Health & insurance
Before You Go
A little planning before departure, particularly for pre-existing illnesses, will save you a lot of trouble later. Before a long trip, get a check-up from your dentist and your doctor if you require regular medication or have a chronic illness, eg high blood pressure or asthma. You should also organise spare contact lenses and glasses (and take your optical prescription with you); get a first-aid and medical kit together; and arrange necessary vaccinations.
Travellers can register with the International Association for Medical Assistance to Travellers (www.iamat.org). Its website can help travellers find a doctor who has recognised training. You might also consider doing a first-aid course (contact the Red Cross or St John International) or attending a remote medicine first-aid course, such as that offered by the Royal Geographical Society (https://wildernessmedicaltraining.co.uk/).
If you are bringing medications with you, carry them in their original containers, clearly labelled. A signed and dated letter from your physician describing all 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.
The World Health Organization (www.who.int/en) recommends that all travellers be adequately covered for diphtheria, tetanus, measles, mumps, rubella and polio, as well as for hepatitis B, regardless of their travel destination.
Although no vaccinations are officially required, many doctors recommend hepatitis A and B immunisations just to be sure; a yellow-fever certificate is an entry requirement if travelling from an infected region.
Find out in advance whether your insurance plan will make payments directly to providers or will reimburse you later for health expenditures (in many countries doctors expect payment in cash). It is vital to ensure that your travel insurance will cover outdoor activities, including paragliding, diving and canyoning, as well as the emergency transport required to get you to a good hospital – or all the way home – by air and with a medical attendant if necessary. Not all insurance policies cover this, so be sure to check the contract carefully. If you need medical care, your insurance company may be able to help locate the nearest hospital or clinic, or ask at your hotel. In an emergency, contact your embassy or consulate.
It is a very good idea to carry a medical and first-aid kit with you, to help yourself in case of minor illness or injury. Following is a list of items you should consider packing.
- antidiarrhoeal drugs (eg loperamide)
- acetaminophen (paracetamol) or aspirin
- anti-inflammatory drugs (eg ibuprofen)
- antihistamines (for hay fever and other allergic reactions)
- antibacterial ointment (eg Bactroban) for cuts and abrasions (prescription only)
- steroid cream or hydrocortisone cream (for allergic rashes)
- bandages, gauze, gauze rolls
- adhesive or paper tape
- scissors, safety pins, tweezers
- pocket knife
- DEET-containing insect repellent for the skin
- oral rehydration salts
- iodine tablets (for water purification)
- syringes and sterile needles (if travelling to remote areas)
There is a wealth of travel-health advice available on the internet – www.lonelyplanet.com is a good place to start. The World Health Organization publishes a superb book called International Travel and Health, which is revised annually and is available online for free at www.who.int/ith. The following are other health-related websites of general interest:
- Centers for Disease Control and Prevention (www.cdc.gov)
- Fit for Travel (www.fitfortravel.scot.nhs.uk)
- MD Travel Health (https://redplanet.travel/mdtravelhealth)
You may also like to consult your government's travel-health website, if one is available:
- Australia (https://smartraveller.gov.au/guide/all-travellers/health/)
- Canada (www.phac-aspc.gc.ca)
- USA (www.cdc.gov/travel)
In the Seychelles
Availability & Cost of Health Care
Health care in the Seychelles is pretty good by African standards, but some travellers have been critical of the standard of the public health system. Generally, public hospitals offer the cheapest service, but may not have the most up-to-date equipment and medications; private hospitals and clinics are more expensive but tend to have more advanced drugs and equipment and better-trained medical staff.
As long as you stay up to date with your vaccinations and take some basic preventive measures, you'd have to be pretty unlucky to succumb to most of the health hazards covered here.
This viral infection transmitted by certain mosquito bites was rare in the Indian Ocean until 2005 when an epidemic hit Réunion, Mauritius and the Seychelles. The unusual name means 'that which bends up' in the East African language of Makonde, a reference to the joint pain and physical distortions it creates in sufferers. Chikungunya is rarely fatal, but it can be, and it's always unpleasant. Symptoms are often flu-like, with joint pain, high fever and body rashes being the most common. It's important not to confuse it with dengue fever.
If you're diagnosed with Chikungunya, expect to be down for at least a week, possibly longer. The joint pain can be horrendous and there is no treatment; those infected need simply to rest inside (preferably under a mosquito net to prevent reinfection), taking gentle exercise to avoid joints stiffening unbearably. The best way to avoid it is to avoid mosquito bites, so bring plenty of repellent, use the anti-mosquito plug-ins wherever you can and bring a mosquito net if you're really thorough.
Dengue fever (or breakbone fever) is present in the Seychelles with outbreaks on the islands of Mahé and Praslin as recently as 2018. Although the risk to travellers remains small, it is recommended that you take precautions to avoid being bitten by mosquitos. It's a particular concern in urban areas, especially after heavy rains and anywhere with standing or stagnant water. Mosquitoes that carry the virus are active from dawn until dusk.
Dengue fever causes a feverish illness with headache and muscle pains similar to those experienced with a bad, prolonged attack of influenza. There might be a rash. Mosquito bites should be avoided whenever possible. Self-treatment: paracetamol and rest.
Hepatitis A is spread through contaminated food (particularly shellfish) and water. It causes jaundice and, although it is rarely fatal, it can cause prolonged lethargy and delayed recovery. If you've had hepatitis A, you shouldn't drink alcohol for up to six months afterwards, but once you've recovered, there won't be any long-term problems. The first symptoms include dark urine and a yellow colour to the whites of the eyes. Sometimes a fever and abdominal pain might be present. Hepatitis A vaccine (Avaxim, VAQTA, Havrix) is given as an injection: a single dose will give protection for up to a year, and a booster after a year gives 10-year protection. Hepatitis A and typhoid vaccines can also be given as a single-dose vaccine (Hepatyrix or Viatim).
Hepatitis B is spread through infected blood, contaminated needles and sexual intercourse. It can also be passed from an infected mother to the baby during childbirth. It affects the liver, causing jaundice and occasionally liver failure. Most people recover completely, but some people might be chronic carriers of the virus, which could lead eventually to cirrhosis or liver cancer. Those visiting high-risk areas for extended periods or those with increased social or occupational risk should be immunised. Many countries now routinely include hepatitis B as part of routine childhood vaccinations. It is given singly or can be given at the same time as hepatitis A (Hepatyrix). A course will give protection for at least five years. It can be given over four weeks or six months.
There is no risk of malaria in the Seychelles.
Rabies is spread by receiving bites or licks on broken skin by an infected animal. The risk is mainly from dogs. It is always fatal once the clinical symptoms start (which might be up to several months after an infected bite), so post-bite vaccination should be given as soon as possible. Post-bite vaccination prevents the virus from spreading to the central nervous system, and is necessary whether or not you were vaccinated before the bite. If you have not already been vaccinated, you will need a course of five injections starting 24 hours after being bitten or as soon as possible after the injury. If you have been vaccinated, you will need fewer post-bite injections (three injections over a month), and have more time to seek medical help.
Although it's not inevitable that you will get diarrhoea while travelling in the region, it's certainly possible. Sometimes dietary changes, such as increased spices or oils, are the cause. To avoid diarrhoea, only eat fresh fruits or vegetables if cooked or peeled, and be wary of dairy products that might contain unpasteurised milk. Although freshly cooked food is often a safe option, plates or serving utensils might be dirty, so you should be highly selective when eating food from street vendors (make sure that cooked food is piping hot all the way through).
If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution containing water (lots), and some salt and sugar. A few loose stools don't require treatment, but if you start having more than four or five stools a day, you should start taking an antibiotic (usually a quinoline drug, such as ciprofloxacin or norfloxacin) and an antidiarrhoeal agent (such as loperamide) if you are not within easy reach of a toilet. However, if diarrhoea is bloody, persists for more than 72 hours or is accompanied by fever, shaking chills or severe abdominal pain, you should seek medical attention
Although yellow fever is not a problem in the Seychelles, travellers should still carry a certificate as evidence of vaccination if they have recently been in an infected country. For a list of these countries, visit the websites of the World Health Organization (www.who.int/ith) or the Centers for Disease Control and Prevention (www.cdc.gov). A traveller without a legally required, up-to-date certificate may be vaccinated and detained in isolation at the place of entry for up to 10 days, or possibly repatriated.
This condition occurs following heavy sweating and excessive fluid loss with inadequate replacement of fluids and salt, and is particularly common in hot climates when taking unaccustomed exercise before full acclimatisation. Symptoms include headache, dizziness and tiredness. Dehydration is already happening by the time you feel thirsty – aim to drink sufficient water to produce pale, diluted urine. Self-treatment is by fluid replacement with water and/or fruit juice, and cooling by cold water and fans. The treatment of the salt-loss component consists of consuming salty fluids as in soup, and adding a little more table salt to foods than usual.
Heat exhaustion is a precursor to the much more serious condition of heatstroke. In this case there is damage to the sweating mechanism, with an excessive rise in body temperature, irrational and hyperactive behaviour, and eventually loss of consciousness and death. Rapid cooling by spraying the body with water and fanning is ideal. Emergency fluid and electrolyte replacement is usually also required by intravenous drip.
Insect Bites & Stings
Mosquitoes in the region rarely carry chikungunya and dengue fever, but they (and other insects) can cause irritation and infected bites. To avoid these, take the same precautions as you would for avoiding malaria, including wearing long pants and long-sleeved shirts, using mosquito repellents, avoiding highly scented perfumes or aftershaves etc.
Bee and wasp stings cause major problems only to those who have a severe allergy to the stings (anaphylaxis), in which case carry an adrenaline (epinephrine) injection.
Leeches may be present in damp rainforest conditions; they attach themselves to your skin to suck your blood. Salt or a lit cigarette end will make them fall off. Ticks can cause skin infections and other more serious diseases. If a tick is found attached, press down around the tick's head with tweezers, grab the head and gently pull upwards.
A number of Indian Ocean species are poisonous or may sting or bite. Watch out above all for sea urchins. Other far rarer creatures to look out for include the gaudy lionfish with its poisonous spined fins, and the cleverly camouflaged – and exceptionally poisonous – stonefish, which lives amid coral formations. Some shells, such as the cone shell, can fire out a deadly poisonous barb. Fire coral, which looks like yellowish brush-like coral growths, packs a powerful sting if touched.
In the Seychelles, two fatal shark attacks on swimmers were reported in 2011; both occurred at Anse Lazio. Still, the risk of shark attacks remains extremely small.
Diving Health & Safety
Officially, a doctor should check you over before you do a course, and fill out a form full of diving health questions. In practice, most dive schools will let you dive or do a course if you complete a medical questionnaire, but the check-up is still a good idea. This is especially so if you have any problem at all with your breathing, ears or sinuses. If you have asthma, any other chronic breathing difficulties or any inner-ear problems, you shouldn't do any scuba diving.
This is a very serious condition – usually, though not always, associated with diver error. The most common symptoms are unusual fatigue or weakness; skin itch; pain in the arms, legs (joints or mid-limbs) or torso; dizziness and vertigo; local numbness, tingling or paralysis; and shortness of breath.
The most common causes of decompression sickness (or the 'bends' as it is commonly known) are diving too deep, staying at depth for too long or ascending too quickly. This results in nitrogen coming out of solution in the blood and forming bubbles, most commonly in the bones and particularly in the joints or in weak spots such as healed fractures.
Note that your last dive should be completed 24 hours before flying in order to minimise the risk of residual nitrogen in the blood that can cause decompression injury.
The only treatment for decompression sickness is to put the patient into a recompression chamber. There are recompression chambers in the Seychelles.
In addition to normal travel insurance, it's a very good idea to take out specific diving cover, which will pay for evacuation to a recompression facility and the cost of hyperbaric treatment in a chamber. Divers Alert Network (www.diversalertnetwork.org) is a nonprofit diving-safety organisation that provides a policy that covers evacuation and recompression.
As a general rule, tap water in the Seychelles is safe to drink, but always take care immediately after a cyclone or cyclonic storm as mains water supplies can become contaminated by dead animals and other debris washed into the system. Never drink from streams as this might put you at risk of waterborne diseases.