For a start, there's no need to bring huge supplies of non-prescription medicines with you, as Thai pharmacies (in Thai 'Raan-khai-yaa; typically open 08.30am-09.00pm) are well stocked with local and International branded medicaments, and of course they are generally much less expensive than at your home. Nearly all pharmacies are run by trained English-speaking pharmacists, who are usually the best people to talk to if your symptoms aren't acute enough to warrant seeing a doctor. Hospital (in Thai 'Rong phayaabahn) cleanliness and efficiency vary, but generally hygiene and health care standard are good and the ratio of medical staff to patients is considerably higher than in most parts of the West. As with head pharmacists, doctors speak English. All provincial capitals have at least one hospital: if you need to get to one, ask at your accommodation for advice on, and possibly transport to, the nearest or most suitable. In the event of a major health crisis, get someone to contact your embassy and insurance company-it may be best to get yourself flown to Bangkok or even home.
There are no compulsory inoculation requirements for people traveling to Thailand from the west, but you should consult a doctor or other health professional for the latest information on recommended immunizations. You'll need to ensure your polio and tetanus boosters are up to date; most doctors also strongly advise vaccinations against typhoid and hepatitis A, and in some cases they might also recommend protecting yourself against Japanese B encephalitis, rebies, hepatitis B, tuberculosis and diphtheria.
If you do decide to have several injections, plan your course at least 4 weeks in advance. There is currently no vaccine against malaria. If you forget to have all your inoculations before leaving home, or don't leave yourself sufficient time, you can get them in Bangkok at, for example, the Thai Red Cross Society's Queen Saovabha Institute.
A traveller's first-aid kit
Among items you might want to carry with you-especially if you're planning to go trekking-are:
- Antihistamine cream.
- Plasters / band-aids.
- Lints and sealed bandages.
- Insect repellent, sunscreen and calamine lotion or similar, to soothe sunburn or insect bites.
- Imodium, Lomotil or Arret for emergency diarrhoea relief.
- Paracetamol / aspirin.
- Multivitamin and mineral tablets.
- Rehydration sachets.
- Hypodermic needles and sterilized skin wipes.
It isn't only malaria that is spread by mosquitoes in Thailand; to a lesser extent, there are risks of contracting diseases such as Japanese B encephalitis and Dengue fever, especially if you visit during the rainy season.
The main message, therefore, is to avoid being bitten by mosquitoes. You should smother yourself and your clothes in mosquito repellent containing the chemical compound DEET, reapplying regularly (shops, guest houses and department stores all over Thailand stock it, but if you want the highest-strength repellent, or convenient roll-ons or sprays, do your shopping before leave home). DEET is strong stuff, and if you have sensitive skin, a natural alternative is citronella, made from a blend of eucalyptus oils.
At night you should either sleep under the mosquito net sprayed with DEET or in the bedroom with mosquito screens across the windows (or in an enclosed air-con room). Accommodation in tourist spots nearly always provides screens or a net (check both for holes), but if you're planning to go way off the beaten track or want the security of having your own mosquito net just in case, wait until you get to Bangkok to buy one, or where department stores sell them for much less than you'd pay in the West.
Plug-in insecticide vaporizers, knock down insect sprays and mosquito coils also widely available in Thailand-help keep the insects at bay; electronic ''buzzers'' are useless. Prophylaxis advice can change form year to year, so it's worth getting the most up-to-date information from your travel health adviser.
Thailand is malarial, with the disease being carried by mosquitoes that bite from dusk to dawn but the risks involved vary across the country. There is a significant risk of malaria, mainly in rural and forested areas, in a narrow strip along the borders with Cambodia and Laos and along the Burmese border as far south as Bangkok.
The only anti-malarial drugs that are likely to be effective in these areas are Doxycycline and Malarone, whose use should be discussed with your travel health adviser. Either needs to be started a couple of days before entering the malarial zone. You need to keep taking Doxycycline, which can be bought cheaply in Thailand if you don't manage to get it before leaving home, four four weeks after exiting the malarial zone. The newer Malarone (not currently available in Thailand) is more expensive, but has fewer common side-effects and only needs to be taken for a week after leaving the high-risk area. Elsewhere in the country the risk of malaria is considered to be so low that anti-malarial tablets are not advised.
The signs of malaria are often similar to flu but are very variable. The incubation period for malignant malaria, which can be fatal, is usually 7-28 days, but it can take up to a year for symptoms of the benign form to occur. The most important symptom is a raised temperature of at least 38°C beginning a week or more after the first potential exposure to malaria: if you suspect anything go to hospital or clinic immediately.
Like malaria, dengue fever, a debilitating and occasionally fatal viral disease, is on the increase throughout tropical Asia, and is endemic to many areas of Thailand. Unlike malaria, though, dengue fever is spread by a mosquito (the Aedes aegypti) that bites during daylight hours-usually in early morning or late afternoon, particularly during and just after the rainy season-so you should use mosquito repellent during the day; Ko Pha Ngan seems to suffer a higher than usual incidence of dengue fever. Symptoms include fever, headaches, fierce joint and muscle pain (''breakbone fever'' is another name for dengue), and possibly a rash and usually develop between 5 and 8 days after being bitten. There is no vaccine against dengue fever; the only treatment is lots of rest, liquids and paracetamol (or any other acetaminophen painkiller, not aspirin), though more serious cases may require hospitalization.
Japanese B encephalitis
If you are travelling in rural areas during the rainy season, especially if it's for long periods or on repeated visits, or in areas know to be infected, you may be at risk of contracting Japanese B encephalitis, a viral inflammation of the brain spread by the Culex mosquito, which breeds in rice fields. A vaccine is available, and although the risk of travellers catching the disease is low, you should at least consult your health adviser.
Other health problems
Wearing protective clothing is a good idea when swimming or snorkelling: a T-shirt will stop you from getting sunburnt in the water, while long trousers can guard against coral grazes. Should you scrape your skin on coral, wash the wound thoroughly with boiled water, apply antiseptic and keep protected until healed. Thailand's seas are home to a few dangerous creatures that you should look out for, notably jellyfish, which tend to be washed towards the beach by rough seas during the monsoon season. All manner of stinging and non-stinging jellyfish can be found in Thailand-as a general rule, those with the longest tentacles tend to have the worst stings-but reports of serious incidents are area; before swimming at this time of the year, ask around at your resort or at the local dive shop to see if there have been any sightings of poisonous varieties.
You also need to be wary of poisonous sea snakes, sea urchins and a couple of less conspicuous species-stingrays, which often lie buried in the sand and stone fish, whose potentially lethal venomous spikes are easily stepped on because the fish look like stones and lie motionless on the sea bed. If stung or bitten you should always seek medical advice as soon as possible, but there are a few ways of alleviating the pain or administering your own first aid in the meantime. If you're stung by a jellyfish, wash the effected area with salt water (not fresh water) and, if possible, with vinegar (failing that, ammonia, citrus fruit juice or even urine may do the trick), and try to remove the fragments of tentacles from the skin with a gloved hand, forceps or thick cloth.
The best way to minimize the risk of stepping on the toxic spines of sea urchins, stingrays and stone fish is to wear thick soled shoes, though these cannot provide total protection; sea urchin spikes should be removed after softening the skin with ointment, though some people recommend applying urine to help dissolve the spines; for stingray and stone fish stings, alleviate the pain by immersing the wound in hot water while awaiting help. In the case of a poisonous snake bite, don't try sucking out the poison or applying a tourniquet: wrap up and immobilize the bitten limb and try to stay still and calm until medical help arrives (all provincial hospitals in Thailand carry supplies of antivenins).
Rabies is widespread in Thailand, mainly carried by dogs (between 4-7% of stray dogs in Bangkok are reported to be rabid), but also cats and monkeys, and is transmitted by bites, scratches or even licks. Dogs are everywhere in Thailand and even if kept as pets they're never very well cared for; hopefully their mangy appearance will discourage the urge to pat them, as you should steer well clear of them.Rabies is invariably fatal if the patient waits until symptoms begin, though modern vaccines and treatments are very effective and deaths are rare. The important thing is, if you are bitten, licked or scratched by an animal, to vigorously clean with soap and disinfect the wound, preferably with something containing iodine, and to seek medical advice regarding treatment right away.
Worms and flukes
Worms can be picked up through the soles of your feet, so avoid going barefoot; worms can also be ingested by eating under cooked meat, and liver flukes by eating raw or undercooked freshwater fish. Worms which cause schistosomiasis (bilharziasis) by attaching themselves to your bladder or intestines can be found in some freshwater rivers and lakes. The risk of contracting this disease is low, but you should certainly avoid swimming in the southern reaches of the Mekong River and the lakes of north-eastern Thailand.
By far the most common traveller's complaint in Thailand, digestive troubles are often caused by contaminated food and water, or sometimes just by overdose of unfamiliar foodstuffs. Break your system in gently by avoiding excessively spicy curries and too much raw fruit in the first few days, and then use your common sense about choosing where and what to eat: if you stick to the most crowded restaurants and noodle stalls you should be perfectly safe. You need to be more rigorous about drinking water, though: stick to bottled water (even when brushing your teeth), which is sold everywhere, or else opt for boiled water or tea.
Stomach trouble usually manifests itself as simple diarrhoea, which should clear up without medical treatment within 3-7 days and is best combated by drinking lots of fluids. If this doesn't work, you're in danger of getting dehydrated and should take some kind of rehydration solution, either a commercial sachet of ORS (Oral Rehydration Solution), sold in all Thai pharmacies, or a do-it-yourself version, which can be made by adding a handful of sugar and a pinch of salt to every litre of boiled or bottled water (soft drinks are not a viable alternative).
If you can eat, avoid fatty foods. Anti-diarrhoeal agents such as Imodium are useful for blocking you up on long bus journeys, but only attack the symptoms and may prolong infections; an antibiotic such as ciprofloxacin, however, can often reduce a diarrhoea to one day. If the diarrhoea persists for a week or more, or if you have blood or mucus in your stools, or an accompanying fever, go to a doctor or hospital.
HIV and AIDS
AIDS is spreading fast in Thailand, primarily because of the widespread sex trade, with an alarming 44% of prostitutes in Chiang Mai testing HIV positive. Condoms are sold in pharmacies, department stores and seven-eleven shops. Should you need to have treatment involving an injection at a hospital, try to check that the needle has been sterilized first; this is not always practicable, however, so you might consider carrying your own syringes. Due to rigorous screening methods, the country's medical blood supply is now considered safe from HIV / AIDS infection.