Travel Reference
In-Depth Information
Health Dr Trish Batchelor
medical-expense options; the higher ones
are chiefly for countries that have extremely
high medical costs, such as the USA. You may
prefer a policy that pays doctors or hospitals
directly rather than you having to pay on the
spot and claim later. If you have to claim later,
make sure you keep all documentation. Some
policies ask you to call back (reverse charges)
to a centre in your home country where an
immediate assessment of your problem is
Specialised travel-medicine clinics are your
best source of information; they stock all avail-
able vaccines and will be able to give specific
recommendations for you and your trip. The
doctors will take into account factors such as
past vaccination history, the length of your trip,
activities you may be undertaking and underly-
ing medical conditions, such as pregnancy.
Most vaccines don't produce immunity
until at least two weeks after they're given, so
visit a doctor four to eight weeks before de-
parture. Ask your doctor for an International
Certificate of Vaccination (otherwise known
as the yellow booklet), which will list all the
vaccinations you've received.
The World Health Organization recom-
mends the following vaccinations for travel-
lers to Southeast Asia:
Adult diphtheria & tetanus Single booster
recommended if none in the previous 10 years. Side effects
include sore arm and fever.
Hepatitis A Provides almost 100% protection for up to a
year, a booster after 12 months provides at least another
20 years protection. Mild side effects such as headache and
sore arm occur in 5% to 10% of people.
Hepatitis B Now considered routine for most travellers.
Given as three shots over six months. A rapid schedule is
also available, as is a combined vaccination with Hepatitis
A. Side effects are mild and uncommon, usually headache
and sore arm. Lifetime protection occurs in 95% of people.
Measles, mumps & rubella (MMR) Two doses of MMR
are required unless you have had the diseases. Occasionally
a rash and flulike illness can develop a week after receiving
the vaccine. Many young adults require a booster.
Polio In 2002, no countries in Southeast Asia reported
cases of polio. Only one booster is required as an adult for
lifetime protection. Inactivated polio vaccine is safe during
the injection is usually recommended as it has fewer side
effects. Sore arm and fever may occur.
Varicella If you haven't had chickenpox, discuss this
vaccination with your doctor.
If you are carrying syringes or needles, be
sure to have a physician's letter document-
ing their medical necessity. If you have a
heart condition ensure you bring a copy of
your electrocardiogram taken just prior to
If you happen to take any regular medica-
tion bring double your needs in case of loss
or theft. In most Southeast Asian countries,
excluding Singapore, you can buy many medi-
cations over the counter without a doctor's
prescription, but it can be difficult to find
some of the newer drugs, particularly the
latest antidepressant drugs, blood pressure
medications and contraceptive pills.
Even if you are fit and healthy, don't travel
without health insurance - accidents do
happen. Declare any existing medical condi-
tions you have - the insurance company will
check if your problem is pre-existing and will
not cover you if it is undeclared. You may
require extra cover for adventure activities
such as rock climbing. If your health insur-
ance doesn't cover you for medical expenses
abroad, consider getting extra insurance. If
you're uninsured, emergency evacuation is
expensive - bills of more than US$100,000 are
not uncommon.
Find out in advance if your insurance plan
will make payments directly to providers
or reimburse you later for overseas health
expenditures. (In many countries doctors
expect payment in cash at the time of treat-
ment.) Some policies offer lower and higher
These immunisations are recommended for
long-term travellers (more than one month)
or those at special risk:
Japanese B Encephalitis Three injections in all. Booster
recommended after two years. Sore arm and headache are
the most common side effects. Rarely an allergic reaction
comprising hives and swelling can occur up to 10 days after
any of the three doses.
Meningitis Single injection. There are two types of
vaccination: the quadrivalent vaccine gives two to three
years protection; meningitis group C vaccine gives around
10 years protection. Recommended for long-term back-
packers aged under 25.
Rabies Three injections in all. A booster after one year will
then provide 10 years protection. Side effects are rare -
occasionally headache and sore arm.
Tuberculosis ( TB) A complex issue. Adult long-term
travellers are usually recommended to have a TB skin test
before and after travel, rather than vaccination. Only one
vaccine given in a lifetime.
The only vaccine required by international
regulations is yellow fever. Proof of vaccina-
tion will only be required if you have visited a
country in the yellow-fever zone within the six
days prior to entering Southeast Asia. If you
are travelling to Southeast Asia from Africa
or South America you should check to see if
you require proof of vaccination.
Recommended items for a personal medi-
cal kit:
Before You Go
Recommended Vaccinations
Required Vaccinations
Medical Checklist
Internet Resources
Further Reading
In Transit
Deep Vein Thrombosis (DVT )
Jet Lag & Motion Sickness
In Bali & Lombok
Availability & Cost of Health Care
Infectious Diseases
Traveller's Diarrhoea
Environmental Hazards
Women's Health
Treatment for minor injuries and common
traveller's health problems is easily accessed
in Bali and to a lesser degree on Lombok (see
p285). But be aware that for serious condi-
tions, you will need to leave the islands.
Travellers tend to worry about contracting
infectious diseases when in the tropics, but
infections are a rare cause of serious illness or
death in travellers. Pre-existing medical con-
ditions such as heart disease, and accidental
injury (especially traffic accidents), account
for most life-threatening problems. Becom-
ing ill in some way, however, is relatively
common. Fortunately most common illnesses
can either be prevented with some common-
sense behaviour or be treated easily with a
well-stocked traveller's medical kit.
The following advice is a general guide only
and does not replace the advice of a doctor
trained in travel medicine.
antifungal cream (eg clotrimazole)
antibacterial cream (eg muciprocin)
antibiotic for skin infections (eg amoxi-
cillin/clavulanate or cephalexin)
It's usually a good idea to consult your
government's travel-health website before
departure, if one is available:
Australia (
Canada (
New Zealand (
antibiotics for diarrhoea include nor-
floxacin or ciprofloxacin; for bacterial
diarrhoea azithromycin; for giardiasis or
amoebic dysentery tinidazole
Make sure all medications are packed in their
antihistamine - there are many options
(eg cetirizine for daytime and prometh-
azine for night)
antiseptic (eg Betadine)
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