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Sri Lanka

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 very useful. 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 before travelling.

If you take any regular medication bring double your needs in case of loss or theft. You’ll be able to buy many medications over the counter in Sri Lanka without a doctor’s prescription, but it can be difficult to find some of the newer drugs, particularly the latest antidepressant drugs, blood pressure medications and contraceptive pills.

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Insurance

Even if you’re fit and healthy don’t travel without health insurance, as accidents do happen. Declare any existing medical conditions; 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 and scuba diving. If your health insurance doesn’t cover you for medical expenses abroad, consider getting extra insurance. If you’re uninsured remember that emergency evacuation is expensive; bills of more than US$100, 000 are not uncommon.

Find out in advance if your insurance company will make payments directly to providers or reimburse you later for overseas expenditures. (In many countries, doctors expect payment in cash.) Some policies offer a range of 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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Vaccinations

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 give 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 (aka 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 Sri Lanka (as well as being up to date with measles, mumps and rubella vaccinations).

Adult diphtheria & tetanus Single booster recommended if none in the previous 10 years. Side effects include 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 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 sore arm. In 95% of people lifetime protection results.

Polio In 2004 polio was still present in Sri Lanka. Only one booster is required as an adult for lifetime protection. Inactivated polio vaccine is safe during pregnancy.

Rabies Three injections in all. A booster after one year will then provide 10 years’ protection. Side effects are rare – occasionally headache and sore arm.

Typhoid Recommended for all travellers to Sri Lanka, even if you only visit urban areas. 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. Sore arm and fever may occur.

Varicella If you haven’t had chickenpox, discuss this vaccination with your doctor.

Immunisations recommended for long-term travellers (more than one month) or those at special risk:

Japanese B Encephalitis Three injections in all. Booster recommended after two years. Sore arm and headache are the most common side effects. Rarely, an allergic reaction of 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 quadravalent vaccine gives two to three years’ protection; meningitis group C vaccine gives around 10 years’ protection. Recommended for long-term backpackers aged under 25.

Tuberculosis (TB) 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 before entering Sri Lanka.

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Medical checklist

Recommended items for a personal medical kit:

antibacterial cream, eg Muciprocin

antibiotic for skin infections, eg Amoxicillin/Clavulanate or Cephalexin

antifungal cream, eg Clotrimazole

antihistamine: there are many options, eg Cetrizine for day and promethazine for night

anti-inflammatory, eg ibuprofen

antiseptic, eg Betadine

antispasmodic for stomach cramps, eg Buscopan

contraceptive

decongestant, eg pseudoephedrine

DEET-based insect repellent

diarrhoea medication: consider an oral rehydration solution (eg Gastrolyte), diarrhoea ‘stopper’ (eg Loperamide) and antinausea medication (eg Prochlorperazine); antibiotics for diarrhoea include Norfloxacin or ciprofloxacin, for bacterial diarrhoea Azithromycin, for giardia or amoebic dysentery Tinidazole

first-aid items, eg scissors, sticking plasters, bandages, gauze, thermometer (but not mercury), sterile needles and syringes, safety pins and tweezers

indigestion tablets or liquid, eg Quick Eze or Mylanta

insect repellent to impregnate clothing and mosquito nets, eg permethrin

iodine tablets (unless you’re pregnant or have a thyroid problem) to purify water

laxative, eg Coloxyl

migraine medication if you are a sufferer

painkiller tablets, eg paracetamol

steroid cream for allergic or itchy rashes, eg 1% to 2% hydrocortisone

sunscreen and hat

throat lozenges

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

urinary tract infection treatment such as Ural or equivalent, if you’re prone to urinary infections

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Further reading

Lonely Planet’s handy pocket-sized Healthy Travel: Asia & India is packed with useful information. Other recommended references include Traveller’s Health by Dr Richard Dawood and Travelling Well by Dr Deborah Mills – check out the website of Travelling Well (www.travellingwell.com.au).

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Dangers & annoyances

Theft

With the usual precautions, most people’s visit to Sri Lanka is trouble free. However, pickpockets can be active on crowded city buses, notably in Colombo along Galle Rd. They often work together – one to jostle you and the other to pick your pocket or slit your bag, often as you board a bus. All you can do is try to keep a little space around you and hold tight to what you’re carrying.

It’s often unwise to sleep with your windows open – particularly if you’re on the ground floor. Thieves sometimes use long poles with hooks to snaffle items of value. Monkeys are genetically gifted pilferers, and can slip through small gaps and steal food from your room.

One thieves’ trick reported by a number of travellers is to take the bottom one or two of a block of travellers cheques, so that you don’t notice anything missing until later.

If you do get robbed, go to the police – you won’t get your money back but passports and tickets are often jettisoned later. One Australian got her passport back after the pickpockets dropped it in a mailbox!

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Touts

Sri Lanka’s tourism industry provides an income to many, from the owner of a fancy hotel to the driver of a three-wheeler who drops you at the door. For those at the top of the financial pyramid, the money pours in; for the folks down the bottom, commissions are the name of the game. Touts or, as they like to call themselves, ‘friends’ or ‘guides’ lurk around bus and train stations, waiting to persuade you to go to a hotel or guesthouse of their choice. (The place you want to stay in, you see, is closed, full of giant bugs, overpriced etc.) If you stay at their suggested hotel, the tout will gain a commission, sometimes up to 30% of your bill. This is sometimes subsidised by extra charges to you, but often the hotelier makes do with less money. Saying you have a reservation, whether true or not, is a good ploy to fend off touts. However, many travellers like going with a tout, as often you get a better deal and you don’t have the headache of tramping the streets.

The airport is a prime breeding ground for touts (and scams). You may be approached with stories designed to make you sign up for a tour on the spot.

Restaurants also play the commission game: your guide gets a kickback for the lunch you ate. Most gem shops, handicraft stalls and spice gardens, basically any business connected to the tourist industry, also have some kind of commission system set up. Just remember: this is how many make a living – you can help out, or you can spend your money elsewhere. Either way, don’t get hung up on beating the commission racket.

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In transit

Deep vein thrombosis (DVT)

DVT occurs when blood clots form in the legs during plane flights, chiefly due to prolonged immobility. The longer the flight the greater the risk. Although most blood clots are reabsorbed uneventfully, some may break off and travel through the blood vessels to the lungs where they could cause life-threatening complications.

The chief symptom of DVT is swelling or pain in 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 with any of these symptoms should seek medical attention immediately.

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.

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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 drink plenty of (nonalcoholic) fluids and eat light meals. On arrival, seek exposure to natural sunlight and readjust your schedule (for meals, sleep etc) as soon as possible.

Antihistamines, such as dimenhydrinate (Dramamine), promethazine (Phenergan) 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

Availability of health care

Medical care is hugely variable in Sri Lanka. Colombo has some good clinics; they may be more expensive than local medical facilities but they’re worth using because a superior standard of care is offered.

Self-treatment may be appropriate if your problem is minor (eg traveller’s diarrhoea), if you are carrying the relevant medication and if you cannot attend a recommended clinic. If you think you may have a serious disease, especially malaria, do not waste time; travel to the nearest quality facility to receive attention. It is always better to be assessed by a doctor than to rely on self-treatment.

Before buying medication over the counter always check the use-by date and ensure the packet is sealed. Don’t accept items that have been poorly stored (eg lying in a glass cabinet exposed to the sun).

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Dengue

This mosquito-borne disease is becomingly increasingly problematic in the tropical world, especially in the cities. As there is no vaccine it can only be prevented by avoiding mosquito bites. The dengue-carrying mosquito bites both day and night so use insect avoidance measures at all times. Symptoms include high fever, severe headache and body ache (dengue was previously known as ‘breakbone fever’). Some people develop a rash and experience diarrhoea. There is no specific treatment – just rest and paracetamol; do not take aspirin because it increases the likelihood of haemorrhaging. See a doctor for diagnosis and monitoring.

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Hepatitis A

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, as you just need to allow time for the liver to heal. All travellers to Sri Lanka 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. The long-term consequences can include liver cancer and cirrhosis.

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Hepatitis E

Hepatitis E is transmitted through contaminated food and water. It has similar symptoms to hepatitis A but is far less common. It’s a severe problem in pregnant women, and can result in the death of both mother and baby. There is currently no vaccine, and prevention is by following safe eating and drinking guidelines.

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HIV

HIV is spread via contaminated body fluids. Avoid unsafe sex, unsterile needles (including in medical facilities), and procedures such as tattooing.

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Japanese b encephalitis

This viral disease is transmitted by mosquitoes and is rare in travellers. Like most mosquito-borne diseases, it is becoming a more common problem in many countries affected by mosquitoes. Most cases occur in rural areas, and vaccination is recommended for travellers spending more than one month outside of cities. There is no treatment, and a third of infected people will die, while another third will suffer permanent brain damage.

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Malaria

Malaria is caused by a parasite transmitted by the bite of an infected mosquito. The most important symptom of malaria is fever, but general symptoms such as headache, diarrhoea, cough or chills may also occur. Diagnosis can only be made by taking a blood sample.

Two strategies should be combined to prevent malaria – mosquito avoidance and antimalarial medications. Most people who catch malaria are taking inadequate or no antimalarial medication.

Travellers are advised to prevent mosquito bites by taking these steps:

using a DEET-containing insect repellent on exposed skin – wash this off at night, as long as you are sleeping under a mosquito net; natural repellents such as citronella can be effective but must be applied more frequently than products containing DEET;

sleeping under a mosquito net impregnated with permethrin;

choosing accommodation with screens and fans (if not air-conditioned);

impregnating clothing with permethrin in high-risk areas;

wearing long sleeves and trousers in light colours;

using mosquito coils;

spraying your room with insect repellent before going out for your evening meal.

There are a variety of medications available. The effectiveness of the chloroquine & Paludrine combination is limited in many parts of South Asia. Common side-effects include nausea (40% of people) and mouth ulcers.

The daily tablet doxycycline is a broad-spectrum antibiotic that has the added benefit of helping to prevent a variety of diseases including leptospirosis, tick-borne disease and typhus. Potential side effects include photosensitivity (a tendency to sunburn), thrush (in women), indigestion, heartburn, nausea and interference with the contraceptive pill. More-serious side effects include ulceration of the oesophagus; you can help prevent this by taking your tablet with a meal and a large glass of water, and never lying down within half an hour of taking it. It must be taken for four weeks after leaving the risk area.

Lariam (Mefloquine) has received much bad press, some of it justified, some not. This weekly tablet suits many people. Serious side effects are rare but include depression, anxiety, psychosis and fits. Anyone with a history of depression, anxiety, other psychological disorders or epilepsy should not take Lariam. If you are pregnant you should consult your doctor before taking Lariam. Tablets must be taken for four weeks after leaving the risk area.

The new drug Malarone is a combination of Atovaquone and Proguanil. Side effects are uncommon and mild, most commonly nausea and headache. It is the best tablet for scuba divers and for those on short trips to high-risk areas. It must be taken for one week after leaving the risk area.

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Rabies

This uniformly fatal disease is spread by the bite or lick of an infected animal, most commonly a dog or monkey. You should seek medical advice immediately after any animal bite, and begin postexposure treatment. Having a pretravel vaccination means that the postbite treatment is very much simplified. If an animal bites you, gently wash the wound with soap and water and apply iodine-based antiseptic. If you are not prevaccinated you will need to receive rabies immunoglobulin as soon as possible, and this is almost impossible to obtain in much of Sri Lanka.

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Tuberculosis

While TB is rare in travellers, those who have significant contact with the local population (such as medical and aid workers and long-term travellers) should take precautions. Vaccination is usually only given to children under the age of five, but adults at risk are recommended to have pre- and post-travel TB testing. The main symptoms are fever, a cough, weight loss, night sweats and tiredness.

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Typhoid

This serious bacterial infection is spread via food and water. It gives a high and slowly progressive fever, and a headache, and it 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 Sri Lanka. Be aware that vaccination is not 100% effective, so you must still be careful with what you eat and drink.

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Traveller’s diarrhoea

Traveller’s diarrhoea is usually caused by a bacteria (there are numerous potential culprits), and therefore responds promptly to antibiotic treatment. 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, though it can be helpful (eg 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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Insect bites & stings

Bedbugs don’t carry disease but their bites are very itchy. They live in the cracks of furniture and walls, and then migrate to the bed at night to feed on you. You can treat the itch with an antihistamine.

Lice inhabit various parts of your body but most commonly your head and pubic area.

Ticks are contracted after walking in rural areas and are commonly found behind the ears, on the belly and in armpits. If you have had a tick bite and experience symptoms, such as a rash at the site of the bite or elsewhere, fever or muscle aches, you should see a doctor. The antimalarial drug doxycycline prevents tick-borne diseases.

Leeches are found in humid rainforest areas. They do not transmit any disease but their bites are often intensely itchy for weeks afterwards and can easily become infected. Apply an iodine-based antiseptic to any leech bite to help prevent infection.

Bee and wasp stings mainly cause problems for people who are allergic to them. Anyone with a serious bee or wasp allergy should carry an adrenaline injection (eg an Epipen) for emergency treatment.

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Skin problems

Fungal rashes are common in humid climates. There are two fungal rashes that affect travellers. The first occurs in moist areas of the body that get less air, such as the groin, armpits and between the toes. It starts as a red patch that slowly spreads and is usually itchy. Treatment involves keeping the skin dry, avoiding chafing and using an antifungal cream, such as Clotrimazole or Lamisil.

Cuts and scratches become easily infected in humid climates. Take meticulous care of any cuts and scratches to prevent complications such as abscesses. Immediately wash all wounds in clean water and apply antiseptic.

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Snakes

There are five species of venomous snakes in Sri Lanka, and it is relatively common to spot them, especially in the dry zone area around Anuradhapura and Polonnaruwa. Be careful when wandering around the ancient ruins. Snake bites do not cause instantaneous death, and antivenins are usually available. Wrap the bitten limb tightly, as you would for a sprained ankle, and then attach a splint to immobilise it. Keep the victim still and seek medical help, if possible with the dead snake for identification.

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