Health - Central Asia - page 486

evacuation if necessary. In
Central Asia a pharmacist is
known as an apoteka in Rus-
sian or dorikhana in Turkic.
Clinics are widely known as
polikliniks .
Self-treatment may be
appropriate if your problem
is minor (eg travellers' diar-
rhoea), you are carrying the
relevant medication and
you cannot attend a recom-
mended clinic. It is always
better to be assessed by a
doctor than to rely on self-
treatment.
Buying medication over
the counter is not recom-
mended, as poorly stored
or out-of-date drugs are
common.
To find the nearest reli-
able medical facility, contact
your insurance company,
your embassy or a top-end
hotel.

contact. The long-term con-
sequences can include liver
cancer and cirrhosis.
HIV
Risk: all countries.
HIV is transmitted via
contaminated body fluids.
Avoid unprotected sex, blood
transfusions and injections
(unless you can see a clean
needle being used) in Cen-
tral Asia.
Leishmaniasis
Risk: Kazakhstan, Turkmeni-
stan, Uzbekistan.
This sandfly-borne para-
site is very rare in travellers
but common in the local
population. There are two
forms of leishmaniasis -
one which only affects the
skin (causing a chronic
ulcer) and one affecting the
internal organs. Avoid sand-
fly bites by following insect
avoidance guidelines.
Malaria
Risk: southern Tajikistan,
southeastern Turkmeni-
stan and far southern Uz-
bekistan; only present in the
warmer summer months
(June to October).
Two strategies should be
combined to prevent malaria
- general mosquito/insect
avoidance and antimalaria
medications. Before you
travel, it is essential you seek
medical advice on the right
medication and dosage. In
general, Chloroquine is rec-
ommended for Turkmenistan
and southern Uzbekistan.
Some resistance to Chloro-
quine is reported in southern
Tajikistan (mainly Khatlon
province), so get your doc-
tor's advice on whether to
take Chloroquine, Larium
(Mefloquine), Doxycycline
or Malarone. See the World
Malaria Risk Chart (www.
iamat.org/pdf/world_ma-
laria_risk_chart.pdf) for
detailed information.
To prevent mosquito
bites, take the following
steps:
¨ Use a DEET-containing
insect repellent on exposed

skin. Natural repellents
such as citronella can be
effective, but must be
applied more frequently
than products containing
DEET.
¨ Sleep under a mosquito
net impregnated with
permethrin.
¨ Choose accommodation
with screens and fans (if not
air-conditioned).
¨ Impregnate clothing with
permethrin in high-risk
areas.
¨ Wear long sleeves and
trousers in light colours.
¨ Use mosquito coils.
¨ Spray your room with
insect repellent before going
out for your evening meal.
Rabies
Risk: all countries.
Still a common problem in
most parts of Central Asia,
this uniformly fatal disease
is spread by the bite or lick
of an infected animal - most
commonly a dog. Having a
pre-travel vaccination (three
shots over a one month
period) means the postbite
treatment is greatly simpli-
fied. If an animal bites you,
gently wash the wound with
soap and water, and apply
iodine-based antiseptic. If
you are not vaccinated you
will need to receive rabies
immunoglobulin as soon as
possible and seek medical
advice.
Tuberculosis (TB)
Risk: all countries.
Medical and aid workers,
and long-term travellers who
have significant contact with
the local population should
take precautions against TB.
Adults at risk are advised to
have pre- and post-travel TB
testing. The main symptoms
are fever, cough, weight loss,
night sweats and tiredness.
Typhoid
Risk: all countries.
This serious bacterial
infection is spread via food
and water. It results in a high
and slowly progressive fever

Infectious
Diseases
Brucellosis
Risk: all countries.
Brucellosis is rare in
travellers but common in
the local population, and
is transmitted via unpas-
teurised dairy products.
Common symptoms include
fever, chills, headache, loss
of appetite and joint pain.
Hepatitis A
Risk: all countries.
A problem throughout the
region, this food- and water-
borne virus infects the liver,
causing jaundice (yellow
skin and eyes), nausea and
lethargy. There is no specific
treatment for hepatitis A,
you just need to allow time
for the liver to heal. All travel-
lers to Central Asia should be
vaccinated.
Hepatitis B
Risk: all countries.
The only sexually trans-
mitted disease that can be
prevented by vaccination,
hepatitis B is spread by
contact with infected body
fluids, including via sexual