Staying Healthy in Bali and Vaccinations

In light of the recent disease outbreaks in Bali including those of Dengue Fever, the Swine Flu and of late, Legionnaires Disease it seemed like a good idea to discuss health and travel. It’s important to note that when travelling anywhere in the tropics – whether it be only Bali or the other islands in the archipelago of Indonesia – be securely vaccinated. This is only common sense.

However, if you are heading over to Bali then I strongly urge you to at least have the Hepatitis A and B vaccinations. You do not want to end up with a bad case of the dreaded Bali Belly! These most prominent vaccinations are truly imperative and especially if travelling with children.

The list is simple – Hepatitis A and B, Tetanus, Cholera and Typhoid. If you are worried about Japanese Encephalitis and Meningitis then by all means be covered but the former in reality is not needed for Bali and is a very painful vaccine procedure.

Reducing the risk of contracting any infections in Bali is simple. Before travelling to Bali consult your doctor. Find out what vaccinations are required and if any existing health concerns might prevent you from travelling. Make sure you carry a copy of your health record and prescription, if there are ongoing health issues that may require treatment while in Bali.

Drinking water: Tap water is unsafe to drink in Bali. Although the quality of water throughout the island varies greatly, some coming piped, some from a well, one should always assume it is unsafe to drink without boiling. People living in Bali shower with the local water, brushing teeth etc. with no ill effects, still your drinking water should be bottled water.

Water in warungs and restaurants is bottled water and food is washed in bottled water. The old claim that salad items should be avoided in Bali, because vegetables were washed in tap water is no longer true. Enjoy a great salad in Bali. Ice in drinks is generally okay, but you may want to decline ice in non-tourist areas.

Bali Belly / Diarrhea: A dose of the runs can knock the wind out of your trip to Bali. A simple way to deal with it is to restrict yourself to extremely simple food for 3 days, which means bread, plain rice, potatoes, plain meat with no sauce and NO green vegetables. You’d be amazed at how a vicious case of diarrhea can disappear under that regime. Diarrhea will deplete your body of fluid, which when combined with hot humid weather will compound your misery. Drink electrolyte drinks such as Pocari Sweat (blue can with white strip) available any where in Bali.

Cuts & Scrapes: Tiny cuts can develop into tropical ulcers under hot humid conditions. A cut measuring 2mm across can be 5cm in diameter within a week and 5mm deep. Wash out any cuts you get and apply Betadine, giving the cut plenty of air to dry.

First aid kit: Don’t expect locals to have or know how to use a first aid kit. Carry your own first aid travel kit and learn how to use it.

Here is a look at the possible diseases you can contract in Bali and how to recognize them.

Hepatitis: There are several types, but all leave the patient with a yellowing of the skin and eyes. This is combined with extreme tiredness, diarrhea and fever. This is a common disease in this part of the world and the effects may last several months. The 2 main kinds of Hepatitis are A & B.

Hepatitis A is generally transmitted by viruses in food, water and human saliva. Hepatitis B is transmitted by viruses in human sexual interaction, contaminated blood or syringes. Vaccines offer a degree of protection and the treatment for hepatitis includes avoiding alcohol.

Typhoid: Typhoid is one of the common vaccinations for Asia. The disease is transmitted by contaminated food or water. Symptoms are intense fever, headaches, abdominal pains, diarrhea and red spots on the body. Very similar symptoms to a type of malaria, with the exact same cycle of fever/chills.

Cholera: Transmitted by contaminated food and water. Symptoms include cramps, low energy, runny diarrhea and vomiting. This disease can quickly leave you dehydrated. In its most severe forms, cholera is one of the most rapidly fatal illnesses known: A healthy person may become hypotensive within an hour of the onset of symptoms and may die within 2-3 hours if no treatment is provided. Vaccinations are not that effective against Cholera.

Tetanus: Transmitted through contact via open wounds. The tetanus booster shot is a very common one to get for long tern travellers, just in case of an accident. Generalized tetanus is the most common type of tetanus, representing about 80% of cases. The generalized form usually presents with a descending pattern. The first sign is trismus or lockjaw, followed by stiffness of the neck, difficulty in swallowing, and rigidity of pectoral and calf muscles. Other symptoms include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate. Spasms may occur frequently and last for several minutes. Spasms continue for 3–4 weeks and complete recovery may take months

Japanese Encephalitis: Transmitted by virus carried by mosquitoes. Most common in rural areas and carried by birds and other animals. Causes swelling of the brain which can be fatal. Japanese encephalitis has an incubation period of 5 to 15 days and the vast majority of infections are asymptomatic: only 1 in 250 infections develop into encephalitis. Severe rigors mark the onset of this disease in humans. Fever, headache and malaise are other non-specific symptoms of this disease which may last for a period of between 1 and 6 days.

Signs which develop during the acute encephalitic stage include neck rigidity, cachexia, hemiparesis, convulsions and a raised body temperature between 38 and 41 degrees Celsius. Mental retardation developed from this disease usually leads to coma. Mortality of this disease varies but is generally much higher in children.

Rabies: Very common disease in Asia, spread through the saliva of dogs, cats and monkeys, which pierce your skin. It is possible to get pre-departure shots for rabies, most people don’t bother. If you suspect the animal that bit you might have rabies consult a doctor for a series of shots. Any mammal may become infected with the rabies virus and develop symptoms, including humans.

Most animals can be infected by the virus and can transmit the disease to humans. Infected bats, monkeys, chickens, cattle, dogs or cats provide the greatest risk to humans. After a typical human infection by bite, the virus directly or indirectly enters the peripheral nervous system. It then travels along the nerves towards the central nervous system. During this phase, the virus cannot be easily detected within the host, and vaccination may still confer cell-mediated immunity to prevent symptomatic rabies. Once the virus reaches the brain, it rapidly causes encephalitis and symptoms appear.

Malaria: Caused by a parasite in the saliva of mosquitoes. Can be fatal. Symptoms are fever /shivering, headaches. Cycles of the symptoms come and go with periods of feeling fine. Each time the symptoms get worse, until the brain overheats. Malaria medication is available to take while on your trip and after you return home. Discuss the effectiveness of the various options with your doctor.

Among other ways of preventing malaria are:

Covering up with long pants and long sleeves at dawn/dusk.
Burning a mosquito coil to rid your room of mosquitoes before sleeping.
Using insect repellent at dawn/dusk sleeping under a mosquito net
Sleep with a strong fan on you
Avoiding black clothes
Sleep in an AC room and keep the doors and windows shut during the day

Dengue Fever: Transmitted by a virus carried by mosquitoes. This mosquito tends to attack during the day and is slightly larger than the malaria carrying variety. In Bali this mosquito likes to hide inside the petals of a certain yellow flower. Symptoms include headaches, fever, joint and muscle pain. The classic dengue fever lasts about six to seven days, with a smaller peak of fever at the trailing end of the fever (the so-called “biphasic pattern”).The only cure is rest and hydration. There are no drugs that will cure dengue but it is manageable.

The climate in Bali is one that is a natural breeding ground for germs. Add to that some of the local methods of washing and cooking and its no wonder people gets sick occasionally. The local method of washing one’s rear after going to the bathroom involves scooping water out of a mandi (brick reservoir of still water) and splashing over oneself with a plastic scoop. A trip to an airport bathroom, will reveal a floor covered in water, which has rebounded of someone else. Same thing for the toilet seat and people’s private bathrooms. A small house used by many people, will have micro-particles floating around on the bathroom floor.

Showering is a variation of the same, with scoops of water being tipped over the participant, ending up all over the bathroom. Fortunately for most visitors a shared bathroom will never be necessary during a trip to Bali and most restaurants have western standards.

So, it is vital to be of reasonable heath before travelling to Bali. People with low immune systems are more prevalent to contracting a disease. And most importantly: HAVE TRAVEL INSURANCE!