As when travelling anywhere in the world a good travel insurance policy is a very wise idea. A motorcycle accident can make an expensive and nasty end to your travels. 'After paying the hospital bills, damage to the bike I hit and goodwill contribution to the local police,' wrote one traveller, 'I wished I had been insured'.
If you undergo medical treatment in Thailand, be sure to collect all receipts and copies of the medical report, in English if possible, for your insurance company.
For basic first aid, it's recommended to carry the following:
The best book on health maintenance in Asia is Disk Schroeder's Staying Healthy in Asia, Africa, and Latin America (Stanford, California: Volunteers in Asia, 1988). In fact, you might want to make this handy little book part of your first aid kit as it clearly describes symptoms and recommended treatment for illnesses common in Thailand (and elsewhere in Asia).
When seriously ill or injured, you should seek medical attention from a qualified doctor, clinic or hospital if at all possible; employ self-treatment only as a last resort.
Make sure you're healthy before you start travelling, and if you are embarking on a long trip make sure your teeth are OK. If you wear glasses bring a spare pair and your prescription. Losing your glasses can be a real problem, although in many places you can get new spectacles made up quickly, cheaply and competently.
If you require a particular medication, take an adequate supply, as it may not be available locally. Take the prescription, with the generic rather than the brand name, which may be unavailable, as it will make getting replacements easier. It's a wise idea to have the prescription with you to show you legally use the medication, it's surprising how often over-the-counter drugs from one place are illegal without a prescription or even banned in another.
There are no health requirements for Thailand in terms of required vaccinations unless you are coming from an infected area. Travellers should have a cholera immunization prior to arriving and a tetanus booster would be a good idea as well in case you injure yourself while travelling. You should also check if any countries you are going to after visiting Thailand require vaccinations. A Japanese encephalitis vaccination is a good idea for those who think they may be at moderate or high risk while in Thailand (see the Japanese encephalitis section for more information). Your doctor may also recommend booster shots against measles or polio.
Plan ahead for getting your vaccinations since some of them require an initial inoculation followed by a booster while some vaccinations should not be given together.
Care in what you eat and drink is the most important health rule; stomach upsets are the most likely travel health problem, but the majority of these upsets will be relatively minor. Don't become paranoid - trying the local food is part of the experience of travel after all.
The number one rule is don't drink the water, and that includes ice. If you don't know for certain that water is safe always assume the worst. Reputable brands of bottled water or soft drinks are generally fine, although in some places refilled bottles are not unknown. Take care with fruit juice, particularly if water may have been added. Milk should be treated with suspicion, as it is often unpasteurized. Boiled milk is fine if it is kept hygienically and yoghurt is always good. Tea or coffee should also be OK since the water should be boiled.
Salads and fruit should be washed with purified water or peeled where possible. Ice cream is usually OK if it is a reputable brand name, but beware of ice cream from street vendors and ice cream that has melted and been refrozen. Thoroughly cooked food is safest, but not if it has been left to cool or if it has been reheated. Take great care with shellfish or fish and avoid undercooked meat.
If a place looks clean and well run and the vendor also looks clean and healthy then the food is probably safe. In general, places that are packed with travellers or locals will be fine, empty restaurants are questionable.
If you're travelling hard and fast and therefore missing meals, or if you simply lose your appetite, you can soon start to lose weight and place your health at risk.
Make sure your diet is well balanced. Eggs, tofu, beans, lentils and nuts are all safe ways to get protein. Fruit you can peel (bananas, oranges or mandarins for example) are always safe and a good source of vitamins. Try to eat plenty of grains (rice) and bread. Remember that although food is generally safer if it is cooked well, overcooked food loses much of its nutritional value. If the food is insufficient it's a good idea to take vitamin and iron pills.
Make sure you drink enough, don't rely on feeling thirsty to indicate when you should drink. Not needing to urinate or very dark yellow urine is a danger sign. Always carry a water bottle with you on long trips. Excessive sweating can lead to loss of salt and therefore muscle cramping. Salt tablets are not a good idea as a preventative but in places where salt is not used much, adding additional salt to food can help.
As with any Asian country, care should be taken in consuming food or drink. Besides malaria, really serious diseases are not too common in Thailand.
Thai soft drinks are safe to drink, as is the weak Chinese tea served in most restaurants. Most ice is produced under hygienic conditions and is therefore theoretically safe. During transit to the local restaurant, however, conditions are not so hygienic (you may see blocks of ice being dragged along the street), but it's very difficult to resist in the hot season. In rural areas, villagers mostly drink collected rainwater. Most travellers can drink this without problems, but some people can't tolerate it. It is best to buy fruit that you can peel and slice yourself (cheaper, too), but most fare at food stalls is reasonably safe.
The simplest way of purifying water is to thoroughly boil it. Technically this means for 10 minutes, something that happens very rarely! Remember that at high altitudes water boils at a lower temperature, so germs are less likely to be killed.
Simple filtering will not remove all dangerous organisms, so if you cannot boil water it should be treated chemically. Chlorine tablets (puritabs, steritabs or other brand names) will kill many, but not all pathogens. Iodine is very effective in purifying water and is available in tablet form (such as Potable Aqua), but follow the directions carefully and remember that too much iodine can be harmful.
If you can't find tablets, tincture of iodine (2%) or iodine crystals can be used. Two drops of tincture of iodine per litre or quart of clear water is the recommended dosage, and the water should then be left to stand for 30 minutes. Iodine crystals can also be used to purify water, but this is a more complicated process, as you have to first prepare a saturated iodine solution. Iodine loses its effectiveness if exposed to air or damp so keep it in a tightly sealed container. Flavoured powder will disguise the taste of treated water and is a good idea if you are travelling with children.
A normal body temperature is 98.6°F or 37°C, more than 2°C higher is a 'high' fever. A normal adult pulse rate is 60 to 80 per minute (children 80 to 100, babies 100 to 140). You should know how to take a temperature and a pulse rate. As a general rule the pulse increases about 20 beats per minute for each °C rise in fever.
Respiration rate (breathing) is also an indicator of illness. Count the number of breaths per minute, between 12 and 20 is normal for adults and older children (up to 30 for younger children, 40 for babies). People with a high fever or serious respiratory illness (like pneumonia) breathe more quickly than normal. More than 40 shallow breaths a minute usually means pneumonia.
Many health problems can be avoided by taking care of your self. Wash your hands frequently; it's quite easy to contaminate your own food. Clean your teeth with purified water rather than straight from the tap. Avoid climatic extremes; keep out of the sun when it's hot. Avoid potential diseases by dressing sensibly. You can get worm infections through bare feet, or dangerous coral cuts by walking over coral without shoes. You can avoid insect bites by covering bare skin when insects are around, by screening windows or beds or by using insect repellents. Seek local advice; if you're told the water is unsafe due to jellyfish, etc, don't go in. In situations were there is no information, discretion is the better part of valour.
Potential medical problems can be broken down into several areas. First there are the climatic and geographical considerations - problems caused by extremes of temperature, altitude or motion. Then there are diseases and illnesses caused by insanitation, insect bites or stings, animal or human contact. Simple cuts, bites or scratches can also cause problems.
Self-diagnosis and treatment can be risky, wherever possible seek qualified help. An embassy or consulate can usually advise a good place to go. So can five-star hotels, although they often recommend doctors with five-star prices. This is when that medical insurance really comes in useful! In some places standards of medical attention are so low that for some ailments the best advice is to get on a plane and go somewhere else.
In the tropics you can get sunburnt surprisingly quickly even through cloud. Use a sunscreen and take extra care to cover areas that don't normally see sun - your feet for example. A hat provides added protection and use zinc cream or some other barrier cream for your nose and lips. Calamine lotion is good for mild sunburn.
Prickly heat is an itchy rash caused by excessive perspiration trapped under the skin. It usually strikes people who have just arrived in a hot climate whose pores have not yet opened sufficiently to cope with greater sweating. Keeping cool by bathing often, using a mild talcum powder, or even by resorting to air conditioning may help until you acclimatize.
Dehydration or salt deficiency can cause heat exhaustion. Take time to acclimatize to high temperatures and make sure you get sufficient liquids. Salt deficiency is characterized by fatigue, lethargy, headaches, giddiness and muscle cramps and in this case salt tablets may help. Vomiting or diarrhoea can deplete your liquid and salt levels. Anhidrotic heat exhaustion, caused by an inability to sweat, is quite rare and unlike the other forms of heat exhaustion is likely to strike people who have been in a hot climate for some time, rather than newcomers.
This serious, sometimes fatal, condition can occur if the body's heat regulating mechanism breaks down and the body temperature rises to dangerous levels. Long, continuous periods of exposure to high temperatures can leave you vulnerable to heat stroke and you should avoid excessive alcohol or strenuous activity when you first arrive in a hot climate.
The symptoms are feeling unwell, not sweating very much or at all, high body temperature (39 to 41°C). Where sweating has ceased the skin becomes flushed and red. Severe, throbbing headaches and lack of coordination will also occur and the sufferer may be confused or aggressive. Eventually the victim will become delirious or convulse. Hospitalization is essential, but meanwhile get the victim out of the sun, remove clothing and cover them with a wet sheet or towel and then fan them continually.
Hot-weather fungal infections are most likely to occur on the scalp, between the toes or fingers (athlete's foot), in the groin (jock itch or crotch rot) and ringworm on the body. You get ringworm (which is a fungal infection, not a worm) from infected animals or by walking on damp areas, like shower floors.
To prevent fungal infections, wear loose, comfortable clothes, avoid artificial fibres, wash frequently and dry carefully. If you do get an infection, wash the infected area daily with a disinfectant or medicated soap and water and rinse and dry well. Apply an anti-fungal powder like the widely available Tinaderm. Try to expose the infected area to air or sunlight as much as possible and wash all towels and underwear in hot water and change them often.
Eating lightly before and during a trip will reduce the chances of motion sickness. If you are prone to motion sickness, try to find a place that minimizes disturbance - near the wing on aircraft, close to amidships on boats, near the centre on buses. Fresh air usually helps; reading or cigarette smoke doesn't. Commercial anti-motion-sickness preparations, which can cause drowsiness, have to be taken before the trip commences; when you're feeling sick it's too late. Ginger is a natural preventative and is available in capsule form.
Traveller's diarrhoea, which can be caused by viruses, bacteria, food poisoning, stress, or simply a change in diet, may strike some visitors who stay for any length of time outside Bangkok, but usually subsides within a few days. A few rushed toilet trips with no other symptoms are not indicative of a serious problem. Moderate diarrhoea, involving half a dozen loose movements in a day, is more of a nuisance.
Dehydration is the main danger with any diarrhoea, particularly for children, so fluid replenishment is the number one treatment. Weak black tea with a little sugar, flat soft drinks diluted with water or soda water are good. With severe diarrhoea a re-hydrating solution is necessary to replace minerals and salts. You should stick to a bland diet (rice or noodle soups are good) and cut out all alcohol and caffeine as you recover.
Lomotil or Imodium can be used to bring relief from the symptoms of diarrhoea, although they do not actually cure them. Only use these drugs if absolutely necessary. If you must travel; for children, Imodium is preferable. Do not use these drugs if you have a high fever or are severely dehydrated. Antibiotics can be very useful in treating severe diarrhoea, especially if nausea, vomiting, stomach cramps or mild fever accompanies it. Three days treatment should be sufficient and an improvement should occur within 24 hours.
If these don't help and/or your stools contain substantial blood and mucus, you may have amoebic dysentery, which can be serious if left untreated - in this case you should see a doctor.
This intestinal parasite is present in contaminated water and the symptoms are stomach cramps, nausea, bloated stomach, watery, foul-smelling diarrhoea and frequent gas. Giardia can appear several weeks after you have been exposed to the parasite, the symptoms may disappear for a few days and then return; this can go on for several weeks. Metronidazole known as Flagyl is the recommended drug, but should only be taken under medical supervision - antibiotics are no use.
This serious illness is caused by contaminated food or water and is characterized by severe diarrhoea, often with blood or mucus in the stool. There are two kinds of dysentery. Bacillary dysentery is characterized by a high fever and rapid development; headache, vomiting and stomach pains are also symptoms. It generally does not last longer than a week, but it is highly contagious.
Amoebic dysentery is more gradual in developing, has no fever or vomiting but is a more serious illness. It is not a self-limiting disease but will persist until treated and can recur and cause long-term damage.
A stool test is necessary with dysentery, but if no medical care is available tetracycline is the prescribed treatment for bacillary dysentery, metronidazole for amoebic dysentery.
Cholera vaccination is not very effective, but outbreaks of cholera are generally widely reported so you can avoid such areas. The disease is characterized by a sudden onset of acute diarrhoea with 'rice water' stools, vomiting, muscular cramps and extreme weakness. If you contract cholera you need medical help, but treat for dehydration (which can be extreme) and, if there is an appreciable delay in getting to hospital, begin taking tetracycline. This drug should not be given to young children or pregnant women and it should not be used past its expiry date.
Bacteria do not cause this but, as the name suggests, a virus and is characterized by stomach cramps, diarrhoea, sometimes vomiting, sometimes a slight fever. All you can do is rest and drink lots of fluids.
Hepatitis A is the most common form of this disease and is spread by contaminated food or water. The symptoms are fever, chills, headache, fatigue, feelings of weakness and aches and pains, followed by loss of appetite, nausea, vomiting abdominal pain, dark urine, light coloured faeces, jaundiced skin and the whites of the eyes may turn yellow. In some case you may feel unwell, tired, have no appetite, experience aches and pains and the jaundiced effect. You should seek medical advice, but in general there is not much you can do apart from rest, drink lots of fluids, eat lightly and avoid fatty foods. People who have had hepatitis must forego alcohol for six months after the illness, as hepatitis attacks the liver and it needs that amount of time to recover.
Hepatitis B, which used to be called serum hepatitis, is spread through sexual contact, especially male homosexual activity, through skin penetration, for example dirty needles and blood transfusions. Avoid having your ears pierced, tattoos done or injections where you have doubts about the sanitary conditions. The symptoms and treatment of type B are much the same as type A but gamma globulin as a prophylaxis is only effective against type A.
Typhoid Fever is another gut infection that travels the fecal-oral route, i.e. contaminated water and food are responsible. Vaccination against typhoid is not totally effective and it is one of the most dangerous infections, so medical help must be sought.
The early symptoms are like so many others, you may feel like you have a bad cold or flu on the way, with a headache, sore throat and fever which rises a little each day until it is around 40°C or more. The pulse is often slow for the amount of fever present and gets slower as the fever rises, unlike a normal fever where the pulse increases. There may also be vomiting, diarrhoea or constipation.
In the second week the high fever and slow pulse continue and a few pink spots may appear on the body, along with trembling, delirium, weakness, weight loss and dehydration. If there are no further complications, the fever and symptoms will slowly go during the third week. However you must get medical help before this. Common complications are pneumonia (acute infection of the lungs) or peritonitis (burst appendix) and typhoid is very infectious.
Keeping them cool should treat the victim's fever and dehydration should also be watched for. Chloramphenicol is the recommended antibiotic but there are fewer side effects with ampicillin.
These parasites are most common in rural, tropical areas and a stool test when you return home is not a bad idea. They can be present on unwashed vegetables or in undercooked meat and you can pick them up through your skin by walking in bare feet. Infestations may not show up for some time, and although they are generally not serious, if left untreated they can cause severe health problems. A stool test is necessary to pinpoint the problem and medication is often available over the counter.
This potentially fatal disease is found in undeveloped tropical areas and is difficult to treat but is preventable with immunization. Tetanus occurs when a germ that lives in the faeces of animals or people infects a wound; so clean all cuts, punctures or animal bites. Tetanus is known as lockjaw and the first symptom may be discomfort in swallowing, stiffening of the jaw and neck, then painful convulsions of the jaw and whole body.
Rabies is found in many countries and is caused by a bite or scratch from an infected animal. Dogs are a noted carrier. Any bite, scratch or even lick from a mammal should be cleaned immediately and thoroughly. Scrub with soap and running water, and then clean with an alcohol solution. If there is any possibility that the animal is infected, medical help should be sought immediately. Even if the animal is not rabid, all bites should be treated seriously as they can become infected or can result in tetanus. A rabies vaccination is now available and should be considered if you are in a high-risk category, e.g. cave explorers (bat bites) or people working with animals.
Sexual contact with an infected sexual partner spreads these diseases and while abstinence is the only 100% preventative, use of a condom is also effective. Gonorrhoea and syphilis are the most common of these diseases and sores, blisters or rashes around the genitals, discharges or pain when urinating are common symptoms. Symptoms may be less marked or not observed at all in women.
The symptoms of syphilis eventually disappear completely but the disease continues and can cause severe problems in later years. Treatment of gonorrhoea and syphilis is by antibiotics.
There are numerous other sexually transmitted diseases for most of which effective treatment is available. There is no cure for herpes and there is also currently no cure for AIDS, which is most commonly spread through male homosexual activity, but is becoming more common amongst heterosexuals in Thailand. Abstinence or the use of condoms is the most effective preventative.
AIDS can also be spread through infected blood transfusions or by dirty needles - vaccinations, acupuncture and tattooing can potentially be as dangerous as intravenous drug use if the equipment is not clean.
Ask 10 doctors around the world about malaria prevention and you may get 10 different opinions. Malaria, a mosquito-carried disease, is on the increase all over Asia and unfortunately most of the strains in Thailand are chloroquine-resistant, including the deadly Plasmodium falciparum. Hence, taking a malaria prophylactic may have little effect as a preventive and will most certainly contribute to an increase in resistance to these drugs, which are also used in the treatment of the disease.
There is much controversy surrounding the use of certain malarial prophylactics, in particular Fansidar. Before leaving, it is wise to get in contact with an infectious diseases hospital or other relevant government health body in your country to find out the latest information regarding malarial prophylactics. Armed with this information, consult a general practitioner for a prescription if you decide to take chemical suppressants. Factors such as your length of stay and the areas you plan to visit are relevant in prescribing anti-malarials. All commonly prescribed malarial suppressants (e.g. chloroquine) have the potential to cause side effects. In particular, persons allergic to sulphonamides should not take Fansidar.
In fact, the use of Fansidar as a prophylactic has been associated with severe and, in some cases, fatal reactions among travellers who have used the drug in multiple doses (i.e. two to five doses of Fansidar). For this reason there is now a move by many medical authorities away from the prescription of Fansidar as a malarial prophylactic, even for those travelling in areas where the disease is chloroquine-resistant. Although the incidence of severe reaction is not high, lack of information about the drug suggests that other malarial prophylactics should be used before considering Fansidar.
Further information can be found in the article, Revised Recommendations For Preventing Malaria in Travellers to Areas with Chloroquine-Resistant Plasmodium falciparum, (published by the Center for Disease Control (CDC) Atlanta Georgia, April 12 1985, Volume 34/No 14).
Most recently the CDC reports that various strains of malaria in Thailand are now chloroquine and Fansidar-resistant. Instead they are recommending a daily dose of 100 milligrammes doxycycline (doxycycline is also said to prevent or suppress bacillary dysentery).
Rather than load up on drugs that may do you more harm than good, you can take a few other simple precautions that can greatly reduce your chances of contracting any kind of malaria. First of all, apply a good mosquito repellent to skin and clothes whenever and wherever mosquitoes are about. The best repellents are those which contain more than 30% DEET (N, N-diethyl-metatoluamide) - for maximum protection, use a 100% DEET preparation if you can find it. A fairly good mosquito repellent called Skeetolene is sold in Thailand (manufactured by the British Dispensary in Bangkok). For those with an allergy or aversion to synthetic repellents, citronella makes a good substitute. Mosquito coils (yaa kan yung baep jut) do an excellent job of repelling mosquitoes in your room and are readily available in Thailand. Day mosquitoes do not carry malaria, so it is only in the night that you have to worry - peak biting hours are a few hours after dusk and a few hours before dawn.
According to the Malaria Centre Region II in Chiang Mai, there is virtually no risk of malaria in urban areas. Since malaria-carrying mosquitoes (Anopheles) only bite from early evening to early morning, you should sleep under a mosquito net (if possible) when in rural areas, even if you see only a few mosquitoes. If you are outside during the biting hours, use an insect repellent. Even in a malarial area, not every mosquito is carrying the parasite responsible for the disease. Hence, the most important thing is to prevent as many of the critters from biting you as possible, to lessen the odds that you will be 'injected' by one carrying the parasite.
Once the parasites are in your bloodstream, they are carried to your liver where they reproduce. Days, weeks, or even months later (some experts say it can take as long as a year or more in certain cases), the parasites will enter the bloodstream again from the liver and this is when the symptoms first occur. Symptoms generally begin with chills and headache, followed by a high fever that lasts several hours. This may be accompanied by nausea, diarrhoea and more intense headaches. After a period of sweating the fever may subside and other symptoms go into remission. Of course, a severe flu attack could produce similar symptoms. That is why if you do develop a high fever and think you may have been exposed to the disease, it is imperative you get a blood check for malaria. Virtually any clinic or hospital in Thailand can administer this simple test.
Early treatment is usually successful in ridding the victim of the disease for good. If untreated or improperly treated, the symptoms will keep returning in cycles as the parasites move from liver to bloodstream and back.
Like many other tropical diseases, malaria is frequently misdiagnosed in western countries, If you should develop the symptoms after a return to your home country, be sure to seek medical attention immediately and inform your doctor that you may have been exposed to malaria.
In some areas of Thailand there is a risk, albeit low, of contracting dengue fever via mosquito transmission. This time it's a day variety (Aedes) you have to worry about. Like malaria, dengue fever seems to be on the increase throughout tropical Asia in recent years. Dengue is found in urban as well as rural areas, especially in areas of human habitation (often indoors) where there is standing water.
Unlike malaria, a virus causes dengue fever and there is no chemical prophylactic or vaccination against it. In Thailand there are some six strains of dengue and once you've had one you develop an immunity specific to that strain. The symptoms come on suddenly and include high fever, severe headache and heavy joint and muscle pain (hence its older name 'break bone fever'), followed a few days later by a rash that spreads from the torso to the arms, legs and face. Various risk factors such as age, immunity and viral strain may mitigate these symptoms so that they are less severe or last only a few days. Even when the basic symptoms are short-lived, it can take several weeks to fully recover from the resultant weakness.
In rare cases dengue may develop into a more severe condition known as dengue haemorrhagic fever (DHF), which is fatal. DHF is most common among Asian children under 15 who are undergoing a second dengue infection, so the risk for DHF for most international travellers is very low.
The best way to prevent dengue, as with malaria, is to take care not to be bitten by mosquitoes. The only treatment for it is bed rest, constant re-hydration and acetaminophen (Tylenol, Panadol).
A few years ago this viral disease was practically unheard of. Although long endemic to tropical Asia (as well as China, Korea, Japan and eastern USSR), there have been recent rainy season epidemics in north Thailand and Vietnam that increase the risk for travellers. A night-biting mosquito (Culex) is the carrier for JE and the risk is said to be greatest in rural zones near areas where pigs are raised or rice is grown, since pigs and certain wild birds, whose habitat may include rice fields, serve as reservoirs for the virus.
Persons who may be at risk of contracting JE in Thailand are those who will be spending long periods of time in rural areas during the rainy season (July to October). If you belong to this group, you may want to get a Japanese encephalitis vaccination. At this writing, the vaccine is only produced in Japan but is available in most Asian capitals. Check with the government health service in your home country before you leave to see if it's available; if not, arrange to be vaccinated in Bangkok, Hong Kong or Singapore, where the vaccine is easy to find.
Timing is important in taking the vaccine; you must receive at least two doses seven to 10 days apart. The USA Center for Disease Control recommends a third dose 21 to 30 days after the first for improved immunity. Immunity lasts about a year at which point it's necessary to get a booster shot, then it's every four years after that.
The symptoms of Japanese encephalitis are sudden fever, chills and headache, followed by vomiting and delirium, a strong aversion to bright light, and sore joints and muscles. Advanced cases may result in convulsions and coma. Estimates of the fatality rate for JE range from 5% to 60%.
As with other mosquito-borne diseases, the best way to prevent JE (outside of the vaccine) is to avoid being bitten.
In hot, humid climates like that of Thailand throughout most of the year, even small wounds can become infected easily. Always keep cuts and scrapes scrupulously clean, especially those on the lower extremities, and you can avoid unnecessary trips to the doctor. If a small wound does become infected, clean it regularly with sterilized water and bandage it with an antibiotic balm or powder. If it's serious, you may have to take a course of antibiotic medication. If the infection is on the legs or feet, stay prone as much as possible until the infection subsides.
Many people who spend lengthy periods of time on the beaches, particularly Koh Samui, end up with infected coral cuts on their feet. Coral formations break the skin and coral particles enter the wound - these cuts are very difficult to keep clean when you're in and out of the water all the time, If a cut becomes infected, stay out of the water until it clears up. Light shoes designed for water sports, e.g. Nike's 'Aqua Socks', provide effective protection against coral as well as sea urchins.
To minimize your chances of being bitten always wear boots, socks and long trousers when walking through undergrowth where snakes may be present. Don't put your hands into holes and crevices and be careful when collecting firewood.
Snakebites do not cause instantaneous death and anti-venoms are usually available. Keep the victim calm and still, wrap the bitten limb tightly, as you would for a sprained ankle, and then attach a splint to immobilize it. Then seek medical help, if possible with the dead snake for identification. Don't attempt to catch the snake if there is any remote possibility of being bitten again. Tourniquets and sucking out the poison are now comprehensively discredited.
Local advice is the best way of avoiding contact with these sea creatures with their stinging tentacles.
Bedbugs live in various places, particularly dirty mattresses and bedding. Spots of blood on bedclothes or on the wall around the bed can be read as a suggestion to find another hotel. Bedbugs leave itchy bites in neat rows. Calamine lotion may help.
Lice cause itching and discomfort and make themselves at home in your hair (head lice), your clothing (body lice) or in your pubic hair (crabs). They get to you by direct contact with infected people or through the sharing of combs, clothing and the like.
Powder or shampoo treatment will kill the lice, and infected clothing should then be washed in very hot water.
Leeches maybe present in damp rainforest conditions and attach themselves to your skin to suck your blood. Trekkers often get them on their legs or in their boots. Salt or a lighted cigarette end will make them fall off. Do not pull them off, as the bite is then more likely to become infected. An insect repellent may keep them away.
Vaseline, alcohol or oil will persuade a tick to let go. You should always check your body if you have been walking through a tick infested area as they can spread typhus.
Poor diet, lowered resistance due to the use of antibiotics for stomach upsets and even contraceptive pills can lead to vaginal infections when travelling in hot climates. Keeping the genital area clean, wearing cotton underwear and skirts or loose-fitting trousers will help to prevent infections.
Yeast infections, characterized by a rash, itch and discharge can be treated with a vinegar or even lemon juice douche or with yoghurt. Nystatin suppositories are the usual medical prescription. Trichomonas is a more serious infection with a discharge and a burning sensation when urinating. Male sexual partners must also be treated and if a vinegar-water douche is not effective medical attention should besought. Flagyl is the prescribed drug.
Most miscarriages occur during the first three months of pregnancy so this is the most risky time to travel. The last three months should also be spent within reasonable distance of good medical care as quite serious problems can develop at this time. Pregnant women should avoid all unnecessary medication, but vaccinations and malarial prophylactics should still be taken where possible. Additional care should be taken to prevent illness and particular attention should be paid to diet and nutrition.
There are several good hospitals in Bangkok and Chiang Mai:
Members of Alcoholics Anonymous who want to contact the Bangkok Group or others who are interested in AA services can call 0 2253 0305 from 7 am to 7 pm or 0 2253 8422 from 7 pm to 7 am for information.
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