Prevention is the key to staying healthy while travelling. A little planning before departure will save trouble later: visit a doctor in good time to discuss vaccinations and prepare any medications that you need to take with you; carry spare contact lenses or glasses.

The South Caucasus is generally a pretty healthy region, but as you would anywhere, minimise the risk of problems by avoiding dodgy food and water, and taking precautions against insect and animal bites.

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Before You Go

Recommended Vaccinations

You should be up-to-date with the vaccinations that you would normally have back home, such as diphtheria, tetanus, measles, mumps, rubella, polio and typhoid. Further vaccines may be advisable for children or the elderly.

Hepatitis A Classed as an intermediate risk in the region: vaccination may be recommended for those who are staying for long periods, particularly in areas with poor sanitation.

Hepatitis B Has high endemicity: vaccination may be recommended for some groups, including people who are likely to have unprotected sex.

Tuberculosis (TB) Vaccination is a good idea for young people who plan to work in high-risk areas such as refugee settlements.

Rabies Exists in all three countries. Consider vaccination if you plan a lot of activities that might bring you into contact with domestic or wild animals, such as cycling, hiking or camping, especially in remote areas where post-bite vaccine may not be available within 24 hours.

Insurance

EU citizens are entitled to free public medical and some dental care in Georgia, Armenia and Azerbaijan under reciprocal arrangements. However, standards of public health care in the region are very patchy and if you want to use far better but expensive Western-standard clinics in the major cities, good insurance coverage is essential. Ideally get a policy that will make payments directly to providers, rather than reimburse you later.

Websites

There is a wealth of travel-health advice online. The following include country-specific information:

wwwnc.cdc.gov/travel The US Centers for Disease Control and Prevention.

www.nathnac.org The UK’s National Travel Health Network and Centre.

In Georgia, Armenia & Azerbaijan

Tap Water

Tap water is generally safe to drink in most of the region, though in Baku and the lowland areas of Azerbaijan, you're better off with bottled purified water, which is easily available. If you aren't sure of your tap water's quality, boil tap water for 10 minutes, use water purification tablets, or use a filter. The South Caucasus is also home to some regionally famous mineral waters of which Georgia's sparkling Borjomi is best known. Keep your empty bottles to refill at springs, which you'll often find beside country roads in upland areas. Most are safe and indeed positively healthy, but check with locals, especially if a spring seems little used, as there can always be a slight risk of contamination.

Availability of Health Care

The capital cities have some expensive, Western-standard clinics. Public medical care is available in all towns, though clinics and hospitals may be ill supplied, and nursing care limited (families and friends are often expected to provide this). In Georgia some formerly public hospitals have been privatized and will charge fully for treatment, although the cost is still modest by Western standards.

In past years it was typically the custom to give cash tips to nurses or doctors for hospital treatment. This is no longer common and in places where it does still happen, foreigners would usually be forgiven for not knowing about it. If you want to give a cash tip for special attention, do it discreetly by putting money in an envelope, with a card saying something like ‘for coffee and cakes in the office’.

Traveller’s Diarrhoea

In general the South Caucasus countries are healthy places and stomach upsets are not noticeably more common than in other parts of Europe. If you do develop diarrhoea, however, be sure to drink plenty of fluids, preferably in the form of an oral rehydration solution such as Gastrolyte. If diarrhoea is bloody, persists for more than 72 hours or is accompanied by fever, shaking, chills or severe abdominal pain, seek medical attention.

Environmental Hazards

Altitude Sickness

Altitude sickness may develop in anyone who ascends quickly to altitudes above 2500m. It is common at 3500m and likely with rapid ascent to 5000m. The risk increases with faster ascents, higher altitudes and greater exertion. Symptoms may include headaches, nausea, vomiting, dizziness, fatigue, insomnia, undue breathlessness or loss of appetite.

Severe cases may involve fluid in the lungs (the most common cause of death from altitude sickness), or swelling of the brain. Anyone showing signs of altitude sickness should not ascend any higher until symptoms have cleared. If symptoms get worse, descend immediately.

Acclimatisation and slow ascent are essential to reduce the risk of altitude sickness: fit, fast climbers are often the most at risk – less dynamic hikers being more likely to pace themselves on steep ascents. Drink at least 4L of water a day to avoid dehydration: a practical way to monitor hydration is to check that urine is clear and plentiful. Avoid tobacco and alcohol. Some climbers credit mint, ginger and garlic as being helpful, though that is largely apocryphal. Diamox (acetazolamide) reduces the headache pain caused by altitude sickness and helps the body acclimatise to the lack of oxygen. It is normally only available on prescription and it is not usually recommended for preventative use.

Hypothermia

Hypothermia occurs when the body loses heat faster than it can produce it. Even on a hot day in the mountains the weather can change rapidly, so carry waterproof garments, warm layers and a hat, and inform others of your route. Hypothermia starts with shivering, loss of judgement and clumsiness. Unless rewarming occurs, the sufferer deteriorates into apathy, confusion and coma. Prevent further heat loss by seeking shelter, warm dry clothing, hot sweet drinks and shared bodily warmth.

Insect Bites & Stings

Mosquitoes are found in most parts of the Caucasus. Malaria is present, though uncommon, from May or June to October in southeast Georgia, the rural lowlands of southern Azerbaijan and some parts of Armenia. Bring a good insect repellent that can be applied to exposed skin and clothing. Repellents containing DEET are generally effective and last longer than plant-extract oils, but wash hands carefully after use as DEET can perish rubber and damage certain plastics, including many types of sunglasses.

Travelling with Children

  • Make sure children are up-to-date with routine vaccinations, and discuss possible travel vaccines well before departure as some are not suitable for children.
  • Be extra wary of contaminated food and water. If your child has vomiting or diarrhoea, lost fluid and salts must be replaced.
  • Children should be encouraged to avoid and mistrust unfamiliar dogs or other mammals because of the potential risk of rabies and other diseases. Shepherd dogs are not pets and can be extremely fierce.