Every year the expatriate population seems to double. Retirement visa’s, affordable luxury accommodation and the new wave of digital global nomads all make our little island paradise a very attractive place to live. But what about health care? May people leave this until last on the list of considerations when they fall in love with the glossy brochures and the gentle sea breeze. Don’t forget Bali is still a part of Indonesia, and we are a third world country. Health care to the general population is very basic in comparison, and it is also expensive.
Our health facilities have improved vastly over the past few decades, but they are still a far cry from what most people would expect in their home country. While there are certain clinics, medical centers and hospitals that cater for the higher socio-economic group and tourists, their facilities are still limited.
Don’t wait until you actually need medical attention to rush to the first clinic that looks “clean”. Do your homework. Ask other expatriates what their opinions are. Visit the facilities; check the staff for their ability in English (or other language). Also ask about their pricing structure. Will they give you a discount if you have a resident’s visa (KITAS)? Will they deal directly with your insurance company? (And you DO have health insurance don’t you!). Don’t expect to see a Western doctor at any of the facilities in Bali. It is extremely difficult to get license for overseas doctors to practice here.
Please, please, please, make sure that you have good health cover. 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. Also note that if you consider that you can put yourself on a flight and hop down to Australia for emergency treatment, think again. Even simple (and relatively common) disease such as Dengue fever will not be accepted on a commercial flight.
The following vaccines are recommended for living in Bali :
• Hepatitis A – This is probably the type of Hepatitis that you will be at most risk of contracting in Bali. Spread by poor hygiene practices and through contaminated food and water. Once you have received the full course you are protected for up to 20 years.
• Hepatitis B – Spread through blood and body fluids. Even if you are not sexually active, or partake in other at risk facilities you are still wise to take this vaccine which is valid for up to 10 years.
• Tetanus – Very important to keep your Tetanus cover up to date (every 10 years). It is a very common disease here, usually contracted through open wounds.
• Typhoid – The typhoid vaccine is wise as it is also spread via poor hygiene practices (Food, Flies, Fingers, Feces, Fornication), however it may not give protection against some of the paratyphoid strains.
• Polio – This is one people tend to forget, however we did have an outbreak of polio in West Java several years ago. You will need a booster every 10 years.
• Japanese Encephalitis – JE is a mosquito borne disease, and yes it is present here, but fortunately it is not common. You might want to discuss this vaccine with your travel health or vaccine clinic.
• Tuberculosis – This is a very active disease in Indonesia. You should probably get your TB status checked before you come to Bali as this is quite complex. (Chest X rays, skin tests etc). Some centers are recommending vaccine, some are now saying just treat the disease if you get it.
• Rabies – This a really nasty (fatal) disease, and the post exposure treatment is outrageously expensive, so you might want to consider this one. The vaccine is 3 shots on day 0,7 and 21.
Naturally if you have children, their standard vaccine program should be kept up to date. You should start your vaccination program 3-6 months before travel, as some vaccines are given in courses over several months.
I can’t find the medication that I take?
This is a real nuisance for those that regularly take prescription medications, only to find that when they need a re-script the medication is not available here or out of stock. Make sure that you can get what you need before you run out. Often the medication IS available but under a different name. As long as the active ingredients are the same it’s fine. Most pharmacies will not stock very expensive medications (such as some asthma inhalers and high end antibiotics) however they will be happy to order them in for you.
If you are considering ordering medications on line and having them sent via mail, think again. The post office will probably report the package to the Department of Health and then you could be hours or days trying to get them released.
A word on allergies
By allergies I mean the mega-allergy kind! This is the kind of allergy that will cause life-threatening reactions such as lumpy red welts and rashes all over the body.
Most people who have these kinds of allergies are already aware of this and carry a pre-dosed adrenaline injector called an “Epipen”, and guess what….we can’t get them here. Make sure that you bring yours with you from overseas.
What blood group are you?
And why does it matter anyway? It matters because the Caucasian (white) population averages about a 15 -25 % negative blood group type. The Asian population averages less than 3%. So if you are a bleeding Caucasian (with a negative blood type), in an Asian country, you are in trouble. If you do not know your own blood group you are being ignorant. (You can find out your own blood type by a simple / cheap blood test with me or directly at any laboratory).
Yes you will get ‘em! You only need to take a walk on the beach to see the semi-wild dogs roaming free to see that even sitting in the sand could give you a dose of the wrigglers. Fortunately treatments are readily available “over the counter” at most pharmacies and supermarkets. Wherever worm infestation is suspected in a family member (or pet), it is wise to treat all other household members. As infestation is so often asymptomatic I usually recommend that worming treatments are used routinely at 3-6 monthly intervals for all family members, including house staff.
Kim Patra is a qualified Midwife & Nurse Practioner who has been living and working in Bali for over 30 years. She now runs her own Private Practice & Mothers & Babies center at her Community Health Care office in Sanur.
Copyright © 2019 Kim Patra
You can read all past articles of
Paradise…in Sickness & in Health at www.BaliAdvertiser.biz