Health & safety
Before you go
A little planning before departure, particularly for pre-existing illnesses, will save you a lot of trouble later. See your dentist before a long trip; carry a spare pair of contact lenses and glasses (and take your optical prescription with you); and carry a first-aid kit with you.
It's tempting to leave it all to the last minute - don't! Many vaccines don't ensure immunity for two weeks, so visit a doctor four to eight weeks before departure.
Bring medications in their original, clearly labelled, containers. A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is also a good idea. If carrying syringes or needles, be sure to have a physician's letter documenting their medical necessity.
Insurance
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); it's also worth ensuring your travel insurance will cover repatriation home or transport to better medical facilities elsewhere. Your insurance company may be able to locate the nearest source of medical help, or you can ask at your hotel. In case of an emergency, contact your embassy or consulate. Your travel insurance will not usually cover you for anything other than emergency dental treatment. Not all insurance covers emergency aeromedical evacuation home or to a hospital in a major city, which may be the only way to get medical attention for a serious emergency.
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Recommended vaccinations
Plan ahead for getting your vaccinations: some of them require more than one injection, while some vaccinations should not be given together. Note that some vaccinations should not be given during pregnancy or to people with allergies - discuss this with your doctor.
Medical checklist
Following is a list of other items you should consider packing in your medical kit.
Antibiotics (if travelling off the beaten track)
Antidiarrhoeal 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 (allergic rashes)
Bandages, gauze, gauze rolls
Adhesive or paper tape
Scissors, safety pins, tweezers
Thermometer
Insect repellent that contains DEET, for the body
Insect spray that contains Permethrin - for clothing, tents and bed nets
Sun block
Oral rehydration salts
Iodine tablets or other water purification tablets
Syringes and sterile needles (if travelling to remote areas)
Internet resources
There is a wealth of travel health advice on the Internet. The World Health Organization (www.who.int/ith) publishes a superb book, International Travel and Health, which is revised annually and is available online at no cost.
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.
The Center for Disease Control (www.cdc.gov/travel/mideast.htm) offers a useful overview of the health issues facing travellers to the Middle East.
The US embassy in Amman has a list of recommended doctors in Jordan at usembassy-amman.org.jo/cons/doctors.doc.
Further reading
Lonely Planet's Healthy Travel - Asia & India 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, International Travel Health Guide by Stuart R Rose, MD and The Travellers' Good Health Guide by Ted Lankester, an especially useful health guide for volunteers and long-term expatriates working in the Middle East.
Required & recommended vaccinations
The following vaccinations are recommended for most travellers to Jordan, though you should check with your local health provider:
diphtheria & tetanus - single booster recommended if you've had none in the previous 10 years
hepatitis A - a single dose at least two to four weeks before departure gives protection for up to a year; a booster 12 months later gives another 10 years or more of protection
hepatitis B - now considered routine for most travellers
measles, mumps & rubella - two doses of MMR recommended unless you have previously had the diseases. Young adults may require a booster.
polio - generally given in childhood and should be boosted every 10 years
typhoid - recommended if you're travelling for more than a couple of weeks
yellow fever - vaccination is required for entry into Jordan for all travellers over one year of age if coming from infected areas such as sub-Saharan Africa, and parts of South America
Dangers & annoyances
Jordan is very safe to visit and travel around; remarkably so considering the turmoil, restrictions and difficulties in other nearby countries. The best general advice for all travellers is to take care - but not to be paranoid. Women who have travelled through places like Turkey will probably find that Jordan is comparatively relaxed and hassle free, but women who have not visited the region before may be annoyed at the leering and possible harassment from local men.
It is always a good idea to check the prevailing security situation before commencing your journey:
Australian Department of Foreign Affairs and Trade (www.smarttraveller.gov.au)
UK Foreign and Commonwealth Office (www.fco.gov.uk/travel)
US Department of State(travel.state.gov)
In transit
Deep vein thrombosis (DVT)
Deep vein thrombosis occurs when blood clots form in the legs during plane flights, chiefly because of a prolonged immobility. The longer the flight is, the greater the risk. Though most clots are reabsorbed uneventfully, some may break off and travel through the blood vessels to the lungs, where they may cause life-threatening complications.
The chief symptom of DVT is swelling or pain of the foot, ankle or calf, usually but not always on just one side. When a blood clot travels to the lungs, it may cause chest pain and difficulty breathing. Travellers with any of these symptoms should immediately seek medical attention.
To prevent the development of DVT on long flights you should walk about the cabin, perform isometric compressions of the leg muscles (ie contract the leg muscles while sitting), drink plenty of fluids, and avoid alcohol and tobacco.
Jet lag & motion sickness
Jet lag is common when crossing more than five time zones; it results in insomnia, fatigue, malaise or nausea. To avoid jet lag try drinking plenty of fluids (non-alcoholic) and eating light meals. Upon arrival, seek exposure to natural sunlight and readjust your schedule (for meals, sleep, etc) as soon as possible.
Antihistamines such as dimenhydrinate (Dramamine) and meclizine (Antivert, 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.
While you're there
Availability & cost of health care
There are modern, well-equipped public hospitals in Amman, Irbid, Aqaba and Karak; smaller hospitals in Madaba, Ramtha and Zarqa; and basic health centres in most other towns. Jordan also boasts over 50 private hospitals, which cater primarily to patients from neighbouring countries, particularly the Gulf States, who are attracted by the lower medical costs. Emergency treatment not requiring hospitalisation is free in Jordan.
Most towns have well-stocked pharmacies, but always make sure to check the expiry date of any medicine you buy in Jordan. It is better to bring any unusual or important medical items with you from home, and always bring a copy of a prescription. The telephone numbers for pharmacies (including those open at night) in Amman and Irbid, and for hospitals in Amman, Zarqa, Irbid and Aqaba, are listed in the two English-language newspapers. All doctors (and most pharmacists) who have studied in Jordan speak English because medicine is taught in English at Jordanian universities, and many have studied abroad. Dental surgeries are also fairly modern and well equipped.
For minor illnesses such as diarrhoea, pharmacists can often provide valuable advice and sell over-the-counter medication.
For an ambulance in Jordan call 193.
Diphtheria & tetanus
Diphtheria is spread through close respiratory contact. It causes a high temperature and severe sore throat. Sometimes a membrane forms across the throat requiring a tracheostomy to prevent suffocation. Vaccination is recommended for those likely to be in close contact with the local population in infected areas. The vaccine is given as an injection alone, or with tetanus (you may well have had this combined injection as a child), and lasts 10 years.
Hepatitis A
Hepatitis A is spread through contaminated food (particularly shellfish) and water. It causes jaundice and, although it is rarely fatal, can cause prolonged lethargy and delayed recovery. Symptoms include dark urine, a yellow colour to the whites of the eyes, fever and abdominal pain. Hepatitis A vaccine (Avaxim, VAQTA, Havrix) is given as an injection; hepatitis A and typhoid vaccines can also be given as a single-dose vaccine, hepatyrix or viatim.
Hepatitis B
Infected blood, contaminated needles and sexual intercourse can all transmit hepatitis B. It can cause jaundice, and affects the liver, occasionally causing liver failure. All travellers should make this a routine vaccination. (Many countries now give hepatitis B vaccination as part of routine childhood vaccination.) The US Center for Disease Control says the level of hepatitis B is high in Jordan. The vaccine is given singly, or at the same time as the hepatitis A vaccine (hepatyrix). A course will give protection for at least five years. It can be given over four weeks, or six months.
HIV
This is spread via infected blood and blood products, sexual intercourse with an infected partner and from an infected mother to her newborn child. It can be spread through 'blood to blood' contacts such as contaminated instruments during medical and dental procedures, acupuncture, body-piercing and sharing used intravenous needles.
Reliable figures aren't available about the number of people in Jordan with HIV or AIDS, but given the strict taboos in Jordanian society about drugs, homosexuality and promiscuity, the disease is relatively rare. Contracting HIV through a blood transfusion is about as unlikely as in most Western countries, and anyone needing serious surgery will probably be sent home anyway.
You may need to supply a negative HIV test in order to get a second visa extension for a stay of longer than three months.
Polio
Generally spread through either contaminated food or water, polio is one of the vaccines given in childhood and should be boosted every 10 years, either orally (a drop on the tongue), or as an injection. Polio may be carried asymptomatically, although it can cause a transient fever and, in rare cases, potentially permanent muscle weakness or paralysis. Polio is not currently present in Jordan but is prevalent in neighbouring countries.
Rabies
Spread through bites or licks on broken skin from an infected animal, rabies is fatal. Animal handlers should be vaccinated, as should those travelling to remote areas where a reliable source of post-bite vaccine is not available within 24 hours. Three injections are needed over a month. If you've come in physical contact with an infected animal and haven't been vaccinated you'll need a course of five injections starting within 24 hours or as soon as possible after the injury. Vaccination does not provide you with immunity, it merely buys you more time to seek appropriate medical help.
Tuberculosis
Tuberculosis (TB) is spread through close respiratory contact and occasionally through infected milk or milk products. BCG vaccine is recommended for those likely to be mixing closely with the local population. It is more important for those visiting family or planning on a long stay, and those employed as teachers and health-care workers. TB can be asymptomatic, although symptoms can include cough, weight loss or fever, months or even years after exposure. An X-ray is the best way to confirm if you have TB. BCG gives a moderate degree of protection against TB. It causes a small permanent scar at the site of injection, and is usually only given in specialised chest clinics. As it's a live vaccine it should not be given to pregnant women or immunocompromised individuals. The BCG vaccine is not available in all countries.
Typhoid
This is spread through food or water that has been contaminated by infected human faeces. The first symptom is usually fever or a pink rash on the abdomen. Septicaemia (blood poisoning) may also occur. Typhoid vaccine (typhim Vi, typherix) will give protection for three years. In some countries, the oral vaccine Vivotif is also available.
Yellow fever
Yellow fever vaccination is not required for Jordan but you do need a yellow fever certificate if arriving from an infected area, or if you've been in an infected area in the couple of weeks prior to arrival in Jordan. There is always the possibility that a traveller without an up-to-date certificate will be vaccinated and detained in isolation at the port of arrival for up to 10 days, or even repatriated. The yellow fever vaccination must be given at a designated clinic, and is valid for 10 years. It is a live vaccine and must not be given to immunocompromised or pregnant travellers.
Traveller's diarrhoea
The chances of getting sick from unhygienic food handling and preparation in Jordan are fairly slim. To prevent diarrhoea:
Avoid tap water unless it has been boiled, filtered or chemically disinfected (iodine tablets)
Beware of ice cream that is sold in the street or anywhere it might have been melted and refrozen; if there's any doubt (eg a power cut in the last day or two), steer well clear
Be careful of shellfish such as mussels, oysters and clams, particularly outside of Aqaba, as well as the raw meat dishes that are available in Lebanese restaurants in Jordan.
Buffet meals are risky, as are empty restaurants; meals freshly cooked in front of you in a busy restaurant packed with locals are much more likely to be safe
If you do develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution containing salt and sugar (weak black tea with a little sugar, soda water, or soft drinks allowed to go flat and diluted 50% with clean water are also good). In an emergency you can make up a solution of six teaspoons of sugar and half a teaspoon of salt to a litre of boiled or bottled water.
A few loose stools don't require treatment but, if you start having more than four or five stools a day, you should start taking an antibiotic (usually a quinolone drug) and an antidiarrhoeal agent (such as loperamide). If diarrhoea is bloody, persists for more than 72 hours, is accompanied by fever, shaking chills or severe abdominal pain, you should seek medical attention.
Where this is not possible the recommended drugs for bacterial diarrhoea (the most likely cause of severe diarrhoea in travellers) are norfloxacin 400mg twice daily for three days or ciprofloxacin 500mg twice daily for five days. These drugs are not recommended for children or pregnant women. The drug for children is co-trimoxazole, with dosage dependent on weight. A five-day course is given. Ampicillin or amoxycillin may be given to pregnant women, but medical care is necessary.
Diving, snorkelling & swimming
Stonefish have a very nasty habit of lying half-submerged in the sand, so wear something on your feet if you're walking into the sea (as opposed to jumping into the deep water from a jetty or boat). If stung by a stonefish, see a doctor immediately. Other nasty creatures to avoid are lionfish which, like the stonefish, have poisonous spikes, and jellyfish, whose sting can be painful. If stung by a jellyfish, douse the rash in vinegar to deactivate any stingers which have not 'fired'. Calamine lotion, antihistamines and analgesics (and urine) may reduce the reaction and relieve the pain. Coral cuts are notoriously slow to heal and, if they're not adequately cleaned, small pieces of coral can become embedded in the wound.
It is important to remember that, if you dive to any depth, it is dangerous to go to certain altitudes until six hours have elapsed. This includes the road to Petra and most roads out of Aqaba. Deeper dives require an even longer wait.
Aqaba has an excellent hospital where cuts, bites and stings can be treated. Most importantly, it has decompression chambers for the 'bends'.
Heat illness
Read this section carefully, especially if you are travelling to Jordan between May and September. Despite the warnings, some visitors get themselves into trouble hiking through the desert in the heat of the day, especially around Wadi Rum.
Heat exhaustion occurs following heavy sweating and excessive fluid loss with inadequate replacement of fluids and salt. This is particularly common in hot climates when taking unaccustomed exercise before full acclimatisation. Symptoms include headache, dizziness and tiredness. Dehydration already occurs by the time you feel thirsty - aim to drink sufficient water such that you produce pale, diluted urine. The treatment of heat exhaustion consists of fluid replacement with water or fruit juice or both, and cooling by cold water and fans. The treatment of the salt loss component consists of salty fluids as in soup or broth, and adding a little more table salt to foods than usual.
Heat stroke is much more serious. This occurs when the body's heat-regulating mechanism breaks down. Excessive rise in body temperature leads to sweating ceasing, irrational and hyperactive behaviour and eventually loss of consciousness and death. Rapid cooling by spraying the body with water and fanning is an ideal treatment. Emergency fluid and electrolyte replacement by intravenous drip is usually also required.
Insect bites & stings
Mosquitoes may not carry malaria but can cause irritation and infected bites. Using DEET-based insect repellents will prevent bites. Mosquitos also spread dengue fever.
Bees and wasps only cause real problems to those with a severe allergy (anaphylaxis). If you have a severe allergy to bee or wasp stings you should carry an adrenaline injection or similar. For general bug bites, calamine lotion or a sting relief spray will give relief and ice packs will reduce the pain and swelling.
Scorpion stings are notoriously painful and in Jordan can actually be fatal. Scorpions often shelter in shoes or clothing so check your shoes in the morning.
Bed bugs are often found in hostels and cheap hotels. They lead to very itchy lumpy bites. Spraying the mattress with an appropriate insect killer will do a good job of getting rid of them.
Scabies are also frequently found in cheap accommodation. These tiny mites live in the skin, particularly between the fingers. They cause an intensely itchy rash. Scabies is easily treated with lotion available from pharmacies; people who you come into contact with also need treating to avoid spreading scabies between asymptomatic carriers.
Snake bites
To minimise your chances of being bitten always wear boots, socks and long trousers when walking through undergrowth where snakes may be present. Don't put your hands into holes and crevices, and be careful when collecting firewood.
Half of those bitten by venomous snakes are not actually injected with poison (envenomed). If bitten by a snake, do not panic. Immobilise the bitten limb with a splint (eg a stick) and apply a bandage over the site, with firm pressure, similar to bandaging a sprain. Do not apply a tourniquet, or cut or suck the bite. Get the victim to medical help as soon as possible so that antivenin can be given if necessary.
Water
Tap water in Jordan is generally safe to drink, but for a short trip it's better to stick to bottled water, or boil water for 10 minutes, use water purification tablets or a filter. In the Jordan Valley, amoebic dysentery can be a problem. The tap water in southern Jordan, particularly Wadi Rum, comes from natural springs at Diseh and so is extremely pure.
Travelling with children
All travellers with children should know how to treat minor ailments and when to seek medical treatment. Make sure the children are up to date with routine vaccinations, and discuss possible travel vaccines well before departure as some vaccines are not suitable for children less than one year old.
In hot, moist climates any wound or break in the skin may lead to infection. The area should be cleaned and then kept dry and clean. Remember to avoid contaminated food and water. If your child is vomiting or experiencing diarrhoea, lost fluid and salts must be replaced. It may be helpful to take rehydration powders for reconstituting with boiled water. Ask your doctor about this.
Children should be encouraged to avoid dogs or other mammals because of the risk of rabies and other diseases. Any bite, scratch or lick from a warm-blooded, furry animal should immediately be thoroughly cleaned. If there is any possibility that the animal is infected with rabies, immediate medical assistance should be sought.
Travel with Children from Lonely Planet includes advice on travel health for younger children.
Women's health
Emotional stress, exhaustion and travelling through different time zones can all contribute to an upset in the menstrual pattern. If using oral contraceptives, remember some antibiotics, diarrhoea and vomiting can stop the pill from working and lead to the risk of pregnancy - remember to take condoms with you just in case. Condoms should be kept in a cool dry place or they may crack and perish.
Emergency contraception is most effective if taken within 24 hours after unprotected sex. The International Planned Parent Federation (www.ippf.org) can advise about the availability of contraception in different countries. Tampons and sanitary towels are easily available in Amman but not necessarily in smaller towns.
Travelling during pregnancy is usually possible but there are important things to consider. Have a medical check-up before embarking on your trip. The most risky times for travel are during the first 12 weeks of pregnancy, when miscarriage is most likely, and after 30 weeks, when complications such as high blood pressure and premature delivery can occur. Most airlines will not accept a traveller after 28 to 32 weeks of pregnancy, and long-haul flights in the later stages can be very uncomfortable. Antenatal facilities vary greatly between countries in the Middle East and you should think carefully before travelling to a country with poor medical facilities or where there are major cultural and language differences from home. Taking written records of the pregnancy, including details of your blood group, is likely to be helpful if you need medical attention while away. Ensure your insurance policy covers pregnancy delivery and postnatal care, but remember insurance policies are only as good as the facilities available.
Jordan
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