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The Netherlands

Health & safety

Before you go

Further reading

Health Advice for Travellers (currently called the 'T6' leaflet) is an annually updated leaflet produced by the UK Department of Health and available free in post offices. It contains some general information, legally required and recommended vaccines for different countries, reciprocal health agreements and an E111 application form. Lonely Planet's Travel with Children includes advice on travel health for younger children. Other recommended references include Traveller's Health by Dr Richard Dawood (published by Oxford University Press) and The Traveller's Good Health Guide by Ted Lankester (published by Sheldon Press).

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Insurance

If you're an EU citizen, a European Health Insurance Card (EHIC), available from health centres or, in the UK, post offices, covers you for most medical care. It will not cover you for nonemergencies or emergency repatriation. Citizens from other countries should find out if there is a reciprocal arrangement for free medical care between their country and the Netherlands. If you do need health insurance, make sure you get a policy that covers you for the worst possible scenario, such as an accident requiring an emergency flight home. Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures.

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Online resources

The WHO's publication International Travel and Health is revised annually and is available online at www.who.int/ith/. Other useful websites include www.mdtravelhealth.com (travel-health recommendations for every country, updated daily), www.fitfortravel.nhs.uk (general travel advice for the layman), www.ageconcern.org.uk (advice on travel for the elderly) and www.mariestopes.org.uk (information on women's health and contraception).

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Prevention is the key to staying healthy while abroad. A little planning before departure, particularly for pre-existing illnesses, will save trouble later: see your dentist before a long trip; carry a spare pair of contact lenses and glasses; and take your optical prescription with you. Bring medications in their original, clearly labelled, containers. A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is also a good idea. If carrying syringes or needles, be sure to have a physician's letter documenting their medical necessity.

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Recommended vaccinations

No jabs are required to travel to the Netherlands. The World Health Organization (WHO) recommends that all travellers should be covered for diphtheria, tetanus, measles, mumps, rubella and polio, as well as hepatitis B, regardless of their destination. Since most vaccines don't produce immunity until at least two weeks after they're given, visit a physician at least six weeks before departure.

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Dangers & annoyances

Much of the Netherlands is utterly safe, but caution is advised in the larger cities. Amsterdam and Rotterdam require a modicum of big-city street sense but nothing you wouldn’t normally do at home.

Cars with foreign registration are popular targets for smash-and-grab theft. Don’t leave things in the car: remove registration and ID papers and the radio/stereo if possible.

If something is stolen, get a police report for insurance purposes but don’t expect the police to retrieve your property or to apprehend the thief – put the matter down to experience.

Mosquitoes can be a pain in summer. They breed in stagnant parts of the canals and in water under houses. In parts of the country near lakes or canals people sleep under netting.

Bicycles can be quite a challenge to pedestrians. Remember when crossing the street to look for speeding bikes as well as cars; straying into a bike lane without looking both ways is a no-no.

Intensive urban development means there’s often little grass for dog dirt, and you may spend more time watching the pavement than the sights.

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Scams

Big cities breed scams. Take special care in the train stations: someone might help you put your bags into a luggage locker, lock the door and hand you the key. When you return you find the key fits a different locker and your stuff is gone. If something feels wrong about a stranger who approaches you, chances are your instincts are right. Thieves sometimes pose as police.

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In transit

Deep vein thrombosis

Blood clots may form in the legs during plane flights, chiefly because of prolonged immobility. The longer the flight, the greater the risk. The chief symptom of deep vein thrombosis (DVT) is swelling or pain of the foot, ankle or calf, usually - but not always - on just one side. When a blood clot travels to the lungs it may cause chest pain and breathing difficulties. Travellers with any of these symptoms should immediately seek medical attention.

To prevent the development of DVT on long flights you should walk about the cabin, contract the leg muscles while sitting, drink plenty of fluids, and avoid alcohol and tobacco.

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Jet lag & motion sickness

To avoid jet lag (which is 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) to the time zone you're in 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.

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While you're there

Heat exhaustion & heat stroke

Heat exhaustion (yes, it can happen, even in the Netherlands!) occurs following excessive fluid loss with inadequate replacement of fluids and salt. Symptoms include headache, dizziness and tiredness. Dehydration is already happening by the time you feel thirsty - aim to drink sufficient water to produce pale, diluted urine. To treat heat exhaustion, replace fluids with water and/or fruit juice, and cool the body with cold water and fans. Treat salt loss with salty fluids such as soup or bouillon, or add a little more table salt to foods than usual.

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

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Insect bites & stings

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

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

Bed bugs lead to very itchy lumpy bites. Spraying the mattress with crawling insect killer after changing bedding will get rid of them.

Scabies are tiny mites that live in the skin, particularly between the fingers. They cause an intensely itchy rash. Scabies is easily treated with lotion from a pharmacy; other members of the household also need treating to avoid spreading scabies between asymptomatic carriers.

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Lyme disease

Ticks can carry a serious bacterial infection called Lyme disease. A bite from an infected tick may produce a red welt and a 'bull's eye' around the spot within a day or two. Mild flu-like symptoms (headache, nausea etc) may follow or may not, but antibiotics are needed to avoid the next stage of the illness - pain in the joints, fatigue and fever. If left untreated, Lyme disease can cause mental and muscular deterioration.

The most risky places in the Netherlands are the wooded areas of Friesland, Groningen and Drenthe, Hoge Veluwe National Park, parts of Zeeland and on the Wadden Islands. The best prevention is to wear clothing that covers your arms and legs when walking in grassy or wooded areas, apply insect repellent containing DEET and check your body for ticks after outdoor activities.

If a tick has attached itself to you, use tweezers to pull it straight out - do not twist it. Do not touch the tick with a hot object such as a cigarette because this can cause the tick to regurgitate noxious saliva into the wound. Do not rub oil or petroleum jelly on it.

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Travelling with children

All travellers with children should know how to treat minor ailments and when to seek medical treatment. Make sure the children are up to date with routine vaccinations, and discuss possible travel vaccines well before departure, as some vaccines are not suitable for children under a year old.

Remember to avoid contaminated food and water. If your child is vomiting or has diarrhoea, lost fluid and salts must be replaced. It may be helpful to take along rehydration powders for reconstituting with boiled water.

Children should be encouraged to avoid and mistrust any dogs or other mammals because of the risk of rabies and other diseases. Any bite, scratch or lick from a warm-blooded, furry animal should immediately be thoroughly cleaned. If there is any possibility that the animal is infected with rabies, immediate medical assistance should be sought.

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Availability & cost of health care

Good health care is readily available. For minor self-limiting illnesses an apotheek (pharmacy) can give valuable advice and sell over-the-counter medication. It can also advise when more specialised help is required and point you in the right direction. The standard of dental care is usually good; however, it is sensible to have a dental checkup before a long trip.

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Sexual health

Emergency contraception is most effective if taken within 24 hours after unprotected sex.

When buying condoms, look for a European CE mark, which means they have been rigorously tested, and then keep them in a cool, dry place or they may crack and perish. Condoms are widely available from pharmacies and vending machines in many restaurants and nightclubs.

The Rutgers Foundation (www.rutgersnissogroep.nl) manages seven regional centres in the Netherlands that provide a range of sexual and reproductive health-care services. Emergency contraception can be obtained at short notice. Contact the telephone helpline at 030-231 34 31. The Amsterdam centre, the Rutgershuis (020-624 54 26; www.acsg.nl; Sarphatistraat 618), is open for walk-in visitors.

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Women's health

Emotional stress, exhaustion and travelling through different time zones can all contribute to an upset in the menstrual pattern. If using oral contraceptives, remember that some antibiotics, diarrhoea and vomiting can stop the pill from working and lead to the risk of pregnancy - remember to take condoms with you just in case. Time zones, gastrointestinal upsets and antibiotics do not affect injectable contraception.

Travelling during pregnancy is usually possible, but there are important things to consider. Always seek a medical checkup before planning your trip. The most risky times for travel are during the first 12 weeks of pregnancy and after 30 weeks. Illness during pregnancy can be more severe, so take special care to avoid contaminated food and water and insect and animal bites. A general rule is to only use vaccines, like other medications, if the risk of infection is substantial. Remember that the baby could be in serious danger if you were to contract infections such as typhoid or hepatitis. Some vaccines are best avoided; for example, those that contain live organisms. However, there is very little evidence that damage has been caused to an unborn child when vaccines have been given to a woman very early in pregnancy before the pregnancy was suspected. Take written records of the pregnancy with you. Ensure your insurance policy covers pregnancy delivery and postnatal care. Always consult your doctor before you travel.

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