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Health

Mongolia’s dry, cold climate and sparse human habitation means there are few of the infectious diseases that plague tropical countries in Asia. The rough-and-tumble landscape and lifestyle, however, presents challenges of its own. Injuries sustained from falling off a horse are common in the summer season. In winter, the biggest threats are the flu and pneumonia, which spread like wildfire in November. If you do become seriously ill in Mongolia, your local embassy can provide details of Western doctors. Serious emergencies may require evacuation to Seoul or Bĕijīng. If in the countryside, make a beeline for Ulaanbaatar to have your ailment diagnosed. The advice here is a general guide only; be sure to seek the advice of a doctor trained in travel medicine.

Before You Go

Prevention is the key to staying healthy while abroad. A little planning before departure, particularly for pre-existing illnesses, will save trouble later. See your dentist before going on a long trip, carry a spare pair of contact lenses and glasses, and take your optical prescription with you. 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. Western medicine can be in short supply in Mongolia. Most medicine comes from China and Russia, and the labels won’t be in English, so bring whatever you think you might need from home. Take extra supplies of prescribed medicine and divide it into separate pieces of luggage; that way if one piece goes astray, you’ll still have a back-up supply.

Required & Recommended Vaccinations

Ask your doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all of the vaccinations you have received, and take it with you. The World Health Organization (WHO) recommends the following vaccinations for travel to Mongolia:

Adult Diphtheria & 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 a sore arm occur with some people.

Hepatitis B Now considered routine for most travellers, it provides lifetime protection for 95% of people. Immunisation is given as three doses over six months, though a rapid schedule is also available, as is a combined vaccination for Hepatitis A. Side effects are mild and uncommon, usually headache and a sore arm.

Measles, Mumps & Rubella (MMR) Two doses of MMR are recommended unless you have had the diseases. Occasionally a rash and flu-like illness can develop a week after receiving the vaccine. Many young adults need a booster.

Typhoid Recommended unless your trip is less than a week. The vaccine offers around 70% protection, lasts for two to three years and comes as a single dose. Tablets are also available, although the injection is usually recommended, as it has fewer side effects. A sore arm and fever may occur.

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

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

Influenza A single jab lasts one year and is recommended for those over 65 years of age or with underlying medical conditions such as heart or lung disease.

Pneumonia A single injection with a booster after five years is recommended for all travellers over 65 years of age or with underlying medical conditions that compromise immunity, such as heart or lung disease, cancer or HIV.

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

Tuberculosis (TB) A complex issue. High-risk, adult, long-term travellers are usually recommended to have a TB skin test before and after travel, rather than a vaccination. Only one vaccine is given in a lifetime. Children under five spending more than three months in China and/or Mongolia should be vaccinated.

Insurance

Adequate cover If your health insurance does not cover you for medical expenses abroad, consider supplemental insurance. Check the Lonely Planet (www.lonelyplanet.com/travel-insurance) site for more information.

Payment policy While you may prefer a policy that pays hospital bills on the spot, rather than paying first and sending in documents later, the only place in Mongolia that might accept this is the SOS Medica clinic.

Pre-existing conditions Declare any existing medical conditions to the insurance company; if your problem is pre-existing, the company will not cover you if it is not declared.

Adventurous activities You may require extra cover for adventurous activities – make sure you are covered for a fall if you plan on riding a horse or a motorbike. If you are uninsured, emergency evacuation is expensive, with bills over US$100,000 not uncommon.

Medical Checklist

Following is a list of items you should consider including in your medical kit – consult your pharmacist for brands available in your country.

  • Antibacterial cream (eg Muciprocin)
  • Antibiotics (prescription only) – for travel well ‘off the beaten track’, carry the prescription with you in case you need it refilled
  • Antifungal cream or powder (eg Clotrimazole) – for fungal skin infections and thrush
  • Antinausea medication (eg Prochlorperazine)
  • Antiseptic (such as povidone-iodine) – for cuts and grazes
  • 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
  • Insect repellent (DEET-based)
  • Loperamide or diphenoxylate – ‘blockers’ for diarrhoea
  • Multivitamins – consider them for long trips, when dietary vitamin intake may be inadequate
  • Rehydration mixture (eg Gastrolyte) – to prevent dehydration, which may occur during bouts of diarrhoea (particularly important when travelling with children)
  • Scissors, tweezers and a thermometer – note that mercury thermometers are prohibited by airlines
  • Sunscreen, lip balm and eye drops
  • Water purification tablets or iodine (iodine is not to be used by pregnant women or people with thyroid problems)

Internet Resources

Lonely Planet website (www.lonelyplanet.com) For further information this is a good place to start.

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

MD Travel Health (www.mdtravelhealth.com) Another website of general interest which provides complete travel health recommendations for every country and is updated daily.

Further Reading

Healthy Travel Asia & India Lonely Planet’s handy pocket-sized health guide.

Traveller’s Health by Dr Richard Dawood.

Travelling Well by Dr Deborah Mills (www.travellingwell.com.au).

Travel with Children Lonely Planet guide useful for families.

In Mongolia

Availability & Cost of Health Care

Advice Health care is readily available in Ulaanbaatar, but choose your hospital and doctor carefully. Ordinary Mongolians won’t know the best place to go, but a reputable travel agency or top-end hotel might. The best advice will come from your embassy.

Cost Consultations cost around US$5, although SOS Medica, a reliable clinic in Ulaanbaatar with Western doctors, charges around US$195.

Medication Most basic drugs are available without a prescription.

Regional areas Health services in the countryside are generally poor but improving in some aimag capitals. Taking very small children to the countryside is therefore risky.

Women's health Female travellers will need to take pads and tampons with them, as these won’t be available outside the main cities.

Infectious Diseases

Bubonic Plague

  • This disease (which wiped out one-third of Europe during the Middle Ages) makes an appearance in remote parts of Mongolia in late summer. Almost 90% of reported cases occur in August and September.
  • The disease (also known as the Black Plague) is normally carried by rodents and can be transmitted to humans by bites from fleas that make their home on the infected animals. It can also be passed from human to human by coughing.
  • The symptoms are fever and enlarged lymph nodes. The untreated disease has a 60% death rate, but if you get to a doctor it can be quickly treated.
  • The best (but not only) drug is the antibiotic Gentamicin, which is available in Mongolia.
  • During an outbreak, travel to infected areas is prohibited, which can greatly affect overland travel. All trains, buses and cars travelling into Ulaanbaatar from infected areas are also thoroughly checked when an outbreak of the plague has been reported, and vehicles are sprayed with disinfectant.

Tuberculosis (TB)

  • TB is a bacterial infection usually transmitted from person to person by coughing but which may be transmitted through consumption of unpasteurised milk.
  • Milk that has been boiled is safe to drink, and the souring of milk to make yoghurt or cheese also kills the bacilli.
  • Travellers are usually not at great risk as close household contact with an infected person is usually required before the disease is passed on. You may need to have a TB test before you travel, as this can help diagnose the disease later if you become ill.

Hepatitis

  • This is a general term for inflammation of the liver.
  • The symptoms are similar in all forms of the illness, and include fever, chills, headache, fatigue and aches, followed by loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-coloured faeces, jaundiced (yellow) skin and yellowing of the whites of the eyes.
  • People who have hepatitis should avoid alcohol for some time after the illness, as the liver needs time to recover.
  • Hepatitis A is transmitted by contaminated food and drinking water. You should seek medical advice, but there is not much you can do apart from resting, drinking lots of fluids, eating lightly and avoiding fatty foods.
  • Hepatitis E is transmitted in the same way as hepatitis A; it can be particularly serious in pregnant women.
  • Hepatitis B is endemic in Mongolia. It is spread through contact with infected blood, blood products or body fluids. The symptoms of hepatitis B may be more severe than type A and the disease can lead to long-term problems such as chronic liver damage, liver cancer or long-term carrier status.
  • Hepatitis C and D are spread in the same way as hepatitis B and can also lead to long-term complications.
  • There are vaccines against hepatitis A and B, but there are currently no vaccines against the other types of hepatitis.

Rabies

  • In the Mongolian countryside, family dogs are often vicious and can be rabid; it is their saliva that is infectious.
  • Any bite, scratch or even a lick from an animal should be cleaned immediately and thoroughly. Scrub with soap and running water, and then apply alcohol or iodine solution.
  • Seek medical help promptly to receive a course of injections to prevent the onset of symptoms and death.
  • The incubation period for rabies depends on where you’re bitten. On the head, face or neck it’s as little as 10 days, whereas on the legs it’s 60 days.

Brucellosis

  • The most likely way for humans to contract this disease is by drinking unboiled milk or eating home-made cheese. People with open cuts on their hands who handle freshly killed meat can also be infected.
  • In humans, brucellosis causes severe headaches, joint and muscle pains, fever and fatigue. There may be diarrhoea and, later, constipation.
  • The onset of the symptoms can occur from five days to several months after exposure, with the average time being two weeks.
  • Most patients recover in two or three weeks, but people can get chronic brucellosis, which recurs sporadically for months or years and can cause long-term health problems. Fatalities are rare but possible.
  • Brucellosis is a serious disease and requires blood tests to make the diagnosis. If you think you may have contracted the disease, seek medical attention, preferably outside Mongolia.

Environmental Hazards

Hypothermia

  • In a country where temperatures can plummet to -40°C, cold is something you should take seriously.
  • Hypothermia occurs when the body loses heat faster than it can produce it and the core temperature of the body falls.
  • If you are trekking at high altitudes or simply taking a long bus trip across the country, particularly at night, be especially prepared. Even in the lowlands, sudden winds from the north can send the temperature plummeting.
  • It is best to dress in layers; silk, wool and some of the new artificial fibres are all good insulting materials. A hat is important, as a lot of heat is lost though the head. A strong, waterproof outer layer is essential (and a ‘space’ blanket for emergencies if trekking).
  • Carry basic supplies, including fluid to drink and food containing simple sugars to generate heat quickly.

Heatstroke

  • This serious, occasionally fatal, condition can occur if the body’s heat-regulating mechanism breaks down and the body temperature rises to dangerous levels.
  • Long, continuous exposure to high temperatures and insufficient fluids can leave you vulnerable to heatstroke.
  • The symptoms are feeling unwell, not sweating very much (or at all) and a high body temperature. Where sweating has ceased, the skin becomes flushed and red.
  • Victims can become confused, aggressive or delirious.
  • Get victims out of the sun, remove their clothing and cover them with a wet sheet or towel and fan continually. Give fluids if they are conscious.

Bites & Stings

Bees and wasps Stings are usually painful rather than dangerous. Calamine lotion or sting-relief spray will give relief and ice packs will reduce the pain and swelling. However, people who are allergic to bees and wasps may require urgent medical care.

Snakes Mongolia has four species of venomous snakes: the Halys viper (agkistrodon halys), the common European viper or adder (vipera berus), Orsini’s viper (vipera ursine) and the small taphrometaphon lineolatum. To minimise your chances of being bitten, always wear boots, socks and long trousers where snakes may be present. Don’t put your hands into holes and crevices, and be careful when collecting firewood.

Bedbugs These live in various places, but particularly in dirty mattresses and bedding, evidenced by spots of blood on bedclothes or on the wall. Bedbugs leave itchy bites in neat rows. Calamine lotion or a sting-relief spray may help.

Lice All lice cause itching and discomfort. They make themselves at home in your hair, your clothing, or in your pubic hair. You catch lice through direct contact with infected people or by sharing combs, clothing and the like. Powder or shampoo treatment will kill the lice and infected clothing should then be washed in very hot, soapy water and left in the sun to dry.

Tap Water

  • Bottled water is generally safe – check that the seal is intact at purchase.
  • Tap water in Ulaanbaatar and other cities is considered bacteria-free, however antiquated plumbing means the water may contain traces of metals that won’t be good for your long-term health.
  • Be cautious about drinking from streams and lakes, as they are easily polluted by livestock. Water is usually OK if you can get it high up in the mountains, near the source. If in doubt, boil your water.
  • The best chemical purifier is iodine, although it should not be used by pregnant women or those with thyroid problems.
  • Water filters should filter out viruses. Ensure your filter has a chemical barrier such as iodine and a small pore size (eg less than four microns).