Thailand Staying Healthy

Common sense is the simplest prescription for good health while you travel. Drink lots of fluids to prevent dehydration and constipation, and wear sturdy, broken-in shoes and clean socks. Sunscreen and heavy-duty bug spray are absolute essentials; make sure you apply regularly to stay burn- and bite-free.

Environmental Hazards

Heat exhaustion and dehydration: Heat exhaustion leads to nausea, excessive thirst, headaches, and dizziness. Avoid it by drinking plenty of fluids, eating salty foods (e.g., crackers), abstaining from dehydrating beverages (e.g., alcohol and caffeinated beverages), and wearing sunscreen. Continuous heat stress can eventually lead to heatstroke, characterized by a rising temperature, severe headache, delirium, and cessation of sweating. Victims should be cooled off with wet towels and taken to a doctor.
Sunburn: Always wear sunscreen (SPF 30 or higher) when spending excessive amounts of time outdoors. If you are planning on spending time on the beaches of Thailand, you are at a higher risk of getting burned, even on a cloudy day. If you get sunburned, drink more fluids than usual and apply an aloe-based lotion. Severe sunburns can lead to sun poisoning, a condition that can cause fever, chills, nausea, and vomiting. Sun poisoning should always be treated by a doctor.
High Altitude: Trekkers in northern Thailand are likely to reach areas of high altitude. Allow your body a couple of days to adjust to the reduced level of oxygen before exerting yourself. Note that alcohol is more potent and UV rays are much stronger at higher elevations.

Insect-Borne Diseases

Many diseases are transmitted by insects—mainly mosquitoes, fleas, ticks, and lice. Be aware of insects in wet or forested areas, especially while hiking and camping. Wear long pants and long sleeves, tuck your pants into your socks, and sleep under a mosquito net. Use insect repellents such as DEET and soak or spray your gear with permethrin (licensed in the US only for use on clothing). Mosquitoes —responsible for malaria, dengue fever, and Japanese encephalitis—can be particularly abundant in rice fields and in wet, swampy, or wooded areas along the border and in northern Thailand. Ticks —which can carry Lyme and other diseases—can be particularly dangerous in rural and forested regions. To stop the intense itch after being bitten, try calamine lotion or topical cortisone creams like Cortaid. Or, take a soothing bath with a half-cup of baking soda or oatmeal.

Malaria: Transmitted by Anopheles mosquitoes that bite at night. The incubation period varies anywhere between 10 days and 4 weeks. Early symptoms include fever, chills, aches, and fatigue, followed by high fever and sweating, sometimes with vomiting and diarrhea. See a doctor for any flu-like sickness that occurs after travel in a risk area. To reduce the risk of contracting malaria, use mosquito repellent, particularly in the evenings and when visiting forested areas. Make sure you see a doctor at least 4-6 weeks before a trip to a high-risk area to get up-to-date malaria prescriptions and recommendations. A doctor may prescribe oral prophylactics, like mefloquine or doxycycline. Be aware that mefloquine can have very serious side effects, including paranoia, psychotic behavior, and nightmares.
Japanese encephalitis: Another mosquito-borne disease, most common during the rainy season (May-Oct.) in agricultural areas near rice fields and livestock. Aside from delirium, most symptoms are flu-like: chills, headache, fever, vomiting, and muscle fatigue. Since the disease carries a high mortality rate, it is vital to go to a hospital as soon as symptoms appear. While the JE-VAX vaccine, usually given in 3 shots over a 30-day period, is effective for a year, it can cause serious side effects in some people. According to the CDC, there is little chance of being infected if you take proper precautions, such as using repellents containing DEET and sleeping under mosquito nets. The vaccine is recommended if you are planning on spending more than one month in rural Thailand or if you are going to have extensive unprotected outdoor, evening, and nighttime exposure in rural areas, such as bicycling or camping.
Yellow fever: A viral disease transmitted by mosquitoes. Derives its name from one of its most common symptoms, the jaundice caused by liver damage. While most cases are mild, the severe ones begin with fever, headache, muscle pain, nausea, and abdominal pain before progressing to jaundice, vomiting of blood, and bloody stools. While there is no specific treatment, there is an effective vaccine that offers 10 years of protection. Note that because one cannot contract this disease while in Thailand, the country does not require that travelers have this vaccine unless they have traveled to an infected area (see www.thaiembdc.org for more info).
Other insect-borne diseases: Lymphatic filariasis is a roundworm infestation transmitted by mosquitoes. Infection causes enlargement of extremities and has no vaccine. In northern Thailand, travelers who eat raw or under-cooked fish are at risk of picking up liver flukes, parasites found in the water, especially in the waters of Nong Han, the largest freshwater lake in northeast Thailand.

Food- And Water-Borne Diseases

Prevention is the best cure: be sure that your food is properly cooked and the water you drink is clean. Watch out for food from markets or street vendors that may have been cooked in unhygienic conditions. Other culprits are raw shellfish, unpasteurized milk, and sauces containing raw eggs. Buy bottled water or purify your own water by bringing it to a rolling boil or treating it with iodine tablets; note, however, that boiling is more reliable. Always wash your hands before eating or bring a quick-drying, purifying, liquid hand cleaner. It may seem like a hassle, but your bowels will thank you. Most Western establishments and Thai establishments that cater to tourists serve water and ice that has been purified. The menu will usually say, but it never hurts to ask.

Traveler’s diarrhea: Results from drinking fecally contaminated water or eating uncooked and contaminated foods. Symptoms include nausea, bloating, and urgency. Try quick-energy, non-sugary foods with protein and carbohydrates to keep your strength up. Over-the-counter anti-diarrheals (e.g., Imodium) may counteract the problem. The most dangerous side effect is dehydration; drink 8 oz. of water with ½tsp. of sugar or honey and a pinch of salt, try uncaffeinated soft drinks, or eat salted crackers. If you develop a fever or your symptoms don’t go away after 4-5 days, consult a doctor. Consult a doctor immediately for treatment of diarrhea in children.
Dysentery: Results from an intestinal infection caused by bacteria in contaminated food or water. Common symptoms include bloody diarrhea, fever, and abdominal pain and tenderness. The most common type of dysentery generally only lasts a week, but it is highly contagious. Seek medical help immediately. Dysentery can be treated with the drugs norfloxacin or ciprofloxacin (commonly known as Cipro). If you are traveling in high-risk (especially rural) regions, consider obtaining a prescription before you leave home.
Cholera: An intestinal disease caused by bacteria in contaminated food. Symptoms include diarrhea, dehydration, vomiting, and muscle cramps. See a doctor immediately; if left untreated, cholera can be lethal within hours. Antibiotics are available, but the most important treatment is rehydration. No vaccine is available in the US.
Hepatitis A: A viral infection of the liver acquired through contaminated water or shellfish from contaminated water. Symptoms include fatigue, fever, loss of appetite, nausea, dark urine, jaundice, vomiting, aches and pains, and light stools. The risk is highest in rural areas and the countryside, but it is also present in urban areas. Ask your doctor about the Hepatitis A vaccine or an injection of immune globulin.
Schistosomiasis: A parasitic disease caused when the larvae of a certain freshwater snail species penetrate unbroken skin. Symptoms include an itchy localized rash, followed in 4-6 weeks by fever, fatigue, headaches, muscle and joint aches, painful urination, diarrhea, nausea, loss of appetite, and night sweats. To avoid it, try not to swim in fresh water in areas with poor sanitation. If exposed to untreated water, rub the area vigorously with a towel and apply rubbing alcohol.
Giardiasis: Transmitted through parasites and acquired by drinking untreated water from streams or lakes. Symptoms include diarrhea, cramps, bloating, fatigue, weight loss, and nausea. If untreated, it can lead to severe dehydration. Giardiasis occurs worldwide.
Typhoid fever: Caused by the salmonella bacteria; common in villages and rural areas in Thailand. While mostly transmitted through contaminated food and water, it may also be acquired by direct contact with another person. Early symptoms include high fever, headaches, fatigue, appetite loss, constipation, and a rash on the abdomen or chest. Antibiotics can treat typhoid, but a vaccination (70-90% effective) is recommended.

Other Infectious Diseases

The following diseases exist all over the world. Travelers should know how to recognize them and what to do if they suspect they have been infected.

Rabies: Transmitted through the saliva of infected animals; fatal if untreated. By the time symptoms (thirst and muscle spasms) appear, the disease is in its terminal stage. If you are bitten, wash the wound, seek immediate medical care, and try to have the animal located. A rabies vaccine, which consists of 3 shots given over a 21-day period, is available and recommended for developing world travel, but is only semi-effective.
Hepatitis B: A viral infection of the liver transmitted via blood or other bodily fluids. Symptoms, which may not surface until years after infection, include jaundice, appetite loss, fever, and joint pain. It is transmitted through unprotected sex and unclean needles. A 3-shot vaccination sequence is recommended for sexually active travelers and anyone planning to seek medical treatment abroad; it must begin 6 months before traveling.
Hepatitis C: Like Hepatitis B, but the mode of transmission differs. IV drug users, those with occupational exposure to blood, hemodialysis patients, and recipients of blood transfusions are at the highest risk, but the disease can also be spread through sexual contact or sharing items like razors and toothbrushes that may have traces of blood on them. No symptoms are usually exhibited. If untreated, Hepatitis C can lead to liver failure.
AIDS and HIV: For detailed information on Acquired Immune Deficiency Syndrome (AIDS) in Thailand, call the 24hr. National AIDS Hotline at ☎+1-800-342-2437. Note that Thailand screens incoming travelers for AIDS, primarily those planning extended visits for work or study, and denies entrance to those who test HIV-positive. Contact the consulate of Thailand for information.
Sexually transmitted infections (STIs): Gonorrhea, chlamydia, genital warts, syphilis, herpes, HPV, and other STIs are easier to catch than HIV and can be just as serious. Though condoms may protect you from some STIs, oral or even tactile contact can lead to transmission. If you think you may have contracted an STI, see a doctor immediately.

Other Health Concerns

Medical Care On The Road

Hospitals in Thailand vary from region to region, but, generally, larger, centralized cities like Bangkok and Chiang Mai have high-quality facilities. Thailand’s health care system is split between public and private institutions. The public system often has limited technical support and is overcrowded and bureaucratic. Private hospitals are more likely to have English-speaking doctors, language interpreters, foreign insurance claim assistance, international emergency medical evacuation access, and embassy liaison services. Private health care is so good that an epidemic of medical tourism (both cosmetic and essential) has broken out. Not only is health care in Thailand much cheaper than in most private hospitals than in the Western world, but foreigners are usually treated extremely well.

General practitioners and dentists are readily available. Most medical staff at large medical institutions speak very good English. Thai medical services are always available: walk-in services are common during the daytime and many hospitals offer 24hr. emergency room service. Unfortunately, emergency hotlines are only useful if you speak Thai. Watch closely at smaller rural hospitals or clincs to make sure that any instruments used during your treatment are thoroughly sanitized, and if you ever need an injection make sure the medical practitioner unwraps a brand-new syringe.

If you are concerned about obtaining medical assistance while traveling, you may wish to employ special support services. The MedPass from GlobalCare, Inc., 6875 Shiloh Rd. East, Alpharetta, GA 30005, USA (☎+1-800-860-1111; www.globalcare.net), provides 24hr. international medical assistance, support, and medical evacuation resources. The International Association for Medical Assistance to Travelers ( IAMAT; US ☎+1-716-754-4883, Canada +1519-836-0102; www.iamat.org) has free membership, lists English-speaking doctors worldwide, and offers detailed info on immunization requirements and sanitation. If your regular insurance policy does not cover travel abroad, you may wish to purchase additional coverage .

Those with medical conditions (such as diabetes, allergies to antibiotics, epilepsy, or heart conditions) may want to obtain a MedicAlert membership (US$40 per year), which includes among other things a stainless-steel ID tag and a 24hr. collect-call number. Contact the MedicAlert Foundation International, 2323 Colorado Ave., Turlock, CA 95382, USA (☎+1-888-633-4298, outside US 209-668-3333; www.medicalert.org).

Women’S Health

Women traveling in unsanitary conditions are vulnerable to urinary tract (including bladder and kidney) infections. Thailand’s hot and humid climate also makes women especially susceptible to vaginal yeast infections. Wearing loose trousers or a skirt and cotton underwear will help, as will over-the-counter remedies like Monistat or Gyne-Lotrimin. Bring supplies from home if you are prone to infection, as they may be difficult to find on the road. In a pinch, some travelers use natural alternatives such as a plain yogurt and lemon juice douche.

Tampons, pads, and contraceptive devices are widely available. Most toiletries can be found in Western establishments like UK’s Boots on Khaosan Rd. and malls on Silom Rd. in Bangkok. Women using birth control pills should bring enough to allow for possible loss or extended stays. Also bring a prescription, since forms of the pill vary considerably. If you need contraceptive services, contact the Planned Parenthood Association of Thailand in Bangkok, 8 Soi Vibhavadi-Rangsit 44, Vibhavadi-Rangsit Road Ladyao, Chatuchak, Bangkok 10900 (☎+66 02 941 2320; www.ppat.or.th). English is the primary language spoken at the branch. Abortion is legal in Thailand, but only in cases where the woman’s health is in danger or she has been raped.

Toilets

Toilets in Thailand are truly unique. While many establishments have Western toilets, some don’t, especially the farther away you get from big cities. If you do encounter a squat toilet, don’t panic; using one may take some practice, but it is very manageable. Most squat toilets are porcelain bowls set in the ground with raised foot grooves on either side. You are expected to put a foot on either side of the bowl and then squat down. The toilet there will be a container of water and a small bucket, which is used both to wash yourself and flush the toilet (scoop water in the bucket, pour the water in the toilet, and the water will disappear). You may want to carry toilet paper with you, but putting this in the toilet is not a good idea. Instead, many establishments provide a wastepaper basket for their disposal. Also abottle of hand sanitizer may come in handy.