Health in Indonesia

 
Health - Before leaving the UK

If you are currently taking prescription medicines, take the instruction leaflet with you, and some spare medicine so that (a) there is no doubt that you are not a drug abuser and (b) if you were unfortunate enough to lose your medication, it makes life a lot easier when you're in an Indonesian pharmacy, trying to explain exactly which medicine it was and what it was for, because the marketing name may vary from country to country but the chemist will understand the written chemical contents.

If you wear glasses or use contact lenses, take a copy of the optician’s written results of your last examination, extra glasses or spare lenses. Prescription diving masks are available for purchase or hire in most dive shops and diving schools.

Contact a medical centre specialising in tropical diseases before you leave (e.g. a hospital or specialist advice centre in larger cities). A ‘last minute’ journey to Indonesia should provide no problem to an already healthy person provided that your departure airport has a ‘walk in’ medical facility. Always carry your vaccinations booklet with you.

Obviously it’s preferable to be vaccinated in advance of your travel date. What is important here is that the medical centre providing the vaccination has regular contact with the NHS advisors on Tropical Diseases.

Websites:
www.nhsdirect.nhs.uk
www.tripprep.com

Below we provide a summary of information aimed at the traveller who is healthy, not pregnant, and plans to stay in Indonesia less than a month. Make sure that you get up-to-date information for your personal circumstances.

Malaria
Malaria occurs in some parts of Indonesia, but much of it depends on area and time of year. The risk of being bitten by a malaria parasite on Bali, Java and the Gili Islands is very slim, which is why ant-malarial drugs (prophylactics) aren’t usually prescribed when travelling to these areas, but you may need them if you’re going to Nusa Tenggara. Whether or not you should be taking any prophylactics depends on your itinerary, but we recommend that you consult your GP or other health advisor before you leave. Prophylactics are heavy drugs, so consider carefully whether or not you will be needing them.
Drugs or not, it makes sense to reduce the risk by taking preventive measures. Measures such as covering your arms, legs and feet in the evening, and spreading an anti-mosquito cream (containing DEET) on exposed areas of skin and sleeping under a mosquito net. You can also impregnate the mosquito net with an insecticide. Make sure that you always have something to hand to suspend your mosquito net from; for example, a piece of rope, screw-in hook or a screwdriver (Swiss Army knife). If despite all measures, you find yourself with flu-like symptoms lasting longer than two days, seek the advice of a medical doctor to rule out malaria. This also applies for the first two months after your return to the UK. If you’re spending the night in a mountain village it’s wise to take extra precautions, though malaria rarely occurs at higher than 1500m.

Vaccinations
DTP and Hepatitis-A: Vaccinations against DTP (diphtheria, tetanus and polio; valid for about 10 years) and hepatitis A are advised. Most people had a DTP vaccination as a child so you can safely travel with a booster in this case. The normal injection with hepatitis A anti-body has a limited effective period, and therefore it makes good sense to have this vaccination just before travelling. If you travel frequently to a country where hepatitis A is present, or plan to stay longer in tropical countries, you should opt for a vaccination with a longer effective period, like Havrix. Keep in mind though that long-term vaccinations are more expensive and still require a booster after six months.
Typhoid: vaccination is advised unless you are planning to be in Indonesia for less than 2 weeks.
Yellow fever: vaccination is only advised if you have been in an infected area prior to travelling to Indonesia

Dengue fever and Japanese B encephalitis
Both of these diseases are carried by mosquitoes, so you can take the same preventative measures as for malaria. These mosquitoes bite during the daytime and under artificial light. For more information about these diseases, and the status of any epidemics, you're advised to seek the advice of the NHS or suitable medical institution.
There is no vaccine against dengue, however, there is for Japanese B encephalitis, which is advised, if you are going to be in Asia for longer than six months.

You can assemble your own tropical first aid kit or buy a ready-made kit. We advise you to obtain a book on how to stay healthy in the tropics, which will contain information about contents of a first aid kit. Sites like http://www.travelhealth.co.uk/books/index.html can point you in the right direction.


Staying healthy in Indonesia

Besides the general advice given here, make sure you have the correct vaccinations and remain as healthy as possible before you leave. Of course you want to avoid getting ill while you’re on holiday but remain alert. If you think you’re ill and not sure what’s wrong, seek advice from a doctor.

Jet lag is when your biological clock is confused, caused by flying through different time zones. The body has to adjust to the new biorhythm for the first few days after your flight, during which time you can feel tired and groggy during the day and awake at night.

Overcoming jet lag
Try to limit your coffee and alcohol intake during the flight, and upon arrival take it easy for the first few days. Try to get into your new local sleep pattern as soon as possible. What we usually do is sleep for an hour when we arrive, but then stay awake and just have an early night.

Diarrhoea
A change of rhythm, climate and food (especially spicy) can throw your stomach out of sorts. As long as it is only loose, watery stools and no other symptoms, it's normally unnecessary to take anything, just take it easy and drink plenty of water in small quantities. It may be necessary to take some Oral Rehydration Salts (ORS) dissolved in water to prevent dehydration, and this is especially important for the elderly and children. Drugs, such as loperamide and diphenoxylate, may be taken if you really have to travel when you have diarrhoea (not suitable for children under two years old). These drugs have the effect of sedating the intestine, which stops stomach cramps and suppresses the feeling of diarrhoea. Only use these drugs when you're on the move and cannot get to the toilet regularly. If the diarrhoea: persists for more than 48 hours, AND is accompanied by headache, vomiting, or blood in the stool OR; you’re taking any other medication at the time, you should contact a doctor. The doctor can send a sample for lab analysis to determine exactly what’s going on. Your diarrhoea can stop quite quickly, but can leave a lasting feeling of lethargy due to the fact that your intestines needs time to recover. Antibiotics are more readily available in Indonesia than in Europe, but remember that alcohol is often a bad combination with antibiotics, and that both diarrhoea can prevent oral contraception pills working properly.

Preventing diarrhoea
Only consume water and soft drinks from properly closed and sealed bottles or cans. Drinks made with boiled bottled water, such as tea or coffee are also fine. Ice is only trustworthy in the form of manufactured bagged ice, but this is widely available. Fruit juice is safe, but only if no water has been added. Food, especially meat and fish must be cooked properly, so that it is well cooked all the way through.

In Indonesia eating food from street stalls is common place, but to prevent illness a good idea is to eat where it's busy. This usually means that the food is good, and that the turnover means the time between food preparation and consumption is the shortest possible. It's probably best not to eat meat at the end of the day, as the meat can sometimes have been lying around all day in the heat unrefrigerated.

Bilharzia
To avoid the infection, carried by tiny worms, don't swim in stagnant water.

A few more health tips

Skin care
Always use a high factor sunscreen cream on exposed skin, even during the rainy season. Snorkelling in a T-shirt is a wise idea as even waterproof sunscreen washes off after a while.
Take all cuts, scratches etc in the tropics seriously; keep a close eye on them, clean them with disinfectant and keep them covered with a plaster during the day. Don't scratch mosquito bites, they're infuriating, but it only makes them worse.
You can avoid attracting biting insects, by wearing light coloured clothing, especially in the evening. Try to avoid resembling a flower, and go easy on the strong perfume aftershave or deodorant. It you're prone to skin irritations, wear cotton or linen clothing, and you can help avoid prickly heat by using talcum powder after your morning shower.
Wash or disinfect your hands after using the toilet, and don't bite your nails.

Sunstroke
Sunstroke can be prevented by wearing a hat, and sunglasses. Always keep a bottle of water with you, especially if you're in the wilderness and unlikely to come across drinking water. If you suspect sunstroke (feeling light-headed, headaches), you can prevent it from getting worse by drinking water and finding somewhere in the shade to sit and stay there, if possible.

When you get home…
After your trip (and this can be months later!), pay close attention to your health for a  while. If you contract flu like symptoms, have stomach problems, or experience something unusual symptoms, contact your GP and let them know where you've been on your travels. If you’ve been in close contact with the local people in more remote areas, consider testing for TB.