Health & safety
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 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. If carrying syringes or needles, be sure to have a physician's letter documenting their medical necessity.
Insurance
If your health insurance does not 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 many countries doctors expect payment in cash.)
Really serious illness or injury may require evacuation, eg to Auckland; make sure that your health insurance has provision for evacuation. Under these circumstances hospitals will accept direct payment from major international insurers but for all other health costs cash up-front is the usual requirement.
New Zealanders may have free access to public but not private facilities in the Cook Islands.
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Recommended vaccinations
The World Health Organization (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. A recent influenza vaccination is always a good idea when travelling. If you have not had chicken pox (varicella) consider being vaccinated.
Medical checklist
It is a very good idea to carry a medical and first-aid kit with you, to help yourself in the case of minor illness or injury. Following is a list of items you should consider packing.
acetaminophen (paracetamol) or aspirin*
adhesive or paper tape
antibacterial ointment, eg Bactroban for cuts and abrasions (prescription only)
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)
anti-inflammatory drugs, eg ibuprofen
bandages, gauze, gauze rolls, waterproof dressings
DEET-containing insect repellent for the skin
Permethrin-containing insect spray for clothing, tents and bed nets
pocket knife+
scissors, safety pins, tweezers+
steroid cream or hydrocortisone cream (for allergic rashes)
sun block
thermometer
+Not in carry-on luggage!
Internet resources
There is a wealth of travel health advice on the Internet. The World Health Organization (WHO) produces a superb text called International Travel and Health, which is revised annually. It is no longer published in book form but is available online at no cost at www.who.int/ith/. Other websites of general interest are MD Travel Health at 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 (CDC) at www.cdc.gov; Fit for Travel at www.fitfortravel.scot.nhs.uk, which has up-to-date information about outbreaks and is very user-friendly, and www.traveldoctor.com.au a similar Australasian site.
It's also a good idea to consult your government's travel health website before departure:
Australia (www.dfat.gov.au/travel/)
Canada (www.hc-sc.gc.ca/pphb-dgspsp/tmp-pmv/pub_e.html)
New Zealand (www.mfat.govt.nz/travel)
UK (www.doh.gov.uk/traveladvice/index.htm)
USA (www.cdc.gov/travel/)
Further reading
Good options for further reading include: Travel with Children by Cathy Lanigan; Healthy Travel Australia, New Zealand and the Pacific by Dr Isabelle Young; and Your Child's Health Abroad: A Manual for Travelling Parents by Dr Jane Wilson-Howarth and Matthew Ellis.
Required & recommended vaccinations
Vaccinations are recommended for hepatitis A, hepatitis B and typhoid fever.
Side-effects of Vaccinations
All injected 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 least likely with hepatitis A and a little more common with hepatitis B and typhoid inoculations. Typhoid inoculation can cause a sensation of nausea within 24 hours and hepatitis B vaccine can produce temporary joint pains.
Dangers & annoyances
The Cook Islands is safer than most places in the world, but a certain amount of common sense is still called for. In general, you will find the Cooks to be just as idyllic as the tourist brochures lead you to expect and the people to be some of the friendliest you will ever meet. As anywhere, crime does exist, but it's practically unheard of for anyone to be attacked or robbed. With normal, minimal caution you should have no problems.
Theft
For some reason, when people come on holiday to the tropics, they leave their sense of security at home. As anywhere else in the world, if you leave wallets lying on car seats or hotel-room doors unlocked, you're at risk of losing your possessions. Even theft of clothes from clotheslines. It's a good idea to check your valuables with hotel management, to prevent theft from your room, and it's always sensible not to flash expensive watches and digital cameras around on an island where there's not too much disposable income. (If you do get something stolen, think twice before you automatically blame the locals; some of the travellers staying here are at the end of round-the-world trips, and your cash might see them home).
You're in more danger of being struck by a falling coconut in the Cook Islands that you are of being mugged.
In transit
Deep vein thrombosis (dvt)
Blood clots may form in the legs during plane flights, chiefly because of prolonged immobility. The longer the flight, the greater the risk. The chief symptom of DVT is swelling or pain of 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 breathing difficulties. 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, contract the leg muscles while sitting, drink plenty of fluids and avoid alcohol and tobacco.
Jet lag & motion sickness
To avoid jet lag (common when crossing more than five time zones) try drinking plenty of nonalchoholic fluids and eating light meals. Upon arrival, get exposure to natural sunlight and readjust your schedule (for meals, sleep and so on) as soon as possible.
Antihistamines such as dimenhydrinate (Dramamine) and meclizine (Antivert, Bonine) are usually the first choice for treating motion sickness. A herbal alternative is ginger.
While you're there
Availability & cost of health care
Rarotonga has readily available doctors in private practice, standard hospital and laboratory facilities with consultants in the major specialties - internal medicine, obstetrics/gynaecology, orthopaedics ophthalmology, paediatrics, pathology, psychiatry and general surgery. Private dentists, opticians and pharmacies are also available. The outer islands have more basic services.
Private consultation and private hospital fees are approximately equivalent to Australian costs. Government-provided service fees vary from modest to negligible but waiting times can be long. Direct payment is required everywhere except where a specific arrangement is made, eg in the case of evacuation or where prolonged hospital stay is necessary; your insurer will need to be contacted by you. Although Rarotonga hospitals will accept credit cards, there might be difficulty with outer island hospitals. If a credit card is not accepted you should be able to arrange cash on credit through the local banking system.
Most commonly used medications are available. Private pharmacies are not allowed by law to dispense listed drugs without prescription from a locally registered practitioner, but many will do so for travellers if shown the container. It is best to have a sufficient supply of a regularly taken drug as a particular brand may not be available and sometimes quantities can be limited. This applies particularly to psychotropic drugs like antidepressants, antipsychotics, anti-epileptics or mood elevators. Insulin is available even in smaller centres, but you cannot guarantee getting a particular brand, combination or preferred administration method. If you have been prescribed 'the very latest' oral antidiabetic or antihypertensive make sure you have enough for the duration of your travel.
The standard of medical and dental care is generally quite good even if facilities are not sophisticated. The overall risk of illness for a normally healthy person is low; the most common problems being diarrhoeal upsets, viral sore throats, and ear and skin infections; all of which can mostly be treated with self-medication. For serious symptoms, eg sustained fever, chest or abdominal pains it is best to go to the nearest clinic or private practitioner in the first instance.
Tampons and pads are readily available. Dengue fever, especially in the first three months of pregnancy, poses a hazard because of fever but otherwise there is no reason why a normal pregnancy should prevent travel to the Cook Islands. However, on general principle immunisation in the first three months of pregnancy is not recommended.
For young children, it is again dengue fever that could be a problem. The disease tends to come in epidemics mainly in the hotter, wetter months so it should be possible to plan holidays accordingly.
Infectious diseases
Despite the long list, the realistic risks to visitors from infectious diseases are very low with the exception of dengue fever.
Dengue fever
Dengue fever is a virus disease spread by the bite of a day-biting mosquito. It causes a feverish illness with headache and severe muscle pains similar to those experienced with a bad, prolonged attack of influenza. Another name is 'break bone fever' and that's what it feels like. Danger signs include prolonged vomiting, blood in the vomit and a blotchy rash. There is no preventive vaccine and mosquito bites should be avoided whenever possible. Self-treatment involves paracetamol, fluids and rest. Do not use aspirin. Haemorrhagic dengue has been reported only occasionally, manifested by signs of bleeding and shock and requires medical care.
Eosinophilic meningitis
A strange illness manifested by scattered abnormal skin sensations, fever and occasionally by the meningitis (headache, vomiting, confusion, neck and spine stiffness) that gives it its name. Eosinophilic meningitis is caused by a microscopic parasite - the rat lungworm - which contaminates raw food. There's no proven specific treatment, but symptoms may require hospitalisation. For prevention pay strict attention to advice on food and drink.
Hepatitis a
A virus disease causing liver inflammation spread by contaminated food or water. Fever, nausea, debility and jaundice (yellow colouration of the skin, eyes and urine) occur and recovery is slow. Most people recover completely but it can be dangerous to people with other forms of liver disease, the elderly and sometimes to pregnant women towards the end of pregnancy. Food is easily contaminated by food handlers or servers, and by flies. There is no specific treatment. The vaccine is close to 100% protective.
Hepatitis b
A virus disease causing liver inflammation but the problem is much more serious than hepatitis A and frequently goes on to cause chronic liver disease and even cancer. It is spread, like HIV, by mixing body fluids, ie sexual intercourse, contaminated needles and accidental blood contamination. Treatment is complex and specialised but vaccination is highly effective.
Hepatitis c
A virus disease similar to hepatitis B causing liver inflammation which can go on to chronic liver disease or result in a symptomless carrier state. Spread almost entirely by blood contamination from shared needles or contaminated needles used for tattooing or body piercing. Treatment is complex and specialised. There is no vaccine available.
Hiv/aids
The incidence of HIV infection is on the rise in the whole South Pacific. Safe sex practise is essential at all times. If an injection is needed in a smaller clinic it is best to provide your own needles. Blood transfusion laboratories do tests for HIV.
Typhoid fever
A bacterial infection acquired from contaminated food or water. The germ can be transmitted by food handlers or 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.
Traveller's diarrhoea
Diarrhoea, ie frequent, loose bowel movements, 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 start taking an antibiotic (usually a quinolone drug) and an antidiarrhoeal 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 you should seek medical attention. Giardiasis is a particular form of persistent, although not 'explosive', diarrhoea caused by a parasite present in contaminated water. One dose (four tablets) of tinidazole usually cures the infection.
To prevent diarrhoea pay strict attention to the precautions regarding food and water.
Environmental hazards
Threats to health from animals and insects are rare indeed but you need to be aware of them.
Bites & stings
The Cooks are blessedly free of dangerous land creatures.
Insects
Mosquitoes can be a real nuisance in the Cooks at certain times of year, particularly during the rainy season from around mid-December to mid-April. The worst times for mosquitos are at dawn and dusk. Use repellent (those containing the compound DEET are the most effective). Mosquito coils are available everywhere in the Cook Islands; lighting one will keep your room free of mosquitoes for about six hours. Screens on windows or mosquito nets over beds are also helpful.
Bee, wasp, centipede and other insect stings are usually painful rather than dangerous. Large centipedes can give a painful or irritating bite, but they're no more dangerous to your health than a bee or wasp sting.
Calamine lotion or Stingose spray will relieve insect bites and stings. Ice packs or antihistamine cream will reduce the pain and swelling. Or you can reduce the itch by using the recommended local remedy for all insect bites: the sap from the base of a rubber-tree leaf.
Jellyfish
Jellyfish are reasonably common outside the encircling coral reef, but are very rarely found inside the island lagoons. The notorious box jellyfish (seawasp) has not been recorded, but the blue-coloured Indo-Pacific 'Man o' War' is found in Cook Island waters. If you see these floating in the water or stranded on the beach it is wiser not to go in. The sting is very painful. Treatment involves ice packs and vinegar; do not use alcohol. Smaller cubo-medusae are abundant and are found particularly on still, overcast days. They usually produce only uncomfortably irritating stings but rarely can cause generalised symptoms, especially in someone with poorly controlled heart disease.
Poisonous cone shells
Poisonous cone shells are plentiful along shallow coral reefs. Stings can be avoided by handling the shell at its blunt end only and preferably using gloves. Stings mainly cause local reactions but nausea, faintness, palpitations or difficulty in breathing are all signs flagging the need for medical attention.
Sea snakes
As in all tropical waters, sea snakes may be seen around coral reefs. Unprovoked, sea snakes are extremely unlikely to attack and their fangs will not penetrate a wet suit. First-aid treatment consists of compression bandaging and splinting of the affected limb. Antivenom is effective, but may have to be flown in. Only about 10% of sea-snake bites cause serious poisoning.
Coral ear
This is the common name for inflammation of the ear canal. It has nothing to do with coral but is caused by water entering the ear canal, activating fungal spores and resulting in secondary 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. Apparently trivial, it can be very, very painful and can spoil a holiday. Apart from diarrhoea it is the most common reason for tourists to consult a doctor. Self-treatment with an antibiotic-plus-steroid eardrop preparation (eg Sofradex, Kenacort Otic) is very effective. Stay out of the water until the pain and itch have gone.
Coral cuts
Cuts and abrasions from dead coral cause no more trouble than similar injuries from any other sort of rock, but live coral can cause prolonged infection. If you injure yourself on live coral don't wait until later to treat it. Get out of the water as soon as possible, cleanse the wound thoroughly (getting out all the little bits of coral), apply an antiseptic and cover with a waterproof dressing. Then get back in the water if you want to.
Diving hazards
Since the Cooks have wonderful opportunities for scuba diving, it is easy to get overexcited and neglect strict depth and time precautions. The temptation to spend longer than safe times at relatively shallow depths is great and a major 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. There's no compression chambers in the Cook Islands. If you have not taken out insurance before leaving home you may be able to do so online with Divers' Alert Network (DAN).
Food & water
The municipal water supply in Avarua and other large towns can be trusted, but elsewhere avoid untreated tap water, and after heavy rain it's worth boiling the water before you drink. In some areas the only fresh water available may be rain water collected in tanks and this should certainly be boiled. Food in restaurants, particularly resort restaurants, is safe. Be adventurous by all means but expect to suffer the consequences if you succumb to adventurous temptation by trying raw fish or crustaceans as eaten by some locals.
Fish poisoning
Rarotonga and several of the other Cook Islands have a serious problem with ciguatera, a form of fish poisoning that affects otherwise safe and edible reef fish living in the island lagoons. Poisoning is characterised by stomach upsets, itching, faintness, slow pulse and bizarre inverted sensations, eg cold feeling hot and vice versa. Ciguatera has been reported in many carnivorous reef fish, especially barracuda but also red snapper, Spanish mackerel and moray eels. There is no safe test to determine whether a fish is poisonous or not, but it's important to remember that the disease only affects reef fish - deep-sea fish (such as wahoo, tuna and mahi mahi) are perfectly safe to eat. You're unlikely to find reef fish on any local restaurant menus anyway, so it's only really a cause for concern if you're catching your own fish inside the lagoon.
The underlying cause of the disease is unclear, but fish caught after times of reef destruction, eg after a major hurricane, are more likely to be poisonous. Pollution is also thought to be a contributory factor in the development of the disease.
Treatment consists of rehydration and if the pulse is very slow, medication may be needed. Healthy adults will make a complete recovery, although disturbed sensation may persist for some weeks.
Heat exhaustion
Heat exhaustion is actually a state of dehydration associated to a greater or lesser extent with salt loss. Natural heat loss is through sweating, making it easy to become dehydrated without realising it. Thirst is a late sign. Small children and old people are especially vulnerable. For adults, heat exhaustion is prevented by drinking at least 3L of water per day and more if actively exercising. Children need about 1.5L to 2.5L per day. Salt replacement solutions are useful since muscle weakness and cramps are due to salt loss 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 pint (0.5L) of water. Salt tablets can result in too much salt being taken in, causing headaches and confusion.
Heat stroke
When the cooling effect of sweating fails, heat stroke ensues. This is a dangerous and emergency condition characterised not only by muscle weakness and exhaustion, but by mental confusion. Skin will be hot and dry. If this occurs 'put the fire out' by cooling the body with water on the outside and if possible with cold drinks for the inside. Seek medical help as a follow-up anyway, but urgently if the person can't drink.
Sunburn
It should go without saying that exposure to the ultraviolet (UV) rays of the sun causes burning of the skin with accompanying pain, dehydration and misery (together with the long-term danger of skin cancer) but experience shows that reminders are necessary. The time of highest risk is between 11am and 3pm and remember that cloud cover does not block out UV rays. The Australian 'Slip, slop, slap' slogan is a useful mantra - slip on a T-shirt or blouse, slop on a sunscreen lotion of at least 20+ rating and slap on a hat. Treat sunburn like any other burn - cool, wet dressings are best. Severe swelling may respond to cortisone cream.
Rarotonga & the Cook Islands
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