Saturday, May 1, 2010

Health Tips when visiting Egypt

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                                   Arabic word for hospital is Mustashfa.

Preventative medicine
Unless you're coming from an infected area there are no compulsory inoculations for Egypt, though you should always be up to date with polio and tetanus. It's also worth being vaccinated against typhoid, which occasionally flares up in parts of Egypt – although the cholera shot is generally acknowledged to be worthless. If you're planning to visit southern Egypt, Sudan or sub-Saharan Africa, the meningitis vaccination is essential, as is yellow fever, which may well be a legal requirement. Though all these vaccinations can be obtained in Cairo (see "Health care"), it is vital to ensure that sterile needles are used. If necessary, supply your own disposable syringe, sold at pharmacies.

While not an issue for most tourists, visitors planning to stay a long time in Egypt or the Middle East should consider vaccination against hepatitis. The Hepatitis A (Havrix monodose) shot is expensive at about £50/US$90 (though your doctor may provide it free), but with a booster a year later it lasts for ten years. Hepatitis B is transmitted like HIV, through body fluids, so you will be protected from it by the same precautions that you take against infection; immunization is only really necessary for medical workers.

Other precautions are fairly obvious, with the most common preventable ailments being heatstroke (see opposite) and food poisoning. Rare meat and raw shellfish top the danger list, which descends via creamy sauces down to salads, juices, raw fruit and vegetables – and if slavishly followed would prevent you from eating most of what's on offer. Visitors who insist on washing everything (and only cleaning their teeth) in mineral water are overreacting. Just use common sense, and accustom your stomach gradually to Egyptian cooking. Asking for dishes to be served very hot (sukhna awi) will reduce the risk of catching anything. Take prompt care of cuts and skin irritations, since flies can quickly spread infections. Anthisan cream (available abroad) is good for bites, swellings and rashes.

Pharmacies, doctors and hospitals
Pharmacies, found in every town, form the advance guard of Egypt's health service. Pharmacists usually speak English and can dispense most drugs without a prescription. Private doctors are equally common, but charge for consultations: expect to pay about £E100 (roughly £9/US$17) a session, excluding the price of any drugs you are prescribed. If you get seriously ill, private hospitals are generally preferable to public-sector ones. Those attached to universities are usually well equipped and competent, but small-town hospitals are often abysmal. Many hospitals (mustashfa) require a deposit at the very least, and often payment on the spot; you will then have to claim it back from your insurance provider. Despite several good hospitals in Cairo and Alexandria, Egypt is no country to fall seriously ill in. In particular, if you need surgery, it is best to get back home for it if you can.

Health hazards
The tapwater in Egyptian towns and cities is heavily chlorinated and mostly safe to drink but is unpalatable and rough on tender stomachs. In rural areas, Sinai campsites and desert rest-houses there's a fair risk of contaminated water. Consequently, most tourists stick to bottled mineral water, which is widely available, tastes better, and won't upset sensitive stomachs. However, excessive fear of tap water is unjustified and hard to sustain in practice if you're here for long. Once your stomach has adjusted, it's usually okay to drink it without further purification (Halazone tablets, iodine crystals, or by boiling).

What you should avoid is any contact with stagnant water that might harbour bilharzia (schistosomiasis) flukes. Irrigation canals and the slower stretches of the River Nile are notoriously infested with these minute worms, which breed in the blood vessels of the abdomen and liver (the main symptom is blood in the urine). Don't drink or swim there, nor walk barefoot in the mud, or even on grass that's wet with Nile water. But it's okay to bathe in the saline pools of the desert oases.

Heat and dust
Many visitors experience problems with Egypt's intense heat, particularly in the south. Because sweat evaporates immediately in the dry atmosphere, you can easily become dehydrated without realizing it. Dehydration is exacerbated by both alcohol and caffeine. Drink plenty of other fluids (at least three litres per day; twice as much if you're exerting yourself) and take a bit of extra salt with your food. Wear a hat and loose-fitting clothes (not synthetic fabrics), and a high-factor sunscreen to protect yourself from sunburn, especially during summer. Try to avoid going out in the middle of the day and wear a T-shirt when snorkelling, as the sun burns you even quicker in the water.

Heat exhaustion – signified by headaches, dizziness and nausea – is treated by resting in a cool place and drinking plenty of water or juice with a pinch of salt. An intense headache, heightened body temperature, flushed skin and the cessation of sweating are symptoms of heatstroke, which can be fatal if not treated immediately. The whole body must be cooled by immersion in tepid water, or the application of wet towels. Seek medical assistance. If walking for long distances in the sun, it is vital to carry drinking water and wear a sunhat; a cotton sunhat can also be drenched with water, wrung to stop it dripping, and worn wet so that the evaporation of the water cools your head – you'll be amazed at how quickly it dries out.

Less seriously, visitors from cooler climates may suffer from prickly heat, an itchy rash caused by excessive perspiration trapped beneath the skin. Wearing loose clothing, keeping cool and bathing often will help relieve the symptoms until your body acclimatizes.

In non-air-conditioned environments, you might employ the traditional Egyptian method of sprinkling water on the ground to cool the surrounding area by evaporation – it also levels the dust.

Desert dust – or grit and smog in Cairo – may cause your eyes to itch and water. Contact lens-users should wear glasses instead, at least part of the time. If ordinary eye drops don't help, try antihistamine decongestant eye drops such as Vernacel, Vascon-A or Optihist. Persistent irritation may indicate trachoma, a contagious infection which is easily cured by antibiotics at an early stage, but eventually causes blindness if left untreated. Its prevalence in Egypt explains the number of older folk with cloudy eyes and the ophthalmologists in every town.

Spending time in the desert, you might find that your sinuses get painfully irritated by wind-borne dust. Covering your nose and mouth with a scarf helps prevent this, while olbas oil or a nasal decongestant spray (available at pharmacies) can relieve the symptoms.

Diarrhoea and worse…
Almost every visitor to Egypt gets diarrhoea at some stage. Unless you're stricken by cramps, the best initial treatment is to simply adapt your diet, using drugs only as a last resort. Plain boiled rice and vegetables are the best things to eat, and you should try to avoid greasy or spicy food, caffeine, alcohol, and most fruit and dairy products (although some say that bananas and prickly pears can help, while yoghurt provides a form of protein that your body can easily absorb). Most importantly, keep your bodily fluids topped up by drinking plenty of bottled water (perhaps mixed with a rehydration sachet or, failing that, salt and sugar). Drugs like Imodium or Lomotil will plug you up, undermining your body's efforts to rid itself of infection, but can be handy as a stop-gap measure if you have to travel. Avoid Enterovioform, which is still available in Egypt despite being suspected of damaging the optic nerve. Antinal (nifuroxazide) is widely prescribed against diarrhoea in Egypt, and available over the counter in pharmacies, but should not be used for more than a couple of days. Don't give any of these quite powerful drugs to children. Also note that having diarrhoea can make drugs less effective if taken orally (contraceptive pills for example), as they pass straight through your system without being absorbed.

If symptoms persist longer than a few days, or if you develop a fever or pass blood in your faeces, get medical help immediately, since diarrhoea can also be a symptom of serious infection. Accompanied by vomiting and fever, it may indicate typhoid, which responds well to antibiotics. Rarer is cholera, which requires urgent treatment with antibiotics and rehydration fluids; it is marked by a sudden onset of acute diarrhoea and cramps, and tends to occur in epidemics rather than isolated cases. Except for the "rice-water shits" typical of cholera, similar symptoms occur with bacilliary dysentery, which is treated with antibiotics. Amoebic dysentery is harder to shift and can cause permanent damage if untreated. The normal remedy is the heavy-duty antibiotic metronidazole (Flagyl), which should only be taken under medical supervision.

Rabies and malaria
Rabies is endemic in Egypt, where many wild animals (including bats, sometimes found in temples, tombs and caves) carry the disease. Avoid touching any strange animal, wild or domestic. Treatment must be given between exposure to the disease and the onset of symptoms; once these appear, rabies is invariably fatal. If you think you've been exposed, return home and seek help immediately.

Currently resurgent throughout Africa, malaria, spread by the anopheles mosquito, could become a problem in Egypt in the future, but isn't currently a threat – it does exist during the summer months in the Fayoum, but not to the extent that warrants the use of malaria pills, although you should take extra steps to avoid mosquito bites while you are there (use repellent and cover bare skin, especially feet and ankles, after dusk –). Consult your doctor, or enquire at a Medical Advisory Service in the UK (see "In the UK and Ireland") for the latest information on malaria risk and prevention. The first signs of infection are muscular soreness and a low fever; four to eight days later, the characteristic bouts of chills and fever appear. If you suspect that you have it, seek treatment immediately.

Mosquitoes and bugs
Even without the risk of malaria, mosquitoes can make your life a misery. Horribly ubiquitous over the summer, these blood-sucking pests are never entirely absent. The only solution is total war, using fans, mosquito coils, rub-on repellent, and perhaps a plug-in Ezalo device, sold at pharmacies. A lot of people in Egypt use citronella oil, obtainable from many pharmacies, as a mosquito repellent, but tests have shown it to be much less effective than repellents containing DEET (diethyltoluamide), which are the ones recommended by medical authorities. X-gnat skin gel is an effective natural alternative. You can also reputedly make yourself less attractive to mosquitoes by taking Vitamin B-12 tablets, starting before you leave home. The theory is that after two weeks of 50mg per day, your blood begins to smell bad to them, but again, medical authorities in general are sceptical. The best guarantee of a bite-less night's sleep is to bring a mosquito net to hang from above your bed (if you bring the sort that can be suspended from a single point, you can usually find ways of tying a string across the room to hang it from, but don't forget to pack a long enough piece of string). Mosquitoes favour shady, damp areas, and anywhere around dusk. Feet are the part of the body that most attracts them, and you should always be sure to put repellent on your ankles if they are uncovered when you go out in the evening.

Equally loathsome – and widespread – are flies, which transmit various diseases. Only insecticide spray or air conditioning offers any protection. Some cheap hotels harbour fleas, scabies, mites, giant roaches and other bugs. Consult a pharmacist if you find yourself with a persistent skin irritation.

Scorpions and snakes
The danger from scorpions and snakes is minimal, as most species are nocturnal, hide during the heat of the day, and generally avoid people. However, you shouldn't go barefoot, turn over rocks or stick your hands into dark crevices anywhere off the beaten track. Whereas the sting of larger, darker scorpions is no worse than a bad wasp sting, the venom of the pale, slender-clawed Buthridae is highly toxic. If stung, cold-pack the affected area and seek medical help immediately.

Egypt has two main types of poisonous snake. Vipers vary in colour from sandy to reddish (or sometimes grey) and leave two fang punctures. The horned viper, Egypt's deadliest snake, is recognizable by its horns. Cobras are recognizable by their distinctive hood and bite mark (a single row of teeth plus fang holes). The smaller Egyptian cobra (coloured sandy olive) is found throughout the country; the longer black-necked cobra (which can spit its venom up to three metres) only in the south. Be somewhat reassured that snakes come out to drink usually at night, and hibernate in the winter. All snakebites should be washed immediately. Stay calm, as panicking sends the venom through your bloodstream more quickly, and get immediate medical help.

Despite a TV campaign, the level of AIDS awareness is low, and most Egyptians still perceive it as a Western problem. Tourists likewise may not think of Egypt as the sort of country that would have an AIDS problem, but the few hundred cases reported here are almost certainly the tip of an iceberg. Prostitution, homosexuality and extra-marital sex in general are so clandestine and taboo that levels of education about them are low, and few Egyptian men take any precautions. As throughout the world, the need for extreme caution, and safe sex, cannot be overstressed. This particularly applies to Western women having a fling in places like Luxor, who may not be aware of just how much of an industry that is. Anyone of either sex or orientation, contemplating any kind of casual affair, whether with Egyptians or with fellow tourists, should always carry condoms and insist on using them. Likewise, be absolutely sure that any injections, tattooing or acupuncture is done with sterile instruments, and that barbers use a new blade if you go to them for a shave. It's also best to avoid having a blood transfusion in Egypt if at all possible. Pharmacies in cities plus a few shops in Hurghada and Sinai are the only places in Egypt to sell condoms (kabout) – either Egyptian-made Tops (liable to rip) or US imports (thick and short). It's best to bring your own supply.

Women's health
Travelling in the heat and taking antibiotics for an upset stomach make women much more susceptible to vaginal infections. The best precautions are to wash regularly with mild soap, and wear cotton underwear and loose clothing. Yeast infections can be treated with Nystatin pessaries (available at pharmacies), "one-shot" Canesten pessaries (bring some from home if you're prone to thrush), or douches of a weak solution of vinegar or lemon juice. Sea bathing can also help. Trichomonas is usually treated with Flagyl, which should only be taken under medical supervision.

Sanitary protection is available from pharmacies in cities and tourist resorts, but seldom anywhere else, so it's wise to bring a supply for your trip.

Bring your own contraceptives, since the only forms widely available in Egypt are old-fashioned, high-dosage pills, the coil, and not too trusty condoms. Cap-users should pack a spare, and enough spermicide and pessaries. If you're on the pill, beware that persistent diarrhoea can render it ineffective.

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