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Health

In Turkey

Prevention is the key to staying healthy while travelling in Turkey. Infectious diseases here are usually associated with poor living conditions and poverty, and can be avoided with a few precautions.

Tap Water

It's not wise to drink tap water if you're only in Turkey on a short visit. Stick to bottled water, boil tap water for 10 minutes or use purification tablets or a filter.

Do not drink river or lake water, which may lead to diarrhoea or vomiting.

Infectious Diseases

Hepatitis A

Spread through Contaminated food (particularly shellfish) and water.

Symptoms & effects Jaundice, dark urine, a yellow colour to the whites of the eyes, fever and abdominal pain. Although rarely fatal, it can cause prolonged lethargy and delayed recovery.

Prevention Vaccine given as an injection, with a booster extending the protection offered. Available in some countries as a combined single-dose vaccine with hepatitis B or typhoid.

Leishmaniasis

Spread through The bite of an infected sandfly or dog. More prevalent in areas bordering Syria.

Symptoms & effects A slowly growing skin lump or ulcer. It may develop into a serious, life-threatening fever, usually accompanied by anaemia and weight loss.

Tuberculosis

Spread through Close respiratory contact and, occasionally, infected milk or milk products.

Symptoms & effects Can be asymptomatic, although symptoms can include a cough, weight loss or fever months or even years after exposure. An X-ray is the best way to confirm if you have tuberculosis.

Prevention BCG vaccine is recommended for those likely to be mixing closely with the local population – visiting family, planning a long stay, or working as a teacher or healthcare worker. As it's a live vaccine, it should not be given to pregnant women or immunocompromised individuals.

Typhoid

Spread through Food or water contaminated by infected human faeces.

Symptoms & effects Initially, usually a fever or a pink rash on the abdomen. Septicaemia (blood poisoning) may also occur.

Prevention Vaccination given by injection. In some countries, an oral vaccine is available.

Diphtheria

Spread through Close respiratory contact.

Symptoms & effects A high temperature and severe sore throat. Sometimes a membrane forms across the throat, requiring a tracheotomy to prevent suffocation.

Prevention The vaccine is given as an injection, normally with tetanus and in many countries as a routine childhood jab. Recommended for those likely to be in close contact with the local population in infected areas.

Leptospirosis

Spread through The excreta of infected rodents, especially rats. It is unusual for travellers to be affected unless living in poor sanitary conditions.

Symptoms & effects Fever, jaundice, and hepatitis and renal failure that may be fatal.

Malaria

Spread through Mosquito bites. Check with your doctor if you are considering travelling to southeastern Turkey. Elsewhere, the risk is minimal to zero.

Symptoms & effects Malaria almost always starts with marked shivering, fever and sweating. Muscle pain, headache and vomiting are common. Symptoms may occur anywhere from a few days to three weeks after a bite by an infected mosquito. The illness can start while you are taking preventative tablets, if they are not fully effective, or after you have finished taking your tablets. Malaria symptoms can be mistaken for flu by travellers who return home during winter.

Prevention Taking antimalarial tablets is inconvenient, but malaria can kill. You must take them if the risk is significant.

Hepatitis B

Spread through Infected blood, contaminated needles and sexual intercourse.

Symptoms & effects Jaundice and liver problems (occasionally failure).

Prevention The vaccine is worth considering for Turkey, where the disease is endemic. Many countries give it as part of routine childhood vaccinations.

Rabies

Spread through Bites or licks on broken skin from an infected animal.

Symptoms & effects Initially, pain or tingling at the site of the bite, with fever, loss of appetite and headache. With 'furious' rabies, there is a growing sense of anxiety, jumpiness, disorientation, neck stiffness, sometimes seizures or convulsions, and hydrophobia (fear of water). 'Dumb' rabies (less common) affects the spinal cord, causing muscle paralysis then heart and lung failure. If untreated, both forms are fatal.

Prevention People travelling to remote areas, where a reliable source of post-bite vaccine is not available within 24 hours, should be vaccinated. Any bite, scratch or lick from a warm-blooded, furry animal should immediately be thoroughly cleaned. If you have not been vaccinated and you get bitten, you will need a course of injections starting as soon as possible after the injury. Vaccination does not provide immunity, it merely buys you more time to seek medical help.

Environmental Hazards

Heat Illness

Causes Sweating heavily, fluid loss and inadequate replacement of fluids and salt. Particularly common when you exercise outside in a hot climate.

Symptoms & effects Headache, dizziness and tiredness.

Prevention Drink sufficient water (you should produce pale, diluted urine). By the time you are thirsty, you are already dehydrated.

Treatment Replace fluids by drinking water, fruit juice or both, and cool down with cold water and fans. Treat salt loss by consuming salty fluids, such as soup or broth, and adding a little more table salt to foods.

Insect Bites & Stings

Causes Mosquitoes, sandflies (located around the Mediterranean beaches), scorpions (found in arid or dry climates), bees and wasps (in the Aegean and Mediterranean coastal areas, particularly around Marmaris), and centipedes.

Symptoms & effects Even if mosquitoes do not carry malaria, they can cause irritation and infected bites. Sandflies have a nasty, itchy bite, and occasionally carry leishmaniasis or Pappataci fever. Turkey's small white scorpions can give a painful sting that will bother you for up to 24 hours.

Prevention DEET-based insect repellent. Citronella candles. Cover up with light-coloured clothing. Avoid riversides and marshy areas from late afternoon onwards. Take a mosquito head net and bed net.

Treatment Antihistamine cream to sooth and reduce inflammation.

Traveller's Diarrhoea

To prevent diarrhoea, avoid tap water unless it has been boiled, filtered or chemically disinfected (with iodine or purification tablets). Eat fresh fruit or vegetables only if they're cooked or you have peeled them yourself, and avoid dairy products that might contain unpasteurised milk. Buffet meals are risky since food may not be kept hot enough; meals freshly cooked in front of you in a busy restaurant are safer.

If you develop diarrhoea, drink plenty of fluids, and preferably an oral rehydration solution containing salt and sugar. A few loose stools don't require treatment, but if you start having more than four or five motions a day, you should take an antidiarrhoeal agent (such as loperamide) or, if that's unavailable, an antibiotic (usually a quinolone drug). 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.

Heatstroke

Causes Extreme heat; high humidity; dehydration; drug or alcohol use or physical exertion in the sun. Occurs when the body's heat-regulating mechanism breaks down.

Symptoms & effects An excessive rise in body temperature; sweating stops; irrational and hyperactive behaviour; and eventually loss of consciousness and death.

Treatment Rapidly cool down by spraying the body with water and using a fan. Emergency fluid intake and replacing electrolytes by intravenous drip are usually also required.

Snake Bites

Prevention Do not walk barefoot or stick your hands into holes or cracks when exploring nature or touring overgrown ruins and little-visited historic sites.

Treatment Do not panic: half of those bitten by venomous snakes are not actually injected with poison (envenomed). Immobilise the bitten limb with a splint (eg a stick) and bandage the site with firm pressure. Do not apply a tourniquet, or cut or suck the bite. Note the snake's appearance for identification purposes, and get medical help as soon as possible so that antivenene can be given.

Availability & Cost of Health Care

Getting Treated

If you need basic care for problems such as cuts, bruises and jabs, you could ask for the local sağulık ocağuı (health centre), but don't expect anyone to speak anything but Turkish.

If your hotel can't recommend the nearest source of medical help, try the travel assistance provided by your insurance or, in an emergency, your embassy or consulate.

Standards

The best private hospitals in İstanbul and Ankara offer world-class service, but they are expensive. Elsewhere, even private hospitals don't always have high standards of care and their state-run equivalents even less so.

Hospitals & clinics Medicine, and even sterile dressings or intravenous fluids, may need to be bought from a local pharmacy. Nursing care is frequently limited or rudimentary, as family and friends often look after Turkish patients.

Dentists Standards vary and there is a risk of hepatitis B and HIV transmission via poorly sterilised equipment, so watch the tools in use carefully. Travel insurance will usually only cover emergency dental treatment.

Pharmacists For minor illnesses, pharmacists can often provide advice and sell over-the-counter medication, including drugs that would require a prescription in your home country. They can also advise when more specialised help is needed.

Before You Go

Required Vaccinations

The following are recommended as routine for travellers, regardless of the region they are visiting:

  • diphtheria-tetanus-pertussis (whooping cough)
  • influenza
  • measles-mumps-rubella (MMR)
  • polio
  • varicella (chickenpox)

The following are also recommended for travellers to Turkey:

  • hepatitis A and B
  • typhoid

Rabies is endemic in Turkey, so if you will be travelling off the beaten track, consider an antirabies vaccination.

Malaria is found from May to October in the provinces of Diyarbakır, Mardin and Şanlıurfa.

Get vaccinations four to eight weeks before departure, and ask for an International Certificate of Vaccination or Prophylaxis (ICVP or 'yellow card'), listing all the vaccinations you've received.

Health Insurance

Turkish doctors generally expect payment in cash. Find out in advance if your travel insurance will reimburse you for overseas health expenditures or, less likely, pay providers directly. If you are required to pay upfront, keep all documentation. Some policies ask you to call a centre in your home country (reverse charges) for an immediate assessment of your problem. It's also worth ensuring your insurance covers ambulances and transport. Not all policies cover emergency medical evacuation home or to a hospital in a major city, which may be necessary in a serious emergency.

Medical Checklist

Consider packing the following in your medical kit:

  • acetaminophen/paracetamol (Tylenol) or aspirin
  • adhesive or paper tape
  • antibacterial cream or ointment
  • antibiotics (if travelling off the beaten track)
  • antidiarrhoeal drugs (eg loperamide)
  • antihistamines (for hay fever and allergic reactions)
  • anti-inflammatory drugs (eg ibuprofen)
  • bandages, gauze and gauze rolls
  • DEET-based insect repellent for the skin
  • insect spray for clothing, tents and bed nets
  • water purification tablets
  • oral rehydration salts (eg Dioralyte)
  • pocket knife, scissors, safety pins and tweezers
  • steroid cream or cortisone
  • sunblock (it's expensive in Turkey)
  • syringes and sterile needles (if travelling to remote areas)
  • thermometer

Websites

Consult your government's travel health website before departure, if one is available. The Health section at www.lonelyplanet.com/turkey has further information.