Health & safety
Pick up a copy of Lonely Planet’s Healthy Travel Asia & India. Other recommended references include Traveller’s Health by Dr Richard Dawood and Travelling Well by Dr Deborah Mills (www.travellingwell.com.au).
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. 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 expenses; in many countries doctors expect payment 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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There is a wealth of travel health advice on the internet. The World Health Organization (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 (CDC; www.cdc.gov) website also has good general information.
The following are recommended items for personal medical kits:
antifungal cream (eg Clotrimazole)
antibacterial cream (eg Muciprocin)
antibiotics if you are planning on visiting rural areas: one for skin infections (eg Amoxicillin/Clavulanate or Cephalexin) and another for diarrhoea (eg Norfloxacin or Ciprofloxacin)
antihistamine – there are many options (eg Cetrizine for daytime and Promethazine for night)
antiseptic (eg Betadine)
anti-spasmodic for stomach cramps (eg Buscopan)
decongestant (eg Pseudoephedrine)
DEET-based insect repellent
anti-diarrhoeal treatments – consider an oral-rehydration solution (eg Gastrolyte), diarrhoea ‘stopper’ (eg Loperamide) and anti-nausea medication (eg Prochlorperazine)
first-aid items such as scissors, elastoplasts, bandages, gauze, thermometer (but not mercury), sterile needles and syringes, safety pins and tweezers
anti-inflammatory (eg Ibuprofen)
indigestion tablets (eg Quick Eze or Mylanta)
iodine tablets (unless you are pregnant or have a thyroid problem) to purify water
Laxative (eg Coloxyl)
migraine medicine – sufferers should take their personal medicine
Permethrin for clothing and mosquito nets
steroid cream for allergic/itchy rashes (eg 1% to 2% hydrocortisone)
sunscreen and hat
thrush (vaginal yeast infection) treatment (eg Clotrimazole pessaries or Diflucan tablet)
Ural or equivalent if you’re prone to urine infections
Pack medications in their original, clearly labelled containers. A signed and dated letter from your physician describing your medical conditions and regular medications (use generic names) is also a good idea. If carrying syringes or needles, be sure to have a physician’s letter documenting their medical 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. In Korea you need a local doctor’s prescription to buy medication, and it may be difficult to obtain particular branded medications available in Western countries.
No special vaccinations are required or recommended for South Korea, but check the latest situation with your tour company before visiting the North.
Drivers routinely jump red lights, so take extra care on pedestrian crossings even if they are protected by lights. Drivers almost never stop for pedestrian crossings that are not protected by traffic lights, so they are useless. Motorcyclists often drive along pavements and pedestrian crossings, particularly in Seoul. Cars also find pavements and pedestrian crossings a convenient place to park.
The lack of street names, signs and numbers can make navigation around cities difficult; don’t expect taxi drivers, passers-by and even shopkeepers to know them. Tip: the small number signs on some buildings have the street name underneath, although only in Han·geul.
Rules on where smoking is and isn’t allowed (like the driving rules) are not always enforced. In theory smoking is banned in schools and hospitals and on public transport, and restricted to designated smoking areas in other public places. The nonsmokers are winning the war but hardcore smokers still light up in restaurants, cafes, bars and PC bang.
Deep vein thrombosis (DVT)
Deep vein thrombosis 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. When a blood clot travels to the lungs, it may cause chest pain and difficulty in breathing. Travellers who find that they have 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 and tobacco.
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), prochlorperazine (Phenergan) and meclizine (Antivert, Bonine) are generally the first choice for the treatment of motion sickness. Their major side effect is drowsiness. A herbal alternative is ginger, which works like a charm for some people.
Air pollution, particularly from vehicles, is an increasing problem in Seoul. If you have severe respiratory problems, speak with your doctor before travelling to any heavily polluted urban centres. This pollution also causes minor respiratory problems such as sinusitis, dry throat and irritated eyes. If troubled by the pollution, leave the city for a few days and get some fresh air.
Eating in restaurants is the biggest risk factor for contracting travellers’ diarrhoea. Ways to avoid it include eating only freshly cooked food and avoiding shellfish and food that has been sitting around in buffets. Peel all fruit and cook vegetables. Eat in busy restaurants with a high turnover of customers.
A mosquito-borne disease that is very rare in travellers; mosquito-avoidance measures are the best way to prevent this disease. It’s widespread in rice-growing areas in southwest Korea.
A problem throughout the country, 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 Korea should be vaccinated against hepatitis A.
The only sexually transmitted disease that can be prevented by vaccination, hepatitis B is spread by body fluids, including sexual contact. Up to 10% of the population are carriers of hepatitis B, and usually are unaware of this. The long-term consequences can include liver cancer and cirrhosis.
HIV is also spread by body fluids. Avoid unsafe sex, sharing needles, invasive cosmetic procedures such as tattooing, and needles that have not been sterilised in a medical setting.
Influenza (flu) symptoms include high fever, muscle aches, runny nose, cough and sore throat. It can be very severe in people over the age of 65 or in those with underlying medical conditions such as heart disease or diabetes – vaccination is recommended for these individuals. There is no specific treatment, just rest and paracetamol.
Japanese B encephalitis
This viral disease is transmitted by mosquitoes, but is very rare in travellers. Most cases occur in rural areas, and vaccination is recommended for travellers spending more than one month outside cities. There is no treatment, and a third of infected people will die, while another third will suffer permanent brain damage. The highest risk is in the southwest rice-growing areas.
Leptospirosis is contracted after exposure to contaminated fresh water (eg rivers). Early symptoms are very similar to the ‘flu’ and include headache and fever. It can vary from a very mild to a fatal disease. Diagnosis is through blood tests, and it is easily treated with Doxycycline.
This tick-borne disease occurs in the summer months. Symptoms include an early rash and general viral symptoms, followed weeks to months later by joint, heart or neurological problems. Prevention is by using general insect-avoidance measures and checking yourself for ticks after walking in forest areas. Treatment is with Doxycycline.
This sometimes fatal disease is spread by the bite or lick of an infected animal – most commonly a dog. You should seek medical advice immediately after any animal bite and commence post-exposure treatment. If an animal bites you, gently wash the wound with soap and water, and apply iodine-based antiseptic. If you are not pre-vaccinated, you will need to receive rabies immunoglobulin as soon as possible.
Sexually transmitted diseases are common throughout the world and the most common include herpes, warts, syphilis, gonorrhoea and chlamydia. People carrying these diseases often have no signs of infection. Condoms will prevent gonorrhoea and chlamydia but not warts or herpes. If after a sexual encounter you develop any rash, lumps, discharge or pain when passing urine, seek immediate medical attention. If you have been sexually active during your travels, have an STD check on your return home.
Only North Korea has significant risk. While tuberculosis is rare, travellers, medical and aid workers, and long-term travellers who have significant contact with the local population, should take precautions. Vaccination is usually only given to children under the age of five, but adults at risk are recommended to undertake pre- and post-travel TB testing. The main symptoms are fever, cough, weight loss, night sweats and tiredness.
This serious bacterial infection is spread via food and water. It gives a high and slowly worsening fever and headache, and may be accompanied by a dry cough and stomach pain. It is diagnosed by blood tests and treated with antibiotics. Vaccination is recommended for all travellers spending more than a week in Korea and travelling outside Seoul. Be aware that vaccination is not 100% effective, so you must still be careful with what you eat and drink.
Scrub typhus is present in the scrub areas of Korea. This is spread by a mite and is very rare in travellers. Symptoms include fever, muscle pains and a rash. Following general insect-avoidance measures when walking in the scrub will help you avoid this disease. Doxycycline works as a prevention and treatment for typhus.
Giardia 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 Giardia, but work in Nepal has shown that they are not specific to Giardia. 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. Giardia is not common in South Korea.
Availability & cost of health care
South Korea is a well-developed country, and the quality of medical care reflects this. Standards of medical care are higher in Seoul and other cities than in rural areas, although making yourself understood can be a problem anywhere.
A recommended hospital in Seoul is the Samsung Medical Center & International Health Service (02-3410 0200; 50 Ilwon-Dong, Gangnam-gu).
Travellers’ diarrhoea is the most common problem which affects travellers – between 10% and 20% of people visiting South Korea will suffer from it. The risk in North Korea is more like 40% to 60%. In the majority of cases, travellers’ diarrhoea is triggered by a bacteria (there are numerous potential culprits), and therefore responds promptly to treatment with antibiotics, which will depend on your circumstances: how sick you are, how quickly you need to get better, where you are etc.
Travellers’ 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 orAzithromycin 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.
In most well-developed areas of Korea, supplies of sanitary products are readily available. Birth-control options may be limited, so bring adequate supplies of your own form of contraception. Heat, humidity and antibiotics can all contribute to thrush. Treatment is with antifungal creams and pessaries such as Clotrimazole. A practical alternative is a single tablet of Fluconazole (Diflucan). Urinary tract infections can be precipitated by dehydration or long bus journeys without toilet stops; bring suitable antibiotics.
Pregnant women should receive specialised advice before travelling. The ideal time to travel is in the second trimester (between 16 and 28 weeks), when the risk of pregnancy-related problems are at their lowest and pregnant women generally feel at their best. During the first trimester there is a risk of miscarriage and in the third trimester complications such as premature labour and high blood pressure are possible. It’s wise to travel with a companion. Always carry a list of quality medical facilities available at your destination and ensure you continue your standard antenatal care at these facilities. Avoid rural travel in areas with poor transportation and medical facilities. Most of all, ensure travel insurance covers all pregnancy-related possibilities, including premature labour.
Travellers’ diarrhoea can quickly lead to dehydration and result in inadequate blood flow to the placenta. Many of the drugs used to treat various diarrhoea bugs are not recommended in pregnancy. Azithromycin is considered safe.