Health & insurance
While the potential dangers of Sri Lankan travel may seem worrisome, most travellers experience nothing more serious than an upset stomach. Travellers tend to worry about contracting infectious diseases, but infections rarely cause serious illness in healthy travellers. Note that hygiene standards are casual at best and bad at worst in many kitchens throughout the country.
Before You Go
The only vaccine required by international regulations is yellow fever. Proof of vaccination will only be required if, in the six days before entering Sri Lanka, you have visited a country in the yellow-fever zone.
The US Centers for Disease Control (CDC) recommends that travellers to Sri Lanka consider the following vaccinations (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.
Hepatitis B Now considered routine for most travellers.
Japanese encephalitis Recommended for rural travel, people who will be doing outdoor activities or for anyone staying longer than 30 days.
Polio Incidence has been unreported in Sri Lanka for several years but must be assumed to be present.
Rabies Three injections in all. A booster after one year will then provide 10 years’ protection.
Typhoid Recommended for all travellers to Sri Lanka, even if you only visit urban areas.
Varicella If you haven’t had chickenpox, discuss this vaccination with your doctor.
Even if you’re fit and healthy, don’t travel without health insurance: accidents do happen. A travel or health insurance policy is essential. You may require extra cover for adventure activities, such as scuba diving. If your normal health insurance doesn’t cover you for medical expenses abroad, get extra insurance. If you’re uninsured, emergency evacuation is expensive, and bills of more than US$100,000 are not uncommon.
In Sri Lanka
Availability & Cost of Health Care
Medical care, and its cost, is hugely variable in Sri Lanka. Colombo has some good clinics aimed at expats; they’re worth using over options aimed at locals because a superior standard of care is offered. Nawaloka Hospital in Colombo also has a good reputation and English-speaking doctors. Embassies and consulates often have lists of recommended medical providers. Elsewhere in Sri Lanka, hotels and guesthouses can usually steer you to a local doctor for at least initial treatment.
Self-treatment may be appropriate if your problem is minor (eg traveller's diarrhoea). If you think you may have a serious disease, especially malaria, do not waste time: travel to the nearest quality facility to receive attention. It is always better to be assessed by a doctor than to rely on self-treatment.
Before buying medication over the counter, always check the use-by date and ensure the packet is sealed. Colombo and larger towns all have good pharmacies; most medications can be purchased without a prescription.
Ayurveda (eye-your-veda) is an ancient system of medicine using herbs, oils, metals and animal products to heal and rejuvenate. Influenced by the system of the same name in India, Ayurveda is widely used in Sri Lanka for a range of ailments.
Ayurveda postulates that the five elements (earth, air, ether, water and light) are linked to the five senses, which in turn shape the nature of an individual’s constitution – his or her dosha (life force). Disease and illness occurs when the dosha is out of balance. The purpose of Ayurvedic treatment is to restore the balance.
For full-on therapeutic treatments, patients must be prepared to make a commitment of weeks or months. It’s a gruelling regimen featuring frequent enemas and a bare minimum diet of simple vegetable-derived calories.
Much more commonly, tourists treat themselves at Ayurvedic massage centres attached to major hotels and in popular tourist centres. Full treatments take up to three hours and include the following relaxing regimens:
- Herbal saunas (Sweda Karma) are based on a 2500-year-old design. The plaster walls are infused with herbal ingredients, including honey and sandalwood powder. The floor of the sauna is covered with herbs. Like a European sauna, a steady mist of medicinal steam is maintained with water sprinkled onto hot coals.
- The steam bath (Vashpa Swedanam) looks like a cross between a coffin and a torture chamber. Patients lie stretched out on a wooden platform, and a giant hinged door covers the body with only the head exposed. From the base of the wooden steam bath, up to 50 different herbs and spices infuse the body.
- The so-called Third Eye of the Lord Shiva treatment (Shiro Dhara) is the highlight for many patients. For up to 45 minutes, a delicate flow of warm oil is poured slowly onto the forehead and then smoothed gently into the temples by the masseuse.
While there are numerous spas with good international reputations, the standards at some Ayurvedic centres are low. The massage oils may be simple coconut oil and the practitioners may be unqualified, and in some instances may even be sex workers. As poisoning cases have resulted from herbal treatments being misadministered, it pays to enquire precisely what the medicine contains and then consult with a conventional physician.
For massage, enquire whether there are both male and female therapists available; we’ve received complaints from female readers about sexual advances from some male Ayurvedic practitioners. In general, it’s not acceptable Ayurvedic practice for males to massage females and vice versa.
Tap water is not safe to drink. Use bottled or filtered water; for the former, look for the small round ‘SLSI’ logo, which shows the water has been tested by the government’s Sri Lanka Standards Institution (the majority of local brands).
Dengue fever This mosquito-borne disease is becomingly increasingly problematic across Asia. As there is no vaccine available, it can only be prevented by avoiding mosquito bites at all times. Symptoms include high fever, severe headache and body ache and sometimes a rash and diarrhoea. Treatment is rest and paracetamol – do not take aspirin or ibuprofen as it increases the likelihood of haemorrhaging. Make sure you see a doctor to 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, you just need to allow time for the liver to heal. All travellers to Sri Lanka should be vaccinated against hepatitis A.
Hepatitis B This sexually transmitted disease is spread by body fluids and can be prevented by vaccination. The long-term consequences can include liver cancer and cirrhosis.
Hepatitis E Transmitted through contaminated food and water, hepatitis E has similar symptoms to hepatitis A, but 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 no commercially available vaccine, and prevention is by following safe eating and drinking guidelines.
HIV Spread via contaminated body fluids and present in Sri Lanka. Avoid unsafe sex, unsterilised needles (including in medical facilities) and procedures such as tattoos.
Influenza Present year-round in the tropics, influenza (flu) symptoms include fever, muscle aches, a runny nose, cough and sore throat. It can be severe in people over the age of 65 or in those with medical conditions such as heart disease or diabetes – vaccination is recommended for these individuals. There is no specific treatment, just rest and paracetamol.
Japanese B encephalitis This viral disease is transmitted by mosquitoes and is rare in travellers. Most cases occur in rural areas and vaccination is recommended for travellers spending more than one month outside cities. There is no treatment, and it may result in permanent brain damage or death. Ask your doctor for further details.
Malaria Malaria was formerly a serious problem, but the World Health Organization declared Sri Lanka malaria-free in 2016. Doctors presently advise that anti-malarial drugs are not necessary.
Rabies This fatal disease is spread by the bite or possibly even the lick of an infected animal – most commonly a dog or monkey. You should seek medical advice immediately after any animal bite and commence postexposure treatment. Having pretravel vaccination means the postbite 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 prevaccinated you will need to receive rabies immunoglobulin as soon as possible, and this can be expensive and tricky to find in some areas.
Tuberculosis While TB is rare in travellers, those who have significant contact with the local population (such as medical and aid workers and long-term travellers) should take precautions. Vaccination is usually only given to children under the age of five, but adults at risk are recommended to have pre- and post-travel TB testing. The main symptoms are fever, cough, weight loss, night sweats and fatigue.
Typhoid This serious bacterial infection is also spread via food and water. It gives a high and 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 who are spending more than a week in Sri Lanka. Be aware that vaccination is not 100% effective, so you must still be careful with what you eat and drink.
This is by far the most common problem affecting travellers in Sri Lanka. It’s usually caused by a bacteria, and thus responds promptly to treatment with antibiotics.
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 ciprofloxacin or azithromycin should kill the bacteria quickly. Seek medical attention quickly if you do not respond to an appropriate antibiotic.
Loperamide is just a ‘stopper’ and doesn’t get to the cause of the problem. It can be helpful, though (eg if you have to go on a long bus ride). Don’t take loperamide if you have a fever or blood in your stools.
Amoebic dysentery Amoebic dysentery is very rare in travellers but is quite often misdiagnosed by poor-quality labs. Symptoms are similar to bacterial diarrhoea: 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.
Giardiasis Giardia 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 best advice is to seek medical treatment. The treatment of choice is tinidazole, with metronidazole being a second-line option.
Air pollution, particularly vehicle pollution, is an increasing problem in most urban hubs. If you have severe respiratory problems, speak with your doctor before travelling. It's worth taking a disposable face mask if you are affected by air quality.
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 ensure their insurance covers them for decompression illness – get specialised dive insurance through an organisation such as Divers Alert Network (www.danasiapacific.org). Certain medical conditions are incompatible with diving; check with your doctor.
Dining out brings with it the possibility of contracting diarrhoea. Ways to help avoid food-related illness:
- eat only freshly cooked food
- avoid shellfish and buffets
- peel fruit
- cook vegetables
- soak salads in iodine water for at least 20 minutes
- eat in busy restaurants with a high customer turnover.
Lowland areas of Sri Lanka can be hot and humid throughout the year. For most visitors, it takes around two weeks to comfortably adapt to the 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. Don’t eat salt tablets (they aggravate the gut); drinking rehydration solution or eating salty food helps. Treat cramps by resting, rehydrating with double-strength rehydration solution and gently stretching.
Dehydration is the main contributor to heat exhaustion. Recovery is usually rapid, and it is common to feel weak for some days afterwards. Symptoms include the following:
- feeling weak
- nausea or vomiting
- sweaty skin
- a fast, weak pulse
- normal or slightly elevated body temperature.
- get out of the heat
- fan the sufferer
- apply cool, wet cloths to the skin
- lay the sufferer flat with their legs raised
- rehydrate with water containing one-quarter teaspoon of salt per litre.
Heatstroke is a serious medical emergency. Symptoms include the following:
- a hot, dry body
- temperature of over 41°C
- loss of coordination
- eventual collapse.
- get out of the heat
- fan the sufferer
- apply cool, wet cloths to the skin or ice to the body, especially to the groin and armpits.
Prickly heat is a common skin rash in the tropics, caused by sweat trapped under the skin. Treat it by moving out of the heat for a few hours and having cool showers. Creams and ointments clog the skin so they should be avoided. Locally bought prickly-heat powder can be helpful.
Insect Bites & Stings
Bedbugs Don’t carry disease, but their bites can be itchy. You can treat the itch with an antihistamine.
Lice Most commonly appear on the head and pubic areas. You may need numerous applications of an antilice shampoo such as pyrethrin.
Ticks Contracted while walking in rural areas. Ticks are commonly found behind the ears, on the belly and in armpits. If you have had a tick bite and have a rash at the site of the bite or elsewhere, fever or muscle aches, see a doctor. Doxycycline prevents tick-borne diseases.
Leeches Found in humid rainforest areas. They do not transmit any disease, but their bites are often itchy for weeks and can easily become infected. Apply an iodine-based antiseptic to any leech bite to help prevent infection.
Bee and wasp stings Anyone with a serious bee or wasp allergy should carry an injection of adrenalin (eg an Epipen).
Fungal rashes There are two common fungal rashes that affect travellers. The first occurs in moist areas, 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. The second, Tinea versicolor, causes light-coloured patches, most commonly on the back, chest and shoulders. Consult a doctor.
Cuts and scratches These become easily infected in humid climates. Immediately wash all wounds in clean water and apply antiseptic. If you develop signs of infection (increasing pain and redness), see a doctor.
Even on a cloudy day sunburn can occur rapidly.
- Use a strong sunscreen (factor 30) and reapply after a swim.
- 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, stay out of the sun until you have recovered, apply cool compresses and, if necessary, take painkillers for the discomfort. One percent hydrocortisone cream applied twice daily is also helpful.
For gynaecological health issues, seek out a female doctor.
Birth control Bring adequate supplies of your own form of contraception.
Sanitary products Pads, but rarely tampons, are readily available.
Thrush 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 These can be precipitated by dehydration or long bus journeys without toilet stops; bring suitable antibiotics.