Health - Central Asia - page 487

and headache, and may be
accompanied by a dry cough
and stomach pain. Be aware
that vaccination is not 100%
effective so you must still
be careful what you eat and
drink.
Travellers' Diarrhoea
Travellers' diarrhoea is de-
fined as the passage of more
than three watery bowel
actions within 24 hours, plus
at least one other symp-
tom, such as fever, cramps,
nausea, vomiting or feeling
generally unwell. It is by far
the most common problem
affecting travellers.
Travellers' diarrhoea is
caused by a bacterium and,
in most cases, treatment
consists of staying well
hydrated; rehydration solu-
tions are the best for this. It
responds promptly to treat-
ment with antibiotics such
as norfloxacin, ciprofloxacin
or azithromycin. Lopera-
mide is just a 'stopper' and
doesn't get to the cause of
the problem. It can be help-
ful, for example, if you have
to go on a long bus ride.
Don't take loperamide if you
have a fever, or blood in your
stools. Seek medical atten-
tion quickly if you do not
respond to an appropriate
antibiotic.
Amoebic Dysentery
Amoebic dysentery is actu-
ally rare in travellers but is
often misdiagnosed. Symp-

toms are similar to bacterial
diarrhoea, ie fever, bloody
diarrhoea and generally
feeling unwell. You should
always seek reliable medi-
cal care if you have blood in
your diarrhoea. Treatment
involves two drugs: tinida-
zole or metroniadzole to
kill the parasite in your gut,
and a second drug to kill the
cysts. If left untreated, com-
plications such as liver or
gut abscesses can occur.
Giardiasis
Giardia is a parasite that
is relatively common in
travellers to Central Asia.
Symptoms include nausea,
bloating, excess gas, fatigue
and intermittent diarrhoea.
'Eggy' burps are often at-
tributed solely to giardia.
The parasite will eventually
go away if left untreated,
but this can take months.
The treatment of choice is
tinidazole; metronidazole is
a second option.
Other Diseases
Kazakhstan occasionally
reports outbreaks of human
plague in the far west. One
fatal case of bubonic plague
was recorded in Kyrgyzstan
in 2013. Outbreaks are often
caused by eating diseased
meat but are also transmit-
ted by the bites of rodent
and marmot fleas.
In 2013 there were out-
breaks of anthrax in Kaza-
khstan.

Crimean-Congo haemor-
rhagic fever is a severe viral
illness characterised by the
sudden onset of intense
fever, headache, aching
limbs, bleeding gums and
sometimes a rash of red
dots on the skin, a week or
two after being bitten by an
infected tick. It's a minor risk
for trekkers and campers in
Central Asia during the sum-
mer months. Insect repellent
will help keep the blighters
off you.

Environmental
Hazards
Altitude Sickness
Altitude sickness is a partic-
ular problem in high-altitude
regions of Kazakhstan, Kyr-
gyzstan and Tajikistan. With
motorable roads (such as
the Pamir Highway) climbing
passes of over 4000m, it's a
problem not just restricted
to trekkers.
Altitude sickness may
develop in those who ascend
rapidly to altitudes greater
than 2500m. Being physi-
cally fit offers no protection.
Risk increases with faster
ascents, higher altitudes and
greater exertion. Symptoms
may include headaches,
nausea, vomiting, dizziness,
malaise, insomnia and loss
of appetite. Severe cases
may be complicated by fluid
in the lungs or swelling of
the brain.

DRINKING WATER

¨ Never drink tap water, especially in Karakalpakstan, Khorezm, Dushanbe and remoter
Kazakhstan.
¨ Bottled water is generally safe - check the seal is intact at purchase.
¨ Avoid ice.
¨ Avoid fresh juices - they may have been watered down.
¨ Boiling water is the most efficient method of purifying it.
¨ The best chemical purifier is iodine. It should not be used by pregnant women or those
with thyroid problems.
¨ Water filters should also filter out viruses. Ensure your filter has a chemical barrier
such as iodine and a small pore size, eg less than four microns.