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Ukraine

Health & safety

Before you go

Insurance

Ukraine has reciprocal health-care arrangements with some countries – the UK, for example – but these are only ever for emergency medical care. Americans and others lacking affordable health insurance should at least consider a policy that covers you for the worst possible scenario, such as an accident requiring an emergency flight home.

Ukraine’s health-care system can usually take care of less serious ailments and afflictions – such as influenza, cuts requiring stitches and simple broken bones – at bargain prices.

Of course having the appropriate level of travel insurance is always a good idea as well.

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Internet resources

Before departing, check with your local public health service for information on current epidemics or health risks for travel to Ukraine. The World Health Organization’s (WHO) 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.scot.nhs.uk (general travel advice), and www.mariestopes.org.uk (information on women’s health and contraception).

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Medical checklist

Pharmacists in Ukraine are the first port of call for many people suffering minor complaints, and they will usually perform a diagnosis if you can explain or point to the problem. Most common medicines are available, but it might be handy to bring the following.

Adhesive tape

Antibacterial ointment (for cuts and abrasions)

Antidiarrhoeal drugs (eg loperamide)

Anti-inflammatory drugs (eg Ibuprofen)

Antihistamine (for hay fever and allergic reactions)

Aspirin or paracetamol

Bandages, gauze, gauze rolls

DEET-based insect repellent for the skin

Eye drops

Insect spray containing pyrethrin, for clothing, tents and bed nets

Oral rehydration salts

Scissors, safety pins, tweezers

Sun block

Thermometer

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Ukraine’s health service is under-resourced­ and decidedly primitive by Western European standards, so it’s important to be prepared. Bring extra supplies of any medication you are taking and familiarise yourself with the Latin name if it’s not on the label.

In Ukraine this is often written in the Roman alphabet alongside any medicine’s local name. Although most Ukrainian hospitals now use disposable syringes, supplies can be short, so it doesn’t hurt to bring your own in a sterilised first-aid kit. Contact lens solution and spare contacts are now readily available in major cities.

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Vaccinations

No jabs are mandatory to enter Ukraine, but it is recommended that your immunisations are current for diphtheria, polio, tetanus, measles (Kyiv experienced an outbreak in 2006), hepatitis A and typhoid (the last two are given jointly). Those going hiking in summer should also consider shots against tick-borne encephalitis and rabies.

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Dangers & annoyances

Crime

As far as crime goes, Ukraine is usually as safe as most Western European countries. The worst that’s likely to befall most visitors is petty theft.

Avoiding this is largely a matter of common sense. Ukrainians can usually spot foreigners at 10 paces, and no matter how hard you try to blend in, you will stand out as a ‘rich’ Westerner, so don’t compound matters by flashing your money around. Watch your wallet and belongings, particularly on public transport and in crowded situations. Stay low-key in appearance and have more than one place on your body where you stash your cash. Avoid being alone at night in parks or secluded places.

There’s one famous scam and growing credit-card fraud. However, the sort of organised robberies on trains that occur in many other parts of Europe don’t happen on domestic routes here. Keep your valuables with you at all times, of course, and travel in 2nd class if you don’t want to draw too much attention to yourself. However, no one is likely to release knock-out gas into your compartment while you sleep.

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Credit-card fraud

Although Ukraine remains largely a cash economy, credit cards are increasingly accepted by up-market hotels, restaurants and shops both in and outside Kyiv. Unfortunately, some embassies have warned of a concomitant rise in credit card fraud. They suggest you use your card only as a last resort, and only in reputable locations. Take all the usual precautions to make sure no one sees or copies down your PIN.

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The dropped-wallet scam

This well-known rort starts with you suddenly noticing a wallet or a large wad of cash on the ground near you. If you pick it up, you’ll be approached by someone saying it’s theirs. They’ll thank you…and then say that they had two wallets or wads of cash and accuse you of stealing the other. Alternatively, they’ll directly accuse you of stealing the first wallet. Accomplices might be brought in as witnesses or ‘police’. Don’t get involved and walk away quickly.

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Racist attacks

Ukraine has tended to be more welcoming to people of African, Asian and Caribbean appearance than neighbouring Russia. However, that has always been relative. In the past couple of years, there’s been a worrying increase in seemingly racially motivated attacks – with the UN and the International Organization for Migration (IOM) speaking out about the problem in 2007 and again in 2008, after an asylum seeker from Congo was stabbed 15 times and died outside a Kyiv metro station.

The situation is nowhere near as bad as, say, in St Petersburg; but if you’re black, Asian or of Middle Eastern appearance, stay alert and exercise extreme caution if going out alone at night.

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As LP Hartley might have reminded us: ‘Ukraine is a foreign country; they do things differently there.’ And the difference that usually strikes overseas travellers is the bureaucratic, apathetic and occasionally downright rude service. Dumbstruck hotel desk staff, unhurried shop assistants and ticket offices that shut just when you get to the front of a long queue – these are all little annoyances from the Soviet Union that independent Ukraine has yet to entirely shake.

Spend a bit longer in the country and you become cognisant of the crazy driving, the crowded public transport, the litter, and the almost superstitious local aversion to ‘draughts’ (ie fresh air), which often means people are unwilling to open a window on a packed marshrutka in 30ºC heat. You might also be astounded by all the passive smoking you’re doing. On the other hand, this is all part of travel’s great tapestry, isn’t it?

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In transit

Deep vein thrombosis (dvt)

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 DVT is swelling or pain of the calf, usually but not always on just one side. When a blood clot travels to the lungs, it might cause chest pain and difficulty breathing. Travellers with any of these symptoms should immediately seek medical attention.

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

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Jet lag & motion sickness

To avoid jet lag (common when crossing more than five time zones) try to drink plenty of non alcoholic fluids and eat light meals. Try to readjust your schedule for meals, sleep etc as soon as you board your flight, or even in the days before departure. Upon arrival, get exposure to natural sunlight.

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

Chornobyl

The risk to short-term visitors to the Chornobyl nuclear power plant is thought to be insignificant. Any areas contaminated enough to present a health risk have been sealed off and should not pose a threat unless you are foolhardy enough to stray from your group and wander off on your own.

However, some authorities have advised against swimming in the Dnipro around Kyiv, although it’s a popular local pastime in summer. Portions of silt flowing downstream may contain minute traces of radiation.

The most absorptive foods are mushrooms and berries. These two staples of the Ukrainian diet should be avoided if they are from the Polissyan woods around Chornobyl or if their origin is uncertain.

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Hypothermia & frostbite

Ukraine’s harsh winters do present a risk of hypothermia, so be alert to the first warning signs, like chattering teeth and shivering, before loss of judgment and clumsiness set in. Unless rewarming occurs at this point, the sufferer deteriorates into apathy, confusion and coma. Prevent further heat loss by seeking shelter; donning warm dry clothing; drinking hot sweet drinks and sharing bodily warmth. Be aware that hypothermia can occur both because of a gradual loss of temperature over hours or following a sudden drop of temperature.

Frostbite is caused by freezing and subsequent damage to bodily extremities. It is dependent on wind-chill, temperature and length of exposure. Frostbite starts as frostnip (white, numb areas of skin) from which complete recovery is expected with rewarming. As frostbite develops, the skin blisters and then becomes black. Adequate clothing, staying dry, keeping well hydrated and ensuring adequate calorie intake best prevent frostbite. Treatment involves rapid rewarming.

Even on a hot summer’s day in the mountains, the weather can change rapidly, particularly on the exposed ridges of Crimea. So always carry waterproof garments and warm layers, and inform others of your route.

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Water

Foreigners in Ukraine should be wary about drinking water straight from the tap. You should at least boil or purify water (with filters, iodine or chlorine). However, an even safer solution is to drink bottled water, which is cheap and plentiful.

It’s normally fine to clean your teeth in tap water, but on trains you shouldn’t even do that. Take a bottle of water into the train bathroom with you.

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Diphtheria

This bacterial infection of the throat, nose and tonsils is resurgent in parts of Eastern Europe, including Ukraine. The disease causes lesions in the infected area and in severe cases can cause swelling and fluid build-up in the neck. In many countries, diphtheria booster shots are recommended every 10 years. Travellers should ensure theirs is current before visiting Ukraine.

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Hiv & aids

Ukraine is the site of Europe’s worst HIV epidemic. The country is thought to have more than 10 times the number of HIV cases than equivalent Western European nations, and the virus continues to spread faster here than elsewhere on the continent. Newly reported HIV diagnoses reached record levels in 2007, and UNAIDS now estimates that 410, 000 people – or 1.4% of the adult population – is HIV positive. That number could be as high as 680, 000. Most cases go unreported, which explains the uncertainty and why official figures released by Ukraine’s Ministry of Health are much lower.

While the epidemic was originally drug-driven, heterosexually transmitted infection is on the increase, rising to about 35% of new HIV cases in 2006, according to UNAIDS. The worst-hit areas are Crimea, Dnipropetrovsk, Donetsk, Odesa and Mykolayiv.

The message should be clear: always practise safe sex.

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Rabies

This is a potential concern considering the number of stray dogs running around in packs throughout Ukraine. If bitten by a dog, seek medical attention immediately (most main hospitals will have a rabies clinic), but don’t panic – while rabies is transmitted via the animal’s saliva, the rabies virus is present in saliva only during the final stages of the disease in the animal, often only in the last week of the dog’s life. It is therefore a relatively rarely transmitted disease. Still, do not take any chances and seek medical attention. Any bite, scratch or even lick from an unknown animal should be cleaned immediately and thoroughly. Scrub with soap and running water, and then apply alcohol or iodine solution.

A rabies vaccination does exist, but it only reduces the level of treatment needed following a bite. Travellers vaccinated against rabies should still seek medical treatment if bitten.

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Tick-borne encephalitis

This is spread by tick bites. It is a serious infection of the brain and some medical practitioners advise vaccination for those planning to spend time hiking in the Carpathians or Crimea between April and August. The risk of getting bitten in Ukraine is quite low, however. So other clinics suggest prophylactic prevention – ie using DEET- and pyrethrin-based insect repellents to prevent tick bites – particularly for short-term visitors. In either case, check your body for ticks each evening.

Two doses of vaccine will give a year’s protection, three doses up to three years’. However, many doctors’ surgeries have to order the vaccine in advance and the shots need to be given at certain intervals for maximum protection. So, if you are planning to have a series of shots, you should look at having the first injection about a month before departure.

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Tuberculosis

As in many countries of the former Soviet Union, the incidence of drug-resistant tuberculosis (TB) has reached epidemic proportions in Ukraine. However, most travellers are at very low risk of contracting this disease, as infection requires prolonged contact with a contagious individual. Many West Europeans and Australians will have been vaccinated against some strains of TB in adolescence. This, and being in good health, is thought by some practitioners to increase your natural immunity against other strains too. American travellers, who won’t usually have been immunised, might want to consider a TB vaccination if going into a high-risk situation. However, its efficacy is questionable when given in adulthood.

In any case, try to avoid spending a lot of time with someone with a persistent dry cough. If that proves to be unavoidable, it’s a sensible precaution to get a TB test on your return home.

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Typhoid & hepatitis a

These diseases are spread through contaminated food (particularly shellfish) and water. Typhoid can cause septicaemia; hepatitis A causes liver inflammation and jaundice. Neither is usually fatal but recovery can be prolonged. Hepatitis A and typhoid immunisation is now routinely provided in a single vaccine. However, the first dose lasts only a year, after which you will need a booster to provide 10 years’ coverage.

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Availability & cost of health care

There are some Western European–standard private clinics in Kyiv but these are usually expensive. By contrast, health care in state-run hospitals is remarkably cheap, although a shortage of cash in the post-Soviet era means equipment is often lacking or outdated. While most doctors at the state-run hospitals don’t speak English, they are usually well trained and can take care of run-of-the-mill ailments and accidents. For serious complaints you should travel to a larger town or ask your embassy or consulate to recommend a private clinic, doctor or dentist in Kyiv.

The US embassy maintains a comprehensive list of regional hospitals at kyiv.usembassy.gov/amcit_medical_serv_ukraine_eng.html.

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Traveller’s diarrhoea

If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution (eg Dioralyte). 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 quinoline drug) and an antidiarrhoeal agent (such as loperamide), and seek medical treatment. Furthermore, if diarrhoea is bloody, persists for more than 72 hours or is accompanied by fever, shaking, chills or severe abdominal pain, you should also seek medical attention.

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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 injected contraception.

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