Most travellers who come to Rarotonga, Samoa or Tonga won't experience anything worse than an upset stomach or a hangover. But if you have an immediate and serious health problem, visit the nearest public hospital or call into a pharmacy for advice. These regions have no malaria, rabies or crocodiles: the main danger is from mosquito-borne dengue fever.
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Before You Go
A little planning before departure will save trouble later.
- A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is a good idea.
- Bring medications in their original, clearly labelled, containers.
- See your dentist before a long trip.
- Carry a spare pair of contact lenses and glasses; take your optical prescription with you.
Required & Recommended Vaccinations
For all countries in the region, vaccinations are recommended for hepatitis A, hepatitis B and typhoid fever. A current influenza shot is also recommended. And check how long it’s been since you had a tetanus booster (once every 10 years is the going rate).
A comprehensive travel- and health-insurance policy is essential for the region. Check whether you’re covered for ‘dangerous’ activities (surfing, snorkelling, diving etc) and make sure your policy has provision for evacuation. Under these circumstances, hospitals will accept direct payment from major international insurers, but for all other health-related costs cash up front is usually required.
Worldwide travel insurance is available at www.lonelyplanet.com/travel-insurance. You can buy, extend and claim online anytime – even if you’re already on the road.
In Rarotonga, Samoa & Tonga
Availability & Cost of Health Care
The further you get from population centres, the more basic the services and facilities. Cost varies between countries but is generally similar to Australia.
Cook Islands, Samoa & Tonga Specialised services may be limited, but private general practitioners, dentists and pharmacies are present.
American Samoa There are doctors in private practice and standard hospital and laboratory facilities with consultants in the major specialities. Private dentists, opticians and pharmacies are also available.
Risk All countries, especially in the hotter, wetter months.
Symptoms & treatment Mosquito-borne dengue fever causes a high fever, headache and severe muscle pains. A fine rash may also be present. Self-treatment includes paracetamol (do not take aspirin), fluids and rest. Danger signs are prolonged vomiting, blood in the vomit, a blotchy, dark-red rash and/or bruising.
Risk Cook Islands, Tonga.
Symptoms & treatment An illness manifested by scattered abnormal skin sensations, fever and sometimes meningitis symptoms (headache, vomiting, confusion, stiffness of the neck and spine). Eosinophilic meningitis is caused by a microscopic parasite – the rat lungworm – that contaminates raw food. There is no proven treatment, but symptoms may require hospitalisation. For prevention, pay strict attention to advice on food and drink.
Risk American Samoa, possibly elsewhere.
Symptoms and treatment Also known as Weil’s disease, leptospirosis produces fever, headache, jaundice and, later, kidney failure. It’s caused by the spirochaete organism found in water contaminated by rat and pig urine. Often confused with dengue fever, this disease is the more serious of the two. The organism penetrates skin, so swimming in flooded areas is a risk. If diagnosed early, it’s cured with penicillin.
Diarrhoea is caused by viruses, bacteria or parasites present in contaminated food or water. In temperate climates the cause is usually viral, but in the tropics bacteria or parasites are more usual.
If you get diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution (eg Diarolyte, Gastrolyte). If you start passing more than four or five stools a day, you should take antibiotics (usually a quinolone drug) and an antidiarrhoeal (eg Loperamide). 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.
To steer yourself clear of diarrhoea, avoid tap water unless it has been boiled, filtered or chemically disinfected (with iodine tablets), and also avoid ice unless you’ve made it yourself from bottled water. This is a sensible overall precaution, but the municipal water supply in capital cities in the region can be trusted.
Beyond the odd mosquito bite, threats to health from animals and insects are rare in the South Pacific. But there are a few things for travellers to be aware of.
Bites & Stings
Watch out for the whip-like stings of the blue-coloured Indo-Pacific man-of-war. If you see these floating in the water or stranded on the beach, play it safe and stay on dry land. The sting is very painful and is best treated with vinegar or ice packs. Do not use alcohol.
Poisonous Cone Shells
Avoid handling these poisonous shells, which abound along shallow coral reefs. Stings cause local reactions, but nausea, faintness, palpitations or difficulty breathing are signs that medical attention is needed.
Sea snakes may be seen around coral reefs. Unprovoked, sea snakes are extremely unlikely to attack – and their fangs will not penetrate a wetsuit. (In Tonga, locals joke that death by sea-snake bite is a voluntary undertaking – you’d have to force one to bite you!)
Sharks do swim around these warm tropical waters, but they rarely pose a threat to humans. Whitetip and blacktip reef sharks are too small to do any damage, but grey reef, tiger and bull sharks occasionally get nippy. If you’re in the sea, remember that so are they.
Dogs have free rein across these island groups, but their bark is generally worse than their bite. Play it safe on the streets: cross the road to avoid packs and don’t try to pat or befriend wandering mutts. And if you are barked at, don’t hang around and continue the conversation.
This is a fungal infection caused by water entering the ear canal. Apart from diarrhoea it is the most common reason for tourists to consult a doctor: it can be very painful and spoil your holiday. Self-treatment with an antibiotic-plus-steroid ear-drop preparation (eg Sofradex, Kenacomb Otic) is very effective. Stay out of the water until the pain and itch have gone.
Infection of cuts and scrapes is very common, and cuts from live coral are particularly prone to infection. Cleanse the wound thoroughly (getting out all the little bits of coral or dirt if needed), apply an antiseptic and cover with a dressing. Change the dressing regularly, never let it sit wet and check often for signs of infection.
Because the region has wonderful opportunities for scuba diving, it's easy to get overexcited and neglect strict depth and time precautions. If you’re inexperienced, make sure you’re diving with a licensed operator who knows what they’re doing and has a realistic understanding of your limits.
Ciguatera poisoning is characterised by stomach upsets, itching, faintness, slow pulse and bizarre inverted sensations – cold feeling hot and vice versa. Ciguatera has been reported in many carnivorous reef fish, including red snapper, barracuda and even smaller reef fish. There is no safe test to determine whether a fish is poisonous or not, although it is reasonable to eat what the locals are eating. Deep-sea tuna is perfectly safe.
Treatment consists of rehydration; if the pulse is very slow, medication may be needed. Healthy adults will make a complete recovery, although disturbed sensation may persist for some weeks – sometimes much longer.
Sunburn is an obvious issue, so use sunscreen liberally. It’s also important to stay hydrated; heat exhaustion is a state of dehydration associated with salt loss.
Heatstroke is more dangerous and happens when the cooling effect of sweating fails. This condition is characterised by muscle weakness and mental confusion. Skin will be hot and dry. If this occurs, ‘put the fire out’ by cooling the body with water on the outside and cold drinks on the inside, and seek urgent medical help.