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Health & safety

Before you go

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 stating 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 most Southeast Asian countries, excluding Singapore, you can buy many medications over the counter without a doctor's prescription, but it can be difficult to find some of the newer drugs, particularly the latest antidepressant drugs, contraceptive pills and blood-pressure medications.

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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. If you're uninsured, emergency evacuation is 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 to be made 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, make sure you keep all 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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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.

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Recommended vaccinations

The World Health Organization (WHO) recommends the following vaccinations for travellers to Southeast Asia:

Adult diphtheria and tetanus Single booster recommended if 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 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 headache and a sore arm. Lifetime protection occurs in 95% of people.

Measles, mumps and rubellaTwo doses of MMR 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 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. A 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) or those at special risk:

Japanese BEncephalitis 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 travellers 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 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.

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Required vaccinations

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.

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Medical checklist

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; Tinidazole for giardiasis or amoebic dysentery

antihistamine for allergies, eg Cetrizine for daytime and Promethazine for night

anti-inflammatories, eg Ibuprofen

antiseptic, eg Betadine

antispasmodic for stomach cramps, eg Buscopa


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, safety pins, Elastoplasts, 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

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

throat lozenges

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

Ural or equivalent if you're prone to urine infections

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Internet resources

There is a wealth of travel health advice on the Internet. For further information, Lonely Planet (www.lonelyplanet.com) is a good place to start. The World Health Organization (WHO; www.who.int/ith) publishes a superb book called International Travel & Health, which is revised annually and is available free online. 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.

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Further reading

Lonely Planet's Healthy Travel - Asia & India is a handy pocket-size book that is packed with useful information including pre-trip 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.

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Dangers & annoyances

There's no glossing over the fact that the Philippines has more than its share of dangers and annoyances. These range from the danger of kidnapping in the south of the country to the wide range of scams and rip-offs that await the unwary traveller in Manila.

Of course, it's not just the outright dangers that can make travel unpleasant in various parts of the Philippines, it's also the annoyances. Depending upon your sensibilities and values, you may find the overt prostitution scene quite disturbing, particularly if you are unlucky enough to see evidence of the Philippines' bustling child prostitution industry (in places like Angeles).

It's also worth pointing out that Manila itself can be extremely challenging for some travellers. The poverty, air and noise pollution, crowds and heavy traffic conditions are enough to make even the most seasoned traveller yearn for escape. Luckily, escape is usually no more than a quick bus or plane ride away.

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The most common scam in the Philippines involves drugging a tourist's drinks or food and then robbing them. Be wary of any overly friendly stranger offering you food or drink. Some moneychangers also scam tourists out of money by using sleight-of-hand gimmicks and short-change scams.

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In transit

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 but not always on just one side. If 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.

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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.

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.

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While you're there

Hepatitis A

A problem found 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.

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Hepatitis B

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.

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Traveller's diarrhoea

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.

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Amoebic dysentery

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 Metroniadzole 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.

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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.

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