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Before You Go

Medications

  • Pack medications in their original, clearly labelled containers.
  • Carry a signed and dated letter from your physician describing your medical conditions and medications, including their generic names.
  • If you have a heart condition bring a copy of your ECG taken just prior to travelling.
  • Bring a double supply of any regular medication in case of loss or theft.

Online Resources

  • Centres for Disease Control & Prevention (CDC; www.cdc.gov) Check health conditions in all destinations and get up-to-date travel advice.
  • World Health Organization (WHO; www.who.int/ith) Has links to national travel and health websites.

It’s also a good idea to consult your government’s travel-health website, if one is available, before departure:

  • Australia (www.smartraveller.gov.au)
  • Canada (www.phac-aspc.gc.ca)
  • New Zealand (www.safetravel.govt.nz)
  • UK (www.gov.uk/foreign-travel-advice)
  • USA (wwwnc.cdc.gov/travel)

Recommended Vaccinations

Proof of yellow-fever vaccination will be required if you have visited a country in the yellow-fever zone (such as Africa or South America) within the six days prior to entering the region. Otherwise the World Health Organization (WHO) recommends the following vaccinations:

  • Adult diphtheria & tetanus Single booster recommended if none have been had 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.
  • Measles, mumps & rubella (MMR) Two doses of MMR are required unless you have had the diseases. Many young adults require a booster.
  • Polio There have been no reported cases of polio in recent years. Only one booster is required as an adult for lifetime protection.
  • Typhoid Recommended unless your trip is less than a week and is only to developed cities. 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 is usually recommended as it has fewer side effects.
  • Varicella If you haven’t had chickenpox, discuss this vaccination with your doctor.

Health Insurance

Even if you’re fit and healthy, don’t travel without health insurance – accidents do happen. You may require extra cover for adventure activities such as rock climbing or diving, as well as scooter/motorcycle riding. If your health insurance doesn’t cover you for medical expenses abroad, ensure you get specific travel insurance. Most hospitals require an upfront guarantee of payment (from yourself or your insurer) prior to admission. Enquire before your trip about payment of medical charges and retain all documentation (medical reports, invoices etc) for claim purposes.

In Malaysia, Singapore & Brunei

Availability & Cost Of Health Care

  • Malaysia The standard of medical care in the major centres is good, and most problems can be adequately dealt with in Kuala Lumpur.
  • Singapore Excellent medical facilities. You cannot buy medication over the counter without a doctor’s prescription.
  • Brunei General care is reasonable. There is no local medical university, so expats and foreign-trained locals run the health-care system. Serious or complex cases are better managed in Singapore, but adequate primary health care and stabilisation are available.

Environmental Hazards

Air Pollution

If you have severe respiratory problems, speak with your doctor before travelling to any heavily polluted urban centres. If troubled by the pollution, leave the city for a few days to get some fresh air.

Bedbugs

Bedbugs live in the cracks of furniture and walls, and migrate to the bed at night to feed on you. They are a particular problem in the region and are more likely to strike in high-turnover accommodation, especially backpacker hostels, though they can be found anywhere. The room may look very clean but they can still be there. Protect yourself with the following strategies:

  • Ask the hotel or hostel what they do to avoid bed bugs. It’s a common problem and reputable establishments should have a pest-control procedure in place.
  • Keep your luggage elevated off the floor to avoid having the critters latch on – this is one of the common ways bedbugs are spread from place to place.
  • Check the room carefully for signs of bugs – you may find their translucent light brown skins or poppy seed–like excrement. Pay particular attention to places less likely to have seen a dusting from cleaning staff.

If you do get bitten:

  • Treat the itch with antihistamine.
  • Thoroughly clean your luggage and launder all your clothes, sealing them after in plastic bags to further protect them.
  • Be sure to tell the management – if they seem unconcerned or refuse to do anything about it, complain to the local tourist office.

Diving & Surfing

If planning on diving or surfing, seek specialised advice before you travel to ensure your medical kit also contains treatment for coral cuts and tropical ear infections. Have a dive medical before you leave your home country – there are certain medical conditions that are incompatible with diving. Hyberbaric chambers are located in Kuantan and Lumut on Peninsular Malaysia, Labuan on Malaysian Borneo, and Singapore.

Tap Water

  • Never drink tap water unless you’ve verified that it’s safe (many parts of Malaysia, Singapore and Brunei have modern treatment plants).
  • Bottled water is generally safe – check the seal is intact at purchase.
  • Avoid ice in places that look dubious.
  • Avoid fruit juices if they have not been freshly squeezed or you suspect they may have been watered down.
  • Boiling water is the most efficient method of purification.
  • The best chemical purifier is iodine. It should not be used by pregnant women or those with thyroid problems.
  • Water filters should also filter out viruses. Ensure your filter has a chemical barrier such as iodine and a small pore size (eg less than 4 microns).

Heat

It can take up to two weeks to adapt to the region’s hot 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. Treat by getting out of the heat, applying cool, wet cloths to the skin, laying flat with legs raised, and rehydrating with water containing a quarter of a teaspoon of salt per litre.

Heat stroke is a serious medical emergency. Symptoms come on suddenly and include weakness, nausea, a body temperature of over 41°C, dizziness, confusion, loss of coordination, fits and, eventually, collapse and loss of consciousness. Seek medical help and commence cooling by getting out of the heat, removing clothes, and applying cool, wet cloths or ice to the body, especially to the groin and armpits.

Prickly heat – an itchy rash of tiny lumps – is caused by sweat being trapped under the skin. Treat by moving out of the heat and into an air-conditioned area for a few hours and by having cool showers. Creams and ointments clog the skin so they should be avoided.

Insect Bites & Stings

  • Lice Most commonly inhabit your head and pubic area. Transmission is via close contact with an infected person. Treat with numerous applications of an anti-lice shampoo such as Permethrin.
  • Ticks Contracted after walking in rural areas. If you are bitten and experience symptoms – such as a rash at the site of the bite or elsewhere, fever or muscle aches – see a doctor. Doxycycline prevents tick-borne diseases.
  • Bees or wasps If allergic to their stings, carry an injection of adrenaline (eg an Epipen) for emergency treatment.
  • Jellyfish Most are not dangerous. If stung, pour vinegar onto the affected area to neutralise the poison. Take painkillers, and seek medical advice if your condition worsens.
Leeches

You may not encounter any of these slimy little vampires while walking through the region’s jungle, but if the trail is leafy and it’s been raining, chances are you’ll be preyed upon.

The local leeches are so small they can squeeze through tight-knit socks. They don’t stay tiny for long, however, since once a leech has attached to your skin, it won’t let go until it has sucked as much blood as it can hold.

Two species are common: the brown leech and the tiger leech. The tiger leech is recognisable by its cream and black stripes, but you’ll probably feel one before you see it. Unlike the brown leech, whose suction is painless, tiger leeches sting a bit. Brown leeches hang around on, or near, the forest floor, waiting to grab onto passing boots or pants. Tiger leeches lurk on the leaves of small trees and tend to attack between the waist and neck, and that can mean any orifice there and around. Keep your shirt tucked in.

Leeches are harmless, but bites can become infected, so it’s best to prevent them becoming attached in the first place. Insect repellent on feet, shoes and socks works temporarily; loose tobacco or washing powder in your shoes and socks is also said to help. Better yet, invest in some leech-proof socks that cover the foot and boot heel and fasten below the knees.

Safe and effective ways to dislodge leeches include flicking them off – try using a credit card to do this and aim for the mouth end as pulling a leech off by the tail can make it dig in harder. Tiger balm, iodine or medicated menthol oil will also get leeches off. Otherwise, succumb to your fate as a reluctant blood donor and they will eventually drop off.

Skin Problems

There are two common fungal rashes that affect travellers in the Tropics. The first occurs in moist areas that get less air, such as the groin, armpits and between the toes. It 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. Tinea versicolour is also common – this fungus causes small, light-coloured patches, most commonly on the back, chest and shoulders. Consult a doctor.

Take meticulous care of any cuts and scratches to prevent infection. Immediately wash all wounds in clean water and apply antiseptic. If you develop signs of infection (increasing pain and redness), see a doctor. Divers and surfers should be particularly careful with coral cuts.

Snakes

Assume all snakes are poisonous. Always wear boots and long pants if walking in an area that may have snakes. First aid in the event of a snake bite 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; the fingers or toes should be kept free so the circulation can be checked. Immobilise the limb with a splint and carry the victim to medical attention. Don’t use tourniquets or try to suck out the venom. Antivenin is available for most species.

Sunburn

Even on a cloudy day, sunburn can occur rapidly. Always use a strong sunscreen (at least SPF 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 (10am to 2pm). If you’re sunburnt, stay out of the sun until you’ve recovered, apply cool compresses and take painkillers for the discomfort. Applied twice daily, 1% hydrocortisone cream is also helpful.

Infectious Diseases

The following are the most common for travellers:

  • Dengue fever Increasingly common in cities. The mosquito that carries dengue bites day and night, so use insect avoidance measures at all times. Symptoms can include high fever, severe headache, body ache, a rash and diarrhoea. There is no specific treatment, just rest and paracetamol – do not take aspirin as it increases the likelihood of hemorrhaging.
  • Hepatitis A This food- and water-borne virus infects the liver, causing jaundice (yellow skin and eyes), nausea and lethargy. All travellers to the region should be vaccinated against it.
  • Hepatitis B The only sexually transmitted disease (STD) that can be prevented by vaccination, hepatitis B is spread by body fluids, including sexual contact.
  • Hepatitis E 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. A vaccine has been developed and is licensed in China, but not elsewhere. Prevention is by following safe eating and drinking guidelines.
  • HIV Unprotected sex is the main method of transmission.
  • Influenza Can be very severe in people over the age of 65 or in those with underlying medical conditions such as heart disease or diabetes; vaccination is recommended for these individuals. There is no specific treatment, just rest and paracetamol.
  • Malaria Uncommon in the region but still present in Malaysian Borneo and deeply forested areas. Antimalarial drugs are rarely recommended for travellers. Remember that malaria can be fatal. Before you travel, seek medical advice on the right medication and dosage for you.
  • Rabies A potential risk, and invariably fatal if untreated, rabies is spread by the bite or lick of an infected animal – most commonly a dog or monkey. 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 pre-vaccinated you will need to receive rabies immunoglobulin as soon as possible.
  • Typhoid This serious bacterial infection is spread via food and water. Symptoms include high and slowly progressive fever, headache, a dry cough and stomach pain. Vaccination, recommended for all travellers spending more than a week in Malaysia, is not 100% effective so you must still be careful with what you eat and drink.

Traveller’s Diarrhoea

By far the most common problem affecting travellers and commonly caused by a bacteria. Treat by staying well hydrated, using a solution such as Gastrolyte. Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin will kill the bacteria quickly.

Loperamide is just a 'stopper,’ but it can be helpful in certain situations, such as if you have to go on a long bus ride. Seek medical attention quickly if you do not respond to an appropriate antibiotic.

Giardiasis is relatively common. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. The treatment of choice is Tinidazole, with Metroniadzole being a second option.

Travelling With Children

There are specific issues you should consider before travelling with your child:

  • All routine vaccinations should be up to date, as many of the common childhood diseases that have been eliminated in the West are still present in parts of Southeast Asia. A travel-health clinic can advise on specific vaccines, but think seriously about rabies vaccination if you’re visiting rural areas or travelling for more than a month, as children are more vulnerable to severe animal bites.
  • Children are more prone to getting serious forms of mosquito-borne diseases such as malaria, Japanese B encephalitis and dengue fever. In particular, malaria is very serious in children and can rapidly lead to death – you should think seriously before taking your child into a malaria-risk area. Permethrin-impregnated clothing is safe to use, and insect repellents should contain between 10% and 20% DEET.
  • Diarrhoea can cause rapid dehydration and you should pay particular attention to keeping your child well hydrated. The best antibiotic for children with diarrhoea is Azithromycin.
  • Children can get very sick, very quickly so locate good medical facilities at your destination and make contact if you are worried – it’s always better to get a medical opinion than to try to treat your own children.

Traditional & Folk Medicine

Throughout 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 utilised 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 bring this vital force back into balance or maintain balance. These therapies are best used for treating chronic disease 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.

Be aware that ‘natural’ doesn’t always mean ‘safe,’ and there can be drug interactions between herbal medicines and Western medicines. If you are using both systems, ensure you inform both practitioners as to what the other has prescribed.

Women’s Health

If travelling while pregnant:

  • find out about quality medical facilities at your destination and ensure you continue your standard antenatal care at these facilities. Avoid travel in rural areas with poor transport and medical facilities.
  • ensure travel insurance covers all pregnancy-related possibilities, including premature labour.
  • be aware that malaria is a high-risk disease in pregnancy. The World Health Organization recommends that pregnant women do not travel to areas with malaria resistant to chloroquine. None of the more effective antimalarial drugs is completely safe in pregnancy.
  • traveller’s diarrhoea can quickly lead to dehydration and result in inadequate blood flow to the placenta. Many of the drugs used to treat various diarrhoea bugs are not recommended in pregnancy. Azithromycin is considered safe.

Additional considerations:

  • In urban areas, supplies of sanitary products are readily available. Birth-control options may be limited 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).
  • Urinary-tract infections can be precipitated by dehydration or long bus journeys without toilet stops; bring suitable antibiotics.