Bali: The Online Travel Guide
"Do not rely on the Internet for health and medical information. What is presented here are a list of health risks that may prompt better discussion between you and your doctor."
A guide to remaining safe and healthy.
Index to the items covered in this guide...
Travelling in a foreign country does not necessarily increase your risk of becoming sick or even of suffering from minor illnesses such as nausea or the dreaded traveller's diarrhoea, provided you exercise a little care and common sense.
Nonetheless, some travellers may experience minor stomach upsets or changed bowel actions while they are away from home. While these are usually nothing more than minor inconveniences and are often the affect of an exotic diet rather than of a serious illness, it is important to be able to recognise a serious problem if one should arise.
The risk of accidents or sunburn are often more dangerous to the traveller than food related illnesses. The sensible traveller will never put aside the notion of common sense where health and safety are concerned - a foreign country is not the place to find yourself in need of emergency medical attention, especially through your own neglect or misadventure. Always take care, and enjoy a safe, healthy holiday.
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 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.
Cholera areas are usually widely reported - discuss the your planned destinations with your doctor or traveller's medical centre before leaving home for the most up-to-date information.
Everyone is at some risk of receiving cuts, scratches and general abrasions etc. whilst walking or travelling. Care must be taken to clean all wounds (even minor ones) using pure water, and if possible, with a disinfectant or antiseptic solution or ointment. After cleaning, cover cuts and scratches with a band-aid or bandage. The rate of infections is high if cuts are not treated, and healing may be very slow. 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.
Cuts and scratches from coral are notoriously slow healing, as the coral injects a weak poison. Always wear some form of footwear to avoid coral cuts when walking across reefs, and cleanse a coral cut with hydrogen-peroxide if it's available.
Violent crime must be considered a risk to travellers, and attacks, including robbery and even rape are unfortunately becoming more common as time goes on. Report all attacks to police, and seek medical attention and counselling, especially if travelling alone. Be aware that nowhere is free of risk.
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 generalised skin rash.
Although seldom fatal and usually running 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.
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.
This is a bacterial infection which causes a moderately sore throat. A greyish membrane is visible over the infected area, and in severe cases the throat may become quite swollen. In tropical countries the infection may also occur in sores and skin ulcers. After a few weeks, the effects of the bacterial toxins may cause severe weakness, mainly affecting the muscles of the neck, and if left unchecked, the inflammation may cause asphyxiation or heart failure.
Transmission of diphtheria is usually via direct contact with an infected person, or by sharing a drinking glass or bottle etc.
In hot climates, and whenever you are very active, ensure you drink plenty of fluids. Always carry a bottle of drinking water with you when hiking, and even whilst on bus trips or just strolling around town.
The most important rule is, "Don't drink the local water" unless you are certain it's safe. Bottled drinking water and soft drinks (soda) are available almost everywhere in the world, and are generally fine, although you must be sure to only use water from containers with a factory seal (usually plastic shrink-wrap). Milk should be treated with suspicion, although cartons of UHT treated milk will be pasteurised, and typically have a long shelf-life even in hot climates. Tea and coffee will generally be OK, as the water used to prepare the drink will have been boiled.
The simplest way to purify water is to boil it thoroughly for at least five minutes to kill bacteria and parasites. Commonly available chlorine tablets will kill many pathogens, but not cysts and the parasites that cause giardia which may be destroyed by adding a few drops of Iodine.
Travelling to a foreign country to score cheap drugs is a false economy, especially if you get caught. Save the airfare, a long stint in jail is too high a price to pay.
Lost body salts due to excessive sweating, vomiting or diarrhoea may be replaced by proprietary electrolyte tablets or drinks as an aid to recovery.
Eating in small, often out of the way places may introduce possible risks that usually don't exist in large and 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. When on the road, keep an eye open for the busiest eateries. If a place is packed with tourists, and generally looks clean and well run, then its food is probably safe, while empty restaurants are often questionable.
As a general rule, food that has been thoroughly cooked is the safest (but not if it has been left to cool or if it has been reheated). Undercooked meats should be avoided, as should shellfish, including oysters, mussels and clams, which can carry dangerous bacteria and parasites. Fruit and salads should be washed with clean (boiled or bottled) water, and peeled wherever possible.
If the food available is limited or of poor quality, or if you are feeling sick and missing meals, you can soon become run-down. Ensure your diet is well balanced. Staples like rice, noodles, breads, eggs, tofu, cooked vegetables and fruits are unlikely to cause illness or an upset stomach, and are a good source of protein and vitamins.
This severe intestinal disorder is caused by a parasite that is present in contaminated water. The symptoms include stomach cramps, nausea, watery diarrhoea and frequent gas. Giardia can appear several weeks after exposure to the parasite, and symptoms may disappear for a few days and then return over a long period. Do not use antibiotics to treat Giardia. A single dose of Flagyl is the recommended drugs for treatment. See a doctor if symptoms persist.
Similar to heatstroke but less severe, the symptoms of heat exhaustion include fatigue, dizziness 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 (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 into normal range of 36.4° and 37.2° C (97.5° and 99° F). This is best accomplished by cooling the victim's skin with a wet towel or gently showering with cold water.
This is a viral disease with several strains, known as hepatitis A, B, C etc. The disease affects the liver, and symptoms include alternating fever and chills, generalised weakness, loss of appetite, nausea and general abdominal discomfort. These symptoms are generally accompanied by jaundice (a yellowing of the skin and eyes, and a darkening of the urine). Often, and particularly in children, there are few specific symptoms, while on some occasions the jaundice may be severe and prolonged.
If left untreated, the most severe result is complete liver failure.
The hepatitis A virus is transmitted person-to-person, or by the contact with infected faecal material, and transmission is particularly prevalent in overcrowded areas with poor sanitation. Contaminated drinking water and food (especially raw or undercooked shellfish and raw vegetables) are also major causes of infection.
An injection of immune gammar globulin is used as a safe and effective short-term prophylaxis against the highly infectious hepatitis A, which is probably the most serious health risk to travellers. Recently, other drugs have been introduced to provide even more effective protection over longer periods. Past infection with the hepatitis A virus gives life-long immunity.
Hepatitis B is a more serious form of viral hepatitis, which is transmitted through contaminated blood or body fluids and by unprotected sexual intercourse. Vaccination is recommended for those who will be staying in high-risk areas for more than 6 months, for those who may share unsterilised needles (for drug use or at tattooists for example) or those have unprotected sexual contact with persons in high-risk groups.
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.
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.
Hookworms are intestinal parasites that take their name from the hooklike appendages surrounding their mouths. They cause symptoms including anaemia, abdominal pain, and diarrhoea.
The eggs of hookworms are deposited on the ground in the faeces 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. Anaemia is a result of the loss of blood, which the worms drain from the intestinal wall for their nourishment.
Hookworm disease is prevalent in many developing countries, and is best prevented by wearing shoes at all times whilst walking in public areas. Seek medical treatment if you suspect infestation.
Although it is an additional cost that must be budgeted 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 traveller 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 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.
This is a viral disease which causes a severe influenza-like illness with headaches, neck stiffness, confusion and ultimately if untreated, coma. Mortality may reach 30% of those that contract the disease, and long-term effects on the nervous system are common amongst survivors. The virus is spread by mosquito bites (generally from those that bite at night, and especially in remote and rural areas). Protection against bites, such as that offered by wearing appropriate clothing, using mosquito nets, citronella or DEET sprays and burning coils is recommended. Anyone planning to stay within a known Japanese Encephalitis area should be vaccinated.
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 as a treatment only, in the case of infection (at the first sign of symptoms) rather than using them as a prophylactic agent.
The principal symptoms of malaria are chills with sweating and fever, headache, and malaise. Malaria has either malignant or benign strains. The incubation period (before symptoms occur) is usually 12 days for the malignant strain but may be up to 30 days for the benign form. Malignant malaria may progress to severe shock, and even life-threatening coma. Benign malaria may produce episodes of fever, which sometimes recur over many years. Malaria is diagnosed while active by microscopic examination of the blood or can be confirmed after recovery by an antibody test.
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 whilst sleeping. 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.
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. Remember that under-cooked eggs (soft yolks) can harbour salmonella
Most developing 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 than at home. Many large hotels in the popular tourist areas have resident doctors.
Even major hospitals in the developing world are 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. Be sure when you purchase traveller's insurance that it covers this possibility.
Health care is not free in most countries, so it is wise to have traveller's insurance. Cash payment for services is usually required so retain all receipts for insurance claims.
Meningitis is an infection of the membranes of the brain and spinal cord, which can be caused by many different bacteria and viruses. Meningococcal meningitis can pose a serious hazard to travellers, as it can occur in epidemics and is easily transmitted through inhalation of bacteria in droplets coughed or sneezed into the air by infected carriers.
The main symptoms are fever with severe headache, stiffness of the neck and back, photophobia and a blotchy rash. The onset is generally sudden, and progression to coma is often rapid if treatment is not started immediately.
This disease is caused by a virus which spreads from person-to-person via inhalation of mucous droplets coughed or sneezed into the air by infected carriers, or by contamination of food and drink with infected faecal material.
The early symptoms include fever, headache, nausea and vomiting as the virus multiplies inside the body, eventually invading the blood-stream and nervous system. Paralysis occurs in less than 1 percent of infections, although the risk increases with age.
An oral vaccine is available to protect against polio, and 10 yearly boosters should be taken to ensure maximum immunity.
Rabies is a viral infection that is acquired via a lick or a bite from an infected animal, often a dog, cat, monkey or bat.
Symptoms include an itching or tingling at the site of the bite, but rapidly progress to include headache, fever, confusion, aggression, hydrophobia and paralysis. It may take many weeks or even months for symptoms to develop.
Never approach or handle animals you don't know, especially if they are acting strangely. Thoroughly cleanse all animal bites with soap and water and seek immediate medical attention if the skin is punctured by a bite.
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.
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 (particularly one that includes ingredients such as indigestible 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.
Tattoo's applied to the skin via needles expose some risk of infection, which is understood by almost everyone. Many visitors to Asian countries however are tempted by the tribal appearance of temporary tattoo's, especially as the temporary tattoo's are not applied by needles. Some of the paints or transfers are however, made with chemicals that may cause skin irritation (including petrol / gasoline). Always ask to patch test temporary tattoo's (on a very small area on the forearm), and note any reaction or irritation over the next few days. Only buy and apply temporary tattoo's if you did not encounter any problems.
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 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.
TB is a bacterial disease that usually affects the lungs, causing a persistent cough, often, accompanied by fever and sweating. The disease is slow to establish itself and general weakness and weight loss are characteristic during the incubation period (which may be up to 3 months). The spread of TB is usually through infected sputum (hence many laws that forbid spitting in public). Another form of TB is spread through milk from infected cows, so never drink unpasteurised milk.
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.
This is a form of Gastroenteritis caused by a virus. Symptoms include often severe stomach cramps, diarrhoea and vomiting. A slight fever is usually also detected. Treatment is restricted to resting, and drinking plenty of fluids (not alcohol).
This viral disease is characterised by a severe influenza-like illness, jaundice, and a tendency to bleed. Monkeys are the major carriers of yellow fever, so principally, this is a disease of jungle areas. There are however, occasional outbreaks in villages and cities. The disease is transmitted to humans by the bite of infected mosquitoes, although it is not transmitted from person-to-person expect by mosquito. The incubation period is about 3 to 6 days.
All occurrences of this disease must be reported to the World Health Organisation. Some countries require proof of immunisation against yellow fever as a condition of entry.
Travellers first-aid kit.
Travellers should always carry a basic first-aid kit to cater for minor emergencies. The contents should include items such as...
You should be aware of how to use the items in your first-aid 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.
Copyright © 1994-1999, Wayne Reid.
Disclaimer: All of the information available within this site is believed to be correct, however the author accepts no responsibility or liability for any outcomes that may result in using this site's contents.