Health & safety
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).
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. You may require extra cover for adventure activities such as rock climbing. If your health insurance doesn’t cover you for medical expenses abroad, consider getting extra insurance –check lonelyplanet.com for more information. If you’re uninsured, emergency evacuationis 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 offer lower and higher medical-expense options; the higher ones are chiefly for countries that have extremely high medical costs, such as the USA. You may prefer a policy that pays doctors or hospitals directly rather than you having to pay on the spot and claim later. If you have to claim later, keep all the documentation. 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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There is a wealth of travel health advice on the internet. The World Health Organization (WHO; www.who.int/ith/) publishes a superb book called International Travel & 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 and is updated daily. The Centers for Disease Control and Prevention (CDC; www.cdc.gov) website also has good general information.
Recommended items for a personal medical kit:
antifungal cream, eg Clotrimazole
antibacterial cream, eg Muciprocin
antibiotics for skin infections, eg Amoxicillin/Clavulanate or Cephalexin
antibiotics for diarrhoea, eg Norfloxacin or Ciprofloxacin; Azithromycin for bacterial diarrhoea; and Tinidazole for giardiasis or amoebic dysentery
antihistamines for allergies, eg Cetrizine for daytime and Promethazine for night
anti-inflammatories, eg Ibuprofen
antinausea medication, eg Prochlorperazine
antiseptic for cuts and scrapes, eg Betadine
antispasmodic for stomach cramps, eg Buscopa
decongestant for colds and flus, eg Pseudoephedrine
DEET-based insect repellent
diarrhoea ‘stopper’, eg Loperamide
first-aid items such as scissors, plasters (Band Aids), bandages, gauze, thermometer (electronic, not mercury), sterile needles and syringes, and tweezers
indigestion medication, eg Quick Eze or Mylanta
iodine tablets (unless you are pregnant or have a thyroid problem) to purify water
laxative, eg Coloxyl
migraine medication (your personal brand), if a migraine sufferer
oral-rehydration solution for diarrhoea, eg Gastrolyte
paracetamol for pain
permethrin (to impregnate clothing and mosquito nets) for repelling insects
steroid cream for allergic/itchy rashes, eg 1% to 2% hydrocortisone
sunscreen and hat
thrush (vaginal yeast infection) treatment, eg Clotrimazole pessaries or Diflucan tablet
urine alkalisation agent, eg Ural, if you’re prone to urinary tract infections.
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 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 happen to take any regular medication, bring double your needs in case of loss or theft. In Laos it can be difficult to find some of the newer drugs, particularly the latest antidepressant drugs, blood pressure medications and contraceptive pills.
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 Southeast Asia. If you are travelling to Southeast Asia from Africa or South America you should check to see if you require proof of vaccination.
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 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. In the US, the yellow booklet is no longer issued, but it is highly unlikely the Lao authorities will ask for proof of vaccinations (unless you have recently been in a yellow-fever affected country).
The World Health Organization (WHO) recommends the following vaccinations for travellers to Southeast Asia:
Adult diphtheria and tetanus – Single booster recommended if you’ve had none in the previous 10 years. Side effects include a 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 a sore arm occur for between 5% and 10% of people.
Hepatitis B – Now considered routine for most travellers. Given as three shots over six months. A rapid schedule is also available, as is a combined vaccination with Hepatitis A. Side effects are mild and uncommon, usually a headache and sore arm. Lifetime protection occurs in 95% of people.
Measles, mumps and rubella – Two doses of MMR required unless you have had the diseases. Occasionally a rash and flulike illness can develop a week after receiving the vaccine. Many young adults require a booster.
Polio – In 2002, no countries in Southeast Asia reported cases of polio. Only one booster is 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. Tablets are also available; however, the injection is usually recommended as it has fewer side effects. Sore arm and fever may occur.
Varicella – If you haven’t had chickenpox, discuss this vaccination with your doctor.
These vaccinations are recommended for people travelling for more than one month, or those at special risk:
Japanese B Encephalitis – Three injections in all. Booster recommended after two years. A sore arm and headache are the most common side effects. Rarely, an allergic reaction comprising hives and swelling can occur up to 10 days after any of the three doses.
Meningitis – Single injection. There are two types of vaccination: the quadrivalent vaccine gives two to three years protection; meningitis group C vaccine gives around 10 years protection. Recommended for long-term backpackers aged under 25.
Rabies – Three injections in all. A booster after one year will provide 10 years protection. Side effects are rare – occasionally a 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 is given in a lifetime.
Over the last 15 years or so Laos has earned a reputation among visitors as a remarkably safe place to travel, with little crime reported and few of the scams so often found in more touristed places such as Vietnam, Cambodia and Thailand. And while the vast majority of Laotians remain honest and welcoming, things aren’t quite as idyllic as they once were. The main change has been in the rise of petty crime, such as theft and low-level scams, which are more annoying than actually dangerous.
That’s not to say Laos is danger free. However, most dangers are easy enough to avoid.
The Lao follow the usual Southeast Asian method of queuing for services, which is to say they don’t form a line at all but simply push en masse towards the point of distribution, whether at ticket counters, post-office windows or bus doors. It won’t help to get angry and shout ‘I was here first!’ since first-come, first-served simply isn’t the way things are done here. Rather it’s ‘first-seen, first-served’. Learn to play the game the Lao way, by pushing your money, passport, letters or whatever to the front of the crowd as best you can. Eventually you’ll get through.
While Lao are generally trustworthy people and theft is much less common than elsewhere in Southeast Asia, it has risen in recent years. Most of the reports we’ve heard involve opportunistic acts that, if you are aware of them, are fairly easily avoided.
Money or goods going missing from hotel rooms is becoming more common, so don’t leave cash or other tempting items (such as women’s cosmetics) out on show. If you ride a crowded bus, watch your luggage and don’t keep money in your trouser pockets. If you ride a bicycle or motorcycle in Vientiane, don’t place anything of value in the basket – thieving duos on motorbikes have been known to ride by and snatch bags from baskets. Also in Vientiane, we’ve had several reports of (usually) women having daypacks stolen after they’ve changed money near the BCEL bank on the riverfront – be especially careful around here.
Other reports involve theft on buses between Vientiane and Luang Prabang, and on the slow boat between Huay Xai and Luang Prabang. Simple locks on your bags are usually enough to discourage the light-fingered.
Deep Vein Thrombosis (DVT)
Deep vein thrombosis (DVT) occurs when blood clots form in the legs during plane flights, chiefly because of prolonged immobility. The longer the flight, the greater the risk. Though most blood clots are reabsorbed uneventfully, some may break off and travel through the blood vessels to the lungs, where they may cause life-threatening complications.
The chief symptom of DVT is swelling or pain of the foot, ankle, or calf, usually on just one side. When a blood clot travels to the lungs, it may cause chest pain and difficulty in 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 (nonalcoholic) and eating light meals. Upon arrival, seek exposure to natural sunlight and readjust your schedule (for meals, sleep etc) as soon as possible.
The winding mountain roads in Laos can be beautiful, but they’re also a problem if you suffer from motion sickness. The section of Rte 13 between Vang Vieng and Luang Prabang is particularly bad, and we heard from one guy who was ill for three days after that making this trip. 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.
This mosquito-borne disease is becomingly increasingly problematic throughout Laos, especially in the cities. As there is no vaccine 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 once known as ‘breakbone fever’). Some people develop a rash and diarrhoea. There’s 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.
This is 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 it.
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 Southeast Asia should be vaccinated against hepatitis A.
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 Southeast Asia, up to 20% of the population are carriers of hepatitis B, and usually are unaware of this. The long-term consequences can include liver cancer and cirrhosis.
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; prevention is by following safe eating and drinking guidelines.
According to Unaids and WHO, Laos remains a ‘low HIV prevalence country’; Unaids reported a range of between 1000 and 1800 as of 2001. However, it’s estimated that only about one fifth of all HIV cases in Laos are actually reported. Heterosexual sex is the main method of transmission in Laos.
The use of condoms greatly decreases but does not eliminate the risk of HIV infection. The Lao phrase for ‘condom’ is thœng anáamái. Condoms can be purchased at most hâan khǎi yáa (pharmacies), but it is worth bringing your own condoms from home.
Present year-round in the tropics, influenza (flu) symptoms include high fever, muscle aches, runny nose, cough and sore throat. It can be very severe in people over the age of 65 or in those with underlying medical conditions such as heart disease or diabetes; vaccination is recommended for these individuals. There is no specific treatment, just rest and paracetamol.
Japanese B Encephalitis
While a rare disease in travellers, at least 50, 000 locals are infected with Japanese B Encephalitis each year in Southeast Asia. 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.
For such a serious and potentially deadly disease, there is an enormous amount of misinformation concerning malaria. You must get expert advice as to whether your trip actually puts you at risk. Many parts of Laos, particularly populated areas, have minimal to no risk of malaria, and the risk of side effects from the antimalaria medication may outweigh the risk of getting the disease. For some 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:
Choose accommodation with screens and fans (if not air-conditioned).
Impregnate clothing with Permethrin in high-risk areas.
Sleep under a mosquito net impregnated with Permethrin.
Spray your room with insect repellent before going out for your evening meal.
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.
Use mosquito coils.
Wear long sleeves and trousers in light colours.
There are a variety of medications available. The effectiveness of the Chloroquine and Paludrine combination is now limited in most of Southeast Asia. Common side effects include nausea (40% of people) and mouth ulcers. It is generally not recommended.
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 seizures. 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, but there is significant resistance in parts of northern Thailand, Laos and Cambodia. Tablets must be taken for four weeks after leaving the risk area.
Doxycycline, taken as a 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 melioidosis. 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.
Malarone is a new drug combining Atovaquone and Proguanil. Side effects are uncommon and mild, most commonly nausea and headaches. It is the best tablet for scuba divers and for those on short trips to high-risk areas. It must be taken for one week after leaving the risk area.
Derivatives of Artesunate are not suitable as a preventive medication. They are useful treatments under medical supervision.
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). Other options include Mefloquine and Quinine but the side effects of these drugs at treatment doses make them less desirable. Fansidar is no longer recommended.
Measles remains a problem in some parts of Southeast Asia. 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.
This infection is contracted by skin contact with soil. It is rare in travellers. The symptoms are very similar to those experienced by tuberculosis sufferers. There is no vaccine but it can be treated with medication.
Opisthorchiasis (liver flukes)
These are tiny worms that are occasionally present in freshwater fish in Laos. The main risk comes from eating raw or undercooked fish. Travellers should in particular avoid eating uncooked pąa dàek (an unpasteurised fermented fish used as an accompaniment for many Lao foods) when travelling in rural Laos. The pąa dàek in Vientiane and Luang Prabang is said to be safe (or safer) simply because it is usually produced from noninfected fish, while the risk of infestation is greatest in the southern provinces.
A rarer way to contract liver flukes is by swimming in the Mekong River or its tributaries around Don Khong (Khong Island) in the far south of Laos.
At low levels, there are virtually no symptoms at all; at higher levels, an overall fatigue, a low-grade fever and swollen or tender liver (or general abdominal pain) are the usual symptoms, along with worms or worm eggs in the faeces. Opisthorchiasis is easily treated with medication. Untreated, patients may develop serious liver infections several years after contact.
This uniformly 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 post-exposure treatment. Having a 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 vaccinated you will need to receive rabies immunoglobulin as soon as possible.
Schistosomiasis (also called bilharzia) is a tiny parasite that enters your skin when swimming in contaminated water – travellers usually only get a light, symptomless infection. If you are concerned, you can be tested three months after exposure. On rare occasions, travellers may develop ‘Katayama fever’. It can occur 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.
Sexually transmitted diseases most common in Laos 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.
This parasite, also transmitted by skin contact with soil, rarely affects travellers. It is characterised by an unusual skin rash called larva currens – a linear rash on the trunk which comes and goes. Most people don’t have other symptoms until their immune system becomes severely suppressed, when the parasite can cause an overwhelming infection. It can be treated with medication.
Tuberculosis (TB) is very rare in short-term travellers. Medical and aid workers, and long-term travellers who have significant contact with the local population should take precautions, however. 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.
This serious bacterial infection is also spread via food and water. It gives a high, slowly progressive fever and 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 Southeast Asia, 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.
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.
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, but work in Nepal has shown that they are not specific to this infection. 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.
Throughout Southeast Asia, traditional medical systems are widely practised. There is a big difference between these traditional healing systems and ‘folk’ medicine. Folk remedies should be avoided, as they often involve rather dubious procedures with potential complications. In comparison, traditional healing systems such as traditional Chinese medicine are well respected, and aspects of them are being increasingly utilised by Western medical practitioners.
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 there can be drug interactions between herbal medicines and Western medicines. If you are utilising both systems ensure you inform both practitioners what the other has prescribed.
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.
Amoebic dysentery is very rare in travellers but is often misdiagnosed by poor-quality labs in Southeast Asia. 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 Metronidazole 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.
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 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 travel in rural 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 during 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.
In the urban areas of Southeast Asia, supplies of sanitary products are readily available. Birth control options may be limited though so bring adequate supplies of your own form of contraception. Heat, humidity and antibiotics can all contribute to thrush. Treatment is with antifungal creams and pessaries such as Clotrimazole. A practical alternative is a single tablet of Fluconazole (Diflucan). Urinary tract infections can be precipitated by dehydration or long bus journeys without toilet stops; bring suitable antibiotics.