Few travellers to Goa will experience anything more than upset stomachs. These days many travellers to Goa also travel with their children – even tiny babies – and the overwhelming majority of small visitors contract nothing worse than an itchy dose of heat rash.

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Before You Go

* Pack medications in their original containers.

* Bring a letter from your physician describing medical conditions and medications or syringes you may need to carry.

* If you have a heart condition, bring a copy of your ECG.

* Bring extra medication in case of loss or theft; it can be difficult to find the latest antidepressants, blood-pressure medications and contraceptive pills.

Recommended Vaccinations

The World Health Organization (WHO) recommends these vaccinations for travellers to India (as well as being up to date with measles, mumps and rubella vaccinations):

Adult diphtheria and tetanus Single booster recommended if none in the previous 10 years.

Hepatitis A Provides almost 100% protection for up to a year; a booster after 12 months provides another 20 years’ protection.

Hepatitis B Considered routine for most travellers. Given as three shots over six months. A rapid schedule is also available, as is a combined vaccination with hepatitis A. In 95% of people lifetime protection results.

Polio Polio is still present in India. Only one booster is required as an adult for lifetime protection. Inactivated polio vaccine is safe during pregnancy.

Typhoid Recommended for all travellers to India, even if you only visit urban areas. The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot. Tablets are also available but the injection has fewer side effects.

Varicella If you haven’t had chickenpox, discuss this vaccination with your doctor.

These immunisations are recommended for long-term travellers (more than one month) or those at special risk.

Japanese B encephalitis Three injections in all. Booster recommended after two years.

Meningitis Single injection. There are two types of vaccination: quadrivalent vaccine gives two to three years’ protection; meningitis group C vaccine gives around 10 years’ protection. Recommended for long-term backpackers aged under 25.

Rabies Three injections in all. A booster after one year will then provide 10 years’ protection.

Tuberculosis (TB) Adult long-term travellers are usually recommended to have a TB skin test before and after travel, rather than vaccination. Only one vaccine given in a lifetime.

In Goa

Availability & Cost of Health Care

Although there are reasonable facilities in Panaji (Panjim), Margao (Madgaon) and Vasco da Gama, Goa does not have the quality of medical care available in the West.

Goa’s ambulance service isn’t always the quickest to respond; it may be quicker, in case of an emergency, to jump in a taxi.

For minor ailments and complaints, Goa has lots of GPs (general practitioners) and family doctors: just ask at your hotel or guest house, or check with locals for a good recommendation. Upmarket hotels also often have a reliable doctor on call.

Often, you just need to drop in to a GP’s office during consultation hours (without an appointment) and a consultation costs in the region of ₹100.

Prescriptions rarely cost more than ₹50 when filled at pharmacies.

There are well-stocked pharmacies in all Goan towns selling drugs manufactured under licence to Western companies. You can buy far more over the counter here than you can in the West, often without prescription.

Tap Water

* Even on a cloudy day sunburn can occur rapidly.

* Use strong sunscreen (at least SPF30), making sure you reapply after swimming, and wear a wide-brimmed hat and sunglasses.

* Avoid lying in the sun during the hottest part of the day (10am to 2pm).

* If you become sunburnt, apply cool compresses and take painkillers. One percent hydrocortisone cream applied twice daily is also helpful.

Infectious Diseases

Dengue Fever This mosquito-borne disease is becoming increasingly problematic in Goa. As there is no vaccine available, it can only be prevented by avoiding mosquito bites. Symptoms include high fever, severe headache and body ache; some people develop a rash and experience diarrhoea. There is no specific treatment – just rest and paracetamol. Don’t take aspirin; it increases the likelihood of haemorrhaging. See a doctor so you can be diagnosed and monitored.

Hepatitis A This food- and water-borne virus infects the liver, causing jaundice (yellow skin and eyes), nausea and lethargy. There is no specific treatment for hepatitis A, other than time for the liver to heal. All travellers to India should be vaccinated.

Hepatitis B The only sexually transmitted disease that can be prevented by vaccination, hepatitis B is spread by body fluids. Long-term consequences can include liver cancer.

Hepatitis E Transmitted through contaminated food and water, hepatitis E has similar symptoms to hepatitis A, but is less common. It is a severe problem in pregnant women and can result in the death of both mother and baby. There is no vaccine; prevention is by following safe eating and drinking guidelines.

HIV India has one of the highest growth rates of HIV in the world. HIV is spread via contaminated body fluids. Avoid unsafe sex, unsterile needles (including in medical facilities) and procedures such as tattoos, unless you’re certain the equipment is sterile.

Rabies Around 30,000 people die annually in India from rabies. This fatal disease is spread by the bite or lick of an infected animal – most commonly a dog or monkey. Pre-travel vaccination means post-bite treatment is greatly simplified. If you are bitten, gently wash the wound with soap and water, apply iodine-based antiseptic, and seek medical help immediately.

Typhoid Spread via food and water, this bacterial infection gives a high and slowly progressive fever, headache and maybe a dry cough and stomach pain. It is treated with antibiotics. Vaccination is recommended for travellers spending more than a week in India. Vaccination is not 100% effective; still be careful with what you eat and drink.

Traveller’s Diarrhoea Defined as the passage of more than three watery bowel actions within 24 hours, plus at least one other symptom such as fever, cramps, nausea, vomiting or feeling generally unwell. This is by far the most common problem affecting travellers; in over 80% of cases it is caused by bacteria, and therefore responds promptly to antibiotics. Treatment consists of staying well hydrated; rehydration solutions such as Gastrolyte are best. Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin kill the bacteria quickly. Loperamide is a ‘stopper’ and doesn’t address the problem. It can be helpful for long bus rides, though. Don’t take Loperamide if you have a fever or blood in your stools.

Amoebic Dysentery Amoebic dysentery is rare in travellers but is often misdiagnosed. Symptoms are similar to bacterial diarrhoea: fever, bloody diarrhoea and generally feeling unwell. Always seek reliable medical care if you have blood in your diarrhoea. Treatment involves Tinidazole or Metronidazole to kill the parasite and a second drug to kill the cysts. If left untreated, complications such as liver or gut abscesses can result.

Giardiasis A relatively common parasite in travellers. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. The parasite eventually goes away if left untreated, but can take months. The treatment of choice is Tinidazole with Metronidazole.

Environmental Hazards

Diving & Surfing

Divers and surfers should seek specialised advice before they travel to ensure their medical kit contains treatment for coral cuts and tropical ear infections. Divers should also get specialised dive insurance through an organisation such as Divers Alert Network and have a dive medical before they travel.

Heat

Dehydration The main contributor to heat exhaustion. Symptoms include: weakness, headache, irritability, nausea, sweaty skin, a fast, weak pulse, and a normal or slightly elevated body temperature. Treatment involves getting out of the heat, fanning the sufferer and applying cool wet cloths to the skin, laying the sufferer flat with their legs raised and rehydrating them with water and salt (¼ teaspoon per litre).

Heatstroke A serious medical emergency. Symptoms come on suddenly and include weakness, nausea, a hot dry body with a body temperature of over 41°C, dizziness, confusion, loss of coordination, fits and eventually collapse and loss of consciousness. Seek medical help and get the person out of the heat, removing their clothes, fanning them and applying cool wet cloths or ice to their body, especially the groin and armpits.

Prickly heat A common rash in the tropical regions, caused by sweat trapped under the skin. The result is an itchy rash of tiny lumps. Treat prickly heat by moving out of the heat and into an air-conditioned area for a few hours. Cool showers also help in treating the rash. Creams and ointments clog the skin and should be avoided. Locally purchased prickly heat powder can be helpful.

Insect Bites & Stings

Bedbugs don’t carry disease but their bites are itchy. You can treat the itch with an antihistamine.

Ticks are contracted while walking in rural areas. Ticks are commonly found behind the ears, on the belly and in armpits. See a doctor if you get a rash at the site of the bite or elsewhere, fever or muscle aches. The antibiotic Doxycycline prevents tick-borne diseases.

Skin Problems

There are two common fungal rashes that affect travellers in humid climates. In either case, consult a doctor.

The first occurs in moist areas such as the groin, armpits and between toes. It starts as a red patch that slowly spreads and is usually itchy. Treatment involves keeping the skin dry, avoiding chafing and using antifungal cream such as Clotrimazole or Lamisil.

Tinea versicolour is the second common rash; this fungus causes small, light-coloured patches, mostly on the back, chest and shoulders.