Health & safety
If your health insurance doesn’t cover you for medical expenses abroad, consider supplemental insurance. Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. (In PNG, most doctors expect payment in cash.)
Check whether your insurance covers evacuation to the nearest major centre (eg Brisbane) – the extra premium is not usually inordinately expensive.
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There is a wealth of travel health advice on the internet. The World Health Organisation publishes a superb book called International Travel and Health, which is revised annually and is available online at www.who.int/ith at no cost.
Other websites of general interest are MD Travel Health (www.mdtravelhealth.com), which provides complete travel health recommendations for every country, updated daily, also at no cost; the Centers for Disease Control and Prevention (www.cdc.gov); Fit for Travel (www.fitfortravel.scot.nhs.uk), which has up-to-date information about outbreaks and is very user-friendly; and www.traveldoctor.com.au, which is a similar Australian site.
It’s also a good idea to consult your government’s travel health website before departure, if one is available:
It is a good idea to carry a medical and first-aid kit with you. Following is a list of items you should consider packing:
acetaminophen (paracetamol) or
adhesive or paper tape
anti-inflammatory drugs (eg ibuprofen)
antibacterial ointment (prescription only, eg Bactroban) for cuts and abrasions
antibiotic plus steroid eardrops (prescription only, eg Sofradex, Kenacort otic)
antibiotics (prescription only), eg ciprofloxacin (Ciproxin) or norfloxacin (Utinor, Noroxin)
antidiarrhoeal drugs (eg loperamide)
antihistamines (for hay fever and allergic reactions)
antigiardia tablets (prescription only, eg tinidazole)
bandages (including a long compression bandage), gauze, gauze rolls, waterproof dressings
DEET-containing insect repellent for the skin
iodine tablets (for water purification)
oral rehydration salts (eg Gastrolyte, Diarolyte, Replyte)
Permethrin-containing insect spray for clothing, tents and bed nets
steroid cream or hydrocortisone cream (for allergic rashes)
syringes and sterile needles, and intravenous fluids if travelling in very remote areas
If you are travelling more than 24 hours away from a town area consider taking a self-diagnostic kit that can identify, from a finger prick, malaria in the blood.
Prevention is the key to staying healthy while abroad. See your dentist before departing, 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. If carrying syringes or needles, be sure to have a physician’s letter documenting their medical necessity or obtain a prepared pack from a travel health clinic.
The World Health Organisation (WHO) recommends that all travellers be covered for diphtheria, tetanus, measles, mumps, rubella and polio, regardless of their destination. Since most vaccines don’t produce immunity until at least two weeks after they’re given, visit a physician at least six weeks before departure.
Required & recommended vaccinations
When travelling to PNG, vaccination for yellow fever (and the certificate to prove it) is required if you are entering from a yellow fever-endemic country. Vaccinations are also recommended for hepatitis A, hepatitis B, typhoid fever and, for some visitors, Japanese B encephalitis.
All vaccinations can produce slight soreness and redness at the inoculation site, and a mild fever with muscle aches over the first 24 hours. These are less likely with hepatitis A inoculations and a little more common with hepatitis B and typhoid inoculations. Japanese B encephalitis vaccine has been associated with allergic reactions that require an antihistamine. Yellow fever vaccine is dangerous for anyone with an allergy to eggs and in about 5% of cases causes a flu-like illness within a week of vaccination.
It’s very difficult to get the balance right about dangers of travelling in PNG. If you believed the hype then you’d never go and you’d never understand that Melanesians are by nature among the most gentle, hospitable and generous people in the world. While urban drift has undoubtedly caused ‘law and order’ issues, it’s not like the Wild West where gun-law rules and stepping outside is to put your life in danger. That’s just the perception perpetuated by a lazy Australian media, which provides this region’s information to international media. The Australian media doesn’t report on any feel-good, warm-and-fuzzy stories from this part of the world.
If you use your common sense, especially in larger towns, the chance of encountering the notorious raskols (bandits) is small. In all the years we’ve been travelling in the region we’ve never been mugged or robbed. That said, when things do go wrong in PNG, it can be pretty frightening. Violent crime is not unusual, but the victims are rarely tourists.
So what does this mean for the traveller? Most importantly, don’t be paranoid. We’ve heard from travellers who’ve had bad experiences, but the vast majority of feedback (including from lone women) is overwhelmingly positive. Of course, what’s dangerous to one person is everyday to another, and each traveller will decide for themselves what is safe and what is not. Those who have travelled to developing countries in the past probably won’t be overly concerned. But for inexperienced travellers the lack of structure and the number of unemployed standing idly around the cities can be intimidating.
Bear in mind that everything is much more relaxed outside Port Moresby, Lae and Mt Hagen. Tribal fighting is still common deep in the Highlands, and while this can make things unpredictable it rarely embroils outsiders. In villages people quickly get to know you and you rapidly lose the anonymity that makes a stranger a target. Expats will tell you not to ride the buses and PMVs, but that’s just silly. They’ll regale you with stories of rape and pillage and plunder (even murder), but these tales are often urban legends that can have very tenuous connections to real events. It’s worth asking those same expats: so how many times have you been robbed?
It’s pretty simple – in the main areas where travellers are likely to go in the daytime with people around you are highly unlikely to encounter any trouble. The mantra is common sense. Fortunately, common sense is not rocket science, but here are some tips:
Don’t flaunt your wealth – wear unremarkable clothes and keep your camera hidden. Carry a bilum rather than a daypack.
Always keep at least K50 ‘raskol money’ in your pocket to appease any would-be thief. Hide the rest of your money in a money belt or your shoe.
Speak to people rather than being aloof.
Be especially careful on the fortnightly Friday pay nights when things can get pretty wild.
If you get held up, as in this situation anywhere, stay calm. Most robberies are fairly unsophisticated affairs.
Apart from crime, the main annoyance is the zillions of mosquitoes.
There aren’t many actual scams in PNG. However, in the few cities that have taxis there’s a chance you’ll encounter one of the developing world’s favourite cons: ‘Sorry, no change’. If you’re waving anything more than K10 or K20 around, then it might not be a scam at all. But if you only need K5 or K7 in change, for example, they will almost certainly have it.
Acute Mountain Sickness
Areas of PNG’s Highlands higher than 2500m, including Mt Wilhelm (4509m), are high enough for acute mountain sickness (AMS), or altitude sickness, to be a risk. Lack of oxygen at high altitudes affects most people to some extent. Less oxygen reaches the muscles and the brain, requiring the heart and lungs to compensate by working harder. The major risk factor in AMS is the speed with which you make your ascent. AMS is a notoriously fickle affliction and can affect even trekkers accustomed to high altitudes. AMS has been fatal at 3000m, although 3500m to 4500m is the usual range.
Acclimatisation is vital and usually takes from one to three days. Once you are acclimatised to a given height you are unlikely to get AMS at that height, but you can still succumb when you travel higher. If the ascent is too high and too fast, your body’s compensatory reactions may not kick into gear fast enough.
Mild symptoms of AMS usually develop during the first 24 hours. They tend to be worse at night and include headache, dizziness, lethargy, loss of appetite, nausea, breathlessness, difficulty sleeping and irritability. More serious symptoms include breathlessness at rest, a dry irritative cough (which may progress to the production of pink, frothy sputum), severe headache, lack of coordination (typically leading to a ‘drunken walk’), confusion, irrational behaviour, vomiting and eventually unconsciousness.
Treat mild symptoms by resting at the same altitude until recovery, usually a day or two. Take paracetamol or aspirin for headaches. If symptoms persist or become worse, however, immediate descent is necessary – even 500m can help. The most effective treatment for severe AMS is to get down to a lower altitude as quickly as possible – any delay could be fatal.
The drugs acetazolamide (Diamox) and dexamethasone are recommended by some doctors for the prevention of AMS. However, their use is controversial. While they can reduce the symptoms, they may also mask warning signs; severe and fatal AMS has occurred in people taking these drugs. Drug treatments should never be used to avoid descent or to enable further ascent.
Snakes (eg the death adder or highly venomous taipan) seldom attack humans without reason, so when walking in areas in PNG where visibility is not clear (such as long grass, leaf-covered ground or at night), be alert and careful. Compression by pad and bandage over the bite and immobilisation of the limb with any form of splint is the first-aid treatment. Victims should stay still unless there’s no other option. Antivenins are usually available from major medical centres.
The redback (jockey spider) is a distinctive small spider (known for the orange-red stripe on its back) that can cause a very painful bite with occasional generalised poisoning heralded by marked sweating of the affected limb, severe pain, weakness and vomiting. An ice pack is useful as a first-aid measure. An antivenin is available – check with local village clinics.
Leeches are present in swampy jungle areas and easily fix themselves onto skin. They aren’t dangerous except to the rare person who may be allergic. Liberal application of insect repellent to skin, clothing and boots will prevent leech infestation. Pulling a leech off the skin may result in bleeding – it is better to induce the leech to remove itself by applying an insecticide (or burning it with a cigarette tip!).
Saltwater crocodile attacks, though rare, are well recorded. Crocodiles can swim into tidal rivers; heed local warnings.
The notorious box jellyfish (seawasp) has been recorded in the waters of the Torres Straits, but much more common are the whip-like stings from the blue-coloured Indo-Pacific man o’ war. If you see these floating in the water or stranded on the beach it is wise not to go into the water. The sting is very painful and is best treated with vinegar or ice packs. Do not use alcohol.
Poisonous cone shells abound along shallow coral reefs. Stings can be avoided by handling the shell at its blunt end and by using gloves. Stings mainly cause local reactions, but nausea, faintness, palpitations or difficulty in breathing are signs that flag the need for medical attention.
Sea snakes may be seen around coral reefs. They are extremely unlikely to attack and their fangs will not penetrate a wetsuit.
This is a common name for inflammation of the ear canal. It is caused by water entering the canal activating any fungal spores that may be lying around predisposing to bacterial infection and inflammation. It usually starts after swimming but can be reactivated by water dripping into the ear canal after a shower, especially if long, wet hair lies over the ear opening.
It can be very, very painful and can spoil a holiday. Apart from diarrhoea it is the most common reason for travellers to consult a doctor. Self-treatment with an antibiotic plus steroid eardrop preparation is very effective. Stay out of the water until the pain and itch have gone.
Cuts and abrasions from dead coral cause similar injuries to that from any other sort of rock, but live coral can cause prolonged infection. Never touch coral. If you do happen to cut yourself on live coral, treat the wound immediately. Get out of the water, clean the wound thoroughly, getting out all the little bits of coral, apply an antiseptic and cover with a waterproof dressing.
Because the region has wonderful opportunities for scuba diving it is easy to get over-excited and neglect strict depth and time precautions. Few dives are very deep but the temptation to spend longer than safe amounts of time at relatively shallow depths is great and is probably the main cause of decompression illness (the ‘bends’). Early pains may not be severe and may be attributed to other causes, but any muscle or joint pain after scuba diving must be suspect. Keeping well hydrated helps prevent the bends.
At the time of writing, privately run compression chambers could be found at Port Moresby, but transport to a chamber can be difficult. Supply of oxygen to the chambers is sometimes a problem. Novice divers must be especially careful. Even experienced divers should check with organisations like Divers’ Alert Network (DAN; www.danesap.org) about the current site and status of compression chambers, and insurance to cover costs.
Only eat fresh fruits or vegetables if cooked or peeled; be wary of dairy products that might contain unpasteurised milk. Eat food that is hot through and avoid buffet-style meals. Food in restaurants that are frequented by locals is not necessarily safe but most resort hotels have good standards of hygiene, but individual food handlers can carry infection. Food that is piping hot is usually safe. Be wary of salads.
This region lies within the tropics so it is hot and for the most part humid. Heat exhaustion is a state of dehydration associated with salt loss. Natural heat loss is through sweating so it is easy to become dehydrated without realising it. Thirst is a late sign. Heat exhaustion is prevented by drinking at least 2L to 3L of water per day and more if you’re very active. Salt-replacement solutions are useful, as muscle weakness and cramps are due to salt as well as water loss and can be made worse by drinking water alone. The powders used for treating dehydration due to diarrhoea are just as effective when it is due to heat exhaustion. Apart from commercial solutions, a reasonable drink consists of a good pinch of salt to a half-litre (pint) of water. Salt tablets can result in too much salt being taken, and can cause headaches and confusion.
When the cooling effect of sweating fails, heat stroke ensues. This is a dangerous and emergency condition characterised by muscle weakness, exhaustion and mental confusion. Skin will be hot and dry. ‘Put the fire out’ by cooling the body with water on the outside and with cold drinks for the inside, then seek medical help.
Exposure to the ultraviolet rays of the sun causes burning of the skin with accompanying pain and misery and the danger of skin cancer. Cloud cover does not block out UV rays. Sunburn is more likely a problem for those taking Doxycycline as an antimalarial. The Australian ‘slip, slop, slap’ slogan (slip on a shirt, slop on sunscreen and slap on a hat) is a useful mantra. Treat sunburn with cool, wet dressings. Severe swelling may respond to a cortisone cream.
Dengue fever is spread through mosquito bites. It causes a feverish illness with headache and severe muscle pains similar to those experienced with a bad, prolonged attack of influenza. There might also be a fine rash. Mosquito bites should be avoided whenever possible – always use insect repellents. Self-treatment includes paracetamol, fluids and rest. Danger signs are prolonged vomiting, blood in the vomit, and/or a blotchy dark red rash. Dengue fever is not a danger in the Highlands.
Hepatitis A is a virus causing liver inflammation. Fever, debility and jaundice (yellow colouration of the skin and eyes, together with dark urine) occur and recovery is slow. Most people recover completely over time but it can be dangerous to people with other forms of liver disease, the elderly and sometimes to pregnant women in their third trimester. It is spread by contaminated food or water. Self-treatment consists of rest, a low-fat diet and avoidance of alcohol. The vaccine is almost 100% protective.
Like hepatitis A, hepatitis B is a virus causing liver inflammation, but this virus is more serious and often progresses to chronic liver disease and even cancer. It is spread, like HIV, by mixing body fluids through sexual intercourse, contaminated needles and accidental blood contamination. Treatment is complex and specialised but vaccination is highly effective.
HIV infection is on the rise in the whole region of West Melanesia. Government reports usually underestimate the extent of the problem, so when the international conferences discuss the incidence reaching epidemic proportions you can take it that the danger of unprotected sex is huge. Condom use is essential. If you require an injection for anything check that a new needle is being used or have your own supply.
Japanese B Encephalitis
This disease, found in the southern region of PNG including Port Moresby, but excluding the Highlands, is a serious virus transmitted by mosquitoes. Early symptoms are flu-like and this is usually as far as the infection goes, but sometimes the illness proceeds to cause brain fever (encephalitis), which has a high death rate. There is no specific treatment. Effective vaccination is available (involving three costly inoculations over a month). Allergic and sensitivity reactions to the vaccine, though rare, can occur. Vaccination is usually recommended for anyone staying more than a few weeks and/or going to work in villages.
Malaria, found in all areas of PNG below 1000m, is a parasite infection transmitted by infected anopheles mosquitoes. While these mosquitoes are regarded as night feeders they can emerge when light intensity is low (eg in overcast conditions under the jungle canopy or the interior of dark huts). Both malignant (falciparum) and less-threatening but relapsing forms are present here. Since no vaccine is available you’ll have to rely on mosquito-bite prevention (including exposing as little skin as possible, applying topical insect repellents, knockdown insecticides and, where necessary, bed nets impregnated with permethrin) and taking antimalarial drugs before, during and after risk exposure. No antimalarial is 100% effective.
Malaria causes various symptoms but the essence of the disease is fever. In a malarious zone it is best to assume that fever is due to malaria unless blood tests rule it out. This applies up to a few months after leaving the area as well. Malaria is curable if diagnosed early.
Sporadic in the region, typhoid fever is a bacterial infection acquired from contaminated food or water or both. The germ can be transmitted by food handlers and flies, and can be present in inadequately cooked shellfish. It causes fever, debility and late-onset diarrhoea. Untreated it can produce delirium and is occasionally fatal, but the infection is curable with antibiotics. Vaccination is moderately effective but care with eating and drinking is equally important.
A parasite present in contaminated water, giardia produces bloating as well as a foul-smelling, persistent, although not ‘explosive’, diarrhoea. One dose (four tablets) of Tinidazole usually cures the infection.
Availability & cost of health care
The quality of health care varies throughout the country. In the main centres – Port Moresby and Lae – you can expect primary care of a high standard that is limited by the lack of access to sophisticated laboratory and radiological procedures. Specialists in internal medicine, surgery and obstetrics/gynaecology are also available in these centres, while in Port Moresby there are also paediatric, orthopaedic and psychiatric specialists.
In secondary centres, Madang for example, the quality of service can be lower – often because of lower-quality diagnostic and treatment facilities. Small hospitals, health centres and clinics are well-placed throughout these centres but staffing and facilities will vary. Intergovernmental or church mission aid and doctors may be in some of these facilities.
Private medical practitioners will usually expect payment in cash. Consultation fees for a general practitioner are often slightly less than those charged in a Western country. Where hospital facilities (government or private) exist, a cash deposit will be required. Public hospital outpatient services are free or of negligible cost, but apart from serious emergencies waiting time can be very long.
Commonly used drugs, including oral contraceptives and antibiotics, are available in the main centres where there are private pharmacies, but do not expect large supplies. If necessary, special drugs can be flown in. For diabetics, it may not be possible to obtain exactly the type of insulin preparation or drug that you are using and, although alternatives will be available, it is much safer to have enough of your own supply. The more up-to-date antiepileptics and antihypertensives may also be hard to find.
Tampons and pads can be easily obtained in major centres. In smaller centres they may have been sitting on the shelf for some time.
Private dentists practise in Port Moresby. Elsewhere, limited government dental services may be available.
Medical help will be available within a day’s journey. Self-medication for minor skin infections or cuts and for simple diarrhoea is reasonable. In the case of fever in a malarious area it is always best to try and rule malaria out. If you don’t have a diagnostic kit (which is not foolproof anyway), almost all clinics will have the ability to do a blood-smear check. Your medical adviser may have decided to prescribe self-treatment medication for malaria rather than preventive antimalarials, in which case you should still try to get an accurate diagnosis and certainly get to a major medical centre for treatment.
The region is generally not an ideal holiday destination for a pregnant woman. Malaria can cause miscarriage or premature labour and prevention cannot be guaranteed even when taking antimalarials. As far as vaccinations are concerned, the three recommended ones (for hepatitis A, hepatitis B and typhoid fever) do not contain live organisms so are not a problem, but the mumps/measles/rubella vaccine does contain live virus material and should not be given during pregnancy. Also, because of possible allergic reactions, Japanese B encephalitis vaccination is not recommended during pregnancy.
Travel with children can present special problems. In tropical climates, dehydration develops very quickly when a fever and/or diarrhoea and vomiting occur. Malaria is much more dangerous to children than to adults, as is dengue fever. Insect repellents are essential.
Treatments involving local herbs, roots and leaves have evolved over centuries, with each village having their own traditional healers. Some of these folk remedies have effective ingredients, and governments and research institutions are researching many of them. Claims such as AIDS cures and aphrodisiacs can be ignored. Tree-bark concoctions for fever are like aspirin. Chinese herbs are available in all of the main towns.
Buai, or betel-nut chewing is widespread in PNG. It has an astringent effect in the mouth but claims about other healing properties remain unproven. Prolonged use predisposes to mouth cancers.
Diarrhoea is caused by viruses, bacteria or parasites present in contaminated food or water. In temperate climates the cause is usually viral, but in the tropics bacteria or parasites are more usual. If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution (eg Diarolyte, Gastrolyte, Replyte). A few loose stools don’t require treatment, but if you start having more than four or five stools a day, you should take an antibiotic (usually a quinolone drug) and an anti-diarrhoeal agent (such as Loperamide). If diarrhoea is bloody, persists for more than 72 hours or is accompanied by fever, shaking, chills or severe abdominal pain, seek medical attention.