Puerto Rico 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.

Environmental Hazards

To avoid heat exhaustion and dehydration, take extra precautions when hiking in Puerto Rico’s central mountains and visiting the island’s many beaches. 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 always 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. Visitors should be especially careful to avoid sunburn, a common problem for travelers in Puerto Rico. Always wear sunscreen (SPF 30 is or higher) when spending time outdoors. 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 affects the entire body, causing fever, chills, nausea, and vomiting. Sun poisoning should always be treated by a doctor.

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 use 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 diseases including dengue fever—can be particularly dangerous in wet, swampy, or wooded areas, which exist in rural areas of Puerto Rico. Dengue fever is transmitted by Aedes mosquitoes, which bite during the day rather than at night. The incubation period is 3-14 days, though usually 4-7 days. Early symptoms include a high fever, severe headaches, swollen lymph nodes, and muscle aches. Many patients also suffer from nausea, vomiting, and a pink rash. If you experience these symptoms, see a doctor immediately, drink plenty of liquids, and take fever-reducing medication such as acetaminophen (Tylenol). Never take aspirin to treat dengue fever. There is no vaccine available for dengue fever. Ticks—which can carry Lyme disease, among others—can be particularly bad in rural and forested regions, such as the central mountains and national forests of Puerto Rico.

Food- And Water-Borne Diseases

Prevention is the best medicine: 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. Always wash your hands before eating or bring a quick-drying, purifying liquid hand cleaner.

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 tsp. 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.
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.
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.
Schistosomiasis: Also known as bilharzia; a parasitic disease caused when the larvae of flatworm penetrate unbroken skin. Symptoms include an itchy localized rash, followed in 4-6 weeks by fever, fatigue, painful urination, diarrhea, loss of appetite, and night sweats. To avoid it, try not to swim in fresh water; if exposed to untreated water, rub the area vigorously with a towel and apply rubbing alcohol.

Other Infectious Diseases

The following diseases exist in every part of 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.
AIDS and HIV: For detailed information on Acquired Immune Deficiency Syndrome (AIDS) in Puerto Rico, call the US Centers for Disease Control’s 24hr. hotline at ☎800-342-2437, or contact the Joint United Nations Programme on HIV/AIDS (UNAIDS), 20 Ave. Appia, CH-1211 Geneva 27, Switzerland (☎+41 22 791 3666; fax 22 791 4187).
Sexually transmitted infections (STIs): Gonorrhea, chlamydia, genital warts, syphilis, herpes, and other STIs are easier to catch than HIV and can be just as deadly. Hepatitis B and Hepatitis C can also be transmitted sexually. 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

Puerto Rico has one of the best medical systems in the Caribbean. Every municipal center has some kind of health clinic or hospital, and all large cities have major hospitals with 24hr. emergency rooms. Travelers who have a minor medical problem in Puerto Rico can visit any hospital clinic and wait to see a doctor. Most hospitals have English-speaking doctors; smaller hospitals that do not should be able to find a translator. In an emergency, dial ☎911 from any phone and an operator will send out paramedics, a fire brigade, or the police as needed. Alternatively, go directly to the nearest emergency room for immediate service. Puerto Rican hospitals take many American medical insurance plans, but other travelers will have to pay for medical service. Almost all cities and towns have standard pharmacies. Culebra has much more limited medical services and in a real emergency you will have to be evacuated to Fajardo. Isla Mona has no medical services and is very remote.

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 (☎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 ☎716-754-4883, Canada +1 519-836-0102; www.iamat.org) has free membership, lists English-speaking doctors worldwide, and offers detailed info on immunization requirements and sanitation. If your regular 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 (☎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. Over-the-counter medicines can sometimes alleviate symptoms, but if they persist, see a doctor. Vaginal yeast infections may flare up in hot and humid climates. Wearing loosely fitting trousers or a skirt and cotton underwear will help, as will remedies like Monostat or Gynelotrimin. Bring supplies from home if you are prone to infection, as they may be difficult to find on the road. Tampons, pads, and reliable contraceptive devices are widely available in Puerto Rico, though your favorite brand may not be stocked—bring extras of anything you can’t live without. Abortion is legal in Puerto Rico. Planned Parenthood’s affiliate in Puerto Rico is PRO-FAMILIA, Urbanización El Vedado, Calle Padre Las Casas 117, Hato Rey, San Juan (☎787-765-7373; www.profamiliapr.org).