I am constantly bombarded with inquiries from expatriate
and tourist alike as to the travel health recommendations
for Bali and the surrounding islands. Unfortunately due to
lack of data, inaccurate data, or lack of communication among
health facilities throughout the archipelago, it is difficult
to know what diseases are current risks, and in which area
they are a threat. Travel health sites on the internet tend
to bag "Indonesia" into one category, when it is
plain to see that what may be an issue for the surfer in G-land,
is not an issue for the honeymooners at Nusa Dua.
Many aspects have to be taken into account when giving travel
advice to any one particular person. Considerations such as
age, intended activities (trekking, surfing etc), previous
travel experience, existing medical conditions, level of accommodation,
relationship status, socio-economic factors, length of stay;
are just some of the variants that need to be considered.
A skilled travel health professional or travel health center
should be able to give you sound travel advice based on these
factors. I have put together just a few common sense tips
for those who wish to travel, or who are asked by family and
friends for general travel advice for Bali and her neighboring
Islands.
TRAVEL & HEALTH INSURANCE.
Please, please, please, make sure that you have complete
travel & health insurance. Medical care in Indonesia is
now VERY expensive, and you are not covered by your own countries
health fund (e.g. Medicare). Medical assistance, and evacuation,
can cost anywhere between USD $6,000 and $ 60,000. That fee
can double for remote area helicopter retrievals. If you are
a professional sportsman, make sure that your policy covers
you for injuries sustained in your particular field.
VACCINATIONS.
The following vaccines are recommended for travel to Bali.
Hepatitis A.
Hepatitis B - for at risk groups, such as sexually active,
single travelers.
Tetanus.
Typhoid.
Those traveling to remote areas may also consider the following.
Japanese Encephalitis.
Tuberculosis.
Rabies.
You should start your vaccination program 3-6 months before
travel, as some vaccines are given in courses over several
months. Please remember that no vaccine gives 100% protection.
If you show symptoms of any disease that you are already immunized
against, please seek medical advice immediately.
MALARIA.
Bali and most urban areas of Java are declared Malaria free,
however precautions still need to be considered for travel
to the East Islands or remote areas. You should check with
your local travel health center on recommended Malaria prophylaxis
in Indonesia. Many forms of Malaria are now resistant to the
older drugs (chloroquine resistant). Doxycycline is a good
short-term prophylaxis, and Larium is the drug of choice for
longer stay travelers.
Malaria is a tropical disease spread by a night biting mosquito.
There are several different types of Malaria, with symptoms
ranging from transient fever, and generally feeling unwell,
to a severe form of the disease that may cause kidney &
liver failure, as well as attacking the brain. (...in other
words, you DON'T want to get it!!).
Malarial prophylaxis should commence one week before you
plan to enter a "risk" zone, and continue until
4 weeks after you leave. It is very important to comply with
this regime, as the Malaria organism can live in the liver
for up to 4 weeks after you have been exposed, before it rears
it's ugly head! Any suspicious fevers that may arise up to
12 months after leaving a Malaria risk area should be investigated.
INSECT BITES.
Insects, particularly mosquitoes, can spread a myriad of
diseases such as Malaria, Japanese Encephalitis, and Dengue
fever. The best prevention is to avoid being bitten.
Wear long sleeved loose cotton clothes, and apply a personal
insect repellant containing DEET 30-40%, every 4 hours. If
you are using a sunscreen, apply your insect repellant last.
Remember to re-apply your repellant after bathing.
Avoid the use of dark clothing and perfumes/colognes as these
all attract mosquitoes.
Spray your room with a good "Knock down" spray,
each evening at dusk, and before sleeping.
FOOD & WATER.
The golden rule still stands "BOIL IT, PEEL IT, COOK
IT OR FORGET IT". Avoid roadside food stalls, or drinks
with ice that is not hygienically prepared. Should you find
yourself suffering from traveler's diarrhea, or " gastro",
make sure that you take plenty of fluids, preferably sports
drinks (e.g. Gatorade), as they contain essential body salts.
Drugs such as Lomotil, Imodium and charcoal should be taken
with caution, as they can clog up the gut, keeping harmful
toxins inside the body. Simple diarrhea should pass in a few
days with rest, and a careful diet. (No oil, spice or alcohol).
Should your symptoms not pass within a few days, or if they
are severe, with fever and cramping, contact your nearest
medical facility.
Dehydration due to a combination of heat and gastrointestinal
problems is common amongst travelers. Once again make sure
that there is adequate fluid intake, including some "sports
drinks", (Gatorade, Pocari Sweat). Babies and young children
will dehydrate very quickly and should seek medical attention
for gastro-intestinal problems sooner than adults (within
24 hrs).
SEX IN PARADISE.
Unfortunately, a whole smorgasbord of STD's have reached
into even the most remote parts of "Paradise"!!
The temptations of the tropics are many, and readily available...........but
please, leave the deadly souvenirs where they belong....on
the other side of your condom !! Hepatitis C and HIV will
stay with you for life, and they are both fatal.
RECREATIONAL DRUGS.
In one word DON'T !!
The use of narcotic and hallucinogenic drugs in Indonesia
is illegal, and punishable by death.
Drugs for sale on the street are of questionable origin and
content, and are often mixed with toxic substances such as
strychnine, and soap powders.
Many street sellers are paid off by the authorities to "dob
you in'.
Your being present and aware of other people "using",
even if you are not, will also get you arrested.
Magic mushrooms are not illegal, and are very popular among
the transient surfing population. While the drug itself will
not kill you, they have been associated with an alarming amount
of suicide, and homicide cases.
Your consulate can be of no assistance to you if you are
arrested.
........If you really cannot handle reality for 2 weeks,
stick to the arak and whiskey !
ACCIDENTS.
Accidental death is still the largest cause of demise in
travelers worldwide. Flesh and bone versus tarmac and steel,
has pretty much the same result in Paris as it does in Kathmandu.
Wear your seatbelt, helmet, and protective clothing because
you need to, not because the law (or lack of it) says you
have to. There's nothing like riding with "the wind in
your hair" and that sinking sensation as your skull hits
the bricks !
Surfing accidents too, have taken a remarkable toll amongst
travelers. I have seen more than my fair share of surfers,
who, as a result of boards piercing their eyes, have lost
their eyesight. Be a sissy....put a nose guard on your board....you
will "see" the difference!
EAR INFECTIONS.
Swimming and water always play a big part in the holiday
activities. Needless to say ear canal infections are common,
however they are easy to avoid. Always ensure that your ear
canal is clean and dry after swimming or bathing. If you are
prone to ear infections (swimmers ear), a few drops of vinegar
& alcohol, or commercially prepared preparation (i.e.
aqua ear) in the canal after swimming, will prevent these
from occurring. Middle ear infections will need assessment
by a medical practitioner, and the appropriate treatment prescribed.
FUN IN THE SUN !!
The tropical sunshine can be deceiving in its strength. As
with anywhere else in the world, the "Slip, Slap, Slop"
rule for sun block lotions still applies. Don't be fooled
also by cloudy days, as the ultraviolet rays of the sun are
still present. Avoid the midday sun, and be particularly careful
with small children.
" Kim Patra is a qualified Registered Nurse / Midwife,
and mother of three, who has been living and working in Bali
for past 15 years. She has assisted many traveller (... and
others) either as a flying medical escort or just a voice
on the end of the phone! Kim is happy to discuss any health
concerns that your may have. Her e-mail contact is info@chcbali.com
