BALI HEALTH

Before You go

Check with your physician for the latest news on the need for malaria prophylaxis and recommended vaccinations before leaving home. Frequently considered vaccines are: Diphtheria, Pertussis and Tetanus (DPT); Measles, Mumps and Rubella (MMR); and oral Polio vaccine. Gamma Globulin every four months for Hepatitis A is recommended. For longer stays many doctors recommend vaccination to protect against Hepatitis B requiring a series of shots over the course of 7 months. Vaccinations for smallpox and cholera are no longer required, except for visitors coming from infected areas. A cholera vaccination is recommended for travel in outlying areas, but it is only 50% effective.

Find out the generic names for whatever prescription medications you are likely to need as most are available in Indonesia but not under the same brand names as they are known at home. Get copies of doctors' prescriptions for the medications you bring into Indonesia to avoid questions at the customs desk. Those who wear spectacles should bring along prescriptions.

Hygiene
Hygiene cannot be taken for granted in Indonesia. Away from the tourist areas few places have running water or sewerage. Most water comes from wells, and raw sewerage goes into the ground or the rivers. Tap water is not potable and must be boiled.

Most cases of stomach complaints are attributable to your system not being used to the strange foods and stray bacteria. To make sure you do not get something more serious, take the following precautions:

Never drink unboiled water from a well, tap or bak mandi (bath tub). Brush your teeth only with boiled or bottled water, never with water from the tap or bak mandi. Bottled water is available everywhere and usually called "Aqua", which is the most popular and reliable brand name.

Ice in Bali is made in government-regulated factories and is deemed safe for local immunities. Confirm that the ice is made from boiled water before relaxing with an ice drink.

Plates, glasses and silverware are washed in un boiled water and need to be completely dry before use.

Fruits and vegetables without skins pose a higher risk of contamination. To avoid contamination by food handlers, buy fruits in the market and peel them yourself.

To mandi (bathe) two or three times a day is a great way to stay cool and fresh. But be sure to dry yourself well and you may wish to apply a medicated body powder, such as Purol, to avoid the unpleasantness of skin fungus, especially during the rainy season from November to April.
Exposure
Many visitors insist on instant suntans, so overexposure to the heat and sun are frequent health problems. Be especially careful on long walks. Wear a hat, loose-fitting, light-colored, long sleeved cotton clothes, pants, and use a good quality sunscreen (bring a supply with you). Do not wear synthetic fibers that do not allow air to circulate. Tan slowly-don't spoil your trip. Drink plenty of fluids and take salt.

A likely traveling companion. Called "Bali belly" locally. In addition to the strange food and unfamiliar micro-fauna, diarrhea is often the result of attempting to accomplish too much in one day. Taking it easy can be an effective prevention. Ask around before leaving home about what the latest and greatest of the many remedies are and bring some along. Imodium is locally available as are activated carbon tablets (Norit) that will absorb the toxins giving you grief.

When it hits, it is usually self-limiting to two or three days. Relax, take it easy and drink lots of fluids, including rehydration salts such as Servidrat (local brands are Oralit and Pharolit). Especially helpful is water from the young coconut (air kelapa muda) or strong, unsweetened tea. The former is an especially pure antitoxin. Get it straight from the coconut without sugar, ice or food color added. When you are ready, start with bananas, plain rice, crackers, tempe (fermented soybean cakes), and bubur (rice porridge). Avoid fried, spicy or heavy foods and dairy products for a while. After three days without relief, see a doctor.

Intestinal Parasites

It is estimated that 80 to 90 percent of all people in Indonesia have intestinal parasites and these are easily passed on by food handlers. Prevention is difficult, short of fasting, when away from luxury hotel restaurants and even these are no guarantee. It's best to take care of parasites sooner rather than later, by routinely taking a dose of anti-parasite medicine such as Kombatrin (available at all apotik) once a month during your stay and again when you get on the plane home.

If you still have problems when you get back, even if only sporadic, have stool and blood tests. Left untreated, parasites can cause serious damage.

Cuts and Scrapes

Your skin will come into contact with more dirt and bacteria than it did back home, so wash your face and hands more often. Cuts should be taken seriously and cleaned with an antiseptic like Betadine solution available from any pharmacy (apotik). Once clean, antibiotic powder (Sulfanilamide) or ointment, both available locally, should be applied. Cover the cut during the day to keep it clean, but leave it uncovered at night and whenever you are resting so that it can dry. Constant covering will retain moisture in the wound and only encourage an infection. Repeat this ritual after every bath. Areas of redness around the cut indicate infection and a doctor should be consulted. At the first sign of swelling it is advisable to take broad spectrum antibiotics to prevent a really nasty infection.

Malaria is very rare in Bali, particularly in the southern tourist areas, but if you're heading beyond the island take a prophylaxis. Mefloquine (Larium) is recommended as it is effective against both Chloroquine and Fansidar-resistant varieties which are present in Indonesia. Prescription runs from one week before departure through four weeks after leaving the infected area. Malaria symptoms are fever, chills and sweating, headaches, and muscle aches.

The other mosquito concern is dengue fever, spread by the morning-biting Aedes aegypti, Especially during the rainy season. The most effective prevention is not getting bitten (there is no prophylaxis for dengue). Dengue fever symptoms are headache, pain behind the eyes, high fever, muscle and joint pains and rash appearing between the third and fifth days of illness. Within days, the fever subsides and recovery is seldom hampered with complications. The more serious variant, dengue hemorrhagic fever (DHF), which can be fatal, may be the reaction of a secondary infection with remaining immunities following a primary attack.
Cases of Japanese oncephaltis, a viral infection affecting the brain, have occurred recently and are added cause to take protective measures against mosquito bites.
Portable nets (kelambu) provide protection at night when sleeping; you can buy these in most general stores for $5. They're a hassle to put up in hotel rooms. Upon request, your room will be sprayed for insects. Be sure this is done long before you are ready to sleep if you want to avoid the smell and inhaling fumes. Aerosols clear out insect intruders, but do not have residual effect. You can also buy slow-burning mosquito coils (obat nyamuk bakar), which last 6-8 hours. Light one before you go out for dinner to drive the critters away. Double Rabbit is one of the more reliable brands. (There are brands which do not contain pyrethrum, so are ineffective. An electric (smokeless) version is also available.
Insect repellents and lotions are widely available and supermarkets do sell OFF! Any chemical repellent container deet (diethyl toluamide) should be applied with caution and never to the face. Application to clothing can be more effective. A local non-chemical solution is citronella oil (minyak gosok, cap tawon).

Aids & Hepatitis B
Surprise! Safe sex is also a good idea. Foreign experts project the HIV~AIDS problem to be one of monumental proportions in Indonesia. Documentation, awareness and education is just beginning. Another area of concern is the Hepatitis B virus which affects liver function and is only sometimes curable and can be fatal. The prevalence of Hepatitis B in Indonesia is the basis for international concern over the ominous possibilities for the spread of HIV virus, which is passed on in the same ways.

Bali Medical Treatment
The Indonesian name for pharmacy is apotik and a hospital is called rumah sakit. Smaller villages only have government clinics, called Puskesmas, which are not equipped to deal with anything serious.
Fancier hotels often have doctors on call or can recommend one. Misuse of antibiotics is still a concern in Indonesia. They should only be used for bacterial diseases and then for at least 10 to 14 days to prevent developing antibiotic resistant strains of your affliction.
Indonesians don't feel they've had their money's worth from a doctor ($5) without getting an injection or antibiotics. If either is prescribed, be sure it's necessary.
Ensure syringes have never been used before or better yet, buy your own disposable from an apotik (pharmacy) and take it to the clinic.

Bali Emergency Medical Assistance
Even in the big cities outside of Jakarta, emergency care leaves much to be desired. Your best bet in the event of a life-threatening emergency or accident is to get on the first plane to Jakarta or Singapore. Contact your embassy or consulate by phone for assistance (see below). Medivac airlifts can be expensive. Most embassies recommend that you buy insurance to cover the cost of this when traveling in Indonesia.

International SOS is a well-respected outfit and is considered to have the best response time and operation in Indonesia. International SOS has 24-hour alarm centers in Bali, Jakarta, Singapore, Sydney, Bangkok, Hong Kong, Seoul, Beijing, and Ho Chi Minh City. International SOS Bali has a 24-hour Emergency Room & Clinic at Jalan By Pass Ngurah Rai No. 24X, near the Dewa Ruci roundabout and the Bali Galleria Mail Shopping Center. Phone (62-361) 755 768, fax: (62-361) 764 530. For more information on rates and types of coverage, visit their website at www.internationalsos.com

Bali Insurance
Check your health insurance before coming to make sure you are covered. Travel insurance should include coverage of a medical evacuation to Singapore and a 24-hour worldwide phone number as well as some extras like luggage loss and trip cancellation.
International SOS offers a wide range of emergency services worldwide and have numerous large corporate clients. In Jakarta, you can contact them for rates and type of coverage at the two following offices: PT. Asih Eka Abadi, JL Puri Sakti No. 10 Cipete, Jakarta Selatan, Phone (62-21) 750 5973, fax: (62-21) 750 6002; or at Setiabudi Building II, Jalan H.R. Rasuna Said, Kuningan, Phone (62-21) 520 1034/7524. In Singapore, you can contact them at 331 North Bridge Road, #17-00 Odeon Towers, Singapore 188720, Phone (65) 338-2311, fax: (65) 338-7611.