Health issues and the quality of medical facilities vary enormously depending on where you travel in Southeast Asia.
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.
Accidental injury (such as traffic accidents) and pre-existing medical conditions account for most life-threatening problems. Becoming ill in some way, however, is relatively common and may include respiratory infections, diarrhoea and dengue fever. Fortunately, most common illnesses can be either prevented or treated.
Pack medications in their original, clearly labelled containers. A signed, dated letter from your physician describing your medical conditions and medications, including generic names, is recommended. If carrying syringes or needles, have a physician’s letter stating their medical necessity. If you have a heart condition, bring a copy of your ECG.
If you take any regular medication, bring a double supply in case of loss or theft. In most Southeast Asian countries, excluding Singapore, you can buy many medications over the counter, but it can be difficult to find some of the newer drugs, particularly the latest antidepressants, blood-pressure medications and contraceptive pills.
Even if you are fit and healthy, don’t travel without health insurance – accidents do happen. Adventure activities, such as rock climbing, often require extra coverage. If your existing health insurance doesn’t cover you for medical expenses abroad, consider purchasing travel insurance that includes emergency evacuation.
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.) If you have to claim later, make sure you keep all documentation. Some policies ask you to call a centre in your home country, where an immediate assessment of your problem is made.
Divers should ensure their insurance covers them for decompression illness – get specialised dive insurance through an organisation such as Divers Alert Network (www.diversalertnetwork.org). Have a dive medical before you leave your home country; there are certain medical conditions that are incompatible with diving.
Specialised travel-medicine clinics can advise on which vaccines are recommended for your trip. Some vaccines require multiple injections spaced out over a certain period of time; start the process six weeks prior to departure.
The World Health Organization (WHO) recommends the following vaccinations for travellers to Southeast Asia:
Adult diphtheria and tetanus
Hepatitis A
Hepatitis B
Measles, mumps and rubella (MMR)
Polio
Typhoid
Varicella
The following immunisations are recommended for long-term travellers (more than one month) or those at special risk:
Japanese B Encephalitis
Meningitis
Rabies
Tuberculosis (TB)
The only vaccine required by international regulations is for yellow fever. Proof of vaccination will be required only if you have visited a country in the yellow-fever zone within the six days before 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 medical kit:
antibacterial cream eg mupirocin
antibiotic for skin infections eg amoxicillin/clavulanate or cephalexin
antibiotics for diarrhoea eg norfloxacin or ciprofloxacin; azithromycin for bacterial diarrhoea; tinidazole for giardiasis or amoebic dysentery
antifungal cream eg clotrimazole
antihistamine eg cetirizine for daytime and promethazine for night
anti-inflammatory eg ibuprofen
antiseptic eg Betadine
antispasmodic for stomach cramps eg Buscopan
contraceptives
decongestant eg pseudoephedrine
DEET-based insect repellent
diarrhoea treatment, including an oral rehydration solution (eg Gastrolyte), diarrhoea ‘stopper’ (eg loperamide) and antinausea medication (eg prochlorperazine)
first-aid items eg scissors, plasters, bandages, gauze, thermometer (but not one with mercury), sterile needles and syringes, safety pins and tweezers
indigestion medication eg Quick-Eze or Mylanta
iodine tablets to purify water
laxative eg Coloxyl
paracetamol
permethrin to impregnate clothing and mosquito nets
steroid cream for allergic or itchy rashes eg 1% to 2% hydrocortisone
sunscreen and hat
throat lozenges
thrush (vaginal yeast infection) treatment eg Clotrimazole pessaries or Diflucan tablet
Ural or equivalent if you’re prone to urine infections
Divers and surfers should seek specialised advice on stocking medical kits for coral cuts and tropical ear infection treatments.
Most capital cities in Southeast Asia have clinics that cater specifically to travellers and expats. These clinics are more expensive than local medical facilities but offer a superior standard of care and the staff speak English.
It is difficult to find reliable medical care in rural areas. Your embassy and insurance company are good contacts.
The standard of care in Southeast Asia varies from country to country:
Brunei Darussalam General care is reasonable. There is no local medical university, so expats and foreign-trained locals run the health-care system. Serious or complex cases are better managed in Singapore.
Cambodia There are international clinics in Phnom Penh and Siem Reap and an NGO-run surgical hospital in Battambang that provide primary care and emergency stabilisation. Elsewhere, government hospitals should be avoided. For more serious conditions, it is advisable to be evacuated to Bangkok.
Indonesia Local medical care in general is not yet up to international standards. Foreign doctors are not allowed to work in Indonesia, but some clinics catering to foreigners have ‘international advisers’. Almost all Indonesian doctors work at government hospitals during the day and in private practices at night. This means that private hospitals often don’t have their best staff available during the day. Serious cases are evacuated to Australia or Singapore.
Laos There are no good facilities in Laos; the nearest acceptable facilities are in northern Thailand. The Australian Embassy Clinic in Vientiane treats citizens of Commonwealth countries.
Malaysia Medical care in the major centres is good and most problems can be adequately dealt with in Kuala Lumpur.
Myanmar (Burma) Local medical care is dismal and local hospitals should be used only in desperation. There is an international medical clinic in Yangon.
Philippines Good medical care is available in most major cities.
Singapore Excellent medical facilities and referral centre for most of Southeast Asia.
Thailand After Singapore, Bangkok is the city of choice for expats living in Southeast Asia who require specialised care.
East Timor Private clinics available in Dili. The government hospital is basic and should be avoided.
Vietnam Government hospitals are overcrowded and basic. In order to treat foreigners, the facility needs to obtain a special licence, and so far only a few have been provided. The private clinics in Hanoi, Ho Chi Minh City and Danang should be your first choice.
Food and water contamination are the biggest risk factor for contracting traveller’s diarrhoea. Here are some safety considerations:
Eat only freshly cooked food and fruit that can be peeled.
Avoid food that has been sitting around for hours.
Eat in busy restaurants with a high turnover of customers.
Never drink tap water; opt for bottled or filtered water instead.
Avoid ice.
Avoid fresh juices that may have been watered down.
Boil water or use iodine tablets as a means of purification; pregnant women or those with thyroid problems should avoid iodine use.
Risk areas All countries except Singapore.
This disease, caused by dog hookworm, is particularly common on the beaches of Thailand. The rash starts as a small lump then slowly spreads in a linear fashion. It is intensely itchy, especially at night. It is easily treated with medications and should not be cut out or frozen.
Risk areas All countries.
This mosquito-borne disease is increasingly problematic throughout Southeast Asia, especially in the cities. There is no vaccine, only prevention. The mosquito that carries dengue bites day and night, so use DEET-mosquito cream periodically throughout the day. Symptoms include high fever, severe headache and body ache (dengue used to be known as breakbone fever). Some people develop a rash and experience diarrhoea. There is no specific treatment, just rest and paracetamol – do not take aspirin as it increases the likelihood of haemorrhaging. See a doctor to be diagnosed and monitored.
Don't assume this is a rural issue: Southeast Asia's cities, such as Bangkok and Singapore, as well as Thailand’s southern islands and Chiang Mai province are high-risk areas.
Risk areas 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 travellers to Southeast Asia should be vaccinated against hepatitis A.
Risk areas All countries.
The only serious sexually transmitted disease that can be prevented by vaccination, hepatitis B is spread by body fluids. In some parts of Southeast Asia, up to 20% of the population carry hepatitis B, and usually are unaware of it. The long-term consequences can include liver cancer and cirrhosis.
Risk areas All countries.
Hepatitis E is transmitted through contaminated food and water, and has similar symptoms to hepatitis A but is far less common. It is a severe problem in pregnant women, and can result in the death of both mother and baby. There is currently no vaccine; prevention is by following safe eating and drinking guidelines.
The following diseases are common in the local population (in all countries except Singapore) but rare in travellers.
Filariasis – a mosquito-borne disease prevented by mosquito-avoidance measures.
Typhus – murine typhus is spread by the bite of a flea and scrub typhus is spread via a mite; symptoms include fever, muscle pains and a rash. Prevention is through general insect-avoidance measures or doxycycline.
Tuberculosis – medical and aid workers and long-term travellers should take precautions and consider pre- and post-travel testing; symptoms are fever, cough, weight loss and tiredness.
Meliodosis (Thailand only) – an infection contracted by skin contact with soil; symptoms are similar to tuberculosis.
Japanese B Encephalitis (Vietnam, Thailand and Indonesia are highest risk areas) – a viral disease, transmitted by mosquitoes; most cases occur in rural areas and vaccination is recommended for travellers spending more than one month outside cities.
Risk areas All countries.
HIV is now one of the most common causes of death in people under the age of 50 in Thailand. The Southeast Asian countries with the worst and most rapidly increasing HIV problem are Myanmar, Thailand and Vietnam. Heterosexual sex is now the main method of transmission in these countries.
Risk areas All countries.
Present year-round in the tropics, influenza (flu) symptoms include high fever, muscle aches, runny nose, cough and sore throat. It can be very severe in people over the age of 65, and in those with underlying medical conditions such as heart disease or diabetes; vaccination is recommended for these individuals. There is no specific treatment, just rest and paracetamol.
Risk areas Thailand and Malaysia.
Leptospirosis is most commonly contracted after river rafting or canyoning. Early symptoms are very similar to the flu, and include headache and fever. The disease can vary from very mild to fatal. Diagnosis is through blood tests and it is easily treated with doxycycline.
Risk areas All countries except Singapore and Brunei.
Many parts of Southeast Asia, particularly city and resort areas, have minimal to no risk of malaria, and the risk of side effects from the prevention tablets may outweigh the risk of getting the disease.
For most rural areas, however, the risk of contracting the disease is increased and malaria can be fatal. Before you travel, seek medical advice on the right medication and dosage.
Malaria is caused by a parasite transmitted by the bite of an infected mosquito. The most important symptom of malaria is fever, but general symptoms such as headache, diarrhoea, cough or chills may also occur. Diagnosis can only be made by taking a blood sample.
Two strategies are combined to prevent malaria – mosquito avoidance and antimalarial medications.
Travellers are advised to prevent mosquito bites by taking the following steps:
Use an insect repellent containing DEET on exposed skin.
Sleep under a mosquito net that is impregnated with permethrin.
Choose accommodation with screens and fans (if not air-conditioned).
Impregnate clothing with permethrin when 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.
Risk areas All countries except Singapore and Brunei.
Measles remains a problem in some parts of Southeast Asia. This highly contagious bacterial infection is spread via coughing and sneezing. Most people born before 1966 are immune as they had the disease during childhood. Measles starts with a high fever and rash, and can be complicated by pneumonia and brain disease. There is no specific treatment.
Risk areas All countries except Singapore and Brunei.
Still a common problem in most parts of Southeast Asia, this uniformly fatal disease is spread by the bite or lick of an infected animal, most commonly a dog or monkey. You should seek medical advice immediately after any animal bite and commence post-exposure treatment. Having a pre-travel vaccination means the post-bite treatment is greatly simplified. If an animal bites you, gently wash the wound with soap and water, and apply iodine-based antiseptic. If you are not pre-vaccinated you will need to receive rabies immunoglobulin as soon as possible.
Risk areas Laos, Philippines, Vietnam and Sulawesi (Indonesia).
Schistosomiasis is a tiny parasite that enters your skin after you’ve been swimming in contaminated water. Travellers usually only get a light infection and hence develop no symptoms. On rare occasions, travellers may develop ‘Katayama fever’. This occurs some weeks after exposure, as the parasite passes through the lungs and causes an allergic reaction; symptoms are coughing and fever. Schistosomiasis is easily treated with medications.
Risk areas All countries.
Sexually transmitted diseases most commonly found in Southeast Asia include herpes, warts, syphilis, gonorrhoea and chlamydia. People carrying these diseases often have no signs of infection. Condoms will prevent gonorrhoea and chlamydia but not warts or herpes. If after a sexual encounter you develop any rash, lumps, discharge or pain when passing urine, seek immediate medical attention. If you have been sexually active during your travels, have an STD check on your return home.
Risk areas Cambodia, Myanmar and Thailand.
This parasite, transmitted by skin-contact with soil, is common in travellers but rarely affects them. It is characterised by an unusual skin rash called larva currens – a linear rash on the trunk that comes and goes. Most people don’t have other symptoms until their immune system becomes severely suppressed, when the parasite can cause an overwhelming infection. It can be treated with medications.
Risk areas All countries except Singapore.
This serious bacterial infection is spread via food and water. It gives a high and slowly progressive fever and a headache, and may be accompanied by a dry cough and stomach pain. It is diagnosed by blood tests and treated with antibiotics. Vaccination is recommended for all travellers spending more than a week in Southeast Asia, or travelling outside the major cities. Vaccination is not 100% effective so you must still be careful about what you eat and drink.
Traveller’s diarrhoea is by far the most common problem that affects travellers – between 30% and 50% of people will suffer from it within two weeks of starting their trip. In over 80% of cases, traveller’s diarrhoea is caused by bacteria (there are numerous potential culprits), and therefore responds promptly to treatment with antibiotics. Treatment will depend on your situation – how sick you are, how quickly you need to get better and so on.
Traveller’s diarrhoea is defined as the passage of more than three watery bowel actions within 24 hours, plus at least one other symptom such as fever, cramps, nausea, vomiting or feeling generally unwell.
Treatment consists of staying well hydrated; rehydration solutions such as Gastrolyte are the best for this. Antibiotics such as norfloxacin, ciprofloxacin or azithromycin will kill the bacteria quickly.
Loperamide is just a ‘stopper’. It can be helpful 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 attention quickly if you do not respond to an appropriate antibiotic.
Amoebic dysentery is very rare in travellers but is often misdiagnosed by poor-quality labs in Southeast Asia. Symptoms are similar to bacterial diarrhoea – fever, bloody diarrhoea and generally feeling unwell. You should always seek reliable medical care if you have blood in your diarrhoea. Treatment involves two drugs: tinidazole or metronidazole to kill the parasite in your gut, and then a second drug to kill the cysts. If left untreated, complications such as liver or gut abscesses can occur.
Giardia lamblia is a relatively common parasite in travellers. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. ‘Eggy’ burps are often attributed solely to giardiasis, but work in Nepal has shown that they are not specific to this infection. The parasite will eventually go away if left untreated but this can take months. The treatment of choice is tinidazole, with metronidazole being a second option.
Many parts of Southeast Asia are hot and humid. For most people it takes at least two weeks to adapt to the climate. Swelling of the feet and ankles is common, as are muscle cramps caused by excessive sweating. You can prevent these by avoiding dehydration and excessive activity; you should also take it easy when you first arrive. Treat cramps by stopping activity, resting, rehydrating with double-strength rehydration solution and gently stretching.
Dehydration is the main contributor to heat exhaustion. Symptoms include weakness, headache, irritability, nausea or vomiting, sweaty skin, a fast pulse, and a slightly elevated body temperature. Treatment involves getting out of the heat, fanning and applying cool wet cloths to the skin, lying flat with legs raised, and rehydrating with water containing a quarter of a teaspoon of salt per litre. Recovery is usually rapid, though it is common to feel weak afterwards.
Heat stroke is a serious medical emergency. Symptoms come on suddenly and include weakness, nausea, a hot dry body with a body temperature of over 41°C, dizziness, confusion, loss of coordination, seizures, and eventually collapse and loss of consciousness. Seek medical help and commence cooling by getting out of the heat, removing clothes, fanning and applying cool wet cloths or ice to the body, especially to the groin and armpits.
Prickly heat is a common skin rash in the tropics caused by sweat being trapped under the skin. The result is an itchy rash of tiny lumps. Treat by moving out of the heat and into an air-conditioned area for a few hours and by having cool showers. Creams and ointments clog the skin so they should be avoided. Locally bought prickly-heat powder can be helpful.
Bedbugs don’t carry disease but their bites are very itchy. They live in the cracks of furniture and walls, and then migrate to the bed at night to feed on you. You can treat the itch with an antihistamine.
Lice inhabit various parts of your body, but most commonly your head and pubic area. Transmission is via close contact with an infected person. Lice can be difficult to treat and you may need numerous applications of an anti-lice shampoo. Pubic lice are usually contracted from sexual contact.
Ticks are contracted after walking in rural areas. They are commonly found behind the ears, on the belly and in armpits. If you have had a tick bite and experience symptoms such as a rash at the site of the bite or elsewhere, or fever or muscle aches, you should see a doctor. Doxycycline prevents tick-borne diseases.
Leeches are found in humid rainforest areas. They do not transmit any disease but their bites are often intensely itchy for weeks afterwards and can easily become infected. Apply an iodine-based antiseptic to any leech bite to help prevent infection.
Bee and wasp stings mainly cause problems for people who are allergic to them. Anyone with a serious bee or wasp allergy should carry an injection of adrenaline (eg an Epipen) for emergency treatment. For others, pain is the main problem – apply ice to the sting and take painkillers.
Most jellyfish in Southeast Asian waters are not dangerous, just irritating. First aid for jellyfish stings involves pouring vinegar onto the affected area to neutralise the poison. Do not rub sand or water onto the stings. Take painkillers, and if you feel ill in any way after being stung seek medical advice. Take local advice if there are dangerous jellyfish around and keep out of the water.
Sandflies inhabit beaches (usually the more remote ones) across Southeast Asia. They have a nasty bite that is extremely itchy and can easily become infected. Use an antihistamine to quell the itching, and, if you have to itch, use the palm of your hand and not your nails or infection may follow.
Numerous parasites are common in local populations in Southeast Asia; however, most of these are rare in travellers. The two rules for avoiding parasitic infections are to wear shoes and to avoid eating raw food, especially fish, pork and vegetables. A number of parasites are transmitted via the skin by walking barefoot, including Strongyloides, hookworm and cutaneouslarva migrans.
Fungal rashes are common in humid climates. There are two common fungal rashes that tend to affect travellers. The first occurs in moist areas that get less air, such as the groin, armpits and between the toes. It starts as a red patch that slowly spreads and is usually itchy. Treatment involves keeping the skin dry, avoiding chafing and using an antifungal cream such as clotrimazole or Lamisil. Tinea versicolor is also common – this fungus causes small, light-coloured patches, most commonly on the back, chest and shoulders. Consult a doctor.
Cuts and scratches become easily infected in humid climates. Take meticulous care of them to prevent complications such as abscesses. Immediately wash all wounds in clean water and apply antiseptic. If you develop signs of infection (increasing pain and redness), see a doctor. Divers and surfers should be particularly careful with coral cuts as they can be easily infected.
Southeast Asia is home to many species of both poisonous and harmless snakes. Assume that all snakes are poisonous and never try to catch one. Wear boots and long pants if walking in an area that may have snakes. First aid in the event of a snakebite involves pressure immobilisation using an elastic bandage firmly wrapped around the affected limb, starting at the bite site and working up towards the chest. The bandage should not be so tight that the circulation is cut off, and the fingers or toes should be kept free so the circulation can be checked. Immobilise the limb with a splint and carry the victim to medical attention. Do not use tourniquets or try to suck the venom out. Antivenin is available for most species, but not necessarily in rural areas of less-developed countries such as Cambodia, Laos and Myanmar.
Even on a cloudy day sunburn can occur rapidly. Always use a strong sunscreen (at least factor 30), making sure to reapply after a swim, and always wear a wide-brimmed hat and sunglasses outdoors. Avoid lying in the sun during the hottest part of the day (10am to 2pm). If you become sunburnt, stay out of the sun until you have recovered, apply cool compresses and take painkillers for the discomfort. One per cent hydrocortisone cream applied twice daily is also helpful.
Centers for Disease Control & Prevention (www.cdc.gov) Country-specific advice.
International Travel & Health (www.who.int/ith) Health guide published by the WHO.
MD Travel Health (www.mdtravelhealth.com) Travel-health recommendations for every country.
In the urban areas of Southeast Asia, supplies of sanitary products are readily available. Birth-control options may be limited so bring adequate supplies of your own form of contraception. Heat, humidity and antibiotics can all contribute to thrush. Treatment is with antifungal creams and pessaries such as clotrimazole. A practical alternative is a single tablet of fluconazole (Diflucan). Urinary tract infections can be precipitated by dehydration or long bus journeys without toilet stops; bring suitable antibiotics.
Pregnant women should receive specialised advice before travelling. The ideal time to travel is in the second trimester (between 16 and 28 weeks), when the risk of pregnancy-related problems is at its lowest and women generally feel at their best. During the first trimester there is a risk of miscarriage and in the third trimester complications such as premature labour and high blood pressure are possible. It’s wise to travel with a companion. Always carry a list of quality medical facilities available at your destination and ensure you continue your standard antenatal care at these facilities. Avoid rural travel in areas with poor transport and medical facilities. Most of all, ensure travel insurance covers all pregnancy-related possibilities.
Malaria is a high-risk disease during pregnancy. WHO recommends that pregnant women do not travel to areas with chloroquine-resistant malaria. None of the more effective antimalarial drugs are completely safe in pregnancy.
Traveller’s diarrhoea can quickly lead to dehydration and result in inadequate blood flow to the placenta. Many of the drugs used to treat various diarrhoea bugs are not recommended in pregnancy. Azithromycin is considered safe.