Health & insurance
General health is more of a concern in Cambodia than most other parts of Southeast Asia, due to a lack of international-standard medical-treatment facilities, a prevalence of tropical diseases and poor sanitation. Once you venture into rural areas you are very much on your own, although most provincial capitals have a reasonable clinic these days.
If you feel particularly unwell, try to see a doctor rather than visit a hospital; hospitals in rural areas are pretty primitive and diagnosis can be hit and miss. If you fall seriously ill in Cambodia you should head to Phnom Penh or Siem Reap, as these are the only places in the country with decent emergency treatment. Pharmacies in the larger towns are remarkably well stocked and you don’t need a prescription to get your hands on anything from antibiotics to antimalarials. Prices are also very reasonable, but do check the expiry date, as some medicine may be out of date.
While the potential dangers can seem quite unnerving, in reality few travellers experience anything more than an upset stomach. Don’t let these warnings make you paranoid.
People wearing contact lenses should be aware that Cambodia is an extremely dusty country and this can cause much irritation when travelling. It is generally bearable in cars, but when travelling by motorcycle or pick-up, it is most definitely not. Pack a pair of glasses.
Before You Go
Do not visit Cambodia without medical insurance. Hospitals are extremely basic in the provinces and even in Phnom Penh the facilities are not necessarily what you may be used to at home. Anyone who has a serious injury or illness while in Cambodia may require emergency evacuation to Bangkok. With an insurance policy costing no more than the equivalent of a bottle of beer a day, this evacuation is free. Without an insurance policy, it will cost between US$10,000 and US$20,000. Don’t gamble with your health in Cambodia or you may end up another statistic.
Plan ahead for getting your vaccinations, as some of them require more than one injection over a period of time, while others should not be given in combination.
Record all vaccinations on an International Certificate of Vaccination, available from your doctor. It is a good idea to carry this as proof of your vaccinations when travelling in Cambodia.
Recommended vaccinations for a trip to Cambodia are listed here, but it is imperative that you discuss your needs with your doctor:
Diphtheria and tetanus Vaccinations for these two diseases are usually combined.
Hepatitis A This vaccine provides long-term immunity after an initial injection and a booster at six to 12 months. The hepatitis A vaccine is also available in a combined form with the hepatitis B vaccine – three injections over a six-month period are required.
Hepatitis B Vaccination involves three injections, with a booster at 12 months.
Polio A booster every 10 years maintains immunity.
Tuberculosis Vaccination against TB (BCG vaccine) is recommended for children and young adults who will be living in Cambodia for three months or more.
Typhoid Vaccination against typhoid may be required if you are travelling for more than a few weeks in Cambodia.
Following is a list of items to consider including in a medical kit:
- aspirin or paracetamol – for pain or fever
- antihistamine – for allergies, or to ease the itch from insect bites or stings
- cold and flu tablets, throat lozenges and nasal decongestant
- multivitamins – especially for long trips, when dietary vitamin intake may be inadequate
- loperamide or diphenoxylate – ‘blockers’ for diarrhoea
- rehydration mixture – to prevent dehydration, which may occur during bouts of diarrhoea
- insect repellent, sunscreen, lip balm and eye drops
- calamine lotion or aloe vera – to ease irritation from sunburn
- antifungal cream or powder – for fungal skin infections and thrush
- antiseptic (such as povidone-iodine) – for cuts and grazes
- bandages, plasters and other wound dressings
- water-purification tablets or iodine
- sterile kit (sealed medical kit containing syringes and needles) – highly recommended, as Cambodia has potential medical-hygiene issues
Availability & Cost of Health Care
Self-diagnosis and treatment of health problems can be risky, so always seek professional medical help.
Antibiotics should ideally be administered only under medical supervision. Take only the recommended dose at the prescribed intervals and use the whole course, even if the illness seems to be cured earlier. Stop immediately if there are any serious reactions.
The best clinics and hospitals in Cambodia are found in Phnom Penh and Siem Reap. A consultation usually costs in the region of US$20 to US$50, plus medicine. Elsewhere, facilities are more basic, although a private clinic is usually preferable to a government hospital. For serious injuries, seek treatment in Bangkok.
The number-one rule is be careful of water and ice, although both are usually factory produced, a legacy of the French. If you don’t know for certain that the water is safe, assume the worst. Reputable brands of bottled water or soft drinks are usually fine, but you can’t safely drink tap water. Only use water from containers with a serrated seal. Tea and coffee are generally fine, as they’re made with boiled water.
This viral disease is transmitted by mosquitoes. There is only a small risk to travellers, except during epidemics, which usually occur during and just after the wet season.
Unlike the malaria mosquito, the Aedes aegypti mosquito, which transmits the dengue virus, is most active during the day and is found mainly in urban areas.
Signs and symptoms of dengue fever include a sudden onset of high fever, headache, joint and muscle pains (hence its old name, ‘breakbone fever’), plus nausea and vomiting. A rash of small red spots appears three to four days after the onset of fever.
Seek medical attention if you think you may be infected. A blood test can diagnose infection, but there is no specific treatment for the disease. Aspirin should be avoided, as it increases the risk of haemorrhaging, but plenty of rest is advised.
There is no vaccine against dengue fever. The best prevention is to avoid mosquito bites at all times.
Fungal infections occur more commonly in hot weather and are usually on the scalp, between the toes (athlete’s foot) or fingers, in the groin and on the body (ringworm). Ringworm, a fungal infection, not a worm, is contracted from infected animals or other people. Moisture encourages these infections.
To prevent fungal infections wear loose, comfortable clothes, avoid artificial fibres, wash frequently and dry yourself carefully.
Hepatitis is a general term for inflammation of the liver. Several different viruses cause hepatitis, and they differ in the way that they are transmitted. The symptoms are similar in all forms of the illness, and include fever, chills, headache, fatigue, feelings of weakness, and aches and pains, followed by loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-coloured faeces, jaundiced (yellow) skin and yellowing of the whites of the eyes.
Hepatitis A and E are both transmitted by ingesting contaminated food or water. Seek medical advice, but there is not much you can do apart from resting, drinking lots of fluids, eating lightly and avoiding fatty foods.
There are almost 300 million chronic carriers of hepatitis B in the world. It is spread through contact with infected blood, blood products or body fluids; for example, through sexual contact, unsterilized needles, blood transfusions or contact with blood via small breaks in the skin. Hepatitis C and D are spread in the same way as hepatitis B and can also lead to long-term complications.
HIV & AIDS
Infection with the human immunodeficiency virus (HIV) may lead to acquired immune deficiency syndrome (AIDS), which is a fatal disease. Any exposure to blood, blood products or body fluids may put the individual at risk.
The disease is often transmitted through sexual contact or dirty needles, so vaccinations, acupuncture, tattooing and body piercing can be potentially as dangerous as intravenous drug use.
These parasites are most common in rural Cambodia. The various worms have different ways of infecting people. Some may be ingested in food such as undercooked meat (eg tapeworms) and some enter through your skin (eg hookworms). Consider having a stool test when you return home to check for worms and to determine the appropriate treatment.
This serious and potentially fatal disease is spread by mosquitoes. If you are travelling in endemic areas it is extremely important to avoid mosquito bites and to take tablets to prevent the disease developing if you become infected. There is no malaria in Phnom Penh, Siem Reap and most other major urban areas in Cambodia, so visitors on short trips to the most popular places do not need to take medication. The areas where malaria is most prevalent is along remote areas of the Thai border and on some offshore islands. Malaria self-test kits are widely available in Cambodia, but are not that reliable.
Symptoms of malaria include fever, chills and sweating, headache, aching joints, diarrhoea and stomach pains, usually preceded by a vague feeling of ill health. Seek medical help immediately if malaria is suspected, as, without treatment, the disease can rapidly become more serious or even fatal.
Sexually Transmitted Infections (STIs)
Gonorrhoea, herpes and syphilis are among these infections. Sores, blisters or a rash around the genitals and discharges or pain when urinating are common symptoms. With some STIs, such as wart virus or chlamydia, symptoms may be less marked or not observed at all, especially in women. Reliable condoms are widely available throughout urban areas of Cambodia.
Typhoid fever is a dangerous gut infection caused by contaminated water and food. Medical help must be sought.
In its initial stages sufferers may feel they have a bad cold or flu on the way, as early symptoms are a headache, body aches and a fever that rises a little each day until it is around 40°C (104°F) or higher. There may also be vomiting, abdominal pain, diarrhoea or constipation.
In the second week, the high fever continues and a few pink spots may appear on the body; trembling, delirium, weakness, weight loss and dehydration may occur.
Simple things like a change of water, food or climate can all cause a mild bout of diarrhoea, but a few rushed toilet trips with no other symptoms are not indicative of a major problem. Almost everyone gets a mild bout of the runs on a longer visit to Cambodia.
Dehydration is the main danger with diarrhoea, particularly in children or the elderly as it can occur quite quickly. Under all circumstances fluid replacement is the most important thing to remember. Stick to a bland diet as you recover. Commercially available oral rehydration salts are very useful; add them to boiled or bottled water.
Gut-paralysing drugs such as Lomotil or Imodium can be used to bring relief from the symptoms of diarrhoea, although they do not actually cure the problem. Only use these drugs if you do not have access to toilets and must travel.
There is an adage that says, ‘If you can cook it, boil it or peel it you can eat it…otherwise forget it’. This is slightly extreme, but many travellers have found it is better to be safe than sorry. Vegetables and fruit should be washed with purified water or peeled where possible. Beware of ice cream that is sold in the street (or anywhere), as it might have melted and refrozen. Shellfish such as mussels, oysters and clams should be avoided, as should undercooked meat, particularly in the form of mince.
Dehydration and salt deficiency can cause heat exhaustion. Take time to acclimatise to high temperatures, drink sufficient liquids and do not do anything too physically demanding.
Salt deficiency is characterised by fatigue, lethargy, headaches, giddiness and muscle cramps; salt tablets may help, but adding extra salt to your food is better.
Heatstroke can occur if the body’s heat-regulating mechanism breaks down, causing the body temperature to rise to dangerous levels. Long, continuous periods of exposure to high temperatures and insufficient fluids can leave you vulnerable to heatstroke.
Insect Bites & Stings
Bedbugs live in various places, but particularly in dirty mattresses and bedding, and are evidenced by spots of blood on bedclothes or on the wall. Bedbugs leave itchy bites in neat rows. Calamine lotion or Stingose spray may help.
All lice cause itching and discomfort. They make themselves at home in your hair (head lice), your clothing (body lice) or in your pubic hair (crabs). You catch lice through direct contact with infected people or by sharing combs, clothing and the like. Powder or shampoo treatment will kill the lice, and infected clothing should be washed in very hot, soapy water and left to dry in the sun.
Leeches may be present in damp rainforest conditions; they attach themselves to your skin to suck your blood. Trekkers often get them on their legs or in their boots. Salt or a lighted cigarette end will make them fall off.
Sandflies inhabit beaches (usually the more remote ones) across Southeast Asia. They have a nasty bite that is extremely itchy and can easily become infected. Use an antihistamine to quell the itching, and, if you have to itch, use the palm of your hand and not your nails or infection may follow.
Prickly heat is an itchy rash caused by excessive perspiration trapped under the skin. It usually strikes people who have just arrived in a hot climate. Keeping cool, bathing often, drying the skin, using a mild talcum or prickly heat powder, or finding air-conditioning may help.
To minimise the chances of being bitten by a snake, always wear boots, socks and long trousers when walking through undergrowth where snakes may be present.
Traditional medicine or thnam boran is very popular in rural Cambodia. There are kru Khmer (traditional medicine men) in most districts of the country and some locals trust them more than modern doctors and hospitals. Working with tree bark, roots, herbs and plants, they boil up brews to supposedly cure all ills. However, when it comes to serious conditions such as snake bites, their treatments can be counterproductive.