Health & insurance
Health issues and the quality of medical facilities vary enormously depending on where and how you travel in Laos. Travellers tend to worry about contracting infectious diseases when in the tropics, but infections are a rare cause of serious illness or death in travellers. Pre-existing medical conditions such as heart disease and accidental injury account for most of the life-threatening problems. Falling ill in some way, however, is relatively common. Fortunately, most common illnesses can either be prevented with common-sense behaviour or be treated easily with a well-stocked traveller's medical kit.
Dr Trish Batchelor
Before You Go
Even if you are fit and healthy, don't travel without health insurance, as accidents do happen. Declare any existing medical conditions you have: the insurance company will check if your problem is pre-existing and will not cover you if it is undeclared. You may require extra cover for adventure activities such as rock climbing. If your health insurance doesn't cover you for medical expenses abroad, consider getting extra insurance: check www.lonelyplanet.com/travel-insurance for more information. If you're uninsured, emergency evacuation is extremely expensive.
Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. In Laos, most doctors expect payment in cash. If you have to claim later, keep all the documentation.
The only vaccine required by international regulations is yellow fever. Proof of vaccination will only be required if you have visited a country in the yellow-fever zone within the six days prior to entering Southeast Asia.
Specialised travel-medicine clinics are the best source of information on vaccines and will be able to give tailored recommendations.
Most vaccines don't produce immunity until at least two weeks after they're given, so visit a doctor four to eight weeks before departure. Ask the doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all the vaccinations received.
The World Health Organization (WHO) recommends the following vaccinations for travellers to Southeast Asia, some of which do have side effects:
Adult diphtheria and tetanus Single booster recommended if you've had none in the previous 10 years.
Hepatitis A Provides almost 100% protection for up to a year; a booster after 12 months provides at least another 20 years' protection.
Hepatitis B Now 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. Lifetime protection occurs in 95% of people.
Measles, mumps and rubella Two doses of MMR required unless you have had the diseases. Many young adults require a booster.
Polio Since 2006, India, Indonesia, Nepal and Bangladesh are the only countries in Asia to have reported cases of polio. Only one booster is required as an adult for lifetime protection.
Typhoid Recommended unless the trip is less than a week and only to developed cities. The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot.
There is a wealth of travel health advice on the internet.
World Health Organization (WHO; www.who.int/ith) WHO publishes a superb book called International Travel & Health, which is revised annually and is available online for free.
Centers for Disease Control & Prevention (CDC; www.cdc.gov) Good general information.
It's usually a good idea to consult your government's travel-health website before departure, if one is available.
New Zealand (www.safetravel.govt.nz)
Pack medications in their original, clearly labelled, containers. A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is also a good idea. If carrying syringes or needles, be sure to have a physician's letter documenting their medical necessity.
If you happen to take any regular medication, bring double your needs in case of loss or theft. In Laos it can be difficult to find some newer drugs, particularly the latest antidepressant drugs, blood-pressure medications and contraceptive pills.
The following are some recommended items for a personal medical kit:
- antifungal cream, eg Clotrimazole
- antibacterial cream, eg Muciprocin
- antibiotics for diarrhoea, eg Norfloxacin or Ciprofloxacin; Azithromycin for bacterial diarrhoea; and Tinidazole for giardiasis or amoebic dysentery
- antihistamines for allergies, eg Cetrizine for daytime and Promethazine for night
- anti-inflammatories, eg Ibuprofen
- antinausea medication, eg Prochlorperazine
- antiseptic for cuts and scrapes, eg Betadine
- antispasmodic for stomach cramps, eg Buscopan
- decongestant for colds and flus, eg Pseudoephedrine
- DEET-based insect repellent
- diarrhoea 'stopper', eg Loperamide
- first-aid items such as scissors, plasters (Band Aids), bandages, gauze, thermometer (electronic, not mercury), sterile needles and syringes, and tweezers
- indigestion medication, eg Quick Eze or Mylanta
- iodine tablets to purify water
- oral-rehydration solution for diarrhoea, eg Gastrolyte
- paracetamol for pain
- permethrin (to impregnate clothing and mosquito nets) for repelling insects
- sunscreen and hat
- throat lozenges
- thrush (vaginal yeast infection) treatment, eg Clotrimazole pessaries or Diflucan tablet
Availability & Cost of Healthcare
Laos has no facilities for major medical emergencies. The state-run hospitals and clinics are among the most basic in Southeast Asia in terms of the standards of hygiene, staff training, supplies and equipment.
For minor to moderate conditions, including malaria, Mahasot Hospital's International Clinic in Vientiane has a decent reputation. Some foreign embassies in Vientiane also maintain small but professional medical centres, including the Australian Embassy Clinic and the French Embassy Medical Center.
For any serious conditions, Thailand is the destination of choice. If a medical problem can wait until Bangkok, then all the better, as there are excellent hospitals there.
For medical emergencies that can't be delayed before reaching Bangkok, ambulances can be arranged from nearby Nong Khai or Udon Thani in Thailand. Nong Khai Wattana General Hospital (042-465201) is the closest. The better Aek Udon Hospital in Udon Thani is an hour further from the border by road.
Buying medication over the counter is not recommended, as fake medications and poorly stored or out-of-date drugs are common in Laos.
This mosquito-borne disease is becomingly increasingly problematic throughout Laos, especially in the cities. As there is no vaccine it can only be prevented by avoiding mosquito bites. The mosquito that carries dengue bites day and night, so use insect avoidance measures at all times. Symptoms include high fever, severe headache and body ache (dengue was once known as 'breakbone fever'). Some people develop a rash and diarrhoea. There's no specific treatment, just rest and paracetamol. Do not take aspirin as it increases the likelihood of haemorrhaging. See a doctor to be diagnosed and monitored.
A problem throughout the region, 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, you just need to allow time for the liver to heal. All travellers to Southeast Asia should be vaccinated against hepatitis A.
The only sexually transmitted disease that can be prevented by vaccination, hepatitis B is spread by body fluids, including sexual contact. In some parts of Southeast Asia, up to 20% of the population are carriers of hepatitis B, and usually are unaware of this. The long-term consequences can include liver cancer and cirrhosis.
Hepatitis E is transmitted through contaminated food and water and has similar symptoms to hepatitis A, but it is far less common. It is a severe problem in pregnant women and can result in the death of both mother and baby. There is currently no vaccine; prevention is by following safe eating and drinking guidelines.
According to Unaids and WHO, Laos remains a 'low HIV prevalence country'. However, it's estimated that only about one-fifth of all HIV cases in Laos are actually reported. Heterosexual sex is the main method of transmission in Laos. The use of condoms greatly decreases but does not eliminate the risk of HIV infection.
Many parts of Laos, particularly populated areas, have minimal to no risk of malaria, and the risk of side effects from antimalaria medication may outweigh the risk of getting the disease. For some rural areas, however, the risk of contracting the disease far outweighs the risk of any tablet side effects. Remember that malaria can be fatal.
Malaria is caused by a parasite transmitted by the bite of an infected mosquito. The most important symptom of malaria is fever, but general symptoms such as a headache, diarrhoea, cough or chills may also occur. Diagnosis can only be made by taking a blood sample.
Two strategies should be combined to prevent malaria: mosquito avoidance and antimalarial medications. Most people who catch malaria are taking inadequate or no antimalarial medication.
Travellers are advised to prevent mosquito bites by taking these steps:
- Choose accommodation with screens and fans.
- Impregnate clothing with Permethrin in high-risk areas.
- Sleep under a mosquito net impregnated with Permethrin.
- Spray your room with insect repellent before going out for your evening meal.
- Use an insect repellent containing DEET on exposed skin.
- Wear long sleeves and trousers in light colours.
Opisthorchiasis (Liver Flukes)
These are tiny worms that are occasionally present in freshwater fish in Laos. The main risk comes from eating raw or undercooked fish. Travellers should in particular avoid eating uncooked Ъąh dàak (an unpasteurised fermented fish used as an accompaniment for many Lao foods) when travelling in rural Laos.
A rarer way to contract liver flukes is by swimming in the Mekong River or its tributaries around Don Khong in the far south of Laos.
At low levels, there are virtually no symptoms at all; at higher levels, an overall fatigue, low-grade fever and swollen or tender liver (or general abdominal pain) are the usual symptoms, along with worms or worm eggs in the faeces. Opisthorchiasis is easily treated with medication.
This uniformly fatal disease is spread by the bite or lick of an infected animal, most commonly a dog or monkey. You should seek medical advice immediately after any animal bite and commence post-exposure treatment. Having a pre-travel vaccination means the post-bite treatment is greatly simplified. If an animal bites you, gently wash the wound with soap and water, and apply iodine-based antiseptic. If you are not vaccinated you will need to receive rabies immunoglobulin as soon as possible.
Sexually transmitted diseases (STDs) most common in Laos include herpes, warts, syphilis, gonorrhoea and chlamydia. People carrying these diseases often have no signs of infection. Condoms will prevent gonorrhoea and chlamydia but not warts or herpes. If after a sexual encounter you develop any rash, lumps, discharge or pain when passing urine, seek immediate medical attention. If you have been sexually active during your travels, have an STD check on your return home.
Tuberculosis (TB) is very rare in short-term travellers. Medical and aid workers, and long-term travellers who have significant contact with the local population, should take precautions, however. Vaccination is usually only given to children under the age of five, but adults at risk are advised to get pre- and post-travel TB testing. The main symptoms are fever, cough, weight loss, night sweats and tiredness.
This serious bacterial infection is also spread via food and water. It gives a high, slowly progressive fever and headache, and may be accompanied by a dry cough and stomach pain. It is diagnosed by blood tests and treated with antibiotics. Vaccination is recommended for all travellers spending more than a week in Southeast Asia, or travelling outside of the major cities.
Traveller's diarrhoea is by far the most common problem affecting travellers. Somewhere between 30% and 50% of people will suffer from it within two weeks of starting their trip.
Traveller's diarrhoea is 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.
Treatment consists of staying well hydrated. Rehydration solutions like Gastrolyte are the best for this. Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin will kill the bacteria quickly.
Loperamide is just a 'stopper' and doesn't get to the cause of the problem, but it can be helpful when taking a long bus ride. Don't take Loperamide if you have a fever, or blood in your stools. Seek medical attention quickly if you do not respond to an appropriate antibiotic.
Amoebic dysentery is very rare in travellers but is often misdiagnosed by poor-quality labs in Southeast Asia. Symptoms are similar to bacterial diarrhoea, ie fever, bloody diarrhoea and generally feeling unwell. You should always seek reliable medical care if you have blood in your diarrhoea. Treatment involves two drugs: Tinidazole or Metronidazole to kill the parasite in your gut and then a second drug to kill the cysts. If left untreated complications such as liver or gut abscesses can occur.
Giardia lamblia is a parasite that is relatively common in travellers. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. The parasite will eventually go away if left untreated but this can take months. The treatment of choice is Tinidazole, with Metronidazole being a second-line option.
- Never drink tap water.
- Bottled water is generally safe, but check the seal is intact at purchase.
- Boiling water is the most efficient method of purifying it.
- The best chemical purifier is iodine. It should not be used by pregnant women or people who suffer with thyroid problems.
- Water filters should protect against viruses. Ensure your filter has a chemical barrier such as iodine and a small pore size.
Eating in restaurants is the biggest risk factor for contracting traveller's diarrhoea. Ways to avoid it include eating only freshly cooked food, and avoiding shellfish and food that has been sitting around in buffets. Peel all fruit and cook all vegetables. Eat in busy restaurants with a high turnover of customers.
Many parts of Southeast Asia are hot and humid throughout the year and it takes time to adapt to the climate. Swelling of the feet and ankles is common, as are muscle cramps caused by excessive sweating. Prevent these by avoiding dehydration and excessive activity in the heat.
Dehydration is the main contributor to heat exhaustion. Symptoms include feeling weak, headache, irritability, nausea or vomiting, sweaty skin, a fast, weak pulse and a normal or slightly elevated body temperature. Treatment involves getting out of the heat and/or sun, fanning the victim and applying cool wet cloths to the skin and rehydrating with water containing a quarter of a teaspoon of salt per litre. Recovery is usually rapid, though it is common to feel weak for some days afterwards.
Heatstroke is 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, seizures and eventually collapse and loss of consciousness. Seek medical help and commence cooling by getting the person out of the heat, removing their clothes, fanning them and applying cool wet cloths or ice to their body, especially to the groin and armpits.
Prickly heat is a common skin rash in the tropics, caused by sweat being trapped under the skin. The result is an itchy rash of tiny lumps. Treat by moving out of the heat and into an air-conditioned area for a few hours and by having cool showers. Locally bought prickly heat powder can be helpful.
Insect Bites & Stings
Bedbugs don't carry disease but their bites are very itchy. They live in the cracks of furniture and walls and then migrate to the bed at night to feed on you. You can treat the itch with an antihistamine.
Ticks are contracted during walks in rural areas. They are commonly found behind the ears, on the belly and in armpits. If you have had a tick bite and experience symptoms such as a rash, fever or muscle aches, then see a doctor. Doxycycline prevents tick-borne diseases.
Leeches are found in humid forest areas. They do not transmit any disease but their bites are often intensely itchy for weeks afterwards and can easily become infected. Apply an iodine-based antiseptic to any leech bite to help prevent infection.
Bee and wasp stings mainly cause problems for people who are allergic to them. Anyone with a serious bee or wasp allergy should carry an injection of adrenaline (eg an Epipen) for emergency treatment.
Fungal rashes are common in humid climates. Watch out for moist areas that get less air, such as the groin, armpits and between the toes. The problem starts as a red patch that slowly spreads and is usually itchy. Treatment involves keeping the skin dry, avoiding chafing and using an antifungal cream such as Clotrimazole or Lamisil.
Cuts and scratches become easily infected in humid climates. Take meticulous care of any cuts and scratches to prevent complications such as abscesses. Immediately wash all wounds in clean water and apply antiseptic.
Southeast Asia is home to many species of both poisonous and harmless snakes. Assume all snakes are poisonous and never try to catch one. Always wear boots and long pants if walking in an area that may have snakes. First aid in the event of a snakebite involves pressure immobilisation via an elastic bandage firmly wrapped around the affected limb, starting at the bite site and working up towards the chest. The bandage should not be so tight that the circulation is cut off, and the fingers or toes should be kept free so the circulation can be checked. Do not use tourniquets or try to suck the venom out.
Even on a cloudy day, sunburn can occur rapidly. Always use a strong sunscreen (at least factor 30), making sure to reapply after a swim, and always wear a wide-brimmed hat and sunglasses outdoors. Avoid lying in the sun during the hottest part of the day (from 10am to 2pm). If you are sunburnt stay out of the sun until you have recovered.
In urban areas, supplies of sanitary products are readily available. Birth control options may be limited though, so bring adequate supplies of your own form of contraception. Heat, humidity and antibiotics can all contribute to thrush. Treatment is with antifungal creams and pessaries such as Clotrimazole. A practical alternative is a single tablet of Fluconazole (Diflucan).
Pregnant women should receive specialised advice before travelling. The ideal time to travel is in the second trimester (between 16 and 28 weeks), when the risk of pregnancy-related problems are lowest and pregnant women generally feel at their best. Always carry a list of quality medical facilities available at your destination and ensure you continue your standard antenatal care at these facilities. Most of all, ensure travel insurance covers all pregnancy-related possibilities, including premature labour.
Malaria is a high-risk disease during pregnancy. None of the more effective antimalarial drugs are completely safe in pregnancy.
Throughout Southeast Asia, traditional medical systems are widely practised. There is a big difference between these traditional healing systems and 'folk' medicine. Folk remedies should be avoided, as they often involve rather dubious procedures with potential complications. In comparison, traditional healing systems such as traditional Chinese medicine are well respected, and aspects of them are being increasingly used by Western medical practitioners.
All traditional Asian medical systems identify a vital life force, and see blockage or imbalance as causing disease. Techniques such as herbal medicines, massage and acupuncture are utilised to bring this vital force back into balance, or to maintain balance. These therapies are best used for treating diseases such as chronic fatigue, arthritis, irritable bowel syndrome and some chronic skin conditions. Traditional medicines should be avoided for treating serious acute infections such as malaria.