Health & safety
Before you go
Prevention is the key to staying healthy while overseas. A little planning before departure, particularly for pre-existing illnesses, will save you a lot of trouble later. Make sure you 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. (Check the Travel Links section of LonelyPlanet.com at www.lonelyplanet.com for more information.) Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. (In French Polynesia doctors will often expect payment in cash.)
If you are a European Union citizen you have the same rights in French Polynesia as you do in France; remember to fill in the EU Form E111 before leaving home. It is still best to have private health insurance cover. Serious illness or injury may require evacuation, eg from an outer island to Tahiti or even from Tahiti to a major city such as Los Angeles or Auckland; make sure that health insurance has provision for evacuation. Under these circumstances hospitals accept direct payment from major international insurers but for all other health costs cash up front is usually required.
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Recommended vaccinations
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, make sure you 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.
antibiotics (prescription only), eg ciprofloxacin (Ciproxin) or norfloxacin (Utinor; Noroxin)
antibiotic plus steroid eardrops (prescription only), eg Sofradex, Kenacort Otic
antidiarrhoeal drugs, eg loperamide
acetaminophen (paracetamol) or aspirin
anti-inflammatory drugs, eg ibuprofen
antihistamines (for hay fever and allergic reactions)
antibacterial ointment, eg Bactroban for cuts and abrasions (prescription only)
antigiardia tablets such as tinidazole (prescription only)
steroid cream or hydrocortisone cream (for allergic rashes)
bandages, gauze, gauze rolls, waterproof dressings
adhesive or paper tape
scissors, safety pins, tweezers
thermometer
pocket knife
DEET-containing insect repellent for the skin
Permethrin-containing insect spray for clothing, tents and bed nets
sun block
oral rehydration salts, eg Gastrolyte,
Diarolyte, Replyte
iodine tablets (for water purification)
syringes and sterile needles, and intravenous fluids if travelling in very remote areas
Note that aspirin should not be used for fever because it can cause bleeding in dengue fever. Also, don't take the scissors, tweezers or pocket knife in your carry-on luggage.
Internet resources
There is a wealth of travel health advice on the Internet. For further information, LonelyPlanet.com (www.lonelyplanet.com) is a good place to start. 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:
Centers for Disease Control and Prevention (www.cdc.gov)
Fit for Travel (www.fitfortravel.scot.nhs.uk) Up-to-date information about outbreaks, very user-friendly.
MD Travel Health (www.mdtravelhealth.com) Provides complete travel health recommendations for every country, updated daily, at no cost.
Travel Doctor (www.traveldoctor.com.au) An Australasian site, similar to Fit for Travel.
It's also a good idea to consult your government's travel health website before your 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
French Polynesia is not a particularly dangerous or annoying destination, which is all the more reason to go there.
Although it's rarely a problem for travellers, French Polynesian men like their beer, particularly at festivals and feasts. There are two points to remember: some French Polynesians are not good drunks and most of them are probably bigger than you. The locally grown marijuana, known as pakalolo, is very prevalent, but while locals will often offer to share a joint with you, they'll rarely sell the drug to foreigners.
You're unlikely to be kept awake by late-night revelry anywhere except in the heart of Pape'ete, but the roosters are another matter. A nonstop symphony can 'entertain' you until the early hours (when roosters are supposed to make a racket) and then some of them duly begin all over again.
French Polynesia may not have malaria, but the mosquitoes are hellbent on sucking blood anyway. They are tolerable during the cooler season from May to October but can be a real bother in the hotter, wetter months. For some reason, marae (sacred sites) seem to attract them in swarms, and standing to read an explanatory notice board when visiting a historic marae can be a real test of any visitor's enthusiasm. If anything, the tiny nono (black flies) of the Marquesas are even worse.
Swimming in French Polynesia usually means staying within the calm, protected waters of a lagoon, but swimmers should always be aware of tides and currents, and particularly of the swift movement of water out of a lagoon and through a pass into the open sea.
Although early explorers all complained about the French Polynesian propensity for theft, it is not a problem today. This is not to say that your camera won't disappear if you leave it lying around on the beach, but even busy Pape'ete is relatively safe compared with cities in the USA and Europe. There is the odd pickpocket and occasional robberies do occur. If you have valuables and you are staying in a more expensive hotel, it's probably wise to use the hotel safe. Don't leave anything of value in a rental car.
Violence is also rarely a problem in French Polynesia. Intoxicated youths or cranked-out crystal-meth junkies are the most likely troublemakers - they might address you as a titoi (wanker), but this is unlikely to ruin your holiday!
In transit
Deep vein thrombosis (dvt)
Blood clots may form in the legs during plane flights, chiefly because of prolonged immobility. And the longer the flight, the greater the risk. The chief symptom of DVT is swelling of 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 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
French Polynesia has doctors in private practice, and standard hospital and laboratory facilities with consultants in the major specialities - internal medicine, obstetrics/gynaecology, orthopaedics, ophthalmology, paediatrics, pathology, psychiatry and general surgery. Private dentists, opticians and pharmacies are also available. French Polynesia has good military medical facilities but the private sector is so well developed that civilians will not normally have access to these. The outer islands, of course, have more basic services.
Private consultation and private hospital fees are approximately equivalent to Australian costs. It costs about 3500 CFP to see a GP; specialists are more expensive. Government-provided service fees vary from modest to negligible but waiting times can be very 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 most of the larger hospitals are coming into line in accepting credit cards, there will be difficulty with the more remote small hospitals. Doctors will accept credit cards but prefer cash, and not all credit cards are acceptable - check with the relevant company beforehand. 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 a prescription from a locally registered practitioner, but many will do so for travellers if shown the container. While the container should preferably specify the generic name of the drug, this has become much less of a problem with the use of Internet search engines. Asthma inhalers and most anti-inflammatories are available over the counter.
It's 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.
Except in the remote, poorly staffed clinics, 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 are 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, or 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 in main centres but do not rely on getting them if you travel to one of the outer islands. 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 region. However, on general principles 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 viral 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 it requires medical care.
Eosinophilic meningitis
A strange illness manifested by scattered abnormal skin sensations, fever and sometimes by the meningitis (headache, vomiting, confusion, neck and spine stiffness) which gives it its name, eosinophilic meningitis is caused by a microscopic parasite - the rat lungworm - that contaminates raw food. There is no proven specific treatment, but symptoms may require hospitalisation. For prevention pay strict attention to advice on food and drink.
Hepatitis a
This is a viral disease, causing liver inflammation and spread by contaminated food or water. Fever, nausea, debility and jaundice (yellow coloration 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 preparers, handlers or servers, and by flies. There is no specific treatment. The vaccine is close to 100% protective.
Hepatitis b
This is a viral disease causing liver inflammation, but it 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 by sexual intercourse, contaminated needles or accidental blood contamination. Treatment is complex and specialised but vaccination is highly effective.
Hepatitis c
A viral disease similar to hepatitis B, and causing liver inflammation, which can go on to chronic liver disease or result in a symptomless carrier state. It's 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 region. It is fast becoming a major problem in French Polynesia. Safe sex practice 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.
Leptospirosis
Also known as Weil's disease, leptospirosis produces fever, headache, jaundice and, later, kidney failure. It is caused by a spirochaete organism found in water contaminated by rat urine. The organism penetrates skin, so swimming in flooded areas is a risk practice. If diagnosed early it is cured with penicillin.
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 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.
Environmental hazards
Threats to health from animals and insects are rare indeed but you need to be aware of them.
Jellyfish
The notorious box jellyfish (seawasp) has not been recorded in these waters, but the blue-coloured Indo-Pacific 'Man o' War' is found in all 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 abound 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; nausea, faintness, palpitations or difficulty in breathing flag 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 wetsuit. First-aid treatment consists of compression bandaging and splinting of the affected limb. Antivenin is effective, but may have to be flown in. Only about 10% of sea-snake bites cause serious poisoning.
Stone fish
These are very well camouflaged and are quite prolific on coral reefs and rocky areas. If you do get stung apply heat immediately and head for the hospital. Wearing plastic, waterproof sandals provides the best protection.
Coral ear
This is a commonly used name for inflammation of the ear canal. It has nothing to do with coral but is caused by water entering the canal, activating fungal spores 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
Because the region has 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 is probably the main 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. Privately run compression chambers are available on Tahiti but transport to a chamber can be difficult. Supply of oxygen to the chambers is sometimes a problem. Even experienced divers should check with organisations like DAN (Divers' Alert Network; www.diversdalertnetwork.org) about the current site and status of compression chambers, and insurance to cover costs both for local treatment and evacuation. Novice divers must be especially careful. If you have not taken out insurance before leaving home you may be able to do so online with DAN.
Food & water
The municipal water supply in Pape'ete and other large towns can be trusted, but elsewhere avoid untreated tap water. In some areas the only fresh water available may be rainwater collected in tanks, and this should 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
Ciguatera is a form of poisoning that affects otherwise safe and edible fish unpredictably. 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; in French Polynesia it is quite frequent in the smaller reef fish. There is no safe test to determine whether a fish is poisonous or not. Although local knowledge is not entirely reliable, it is reasonable to eat what the locals are eating. However, fish caught after times of reef destruction, eg after a major hurricane, are more likely to be poisonous. 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
French Polynesia lies within the tropics, so it is hot and frequently humid.
Heat exhaustion
Heat exhaustion is actually a state of dehydration associated to a greater or lesser extent with salt loss. Salt is lost 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 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 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 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 15-plus rating, and slap on a hat. Treat sunburn like any other burn - cool, wet dressings are best. Severe swelling may respond to a cortisone cream.
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