Health / Health Precaution
The necessity of special health precautions to visit or live in a country like Thailand are sometimes underestimated but most often exaggerated. A journey to or stay in Bangkok is no jungle expedition, and this author has lived in Southeast Asia for more than a decade without falling ill with any tropical disease. Bangkok basically is a modern city - in the tropics, but a modern city nevertheless. To be involved in a road accident or to suffer from vehicle pollution ranks higher on the scale of potential health hazards than do malaria or cholera.
However, common sense recommends a few adjustments to Thailand as a tropical country. Around mid-day one should look for shade. One should be careful with drinking water - an easy task in Thailand as cheap bottled water is available practically everywhere.
It’s advisable to avoid dishes with raw ingredients - vegetables as well as meats and fish. There aren’t many Thai dishes with raw ingredients but where cooking is influenced by Vietnamese traditions, many foods remain uncooked.
A few Thai terms will make it easier for the visitor to distinguish whether a food is raw or cooked: raw - dib; well cooked - sook; raw fish - goy; raw meat - laab. Naem is an uncooked, pickled pork sausage; yam are marinated raw meats or fish.
Malaria
Of all the diseases that pose a potential danger in a tropical country like Thailand, only malaria is a real tropical disease - the transmitting Anopheles mosquito doesn’t live in cooler climates.
While the danger to be infected with malaria is minimal in Bangkok and other major cities of the country, the risk is real in rural areas especially along the Cambodian border. Chemoprophylaxis is generally not recommended for persons who stay in urban areas or who have only daytime exposure in rural areas as the Anopheles mosquito feeds only during the night hours.
A publication named Advice for Travelers, reprinted an article from the 3/88 issue of Scientific American and gave the following detailed general information on malaria and its prevention: "Provision of appropriate malaria chemoprophylaxis is the most important preventive measure for travelers to malarial areas. Several hundred American civilians contract malaria each year, and infections from Plasmodium falciparum are potentially lethal. Morbidity and mortality are largely avoidable with chemoprophylaxis... Chloroquine-resistant P. falciparum (CRPF) malaria occurs in many areas. and is becoming more widely prevalent... Because even brief exposure to infected mosquitoes can produce malaria, travel in malarial regions, no matter how brief, mandates the use of chemoprophylaxis. When uncertainty exists over the need for chemoprophylaxis, it should be initiated; if a traveler can ascertain that malaria is not a risk after arriving in an area, prophylaxis can be terminated as long as further travel into malarial areas is not planned. Travelers should be advised that it is possible to acquire malaria despite prophylaxis and regardless of the prophylactic regimen used."
"Symptoms can begin as early as eight days after infection or as late as several months after departure from a malarial area. Travelers should be cautioned to seek medical attention promptly for any febrile illness and to inform the physician of their itinerary. The wisdom of general protective measures against mosquito bites should also be stressed. Because the vector mosquitoes usually feed at night, it is advisable to diminish exposure between dusk and dawn by remaining in screened areas, using mosquito netting, covering exposed skin with clothing, and using insect repellent. The most effective insect repellents contain N,N-diethyl-m-toluamide (DEET)."
"The mainstay of malaria chemoprophylaxis is chloroquine. Chloroquine phosphate 500 mg (300 mg of chloroquine base) should be taken once weekly beginning one to two weeks prior to travel and continuing during the stay and for six weeks after departure from malarial areas. Minor side effects, including gastrointestinal disturbances, dizziness, blurred vision, and headache, may be alleviated by taking the drug after meals. Serious side effects are rare..."
"For chemoprophylaxis in areas where chloroquine resistant P. falciparum malaria occurs, it was formerly recommended that a single tablet of Fansidar, which contains 500 mg of long-acting sulfadoxine and 25 mg of pyrimethamine, be taken once a week along with chloroquine beginning one to two weeks before arrival in an endemic area and continuing for six weeks after departure from such an area. However, severe mucocutaneous reactions, including erythma multiforme, Stevens Johnson syndrome, and toxic epidermal necrolysis, have developed after the use of two or more doses of Fansidar. These reactions have produced fatalities with an incidence of about one in 11,000 to 20,000 among American travelers. Thus, recommendation for chemoprophylaxis have been revised to balance the risk of acquiring CRPF malaria with that of using Fansidar. Any history of adverse reactions to sulfonamides or pyrimethamine should preclude the use of this combination.
Because some strains of P. falciparum and all other Plasmodium species are susceptible to chloroquine, weekly chloroquine administration remains essential in areas where CRPF malaria occurs."
Cholera
Cholera is not a tropical disease in the sense that it couldn’t occur in cooler climates. But because it’s a disease associated with poor sanitary conditions, and because such conditions are more often found in tropical countries than in countries with moderate climates, it’s often seen as a tropical disease.
While there have been cholera epidemics in Thailand in earlier times, the country is now not seen as a cholera risk area.
As cholera is highly contagious, outbreaks of the disease anywhere around the globe receive much international media attention. The cholera vaccination currently available is considered not very efficient.
Rabies
Any warm blooded animal around the world can be infected with rabies, including those of the species Homo Sapiens. In general, rabies is much more common in tropical countries than in those with a cooler climate.
A vaccination against the disease which is fatal if unchecked is commonly only undertaken after there is reason to suspect that a person could be infected - usually after being bitten by any warm-blooded animal (though the disease can also be transmitted through the saliva of an infected animal alone).
The rabies vaccination is one of the most elaborate and most expensive one of all vaccinations. Several injections are given subcutaneous over a number of days.
Aids
As Thailand is a sexually liberal country, it cannot come as a surprise that it does have its problems with the AIDS disease. A report in the Bangkok Post of April 20, 1991 indicated that at that time there were some 200,000 to 300,000 people in the country infected with the AIDS virus.
From 1986 on, the kingdom had a law baning foreigners infected with AIDS from entering the country. However, the ban was revoked in mid-1991 as it was considered ineffective and detrimental to the reputation of the country. The Bangkok Post of June 2, 1991 reported that in the five years the ban was in effect, only 10 foreigners had been barred from entering the country after they revealed to the immigration police at the airport that they were AIDS sufferers. It can reasonably be assumed that a larger number of foreign AIDS sufferers had throughout the years visited Thailand but not mentioned upon entry that they were infected with the disease.
A Draconian anti-AIDS law was discussed in Thailand at the beginning of 1991. The bill would permit the authorities to compel any prostitute to undergo blood tests; those found positive would be prohibited from continuing to work and confined to one of several rehabilitation centers to be set up.
However, at a panel discussion with officials from the Thai government and the World Health Organization, held in Bangkok April 19, 1991, there was wide consensus that these laws would most probably be counter-effective as they would just drive AIDS carriers underground. As high government officials agreed with that view it is unlikely that Draconian legal measures will be introduced in Thailand.
At another panel discussion in Bangkok on May 1, 1991, again participated in by officials of the Thai government and of the World Health Organization, Mechai Viravaidya, the famous Thai family planning and anti-AIDS activist and Minister at the Office of the Prime Minister, gave a gloomy assessment of the AIDS situation in Thailand.
In the Bangkok Post of May 2, 1991, Mr Mechai was quoted saying: "AIDS is bringing a nationwide disaster as it ceaselessly advances without barriers among labourers, prostitutes, farmers, civil servants, students, entertainers and housewives... The country is rapidly losing the strength of its workforce due to AIDS, and this can cause great economic losses."
The Bangkok Post cited Mr Mechai as saying that there currently are 30,000 AIDS sufferers in Thai hospitals. State hospitals are said to be able to hold up to 90,000 patients. It may, according to Mr Mechai, become necessary to pass legislation to make it compulsory for employers to pay for the medical treatment of AIDS-infected employees. The spread of AIDS might discourage foreign investment and seriously harm the Thai economy.
Hepatitis B
Asiaweek, in its issue of June 15, 1990, has warned of a much underrated health hazard in East Asia, including Thailand: Hepatitis B. Asiaweek called it "the killer disease of the region." According to the magazine, Hepatitis B is transmitted much in the same ways as AIDS but "much easier to catch than AIDS" and "far more deadly." Hepatitis B is a viral infection of the liver that once contracted may clear up after a few weeks and then leave the person immune. But remaining dormant for years or decades it can result in cancer of the liver or cirrhosis "and early death."
The disease seems to be more deadly for the male. The magazine estimated that around the world, there are 300 million Hepatitis B carriers, three-quarters of them in China and Southeast Asia. In all of Southeast Asia, cancer of the liver is listed as the leading cause of death for men. Asiaweek quotes Dr. Chen, director of the National Taiwan University Hospital’s Hepatitis Research Center: "For people over 40 years of age here, nearly 90% have been infected in the past."
Asiaweek elaborated that, "...like AIDS, Hepatitis B is transmitted through an infected person’s body fluids and blood. That means it can be caught by sexual contact or from needles used for drugs, acupuncture and tattoos. Mothers can infect their babies at or after birth... The infection cannot be passed casually but must go into the body through a break in a mucus membrane or a cut in the skin. Yet the hepatitis virus is much more infectious than AIDS. It is far more concentrated, much tougher and more stable."
Asiaweek asks: "Since the disease is at present incurable, what does one do if one gets it?" The magazine cites a hepatitis specialist who suggests that those who have been infected should have a regular screening for liver cancer and points out that cancer of the liver in an early stage is still operative but advanced stages are not.
According to Asiaweek, effective vaccines have been available since the early ‘80’s. However, the magazine quotes a Malaysian physician as saying: "The people who come for the vaccine are mainly those in low-risk groups and many in the high-risk category are not yet aware." The physician proposes that, according to Asiaweek, "...prostitutes who have not yet been infected should be vaccinated to prevent them from contracting the virus and passing it on."
Poisonous Animals
The first association most people have with poisonous animals are snakes. But while many poisonous snakes are at home in Southeast Asian jungles, they are found in urban areas primarily in zoos.
As poisonous snakes don’t see mammals of the size of humans as potential prey but rather as enemies with whom an encounter will be rather disadvantageous for the snake, the snake will attempt to flee the scene much rather than to attack. Encounters therefore usually happen accidentally.
This author has been told by a jungle guide that it is advisable to step firmly on the ground when walking through areas uninhabited by humans. Snakes, he explained, react on ground vibration and will escape the approaching human.
In general, the danger of poisonous sea animals is taken too lightly when compared to snakes. The most common poisonous sea animal are jelly-fish. However, the most dangerous jelly-fish are not at home in Thai waters. And while some jelly-fish are found in coastal waters, especially during the rainy season, it’s not like on the Southern Chinese or Northern Australian coast - that the authorities would have to warn against swimming in certain bays or during certain times of the year because the sea would be infested with jelly-fish.
On stony or rocky beaches, those not wearing water sandals risk stepping onto sea-urchins. Wounds will usually infect and heal only slowly. The following recommendation is given by the Australian-New Zealand Women’s Club (please note: no responsibility taken by Cockatoo Press or this author):
"If you tread on a sea-urchin, try to pull out any spines you can and seek medical help. If the latter is not possible, strike the affected part of your foot with a large, smooth pebble or the bottom edge of a bottle. This will break down the offending spines which the body can then absorb. Many a hardy Pattaya-goer has successfully resorted to this method."
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