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Thailand

Health & safety

Before you go

Further reading

Lonely Planet’s Healthy Travel – Asia & India is a handy pocket-size book that is packed with useful information including pretrip planning, emergency first aid, immunisation and disease information, and what to do if you get sick on the road. Other recommended references include Traveller’s Health by Dr Richard Dawood and Travelling Well by Dr Deborah Mills – check out the website www.travellingwell.com.au.

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Insurance

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 such as rock climbing. If your health insurance doesn’t cover you for medical expenses abroad (emergency evacuation is expensive; bills of over US$100, 000 are not uncommon), you should get travel insurance. The travel insurance we recommend is very flexible: you can buy, extend and claim online from anywhere in the world 24/7, even if you've already left home.

In many countries doctors expect payment in cash. Keep all documentation (medical reports, invoices etc) for claim purposes. 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. It is always wise to inform your insurance company if you seek medical advice whilst abroad.

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Internet resources

There is a wealth of travel-health advice on the internet. For further information, Lonely Planet (www.lonelyplanet.com) is a good place to start. International Travel & Health is a superb book published by WHO (www.who.int/ith), which is revised annually and is 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.

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Medical checklist

The following are recommended items for a personal medical kit:

antibacterial cream (eg Muciprocin)

antibiotics for skin infections (eg Amoxicillin/Clavulanate or Cephalexin)

antibiotics for diarrhoea (eg Norfloxacin or Ciprofloxacin); for bacterial diarrhoea (eg Azithromycin); for giardiasis or amoebic dysentery (eg Tinidazole)

anti-diarrhoeal treatments – consider an oral rehydration solution (eg Gastrolyte); diarrhoea ‘stopper’ (eg Loperamide); and anti-nausea medication (eg Prochlorperazine)

antifungal cream (eg Clotrimazole)

antihistamine (eg Cetrizine for daytime and Promethazine for night)

antiseptic (eg Betadine)

antispasmodic for stomach cramps (eg Buscopan)

contraceptives

decongestant (eg Pseudoephedrine)

DEET-based insect repellent

first-aid items such as scissors, Elastoplasts, bandages, gauze, thermometer (but not mercury), sterile needles and syringes, safety pins and tweezers

Ibuprofen or another anti-inflammatory

indigestion medication (eg Quick Eze or Mylanta)

iodine tablets (unless you are pregnant or have a thyroid problem) to purify the water

laxative (eg Coloxyl)

paracetamol

Permethrin to impregnate clothing and mosquito nets

steroid cream for allergic/itchy rashes (eg 1% to 2% hydrocortisone)

sunscreen and hat

throat lozenges

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

Ural or equivalent if you are prone to urine infections

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Pack medications in clearly labelled original containers. A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is 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 or theft. In Thailand you can buy many medications over the counter without a doctor’s prescription, but it can be difficult to find the exact medication you are taking. It is safer to bring adequate supplies from home.

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Vaccinations

Specialised travel-medicine clinics are your best source of information; they stock all available vaccines and will usually have medical kits and other products such as impregnated mosquito nets available. The doctors will take into account factors such as your past vaccination history, the length of your trip, activities you may be undertaking and underlying medical conditions, such as pregnancy, before making their individualised recommendations.

Most vaccines don’t produce immunity until around two weeks after they’re given. Ideally you should visit a doctor six to eight weeks before departure, but it is never too late. Ask your doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all the vaccinations you’ve received.

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Recommended vaccinations

Recommended Vaccinations

The following vaccinations are those recommended by the World Health Organization (WHO) for travellers to Thailand:

Adult Diphtheria, Tetanus & Pertussis 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 six to 12 months likely provides lifetime 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 available, as is a combined vaccination with Hepatitis A. Side effects are mild and uncommon, usually headache and sore arm. Lifetime protection occurs in 95% of people.

Measles, Mumps & Rubella Two doses of MMR required unless you have had the diseases. Occasionally a rash and flu-like illness can develop a week after receiving the vaccine. Many young adults require a booster.

Polio There have been no cases for many years in Thailand so no booster required. Note that only one booster is required as an adult for lifetime protection.

Typhoid Recommended unless your trip is less than a week and only to the major cities. 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.

The following immunisations are recommended for long-term travellers (more than one month) or those at special risk:

Influenza Particularly recommended for travellers over 55 years of age or with underlying medical conditions such as diabetes or heart disease. Influenza is however common in all ages and the vaccine should be considered by all travellers.

Japanese B Encephalitis Three injections in all. Booster recommended after three years. Sore arm and headache are the most common side effects. Rarely, an allergic reaction comprising hives and swelling can occur up to 10 days after any of the three doses.

Rabies Three injections in all. No booster required for travellers. Those at continued risk (animal workers etc) should discuss booster recommendations with their doctor. Side effects are rare – occasionally headache and sore arm.

Tuberculosis A complex issue. Adult long-term travellers or expats are usually recommended to have a TB skin test or Quantiferon blood test before and after travel, rather than vaccination. For expatriate children under five, BCG vaccination is highly recommended. Only one vaccine 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 prior to entering Thailand. If you are travelling to Thailand from Africa or South America you should check to see if you require proof of vaccination.

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Dangers & annoyances

Dangers & Annoyances

Although Thailand is in not a dangerous country to visit, it is smart to exercise caution, especially when it comes to dealing with strangers (both Thai and foreigners) and travelling alone. In reality, you are more likely to be ripped off or have a personal possession surreptitiously stolen than you are to be physically harmed.

Assault

Assault of travellers is rare in Thailand, but it does happen. We’ve received letters detailing fights between travellers and Thai guesthouse workers or other Thai youths. While both parties are probably to blame (and alcohol is often a factor), do be aware that causing a Thai to ‘lose face’ (feel public embarrassment or humiliation) might elicit an inexplicably strong and violent reaction. While a good cuss-out might be an acceptable way to vent anger in the West, it is an invitation for fisticuffs, a sneak attack or worse by a Thai. While gun violence is almost unheard of in Thailand, there have been a few instances of foreigners getting into fights with off-duty police officers who have used their weapons in retaliation.

There is a surprising amount of assaults in Ko Samui and Ko Pha-Ngan considering their idyllic settings. Oftentimes alcohol is the number one contributor to bad choices and worse outcomes. Ko Pha-Ngan’s Full Moon party is becoming increasingly violent and dangerous. There are often reports of fights, rapes and robbings. Women, especially solo travellers in Samui or Pha-Ngan, need to be smart and somewhat sober when interacting with the opposite sex, be they Thai or faràng. Opportunists pounce when too many whisky buckets are involved. Also be aware that an innocent flirtation might convey firmer intentions to a recipient who does not share your culture’s sexual norms.

Border Issues

Thailand enjoys much better relations with its neighbours than it did a decade ago and many land borders are now functional and safe passages for goods and people. The ongoing violence in the Deep South has made the once popular crossing at Sungai Koloka potentially dangerous proposition.

Cross-border relations with Thailand and Myanmar during the Thaksin era have resulted in increased cooperation between the two governments and the discontinuation of the Thai army providing assistance to minority resistance groups in Myanmar. Many of the border crossings between Thailand and Myanmar are day-use only and attract people renewing their visas or poking around the border markets. On rare occasions the Myanmar government has impetuously closed these points without notice, leaving day-pass visitors stranded. More likely closures are due to news-making events like Thailand’s 2006 coup. Keeping abreast of current events prior to arriving at the border will prevent potential problems.

The long-contested border temple of Khao Phra Wihan (known as ‘Preah Vihear’ in Cambodia), in the far northeast of the country, resulted in a military buildup and violent clashes between Thai and Cambodian forces in 2007. Although tensions have relaxed since, the temple is still closed to visitors.

Deep South Violence

Currently Thailand’s southernmost Muslim majority provinces (Yala, Pattani and Narathiwat) experience frequent occurrences of violence believed to be connected to an amorphous but ongoing ethno-nationalist struggle. Since 2002, violence has escalated from attacks on perceived symbols of the government (provincial officials, soldiers, teachers and monks) to seemingly random (though possibly vendetta-motivated) killings on average citizens, and increasingly sophisticated, coordinated bombings of marketplaces, banks and train stations. From 2004 to 2007 there was an average of 160 violent occurrences per month. Attacks varied from insurgent-style activity to gang-like shootings, further complicating attempts to clearly define the groups and their intentions. Most violence is confined to the three provinces known collectively as the Deep South and primarily to more rural districts within these provinces, though bombings have occurred in downtown sections of the provincial capitals of Yala and Pattani provinces.

Periodic bombings have also occurred in the southern commercial and transport hub of Hat Yai and in border districts of Songkhla Province. Although the Thai government has political motivations to connect the violence in the Deep South to global terror networks such as Al Qaeda and regional militant groups such as Jemaah Islamiyah, most observers do not believe that the region’s insurgents are closely linked to these groups.

At the time of writing, no foreign tourists had been directly targeted, but civilian attacks have increased and it is a distinct possibility that an unsuspecting traveller might get caught in the wrong place. We would discourage taking the train through the Thai–Malaysian border at Sungai Kolok – a popular crossing for tourists heading to the Perhentian Islands in Malaysia. It would be safer to cross the border on the western side of the peninsula, either by bus or train from Hat Yai or by boat from Satun.

Although Hat Yai is considered a target for bombings, it is still a functioning city and for now is safe enough to travel in and out of, though this situation should be monitored. The provincial capital of Songkhla should also be fairly safe for visitors, although caution should be exercised. It is not advisable to travel between Hat Yai and Songkhla after dark.

Druggings & Drug Possession

More common amongst sex tourists than backpackers, male travellers have reported accepting cigarettes, drinks or food from flirtatious Thai women only to wake up sometime later with a headache and without their valuables. Inviting a prostitute to your hotel room can have the same results.

It is illegal to buy, sell or possess opium, heroin, amphetamines, hallucinogenic mushrooms and marijuana in Thailand. A new era of vigilance against drug use and possession was ushered in by former Prime Minister Thaksin’s 2003 war on drugs; during the height of the campaign police searched partygoers in Bangkok nightclubs and effectively scared many of the recreational drug users into abstinence for a time. Things have relaxed somewhat since the 2006 coup but the country is no longer a chemical free-for-all.

Belying Thailand’s anything-goes atmosphere are severely strict punishments for possession and trafficking that are not relaxed for foreigners. Possession of drugs can result in at least one year or more of prison time. Drug smuggling – defined as attempting to cross a border with drugs in your possession – carries considerably higher penalties, including execution.

During citywide festivals, such as Bangkok’s New Year’s Eve and Ko Pha-Ngan’s Full Moon parties, police set up road blocks and inspection stations in an attempt to apprehend drug suppliers and their contraband. In some cases, enforcement of the drug laws is merely leverage for exacting massive bribes. Ko Pha- Ngan’s police are notorious for bribable ‘sting’ operations in which a drug dealer makes an exchange with a customer, followed shortly by a police bust and an on-site demand of 70,000B to avoid arrest.

Another party town, Pai has seen a recent revival of the Thaksin-era urine drug tests on bar patrons by police. As of writing, the strong-arm gift of freedom in such cases is 10,000B. The Pai police have been following a policy of intimidation towards foreign revellers, often fining bars for creative applications of the entertainment prohibitions and entering establishments visibly carrying weapons.

Scams

Thais can be so friendly and laid-back that some visitors are lulled into a false sense of security making them vulnerable to scams of all kinds. Bangkok is especially good at long-involved frauds that dupe travellers into thinking that they’ve made a friend and are getting a bargain.

Most scams begin in the same way: a friendly and well-dressed Thai, or sometimes even a foreigner, approaches you and strikes up a conversation. Invariably your destination is closed or being cleaned, but your new friend offers several alternative activities, such as sightseeing at smaller temples or shopping at authentic markets. After you’ve come to trust the person, you are next invited to a gem and jewellery shop because your new-found friend is picking up some merchandise for himself. Somewhere along the way he usually claims to have a connection, often a relative, in your home country (what a coincidence!) with whom he has a regular gem export-import business. One way or another, you are convinced that you can turn a profit by arranging a gem purchase and reselling the merchandise at home. After all, the jewellery shop just happens to be offering a generous discount today – it’s a government or religious holiday, or perhaps it’s the shop’s 10th anniversary, or maybe they’ve just taken a liking to you!

There are seemingly infinite numbers of variations on the scam described above, almost all of which end up with you making a purchase of small low-quality gems and posting them to your home country. Once you return home, of course, the cheap jewels turn out to be worth much less than you paid for them (perhaps one-tenth to one-half).

The Thai police are usually no help whatsoever, believing that merchants are entitled to whatever price they can get.

Card games are another way to separate travellers from their money. A friendly stranger approaches the lone traveller on the street, strikes up a conversation and then invites them to their house or apartment for a drink or meal. After a bit of socialising a friend or relative of the con arrives on the scene; it just so happens a little high-stakes card game is planned for later that day. Like the gem scam, the card game has many variations, but eventually the victim is shown some cheating tactics to use with help from the ‘dealer’, some practise sessions take place and finally the game gets under way with several high rollers at the table. And if you don’t know how this ends, we suggest you watch the movie The Hustler Again, the police won’t take any action because gambling is illegal in Thailand and you’ve actually broken the law.

Other minor scams involve túk-túk drivers, hotel employees and bar girls who take new arrivals on city tours; these almost always end up in high-pressure sales situations at silk, jewellery or handicraft shops. In this case the victim’s greed isn’t the ruling motivation – it’s simply a matter of weak sales resistance.

Follow TAT’s number-one suggestion to tourists: Disregard all offers of free shopping or sightseeing help from strangers. These invariably take a commission from your purchases.

Contact the tourist police (tel:1155) if you have any problems with consumer fraud.

Theft & Fraud

Exercise diligence when it comes to your personal belongings. Ensure that your room is securely locked and carry your most important effects (passport, money, credit cards) on your person. Take care when leaving valuables in hotel safes.

Follow the same practise when you’re travelling. A locked bag will not prevent theft on a long-haul bus when you’re snoozing and the practised thief has hours alone with your luggage. This is a common occurrence on the tourist buses from Khao San Rd to the southern beaches or north to Chiang Mai.

When using a credit card, don’t let vendors take your credit card out of your sight to run it through the machine. Unscrupulous merchants have been known to rub off three or four or more receipts with one purchase. Sometimes they wait several weeks – even months – between submitting each charge receipt to the bank, so that you can’t remember whether you’d been billed by the same vendor more than once.

To avoid losing all of your travel money in an instant, always use a credit card that is not directly linked to your bank account back home so that the operator doesn’t have access to immediate funds.

Touts

Touting is a long-time tradition in Asia, and while Thailand doesn’t have as many touts as, say, India, it has its share.

In the popular tourist spots you’ll be approached, sometimes surrounded, by guesthouse touts who get a commission for bringing in potential guests. While it is annoying for the traveller, it is an acceptable form of advertising among small-scale businesses. Take anything a tout says with scepticism. Since touts get paid for delivering you to a guesthouse or hotel (whether you check in or not), they’ll say anything to get you in the door. Some places refuse to pay commissions so in return the touts will steer customers to places that do pay. This type of commission work is not limited to low-budget guesthouses. Travel agencies are notorious for talking newly arrived tourists into staying at badly located, overpriced hotels.

Travel agencies often masquerade as TAT, the government-funded tourist information office. They might put up agents wearing fake TAT badges or have signs that read TAT in big letters to entice travellers into their offices where they can sell them overpriced bus and train tickets. Be aware that the official TAT offices do not make hotel or transport bookings. If such a place offers to do this for you then they are a travel agent not a tourist information office.

When making transport arrangements, talk to several travel agencies to look for the best price, as the commission percentage varies greatly between agents. Also resist any high-sales tactics from an agent trying to sign you up for everything: plane tickets, hotel, tours etc. The most honest Thais are typically very low-key and often sub-par salespeople.

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The most reputable bus companies depart from Baw Khaw Saw (BKS) public bus terminals. Private buses and minivans that pick up customers from tourist centres such as Th Khao San experience a higher incidence of reported theft, lateness and unreliability. Sometimes these tourist-oriented services pick up passengers from their guesthouse only to drop them off at the public bus terminal. Other complaints include the alleged VIP bus turning out to be a cramped minibus that arrives four hours late.

Readers have also consistently reported having their stowed bags rifled through. Theft is a serious problem on long-haul tourist buses originating out of Bangkok. Keep all valuables on your person, not stored in your luggage as even locked bags can be tampered with and you won’t realize anything is missing until days later.

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In transit

Deep vein thrombosis (DVT)

Deep vein thrombosis (DVT) 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 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 difficulty in breathing. 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, perform isometric compressions of the leg muscles (ie contract the leg muscles while sitting), drink plenty of fluids (nonalcoholic) and avoid 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 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) 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

Air pollution

Air pollution, particularly vehicle pollution, is an increasing problem in most of Southeast Asia’s major cities. If you have severe respiratory problems speak with your doctor before travelling to any heavily polluted urban centres. This pollution can also cause minor respiratory problems such as sinusitis, dry throat and irritated eyes. If you are troubled by the pollution leave the city for a few days and get some fresh air.

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Diving

Divers and surfers should seek specialised advice before they travel to ensure their medical kit contains treatment for coral cuts and tropical ear infections, as well as treatment for the standard problems.

Divers should also make sure that their insurance covers them for decompression illness – get specialised dive insurance through an organisation such as Divers Alert Network (DAN; www.danseap.org). Have a dive medical before you leave your home country – there are certain medical conditions that are incompatible with diving and economic considerations may override health considerations for some dive operators in Thailand.

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Food

Eating in restaurants is the biggest risk factor for contracting traveller’s diarrhoea. Ways to avoid it include eating only freshly cooked food, avoiding shellfish, and not eating food that has been sitting around in buffets. Peel all fruit, cook vegetables, and soak salads in iodine water for at least 20 minutes. Eat in busy restaurants with a high turnover of customers.

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Heat

Many parts of Thailand are hot and humid throughout the year. For most people it takes at least two weeks to adapt to the hot climate. Swelling of the feet and ankles is common, as are muscle cramps caused by excessive sweating. Prevent these by avoiding dehydration and excessive activity in the heat. Take it easy when you first arrive. Don’t eat salt tablets (they aggravate the gut), but drinking rehydration solution or eating salty food helps. Treat cramps by stopping activity, resting, rehydrating with double-strength rehydration solution and gently stretching.

Dehydration is the main contributor to heat exhaustion. Symptoms include feeling weak; headache; irritability; nausea or vomiting; sweaty skin; a fast, weak pulse; and a normal or slightly elevated body temperature. Treatment involves getting out of the heat and/or sun; fanning the victim and applying cool wet cloths to the skin; laying the victim flat with their legs raised; and rehydrating with water containing ¼ teaspoon of salt per litre. Recovery is usually rapid and it is common to feel weak for some days afterwards.

Heat stroke is a serious medical emergency. Symptoms come on suddenly and include weakness, nausea, a hot dry body with a body temperature of over 41°C, dizziness, confusion, loss of coordination, fits and eventually collapse and loss of consciousness. Seek medical help and commence cooling by getting the person out of the heat, removing their clothes, fanning them and applying cool wet cloths or ice to their body, especially to the groin and armpits.

Prickly heat is a common skin rash in the tropics, caused by sweat being trapped under the skin. The result is an itchy rash of tiny lumps. Treat by moving out of the heat and into an air-conditioned area for a few hours and by having cool showers. Creams and ointments clog the skin so they should be avoided. Locally bought prickly-heat powder can be helpful.

Tropical fatigue is common in long-term expats based in the tropics. It’s rarely due to disease and is caused by the climate, inadequate mental rest, excessive alcohol intake and the demands of daily work in a different culture.

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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. Transmission is via close contact with an infected person. They can be difficult to treat and you may need numerous applications of an antilice shampoo such as Permethrin. Pubic lice are usually contracted from sexual contact.

Ticks are contracted when walking in rural areas. They’re 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. 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 injection of adrenaline (eg an Epipen) for emergency treatment. For others, pain is the main problem – apply ice to the sting and take painkillers.

Most jellyfish in Southeast Asian waters are not dangerous, just irritating. First aid for jellyfish stings involves pouring vinegar onto the affected area to neutralise the poison. Do not rub sand or water onto the stings. Take painkillers, and anyone who feels ill in any way after being stung should seek medical advice. Take local advice if there are dangerous jellyfish around and keep out of the water.

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Parasites

Numerous parasites are common in local populations in Southeast Asia, but most of these are rare in travellers. The two rules to follow if you wish to avoid parasitic infections are to wear shoes and to avoid eating raw food, especially fish, pork and vegetables. A number of parasites, including strongyloides, hookworm and cutaneous larva migrans, are transmitted via the skin by walking barefoot.

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Skin problems

Fungal rashes are common in humid climates. Two common fungal rashes affect travellers. The first occurs in moist areas 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. Tinea versicolor is also common – this fungus causes small and light-coloured patches, most commonly on the back, chest and shoulders. Consult a doctor.

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. If you develop signs of infection (increasing pain and redness) see a doctor. Divers and surfers should be particularly careful with coral cuts as they can easily become infected.

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Snakes

Thailand is home to many species of both poisonous and harmless snakes. Assume all snakes are poisonous and never try to catch one. Always wear boots and long pants if walking in an area that may have snakes. First aid in the event of a snake bite involves pressure immobilisation via an elastic bandage firmly wrapped around the affected limb, starting at the bite site and working up towards the chest. The bandage should not be so tight that the circulation is cut off, and the fingers or toes should be kept free so the circulation can be checked. Immobilise the limb with a splint and carry the victim to medical attention. Do not use tourniquets or try to suck the venom out. Antivenin is available for most species.

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Sunburn

Even on a cloudy day, sunburn can occur rapidly. Always use a strong sunscreen (at least factor 30), making sure to reapply after a swim, and always wear a wide-brimmed hat and sunglasses outdoors. Avoid lying in the sun during the hottest part of the day (10am to 2pm). If you become sunburnt stay out of the sun until you have recovered, apply cool compresses and take painkillers for the discomfort. One per cent hydrocortisone cream applied twice daily is also helpful.

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Avian influenza

To date Thailand has reported 25 cases of human ‘bird flu’. The majority of these occurred in 2004, and at the time of writing there have been no reports in 2007. Transmission from domestic birds to humans is rare and requires close contact with an infected bird or its droppings. Human to human transmission has occurred, but it is even more uncommon. Thus far there have been no cases reported in travellers or expatriates. Avoid live poultry markets, and eating raw or undercooked poultry or eggs; wash your hands frequently and seek medical attention if you develop a fever and respiratory symptoms (cough, shortness of breath etc).

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Cutaneous larva migrans

This disease, caused by dog hookworm, is particularly common on the beaches of Thailand. The rash starts as a small lump, then slowly spreads in a linear fashion. It is intensely itchy, especially at night. It is easily treated with medications and should not be cut out or frozen.

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Dengue fever

This mosquito-borne disease is becoming increasingly problematic throughout Southeast Asia, especially in the cities. As there is no vaccine available it can only be prevented by avoiding mosquito bites. The mosquito that carries dengue bites day and night, so use insect-avoidance measures at all times. Symptoms include high fever, severe headache and body aches (dengue was previously known as ‘breakbone fever’). Some people develop a rash and experience diarrhoea. The southern islands of Thailand are particularly high risk. There is no specific treatment, just rest and paracetamol – do not take aspirin as it increases the likelihood of haemorrhaging. See a doctor to be diagnosed and monitored.

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Filariasis

A mosquito-borne disease that is very common in the local population, yet very rare in travellers. Mosquito-avoidance measures are the best way to prevent this disease.

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Hepatitis A

A problem throughout the region, 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 Southeast Asia should be vaccinated against hepatitis A.

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Hepatitis B

The only sexually transmitted disease (STD) that can be prevented by vaccination, hepatitis B is spread by body fluids, including sexual contact. In some parts of Southeast Asia up to 20% of the population are carriers of hepatitis B, and usually unaware of it. 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 and has similar symptoms to hepatitis A, but is far less common. It is 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 now one of the most common causes of death in people under the age of 50 in Thailand. Heterosexual sex is now the main method of transmission in Thailand.

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Influenza

Present year-round in the tropics, 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. All travellers should consider vaccination as influenza is the most common vaccine-preventable disease to affect travellers. There is no specific treatment, just rest and paracetamol.

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Japanese B encephalitis

While a rare disease in travellers, at least 50, 000 locals are infected each year. This viral disease is transmitted 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. Thailand is a high-risk area.

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Leptospirosis

Leptospirosis is most often contracted after river rafting or canyoning. Early symptoms are very similar to the flu and include headache and fever. It can vary from a very mild ailment to a fatal disease. Diagnosis is made through blood tests and it is easily treated with Doxycycline.

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Malaria

For such a serious and potentially deadly disease, there is an enormous amount of misinformation concerning malaria. You must get expert advice as to whether your trip actually puts you at risk. Many parts of Southeast Asia, particularly city and resort areas, have minimal to no risk of malaria, and the risk of side effects from the tablets may outweigh the risk of getting the disease. For most rural areas, however, the risk of contracting the disease far outweighs the risk of any tablet side effects. Remember that malaria can be fatal. Before you travel, seek medical advice on the right medication and dosage for you.

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. A 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.

There is a variety of preventive medication available:

Artesunate Derivatives of Artesunate are not suitable as a preventive medication. They are useful treatments under medical supervision.

Chloroquine and Paludrine The effectiveness of this combination is now limited in most of Southeast Asia. Common side effects include nausea (40% of people) and mouth ulcers. Generally not recommended.

Doxycycline This daily tablet is a broad-spectrum antibiotic that has the added benefit of helping to prevent a variety of tropical diseases, including leptospirosis, tick-borne disease, typhus and meliodosis. The 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. Must be taken for four weeks after leaving the risk area.

Lariam (Mefloquine) Lariam 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 having fits. Anyone with a history of depression, anxiety, other psychological disorder or epilepsy should not take Lariam. It is considered safe in the second and third trimesters of pregnancy. It is around 90% effective in most parts of Southeast Asia, but there is significant resistance in parts of northern Thailand, Laos and Cambodia. Tablets must be taken for four weeks after leaving the risk area.

Malarone This drug 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.

A final option is to take no preventive medication but to have a supply of emergency medication should you develop the symptoms of malaria. This is less than ideal, and you’ll need to get to a good medical facility within 24 hours of developing a fever. If you choose this option the most effective and safest treatment is Malarone (four tablets once daily for three days). Other options include Mefloquine and Quinine but the side effects of these drugs at treatment doses make them less desirable. Fansidar is no longer recommended.

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Measles

Measles remains a problem in some parts of Southeast Asia. This highly contagious bacterial infection is spread through coughing and sneezing. Most people born before 1966 are immune as they had the disease in childhood. Measles starts with a high fever and rash, and can be complicated by pneumonia and brain disease. There is no specific treatment.

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Meliodosis

This infection is contracted by skin contact with soil. It is rare in travellers, but in some parts of northeast Thailand up to 30% of the local population are infected. The symptoms are very similar to those experienced by tuberculosis (TB) sufferers. There is no vaccine but it can be treated with medications.

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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 commence post-exposure treatment. Having a pretravel vaccination means the post-bite treatment is greatly 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.

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STDs

Sexually transmitted diseases most common in Thailand 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.

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Strongyloides

This parasite, also transmitted by skin contact with soil, is common in Thailand but rarely affects travellers. It is characterised by an unusual skin rash called larva currens – a linear rash on the trunk which comes and goes. Most people don’t have other symptoms until their immune system becomes severely suppressed, when the parasite can cause an overwhelming infection. It can be treated with medications.

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Tuberculosis

While rare in 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 pre- and post-travel TB testing. The main symptoms are fever, 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, 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 Thailand, or travelling outside of the major cities. Be aware that vaccination is not 100% effective so you must still be careful with what you eat and drink.

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Typhus

Murine typhus is spread by the bite of a flea whereas scrub typhus is spread via a mite. These diseases are rare in travellers. Symptoms include fever, muscle pains and a rash. You can avoid these diseases by following general insect-avoidance measures. Doxycycline will also prevent them.

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Giardiasis

Giardia lamblia 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 giardiasis, but work in Nepal has shown that they are not specific to this infection. 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 option.

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Availability of health care

Most large cities in Thailand now have clinics catering specifically to travellers and expats. These clinics are usually more expensive than local medical facilities, but are worth using, as they will offer a superior standard of care. Additionally they understand the local system, and are aware of the safest local hospitals and best specialists. They can also liaise with insurance companies should you require evacuation.

It is difficult to find reliable medical care in rural areas. Your embassy and insurance company are also good contacts.

Self-treatment may be appropriate if your problem is minor (eg traveller’s diarrhoea), you are carrying the appropriate medication and 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.

Buying medication over the counter is not recommended, because fake medications and poorly stored or out-of-date drugs are common.

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Traditional medicine

Traditional medical systems are practised widely throughout Southeast Asia. There is a big difference between these traditional healing systems and ‘folk’ medicine. Folk remedies should be avoided, as they often involve rather dubious procedures with potential complications. In comparison, traditional healing systems such as traditional Chinese medicine are well respected, and aspects of them are being increasingly used by Western medical practitioners.

All traditional Asian medical systems identify a vital life force, and see blockage or imbalance as causing disease. Techniques such as herbal medicines, massage and acupuncture are used to bring this vital force back into balance, or to maintain balance. These therapies are best used for treating chronic disease such as chronic fatigue, arthritis, irritable bowel syndrome and some chronic skin conditions. Traditional medicines should be avoided for treating serious acute infections such as malaria.

Be aware that ‘natural’ doesn’t always mean ‘safe’, and there can be drug interactions between herbal medicines and Western medicines. If you are using both systems ensure you inform both practitioners what the other has prescribed.

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Traveller’s diarrhoea

Traveller’s diarrhoea is by far the most common problem affecting travellers – between 30% and 50% of people will suffer from it within two weeks of starting their trip. In over 80% of cases, traveller’s diarrhoea is caused by a bacteria (there are numerous potential culprits), and therefore responds promptly to treatment with antibiotics. 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 movements within 24 hours, plus at least one other symptom such as vomiting, fever, cramps, nausea 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. 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.

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Amoebic dysentery

Amoebic dysentery is very rare in travellers but is often misdiagnosed by poor-quality labs in Southeast Asia. Symptoms are similar to bacterial diarrhoea, ie fever, bloody diarrhoea and generally feeling unwell. You should always seek reliable medical care if you have blood in your diarrhoea. Treatment involves two drugs; Tinidazole or Metroniadzole to kill the parasite in your gut and then a second drug to kill the cysts. If left untreated complications such as liver or gut abscesses can occur.

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Women’s health

Pregnant women should receive specialised advice before travelling. The ideal time to travel is in the second trimester (between 16 weeks and 28 weeks), when the risk of pregnancy-related problems is at its 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.

Malaria is a high-risk disease in pregnancy. Advice from WHO recommends that pregnant women do not travel to those areas with Chloroquine-resistant malaria. None of the more effective antimalarial drugs is completely safe in pregnancy.

Traveller’s 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.

In the urban areas of Southeast Asia, 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 of thrush 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.

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