Lonely Planet Laos

by Lonely Planet

  Availability & Cost of Health Care

  Laos has no facilities for major medical emergencies. The state-run hospitals and clinics are among the most basic in Southeast Asia in terms of the standards of hygiene, staff training, supplies and equipment.

  For minor to moderate conditions, including malaria, Mahasot Hospital's International Clinic in Vientiane has a decent reputation. Some foreign embassies in Vientiane also maintain small but professional medical centres, including the Australian Embassy Clinic and the French Embassy Medical Center.

  For any serious conditions, Thailand is the destination of choice. If a medical problem can wait until Bangkok, then all the better, as there are excellent hospitals there.

  For medical emergencies that can't be delayed before reaching Bangkok, ambulances can be arranged from nearby Nong Khai or Udon Thani in Thailand. Nong Khai Wattana General Hospital (%042-465201) in Nong Khai is the closest. The better Aek Udon Hospital ( GOOGLE MAP ; %42 342555; Th Phosri) in Udon Thani is an hour further from the border by road.

  Buying medication over the counter is not recommended, as fake medications and poorly stored or out-of-date drugs are common in Laos.

  Infectious Diseases

  Hepatitis A

  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.

  Hepatitis B

  The only sexually transmitted disease that can be prevented by vaccination, hepatitis B is spread by body fluids, including sexual contact. In some parts of Southeast Asia, up to 20% of the population are carriers of hepatitis B, and usually are unaware of this. The long-term consequences can include liver cancer and cirrhosis.

  Hepatitis E

  Hepatitis E is transmitted through contaminated food and water and has similar symptoms to hepatitis A, but it 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.

  HIV

  According to Unaids and WHO, Laos remains a 'low HIV prevalence country'. However, it's estimated that only about one fifth of all HIV cases in Laos are actually reported. Heterosexual sex is the main method of transmission in Laos. The use of condoms greatly decreases but does not eliminate the risk of HIV infection.

  Malaria

  Many parts of Laos, particularly populated areas, have minimal to no risk of malaria, and the risk of side effects from the antimalaria medication may outweigh the risk of getting the disease. For some rural areas, however, the risk of contracting the disease far outweighs the risk of any tablet side effects. Remember that malaria can be fatal.

  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 should be combined to prevent malaria: mosquito avoidance and antimalarial medications. Most people who catch malaria are taking inadequate or no antimalarial medication.

  Travellers are advised to prevent mosquito bites by taking these steps:

  AChoose accommodation with screens and fans.

  AImpregnate clothing with Permethrin in high-risk areas.

  ASleep under a mosquito net impregnated with Permethrin.

  ASpray your room with insect repellent before going out for your evening meal.

  AUse an insect repellent containing DEET on exposed skin.

  AWear long sleeves and trousers in light colours.

  Malaria Medication

  There are a variety of medications available. Lariam (Mefloquine) has received much bad press, some of it justified, some not. This weekly tablet suits many people. Serious side effects are rare but include depression, anxiety, psychosis and seizures. Anyone with a history of depression, anxiety, other psychological disorders or epilepsy should not take Lariam. It is around 90% effective in most parts of Southeast Asia, but there is significant resistance in parts of northern Thailand, Laos and Cambodia. Tablets must be taken for four weeks after leaving the risk area.

  Doxycycline, taken as a daily tablet, is a broad-spectrum antibiotic that has the added benefit of helping to prevent a variety of tropical diseases. The potential side effects include photosensitivity (a tendency to sunburn), thrush in women, indigestion, heartburn, nausea and interference with the contraceptive pill. More serious side effects include ulceration of the oesophagus – you can help prevent this by taking your tablet with a meal and a large glass of water, and never lying down within half an hour of taking it. It must be taken for four weeks after leaving the risk area.

  Malarone is a new drug combining Atovaquone and Proguanil. Side effects are uncommon and mild, most commonly nausea and headaches. It is the best tablet for those on short trips to high-risk areas. It must be taken for one week after leaving the risk area.

  A final option is to take no preventive medication but to have a supply of emergency medication should you develop the symptoms of malaria. This is less than ideal, and you'll need to get to a good medical facility within 24 hours of developing a fever. If you choose this option the most effective and safest treatment is Malarone (four tablets once daily for three days).

  Opisthorchiasis (Liver Flukes)

  These are tiny worms that are occasionally present in freshwater fish in Laos. The main risk comes from eating raw or undercooked fish. Travellers should in particular avoid eating uncooked Ъąh dàak (an unpasteurised fermented fish used as an accompaniment for many Lao foods) when travelling in rural Laos.

  A rarer way to contract liver flukes is by swimming in the Mekong River or its tributaries around Don Khong in the far south of Laos.

  At low levels, there are virtually no symptoms at all; at higher levels, an overall fatigue, low-grade fever and swollen or tender liver (or general abdominal pain) are the usual symptoms, along with worms or worm eggs in the faeces. Opisthorchiasis is easily treated with medication.

  Rabies

  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 vaccinated you will need to receive rabies immunoglobulin as soon as possible.

  STDs

  Sexually transmitted diseases (STDs) most common in Laos 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.

  Tuberculosis

  Tuberculosis (TB) is very rare in short-term travellers. Medical and aid workers, and long-term travellers who have significant contact with the local population should take precautions, however. Vaccination is usually only given to children under the age of five, but adults at risk are advised to get pre- and post-travel TB testing. The main symptoms are fever, cough, weight loss, night sweats and tiredness.

  Typhoid

  This serious bacterial infection is also spread via food and water. It gives a high, slowly progressive fever and 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 of the major cities.

  Traveller’s D
iarrhoea

  Traveller's diarrhoea is by far the most common problem affecting travellers. Somewhere between 30% and 50% of people will suffer from it within two weeks of starting their trip.

  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 like Gastrolyte are the best for this. Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin will kill the bacteria quickly.

  Loperamide is just a 'stopper' and doesn't get to the cause of the problem, but it can be helpful when taking 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

  Amoebic dysentery is very rare in travellers but is often misdiagnosed by poor-quality labs in Southeast Asia. Symptoms are similar to bacterial diarrhoea, ie 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.

  Giardiasis

  Giardia lamblia is a parasite that is relatively common in travellers. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. 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-line option.

  WATER

  ANever drink tap water.

  ABottled water is generally safe, but check the seal is intact at purchase.

  ABoiling water is the most efficient method of purifying it.

  AThe best chemical purifier is iodine. It should not be used by pregnant women or people who suffer with thyroid problems.

  AWater filters should protect against viruses. Ensure your filter has a chemical barrier such as iodine and a small pore size.

  Environmental Hazards

  Food

  Eating in restaurants is the biggest risk factor for contracting traveller's diarrhoea. Ways to avoid it include eating only freshly cooked food, and avoiding shellfish and food that has been sitting around in buffets. Peel all fruit and cook all vegetables. Eat in busy restaurants with a high turnover of customers.

  Heat

  Many parts of Southeast Asia are hot and humid throughout the year and it takes time to adapt to the climate. Swelling of the feet and ankles is common, as are muscle cramps caused by excessive sweating. Prevent these by avoiding dehydration and excessive activity in the heat.

  Dehydration is the main contributor to heat exhaustion. Symptoms include feeling weak, headache, irritability, nausea or vomiting, sweaty skin, a fast, weak pulse and a normal or slightly elevated body temperature. Treatment involves getting out of the heat and/or sun, fanning the victim and applying cool wet cloths to the skin 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 for some days afterwards.

  Heatstroke 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 the person out of the heat, removing their clothes, fanning them and applying cool wet cloths or ice to their 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. Locally bought prickly heat powder can be helpful.

  Insect Bites & Stings

  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.

  Ticks are contracted during walks 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, fever or muscle aches, then see a doctor. Doxycycline prevents tick-borne diseases.

  Leeches are found in humid forest 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.

  Skin Problems

  Fungal rashes are common in humid climates. Watch out for moist areas that get less air, such as the groin, armpits and between the toes. The problem 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.

  Cuts and scratches become easily infected in humid climates. Take meticulous care of any cuts and scratches to prevent complications such as abscesses. Immediately wash all wounds in clean water and apply antiseptic.

  Snakes

  Southeast Asia is home to many species of both poisonous and harmless snakes. Assume all snakes are poisonous and never try to catch one. Always 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 via 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. Do not use tourniquets or try to suck the venom out.

  Sunburn

  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 (from 10am to 2pm). If you are sunburnt stay out of the sun until you have recovered.

  Women's Health

  In the urban areas of Southeast Asia, supplies of sanitary products are readily available. Birth control options may be limited though, 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).

  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 are lowest and pregnant women generally feel at their best. Always carry a list of quality medical facilities available at your destination and ensure you continue your standard antenatal care at these facilities. Most of all, ensure travel insurance covers all pregnancy-related possibilities, including premature labour.

  Malaria is a high-risk disease during pregnancy. None of the more effective antimalarial drugs are completely safe in pregnancy.

  Traditional Medicine

  Throughout Southeast Asia, traditional medical systems are widely practised. There is a big difference between these traditional healing systems and 'folk' medicine. Folk remedies should be avoided, as they often involve rather dubious procedures with potential complications. In comparison, traditional healing systems such as traditional Chinese medicine are well respected, and aspects of them are being increasingly used by Western medical practitioners.

  All traditional Asian medical systems identify a vital life force, and see blockage or imbalance as causing disease. Techniques such as herbal medicines, massage and acupunct
ure are utilised to bring this vital force back into balance, or to maintain balance. These therapies are best used for treating chronic disease such as chronic fatigue, arthritis, irritable bowel syndrome and some chronic skin conditions. Traditional medicines should be avoided for treating serious acute infections such as malaria.

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