Pakistan

Health & safety

Before you go

Travellers tend to worry about contracting infectious diseases in this part of the world, but infections are rarely a cause of serious illness or death in travellers. Pre-existing medical conditions such as heart disease, and accidental injury (especially traffic accidents) account for most life-threatening problems. Becoming ill in some way, however, is very common. Fortunately, most travellers’ illnesses can either be prevented with some common-sense behaviour or treated easily with a well-stocked medical kit.

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

Pack medications in original, clearly labelled containers. A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is useful. If carrying syringes or needles, have a physician’s letter documenting their necessity. If you have a heart condition bring a copy of your ECG taken just prior to travelling.

If you take any regular medication bring double your needs in case of loss or theft. In Pakistan you can buy many medications over the counter without a prescription, but this is not recommended, as fake, poorly stored or out-of-date drugs are common. It can also be difficult to find some newer drugs, particularly the latest antidepressants, blood-pressure medication and contraceptive pills.

Have your teeth checked before you travel, and if you wear glasses take a spare pair and your prescription.

^ Back to top

Insurance

Even if you are healthy, don’t travel without health insurance, as accidents do happen. Declare any existing medical conditions you have – the insurance company will check and will not cover you where a condition was undeclared. You may require extra cover for adventure activities such as skiing. If your health insurance doesn’t cover you for medical expenses abroad, consider getting extra insurance. If you’re uninsured, keep in mind that emergency evacuation is expensive, with bills of over US$100, 000 being common.

Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. In Pakistan the doctors usually expect payment in cash. 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, make sure you keep all documentation. Some policies ask you to call (reverse charges) a centre in your home country, where an immediate assessment of your problem is made.

^ Back to top

Recommended vaccinations

Specialised travel-medicine clinics are your best source of information; they stock all available vaccines and can give specific recommendations for your trip. Doctors will take into account factors like past vaccination history, the length of your trip, activities you may be undertaking and underlying conditions.

Most vaccines don’t produce immunity until at least two weeks after they have been given, so visit a doctor four to eight weeks before departure. Ask your doctor for an International Certificate of Vaccination (known as the yellow booklet), which will list all the vaccinations you’ve received.

The World Health Organization (WHO) recommends the following vaccinations for travellers to the Indian subcontinent:

Adult diphtheria and tetanus A single booster is recommended if you haven’t been vaccinated or boosted against these 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 sore arm occur in 5% to 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. In 95% of people lifetime protection results.

Measles, mumps and rubella (MMR) Two doses of MMR are required unless you have had the diseases. Occasionally a rash and flu-like illness can develop a week after receiving the vaccine. Many young adults require a booster.

Polio In 2003 polio was still present in Pakistan. Only one booster is required for adults for lifetime protection. Inactivated polio vaccine is safe during pregnancy.

Typhoid Recommended for all travellers to Pakistan, even if you only visit urban areas. It offers around 70% protection, lasts for two to three years and comes as a single shot. Tablets are also available, but 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 immunisations are recommended for long-term travellers (more than one month in infected areas) or those at special risk:

Japanese B Encephalitis Three injections in all. A booster is recommended after two years. Sore arm and headache are the most common side effects. An allergic reaction comprising hives and swelling can occur up to 10 days after any of the three doses, but this reaction is rare.

Meningitis Single injection. There are two types; the quadrivalent vaccine gives two to three years’ protection, and the 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 then provide 10 years’ protection. Side effects are rare – occasionally a headache and sore arm.

Tuberculosis (TB) A complex issue. 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.

^ Back to top

Required vaccinations

The sole vaccine required by law is yellow fever. Proof of vaccination will only be required if you’ve visited a country in the yellow-fever zone within six days prior to entering Pakistan. If you’re travelling to Pakistan from Africa or South America, check to see whether you require proof of vaccination ­before leaving your home country.

^ Back to top

Medical checklist

Recommended for a personal medical kit:

Antibacterial cream, eg ­Muciprocin

Antibiotic for skin infections, eg Cepha-lexin or Amoxicillin/Clavulanate

Antibiotics for diarrhoea include Norfloxacin or Ciprofloxacin; for bacterial diarrhoea Azithromycin; for giardia or amoebic dysentery Tinidazole

Antifungal cream, eg ­Clotrimazole

Antihistamine – there are many options, eg Cetrizine for daytime and Promethazine for night

Antiseptic, eg Betadine

Antispasmodic for stomach cramps, eg Buscopa

Contraceptive method

Decongestant, eg ­Pseudoephedrine

DEET-based insect repellent

Diarrhoea – consider an oral rehydration solution (eg Gastrolyte), diarrhoea ‘stopper’ (eg Loperamide) and anti-nausea­ medication (eg ­Prochlorperazine)

First-aid items such as scissors, medicated plasters, bandages, gauze, thermometer (but not mercury), sterile needles and syringes, safety pins and tweezers

Ibuprofen or another ­anti-inflammatory

Indigestion tablets, eg Mylanta or Quick Eze

Iodine tablets (unless you are pregnant or have a thyroid problem) to purify water

Laxative, eg Coloxyl

Permethrin to impregnate clothing and mosquito nets

Steroid cream for allergic/itchy rashes, eg 1% to 2% hydrocortisone

Sunscreen and hat

Throat lozenges

Thrush (vaginal yeast infection) treatment, eg Clotrimazole pessaries or Diflucan tablet

Ural or equivalent if prone to urinary tract infections

^ Back to top

Online resources

There’s a wealth of online travel-health advice. For further information, Lonely Planet (www.lonelyplanet.com) is a good place to start. WHO (www.who.int/ith/) publishes a superb book called International Travel & Health, revised annually and 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 (www.cdc.gov) website also has good general information.

^ Back to top

Further reading

Lonely Planet publishes Healthy Travel Asia & India by Isabelle Young and Travelling with Children by Cathy Lanigan, both of which contain useful health information.

^ Back to top

Dangers & annoyances

Sound and air pollution, irksome bureaucracy, exasperating traffic and crowded public transport are the subcontinent’s normal challenges, but daily hassles here are generally low-key compared with those in neighbouring India.

Read local newspapers and talk to tourism officials and other travellers to stay abreast of the latest potential hazards and scams. Also check out the Pakistan branch of Lonely Planet’s Thorn Tree forum (thorntree.lonelyplanet.com), where travellers may post warnings about problems they have encountered.

^ Back to top

Drugs

Charas (hashish) is available in many parts of the country; however, before indulging be warned that drug possession is illegal in Pakistan. Apart from opening yourself up to being taken advantage of, the penalties for possession, use or smuggling of drugs are strictly enforced, with the possibility of long jail sentences and hefty fines. Legislation passed in 1994 makes drug smuggling punishable by death.

Be wary of absolutely anyone, local or tourist, who approaches you with drugs for sale. Some dealers are in cahoots with the police, and will set you up in exchange for a cut of the fine or bribe.

^ Back to top

Theft

Theft has not, so far, been a major problem for travellers in Pakistan. However, exercise the same caution you would while travelling elsewhere; keep your money and passport with you at all times, preferably in a well-concealed moneybelt, and never leave valuables in your hotel room.

^ Back to top

In transit

Deep vein thrombosis (dvt)

This condition 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 in 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 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 around 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.

^ Back to top

Jet lag & motion sickness

Common when crossing more than five time zones, jet lag 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.

Antihistamines such as dimenhydrinate (Dramamine), promethazine (Phenergan) and meclizine (Antivert, Bonine) are usually the first choice for treating motion sickness. The main side effect is drowsiness. A herbal alternative is ginger, which may be eaten plain or candied (a small piece will do) or taken in tablet form (500 to 1000 milligrams).

^ Back to top