Traveller’s diarrhoea can quickly lead to dehydration and result in inadequate blood flow to the placenta. Many of the drugs used to treat various diarrhoea bugs are not recommended in pregnancy. Azithromycin is considered safe.

Urinary tract infections can be precipitated by dehydration or long bus journeys without toilet stops; bring suitable antibiotics.

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