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A guide to remaining safe and healthy.

The items covered in this section are...

• General Tips.
• Accidents.
• Cholera.
• Cuts, scratches, abrasions etc.
• Crime, muggings and attack.
• Dengue fever.
• Diarrhoea tablets.
• Drugs.
• Electrolyte replacement.
• Heat exhaustion.
• First-aid kit.
• Heatstroke.
• Hepatitis.
• HIV.
• Hookworm.
• Insurance.
• Influenza.
• Malaria.
• Meat or vegetarian meals.
• Medical services.
• Sunburn.
• Tetanus.
• Tinea.
• Traveller's Diarrhoea.
• Typhoid.

Please be aware that the information presented below is provided only as a checklist of some of the major health risks associated with travel. You should always seek the advice of a registered health practitioner.

Travel in the third world does not mean that you will become sick or even that you will suffer minor illnesses such as nausea or the dreaded traveller’s diarrhoea, provided you exercise a little common sense.

Many travellers will experience some minor stomach upsets or changed bowel actions while away from home, however these are usually nothing more than minor inconveniences, usually the affect of an exotic diet rather than serious illness. Sometimes, such minor stomach upsets are known as "Bali Belly". Remember, the risk of accidents or sunburn are often more dangerous to the traveller than food related illnesses.

The sensible traveller must never put aside all notions of common sense where health and safety are concerned--a third world country is not a place to find oneself in need of emergency medical attention, especially through neglect or misadventure--so always take care, and enjoy a safe, healthy holiday.

Travellers to foreign countries will often have many questions regarding health risks, vaccinations and what types of food to avoid as well as general health and safety problems. The following list is a overview of some of those more common concerns...

• General Tips.
  • Consult a travel health specialist rather than a regular G.P. to be more certain of getting up-to-date advice and treatments for your trip to Asia.
  • Immunization against potential diseases should be considered several weeks before your trip.
  • The World Health Authority "Yellow Book" is considered the best source for determining which vaccinations are required in particular geographical areas.
  • Some vaccinations may not be taken at the same time as others, so discuss travel health issues with a doctor several weeks before leaving home.
  • Travellers should consider adequate insurance coverage for foreign travel. Emergency medical evacuation coverage to a nearby country such as Australia or Singapore should also be considered.
  • Wear a hat for protection from the harsh burning sun.
  • If you intend to burn mosquito coils at night, be very careful that they cannot set your room on fire. Always be aware of fire risks and plan an escape route from your lodgings in case of an emergency--facilities such as sprinkler systems, hoses and extinguishers are not common, even in large hotels.

Accidents.

An accident, perhaps a fall, a traffic accident or even a cut or scratch pose the biggest risk to any traveller embarking on an adventure holiday. Take care to avoid accidents, but be prepared if they do happen. Always carry a first-aid kit, and consider traveller’s insurance just in case.

People on holidays often exhibit a carefree, even careless attitude, which greatly increases the possibility of accidental injury, and unfortunately for tens of unsuspecting tourists each year--the result is death.

Cholera.

Cholera is a type of gastroenteritis, associated with infection by bacteria found in contaminated water. It produces severe stomach cramps and profound watery diarrhoea, and may lead to severe dehydration. The risk to travellers is usually low (if you stay clear of cholera outbreak areas), however mortality is high if it is left untreated. Immunisation is available but is not always 100% reliable, so seek medical advice if you intend to travel in a high risk area or fear that you have been exposed to cholera.

Some areas of Indonesia, including Bali have been reported as high risk cholera areas--discuss the current situation with your doctor or traveller's medical centre before leaving home for the most up-to-date information.

• Cuts, scratches, abrasions etc.

Everyone is at some risk of receiving cuts, scratches and general abrasions etc. whilst walking or travelling around in Asia. Care must be taken to clean all wounds (even minor ones) using pure water, and if possible, with a disinfectant or antisceptic ointment. After cleaning, cover cuts and scratches with a bandaid or bandage. The rate of infections is high if cuts are not treated. Avoid most risks by wearing shoes whilst walking around, and by keeping an eye open for broken glass, damaged footpaths, holes in the road etc.

• Crime, muggings and attack

Violent crime has never really been considered a risk to travellers throuhout most of Asia, but attacks, including robery and even rape are unfortunately becoming more common as time goes on. Reports indicate that few such crimes are ever solved. Be aware that nowhere is free of risk.

Dengue fever

Dengue fever is an acute infectious tropical disease that is caused by a virus transmitted from person to person by mosquitoes. The symptoms include severe headache, fever, intense joint and muscle pain and a generalized skin rash.

Although seldom fatal and usually runing its course in 6 or 7 days, convalescence is long and slow, and no specific treatment is available.

Dengue is endemic in some parts of the tropics including much of Indonesia, and epidemics periodically occur.

• Diarrhoea tablets.

There are many treatments and tablets available for emergency relief of diarrhoea. It is wise to carry a small supply of diarrhoea tablets, but they should only be used when really necessary. It is most important to avoid alcohol and to maintain an adequate intake of clean water when suffering from diarrhoea.

If treatments such as tablets are used, the instructions should be followed exactly, and of the condition does not respond to treatment, you should consult a doctor. You must always be aware of the possibility that diarrhoea is a symptom that is common to a number of serious diseases, although for most who experience it, the diarrhoea will be caused by a change of diet, too much alcohol, or exposure to some bugs that your body has not had to deal with before.

Drugs.

Travelling to a foreign country to score cheap drugs is a false economy, especially if you get caught. Save the airfare, a stint in an Asian jail is too high a price to pay.

• Electrolyte replacement.

Lost body salts due to excessive sweating, vomiting or diarrhoea may be replaced by proprietary electrolyte tablets or drinks as an aid to recovery.

• Heat exhaustion.

Similar to heatstroke but less severe, the symptoms of heat exhaustion include fatigue, dizzyness and nausea due to prolonged exposure to hot conditions, although temperature is about normal and sweating persists. Be aware of the risk of heat exhaustion when on long bus trips and walks.

Treatment entails cooling the person and providing small sips of water, which may also include glucose or electrolyte replacement tablets, or even a small amount of salt.

The chance of heatstroke and heat exhaustion can be minimised by moderating activity during the hottest part of the day, and by maintaining an adequate intake of fluids and salt.

Heatstroke.

Heatstroke (or sunstroke) is an extreme body response to very hot conditions, generally caused by excessive sweating depleting the body of vital salts. Symptoms include dizziness, tingling sensations, general confusion, and fainting, and usually the skin is dry, hot and red. The body temperature may rise to above 41 degrees Celsius and sweating may have ceased.

If untreated, heatstroke may be fatal, or cause shock, brain damage, or kidney failure, especially in persons with underlying disease.

Treatment must be immediate and and must be focused on bringing the temperature back to normal (39 degrees Celsius). This is best accomplished by cooling the victim's skin with a wet towel or gently showering with cold water.

• Hepatitis.

An injection of immune gammar globulin is used as a safe and effective prophylaxis against the highly infectious hepatitis A, which is probably the most serious health risk to travellers in Asia.

Hepatitis B is a more serious form of viral hepatitis. Vaccination is recommended for those who will be staying for more than 6 months or for those who may share needles with or have sexual contact with persons in high-risk groups, such as drug users and prostitutes.

Other hepatitis strains (Non-A/Non-B types) have been recently identified, and the risks, the need for vaccination and methods of prevention against these should be discussed with your doctor.

HIV.

Most at risk, are those who share needles with, or have unprotected sexual contact with persons in high-risk groups, such as drug users and prostitutes, however a good rule of thumb is, all unknown people are high risk.

• Hookworm.

Hookworms are intestinal parasites that take their name from the hooklike appendages surrounding their mouths. They cause symptoms including anemia, abdominal pain, and diarrhoea.

The eggs of hookworms are deposited on the ground in the feces of animals and people suffering from infestation, and develop into larvae that are able to penetrate the skin of anyone who comes into contact with them by walking barefooted in the contaminated area.

After entering the body, the larvae travel through the bloodstream eventually maturing into adults and attaching themselves to the walls of the small intestine. Anemia is a result of the loss of blood, which the worms drain from the intestinal wall for their nourishment.

Hookworm disease is prevalent in much of Asia, and is best prevented by wearing shoes at all times whilst walking in public areas. Seek medical treatment if you suspect infestation.

• Insurance.

Although it is an additional cost that must be budgetted for, travel insurance may be a good investment for anyone contemplating a low cost back-packer style holiday. The risks are increased simply because the traveler tends to be more adventurous and more mobile. Always consider the need for insurance (including emergency evacuation cover), but be very careful to read the "small-print".

• Influenza.

Influenza is a common viral infection that is spread from casual person to person contact. Discuss the need for Influenza vaccination with your doctor or travellers medical centre prior to leaving home.

• Malaria.

A lot of discussion about the use of Malaria prophylaxis has been generated recently, with the opinion of whether to use a prophylactic agent divided evenly between those who would, and those who would not. The best advice is that you consult a traveller's medical centre before leaving home, and discuss the relative merits of the argument.

Due to the emergence of chloroquine resistant strains, more powerful drugs with reportedly unpleasant side-effects, including dizziness, nausea, and palpitations are often prescribed. Ask your doctor about using these drugs for use as treatment only, in the case of infection (at the first sign of symptoms) rather than using them as a prophylactic agent.

The best protection, is to use an insect repellent containing a 20% or greater concentration of DEET, applied frequently to exposed skin, and to use mosquito nets for protection whilst sleeping in areas where mosquitoes appear to be active. The breeze from a ceiling fan may also assist. Never assume that there is no chance that you will catch malaria--always take appropriate precautions.

If you choose to burn mosquito coils in your room overnight, be very careful to eliminate all risks of them starting a fire.

• Meat or vegetarian meals.

Eating in small, often out of the way places may introduce possible risks don't need to be considered in large popular hotels: issues such as the freshness of ingredients, lack of refrigeration, contamination and even the standards of cleanliness in the food preparation areas must be considered.

Many of the more savvy travellers choose to eat only vegetarian meals whilst on the road. Staples like rice, noodles, breads, cooked vegetables and fruits are far less likely to cause illness or an upset stomach than meat based dishes.

• Medical services.

Most developing Asian countries have only basic medical facilities and hospitals. Larger cities and some villages will have a clinic, but specialist and emergency facilities are less likely to be available. Many large hotels in the popular tourist areas have resident doctors.

First-hand reports have it that the major hospital in Bali is far below the standard that would be expected in the west, and in the most serious injury or illness cases, it may be best to exercise emergency medical evacuation to a nearby country such as Australia (Darwin) or Singapore. Be sure when you purchase traveller’s insurance that it covers this possibility.

Health care is not free, so it is wise to have traveller’s insurance. Cash payment for services is usually required so retain all reciepts for insurance claims.

• Sunburn.

Sunburn will probably affect every visitor to the tropics, although it is generally avoidable if common sense is used. Use a maximum protection sunscreen at all times, wear a hat and stay in the shade during the hottest part of the day. Avoid spending any excess time in the sun, and drink plenty of fluids.

• Traveller's Diarrhoea.

Travelling in any underdeveloped country and eating food that is kept and prepared in less than ideal conditions can expose you to the risk of intestinal bacterial infection. The offending bacteria can also be found in contaminated water.

Common symptoms include an abrupt onset of painful abdominal cramps, nausea, vomiting, and diarrhoea which may contain blood. The symptoms can occur any time from several hours to as much as a couple of days after the exposure to tainted food or water.

You can take precautions to lessen your risk to exposure whilst travelling, and to ease the discomfort should you or one of your party be afflicted.

Agents used to control diarrhoea include antibiotics, which may be obtained with a prescription from home and used if needed, according to the advice of your doctor (generally, antibiotics should be be taken only if really necessary) Treatment may be supplemented with Imodium to relieve the symptoms, and perhaps to help when travelling by bus etc. If the condition is severe, or does not respond to treatment within 24 hours, a doctor should be consulted.

A local remedy for those who would prefer not to use drugs, is to drink cooled water that has been used to boil rice. It is likely that the affect is similar to that of taking Imodium due to the starch contained within the water.

Never drink alcohol or soft-drinks (soda) while suffering from diarrhoea. Replace lost body fluids by drinking plenty of pure water from sealed bottles to prevent dehydration, and replace lost body salts with electrolyte replacement products.

To minimise the chance of suffering a case of diarrhoea, drink water that has been boiled (such as tea and coffee), or pure water from sealed bottles, canned and bottled beverages etc. Avoid ice if you cannot be sure the water was boiled or purified before it was frozen.

Eat only cooked foods. Salads and raw vegetables that have been washed in the local water can yield harmful exposure.

Do not believe that eating expensive meals in large hotel restaurants will be safer than eating in warungs and markets. The places that are used by the local population are often likely to be among the safest to eat at.

Be aware, that changes in diet may cause changed bowel actions, generally without any other symptoms such as cramping or nausea. Many still confuse the effects of a changed diet (particuarly one that includes ingredients such as indigestable palm oil, spices and fruit) with the symptoms of more serious illnesses.

Please discuss recognition of the danger signs and ask for instructions on dealing with illness with your doctor before leaving home.

• Tetanus.

Tetanus vaccinations should be boosted every few years, and should be considered for travellers who will be in higher risk situations (including those who intend to take on jungle walks or other active, outdoor activities). It is better to have the vaccination at home where you are certain the needle will not be contaminated.

• Tinea.

Tinea is a fungal infection of the skin, often affecting the feet and/or the groin. Symptoms include a reddish eruption and cracks in the skin between the toes, accompanied by itching. It is highly infectious and may be contracted by walking barefoot, particularly on moist floors such as bathrooms, shower bases and swimming pools. Treatment is via a locally applied anti-fungal ointment or powder.

• Typhoid.

Typhoid is a bacterial infection caused by micro-organism called Salmonella typhi. It is usually acquired through the ingestion of contaminated food, milk, or water. Symptoms include fever, progressing to diarrhoea (which is often bloody). A rash also may appear on the torso. A tablet or an injectable form of vaccination is available.

Travellers should always carry a basic first-aid kit to cater for minor emergencies. The contents should include items such as...

• Antibiotic ointment (for cuts/abbrasions).
• Antibiotic tablets (for severe bacterial forms of diarrhoea).
• Antifungal cream/powder (for tinea).
• Antiseptic ointment (for cleaning wounds).
• Aspirin.
• Band-aids.
• Calomine lotion.
• Gauze bandage.
• Electrolyte replacement tablets (to replace body salts lost through sweating or diarrhoea).
• Imodium (for symptomatic relief of diarrhoea).
• Insect repellent (containing DEET).
• Personal items.
• Personal medications (always carry prescriptions).
• Safety pins.
• Scissors.
• Soap.
• Sterile syringe and needle (for emergency use).
• Sunscreen.
• Sutches.
• Thermometer (non-mercury type).
• Ti-tree oil (an excellent general antisceptic).
• Toilet paper/facial tissues.
• Tweezers.

You should be aware of how to use the items in your firstaid kit.

Note: Antibiotics should only be used according to their instructions, and are only effective against bacterial diseases as part of a controlled program of treatment. Self diagnosis and administration of treatment should be considered as a last resort. Seek professional medical advice if you fear serious illness.

Return to our Bali: The Online travel guide index.

Last updated: January 5th 1996