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Spain

Health & safety

Before you go

Prevention is the key to staying healthy while abroad. Some predeparture planning 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.

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Insurance

If you’re an EU citizen, a European Health Insurance Card, available from health centresor, in the UK, post offices, covers you for most medical care in public hospitals. It will not cover you for non-emergencies or emergency repatriation home. So even with the card, you will still have to pay for medicine bought from pharmacies, even if prescribed, and perhaps for a few tests and procedures. The card is no good for private medical consultations and treatment in Spain; this includes virtually all dentists, and some of the better clinics and surgeries. Citizens from other countries should find out if there is a reciprocal arrangement for free medical care between their country and Spain. If you do need health insurance, strongly consider a policy that covers you for ambulances and the worst possible scenario, such as an accident requiring an emergency flight home.

Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures; if you have to claim later make sure you keep all documentation. The former option is generally preferable, as it doesn’t require you to pay out of your own pocket in a foreign country.

Worldwide travel insurance is available at www.lonelyplanet.com/travel_services. You can buy, extend and claim online anywhere – even if you’re already on the road.

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Recommended vaccinations

No jabs are necessary for Spain. However, the World Health Organization (WHO) recommends that all travellers should 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.

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Internet resources

International Travel and Health, a WHO publication, is revised annually and is available online at www.who.int/ith. Other useful websites:

Age Concern (www.ageconcern.org.uk) Advice on travel for the elderly.

Fit for Travel (www.fitfortravel.scot.nhs.uk) General travel advice for the lay person.

Marie Stopes International (www.mariestopes.org.uk) Information on women’s health and contraception.

MD Travel Health (www.mdtravelhealth.com) Travel health recommendations for every country; updated daily.

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Dangers & annoyances

Spain is generally a pretty safe country. The main thing to be wary of is petty theft (which may of course not seem so petty if your passport, cash, travellers cheques, credit card and camera go missing). Most visitors to Spain never feel remotely threatened, but a sufficient number have unpleasant experiences to warrant an alert.

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Scams

There must be 50 ways to lose your wallet. As a general rule, talented petty thieves work in groups and capitalise on distraction. More imaginative strikes include someone dropping a milk mixture on to the victim from a balcony. Immediately a concerned citizen comes up to help you brush off what you assume to be pigeon poo, and thus suitably occupied you don’t notice the contents of your pockets slipping away.

Beware: not all thieves look like thieves. Watch out for an old classic: the ladies offering flowers for good luck. We don’t know how they do it, but if you get too involved in a friendly chat with these people, your pockets always wind up empty.

On some highways, especially the AP7 from the French border to Barcelona, bands of delinquents occasionally operate. Beware of men trying to distract you in rest areas and don’t stop along the highway if people driving alongside indicate you have a problem with the car. While one inspects the rear of the car with you, his pals will empty your vehicle. They have even been reported puncturing tyres of cars stopped in rest areas, then following and ‘helping’ the victim when they stop to change the wheel. Hire cars and those with foreign plates are especially targeted. When you do call in at highway rest stops, try to park close to the buildings and leave nothing of value in view.

Even parking your car can be fraught. In some towns fairly dodgy self-appointed parking attendants operate in central areas where you may want to park. They will direct you frantically to a spot. If possible, ignore them and find your own. If unavoidable, you may well want to pay them some token not to scratch or otherwise damage your vehicle after you’ve walked away. You definitely don’t want to leave anything visible in the car (or open the boot/trunk if you intend to leave luggage or anything else in it) under these circumstances.

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In transit

Deep Vein Thrombosis (DVT)

Blood clots may form in the legs during plane flights, chiefly because of prolonged immobility. 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 your leg muscles while sitting, drink plenty of fluids, and avoid alcohol and tobacco.

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While you're there

If you need an ambulance, call 061. For emergency treatment go straight to the urgencias (casualty) section of the nearest hospital.

Good health care is readily available, and farmacias (pharmacies) offer valuable advice and sell over-the-counter medication. In Spain, a system of farmacias de guardia (duty pharmacies) operates so that each district has one open all the time. When a pharmacy is closed, it posts the name of the nearest open one on the door.

Medical costs are lower in Spain than many other European countries, but can still mount quickly if you are uninsured.

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Traveller’s diarrhoea

If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution, such as Dioralyte. If diarrhoea is bloody, persists for more than 72 hours or is accompanied by a fever, shaking, chills or severe abdominal pain, you should seek medical attention.

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Altitude sickness

Lack of oxygen at high altitudes (over 2500m) affects most people to some extent. Symptoms of Acute Mountain Sickness (AMS) usually develop during the first 24 hours at altitude but may be delayed up to three weeks. Mild symptoms include headache, lethargy, dizziness, difficulty sleeping and loss of appetite. AMS may become more severe without warning and can be fatal. Severe symptoms include breathlessness, a dry, irritative cough (which may progress to the production of pink, frothy sputum), severe headache, lack of coordination and balance, confusion, irrational behaviour, vomiting, drowsiness and unconsciousness. There is no hard-and-fast rule as to what is too high: AMS has been fatal at 3000m, although 3500m to 4500m is the usual range.

Treat mild symptoms by resting at the same altitude until recovery, usually for a day or two. Paracetamol or aspirin can be taken for headaches. If symptoms persist or become worse immediate descent is necessary; even 500m can help. Drug treatments should never be used to avoid descent or to enable further ascent.

Diamox (acetazolamide) reduces the headache caused by AMS and helps the body acclimatise to the lack of oxygen. It is only available on prescription and those who are allergic to the sulphonamide antibiotics may also be allergic to Diamox.

In the UK, fact sheets are available from the British Mountaineering Council (0870 010 4878; www.thebmc.co.uk; 177-179 Burton Rd, Manchester, M20 2BB).

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Heat exhaustion & heatstroke

Heat exhaustion occurs following excessive fluid loss with inadequate replacement of fluids and salt. Symptoms include headache, dizziness and tiredness. Dehydration is happening by the time you feel thirsty – aim to drink sufficient water to produce pale, diluted urine. Replace lost fluids by drinking water and/or fruit juice, and cool the body with cold water and fans. Treat salt loss with salty fluids, such as soup, or add a little more table salt to foods than usual.

Heatstroke is much more serious, resulting in irrational and hyperactive behaviour, and eventually loss of consciousness and death. Rapid cooling by spraying the body with water and fanning is ideal. Emergency fluid and electrolyte replacement by intravenous drip is recommended.

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Bites & stings

Bees and wasps only cause real problems to those with a severe allergy (anaphylaxis). If you have a severe allergy to bee or wasp stings, carry an ‘epipen’ or similar adrenaline injection.

In forested areas watch out for the hairy reddish-brown caterpillars of the pine processionary moth. They live in silvery nests up in the pine trees and, come spring, they leave the nest to march in long lines (hence the name). Touching the caterpillars’ hairs sets off a severely irritating allergic skin reaction.

Some Spanish centipedes have a very nasty but nonfatal sting. The ones to watch out for are those with clearly defined segments, which may be patterned with, for instance, black and yellow stripes.

Jellyfish, with their stinging tentacles, generally occur in large numbers or hardly at all, so it’s fairly easy to know when not to go in the sea.

Mosquitoes are found in most parts of Europe. They may not carry malaria, but can cause irritation and infected bites. Use a DEET-based insect repellent.

Sandflies are found around the Mediterranean beaches. They usually cause only a nasty itchy bite but can carry a rare skin disorder called cutaneous leishmaniasis.

Scorpions are found in Spain and their sting can be distressingly painful, but not considered fatal.

The only venomous snake that is even relatively common in Spain is Lataste’s viper. It has a triangular-shaped head, is up to 75cm long, and grey with a zigzag pattern. It lives in dry, rocky areas, away from humans. Its bite can be fatal and needs to be treated with a serum, which state clinics in major towns keep in stock. Also to be avoided is the Montpellier snake, which is blue with a white underside and prominent ridges over the eyes. It lives mainly in scrub and sandy areas, but keeps a low profile and is unlikely to be a threat unless trodden on.

Check for ticks if you have been walking where sheep and goats graze: they can cause skin infections and other more serious diseases.

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Hypothermia

The weather in Spain’s mountains can be extremely changeable at any time of year. Proper preparation will reduce the risks of getting hypothermia. Even on a hot day the weather can change rapidly; carry waterproof garments and warm layers, and inform others of your route.

Hypothermia starts with shivering, loss of judgment and clumsiness. Unless rewarming occurs, the sufferer deteriorates into apathy, confusion and coma. Prevent further heat loss by seeking shelter, warm dry clothing, hot sweet drinks and shared body warmth.

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Water

Tap water is generally safe to drink in Spain. If you are in any doubt, ask ¿Es potable el agua (de grifo) ? (Is the (tap) water drinkable?). Do not drink water from rivers or lakes as it may contain bacteria or viruses that can cause diarrhoea or vomiting.

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Travelling with children

Make sure your children are up to date with routine vaccinations, and discuss possible travel vaccines well before departure as some vaccines are not suitable for children under one year of age.

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Women’s health

Travelling during pregnancy is usually possible but always seek a medical check-up before planning your trip. The most risky times for travel are during the first 12 weeks of pregnancy and after 30 weeks.

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Sexual health

Condoms are widely available, but emergency contraception may not be, so take the necessary precautions. When buying condoms, look for a European CE mark, which means they have been rigorously tested. Remember to also keep them in a cool, dry place so that they don’t crack and perish.

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