In this chapter I am going to give you some information on some more common ailments that you need to be aware of; advise you on how to get medical advice if you need it, and of course give you some insight of how medical care in Thailand differs from that in the west.
A Note About Medical Advice
If you have any problems with safety control systems for controlling chemical process plants I can give you a very good professional opinion, I am an engineer. If you need medical advice, ask a doctor.
That said, what follows is what I have learned during twelve years of living in Thailand, use it as a guide to what you need to know and find out, not as the last word in medical advice.
Advice you should not ignore
Many of the most dangerous diseases and illnesses in Thailand start with symptoms similar to what in the west might be a mild flu or minor infection. You must be aware of this and you must seek medical advice if anyone in your family develops any of the following symptoms:
- Hot and Cold Chills
- Rashes all over the body
- Diarrhoea of Vomiting
- Headaches and Nausea
- Loss of appetite
This is especially important with young children and infants, trust your instincts, if you feel anyone in your family is in any way not well, don’t wait for things to get worse, go get a medical check-up. Believe me, the medical teams at the hospital will not brush your concerns aside, they really would rather you bothered them with a minor illness than have to deal with something that should have been treated earlier. Sometimes a few hours can make a huge difference to the severity of an illness, so seek help and seek help early.
Do not be tempted to self-treat an illness
Because many of Thailand’s most dangerous diseases exhibit early symptoms that are remarkably like flue or other such common western ailments it would be very easy to mistake a serious illness for, say a head cold. It is essential that you do not get tempted to administer treatments yourself, yes medicines are available without prescription in Thailand but those medicines might mask symptoms of what is a fatal disease.
If you feel you need to administer a medication, STOP AND THINK - You've recognized the symptoms of illeness but you may be very wrong in your assumptions as to what that illness is - You should be seeking medical advice.
Oh and Consider Carrying single use Thermomters - We've used the Nextemp brand and found them to be accurate and easy to use - A couple of these will fit in your fist aid kit with next to no weight they are reliable and unbreakable - No worries about broken thermoemters in little mouths:
Don't Give Disease A Helping Hand
Encourage everyone in your family to wash their hands more frequently than normal while they are in Thailand and carry sterilized whipes, for hands, table tops and anything you are going to eat with that you are not sure has been thoroughly cleaned.
Some General Comments on Medical Care in Thailand
Let’s put one worry aside: You are not at risk of HIV infection when receiving medical attention in a Thai hospital, including when being operated on.
My wife and I have a very high opinion of the medical care in Thailand’s main towns and cities, but we attend the best hospitals and therein is the fist problem of getting medical attention.
If you are staying in Bangkok, Chiang Mai, Pattaya Samuii, Phuket or any of the main holiday destinations you will have access to some of the best medical treatment available in Asia. The Bangkok Pattaya Hospital and Samitivej are the two hospitals I have used and I strongly advise that you find out which is your nearest ‘International Hospital’ as soon as you arrive.
I have included and list of hospitals in the main tourist areas in the attachments to this guide.
If you are on any of the smaller islands or in any of the provinces away from Bangkok and the main tourist areas then do not expect the local hospitals to provide anything but the most rudimentary treatment.
A word of caution, the world’s travel industry runs on greased palms, if your tour representative is Thai, he/she will receive commission on every piece of business to which he/she introduces you, including medical care. Likewise the hotel reception, tour guide and taxi driver. Their consideration in recommending a hospital WILL NOT BE what is the best treatment for you it WILL BE which hospital or clinic gives them the best kickback or bribe.
Avoid ‘clinics’ since they will not have the facilities of a hospital. For any serious illness or accident get a second opinion.
Medical Care and Insurance
This is something you must be aware of.
Thailand does not provide any form of free medical care for foreigners who are visiting on holiday, if you or your child fall ill or need medical care during your visit you will have to pay for it, if you can’t pay you will not get treatment.
This is extremely important, there are no reciprocal health care agreements, no laws that compel a doctor or hospital to treat you and your embassy will not help either. You absolutely must have health insurance that names each person traveling. I suggest a minimum of $500,000 for medical treatment, plus $500,000 repatriation cover.
If you are separated from the parent who is traveling with your children I would insist on a full comprehensive medical insurance as being a condition of your signing the parental permission to travel. If your children get ill or need medical treatment in Thailand and there is no insurance it could cost every penny you have, and then some.
Here’s something I will never understand. It is customary that when you go to a Thai doctor he/she will give you an examination and then call for tests. Its at this point your doctor will declare that you might have condition ‘X’.
Condition ‘X’ will undoubtedly be the worst thing you could ever imagine. Cancer, TB, HIV or a serious heart condition might well be expected.
Stay calm, its all part of the mumbo jumbo, wait for the test results.
From my own experience and that of friends, I have have seen Thai doctors provide excellent care and treatment for all manner of conditions and illnesses from the minor to the very severe. You name it, Thai doctors can deal with it.
I don’t have the knowledge or experience to give any specific advice on children’s illnesses, you’ll need to speak to a doctor for that, the advice that follows covers how to get help and issues relating to that help.
Be very aware that illnesses that are uncomfortable for adults can very quickly become dangerous for small children, for example, food poisoning or any vomiting or diarrhea can be extremely dangerous for infants, the same goes for heat stroke or sunburn. If your child becomes ill it is very important that you get help as quickly as possible.
For this reason I strongly recommend that you think carefully about where you choose to go with small children, remote islands and trips into the hills might seem very inviting, but you should consider how long it would take for you to get from where you plan to stay to a hospital if your child becomes ill. More about that can be found under the heading “Choosing a Destination with Medical Care in Mind’.
All the larger private hospitals will have a pediatrics department. If our child is ill he/she will get to see a pediatrician within moments, I’ll bet far quicker than in your home country.
Getting to see a Doctor for minor illnesses, food poisoning etc ask your hotel to call a doctor for you. For more serious conditions go straight to you nearest Private International Hospital , go directly to the hospital reception and ask to see a doctor. If it’s an emergency go to the Accident and Emergency entrance.
My Thai dentist is superb and cheap. As a regular patient I get inspections and cleaning for free! A gold filling recently cost me less than US$160. So if you are getting near your holiday and you need treatment you might wait until you get there.
If you decide to do this, contact the dentist during the first few days of your holiday and make sure that there is enough time to finish any work that is undertaken.
Tip: If you need emergency dental treatment go to the hospital and get an appointment to see a doctor (not a dentist). The doctor will recommend you see a dentist, get this written down. Now your trip to the dentist is on medical advice and your insurance will pay for it. See I have saved you some money already.
A Note on Medicines
If you or your children take any medications, make sure that you have a supply sufficient for the full period of your holiday plus a little extra for delays.
Carry essential medicines in your hand luggage, just incase your hold luggage goes missing.
If your medication includes the use of hypodermic needles get a doctor’s note to say that you need these for medicines that your doctor has prescribed. You do not want to be mistaken for a drug addict in Thailand.
If you need prescription medicines while in Thailand do not be tempted to buy them at a local pharmacy, they may be ‘fake copies’, out of date or both. There are reputable pharmacies in Thailand, in particular the British company Boots has outlets at many of Thailand’s main holiday destinations. The best advice is, if you need prescription drugs get them from an International Private Hospital.
Prescribed Medicines in Thailand.
If you or your children go to hospital or the doctors in Thailand you will invariably leave with a bag of smarties (more medicines than you can believe).
Most of these will be unnecessary or at least optional. Tell your doctor that you do not want to take a lot of medication and discuss each medicine with the doctor, get him/her to explain what the medicine is, why it is needed and what the side effects might be.
These days I check all medicines I or my family are given on the internet - You cannot be too careful with understanding drug side effects.
I once went the a reputable international hospital with a severe earache, you know the kind where you can’t move your head without your ear throbbing. The doctor correctly diagnosed and prescribed treatment for an ear infection and then suggested, I have an X-ray to check my neck out. You just have to be a bit critical of the advice you get sometimes.
Tip: I suffer with some allergies, if I am ever prescribed a medicine I have never had before I take the first lot of medicine in the hospital and then sit and read the newspaper for half an hour; I figure that if I have a reaction to the medicine help is at hand.
Any stay in a Thai hospital will involve fitting a saline drip, by association this is distressing to parents, because we would only expect to have a drip fitted if we are seriously ill. Do not panic. Thai doctors will ask for a drip to be fitted for a host of reasons, mainly re-hydration but also because they can give medication into the drip rather than into a vein.
If you are concerned about this, discuss it with the doctor, get him/her to explain and if you are not get a second medical opinion.
Vaccinations for Thailand
The only mandatory vaccination for visitors to Thailand is Yellow Fever, and this only for people traveling from areas of the word where Yellow Fever is prevalent.
There are however a list of vaccinations that are recommended for travel to Thailand and I strongly advise that you discuss these with your doctor; as I say above we don’t take anti malaria medicines because of the health risks associated with long term medication but there are a number of reasons why you need the Thailand Vaccinations:
Most importantly, the vaccinations are against real diseases that are present and that people do die of.
And if that is not bad enough; If you or your children become ill with a disease for which you have been recommended to have a vaccination but for which you chose not to take the advice, you may very well have invalidated your insurance cover.
We have had vaccinations for MMR, Polio, Typhoid. Hepatitis A, B, TB, Japanese Encephalitis and Tetanus.
Many parents in Europe and the US are electing not to have their children vaccinated against MMR, and perhaps other vaccinations too. If you are one of these parents I again strongly advise you discuss the need for vaccinations with your doctor; MMR, Polio and the diseases for which vaccinations are recommended prior to traveling to Thailand are real and present dangers, the risks are very much more than they are in the developed world. The comparative risks that you may have taken into account in your decision not to vaccination back home, just do not apply in Thailand.
Vaccinate in Time!
Don’t leave vaccinations to the last minute before you go, some take several weeks to become effective and if you are worried about side effects then taking them early will enable you plenty of time to spread them over several sessions.
Again, talk to your doctor, but do so early.
Choosing a Destination With Medical Care in Mind
All this good advice is not much use if you are miles from the hospital, this is something that has always been part of our considerations when choosing a destination for a family holiday.
My advice is simply this; if you are concerned about access to good medical care or perhaps you haven’t given it much thought but a member of your family has a condition that might require medical attention, stick to the main tourist areas.
Bangkok, Chiang Mai, Pattaya, Samuii, Phuket all have excellent hospitals and doctors that speak English and have been working for many years with foreigners.
Be aware that if you move away from these areas medical facilities become quite provincial, you may have trouble finding a doctor with a reasonable command of English.
When our children were very young, under two years old, we restricted our travels to within a couple of hours drive of these main tourist areas, but I can assure you that gives plenty of scope for even the most adventurous of families to have an enjoyable time.
If you are considering a stay on one of Thailand’s many islands then do take a look at how long the ferry ride is and how often the ferries run. One of my favorite spots is Kho Tao, but that is a three and a half hour ferry ride from the mainland and the service is limited.
Some of the resorts on the islands have their own powerboat service which would reduce the time to get too the mainland in an emergency. Do think these things through as part of your planning, it is extremely unlikely that you need to get to a doctor or hospital in a hurry, but it will be so much easier to so if you have considered the options before you need to call upon them.
A First Aid Kit
It’s my betting that ‘keeping a first aid kit’ can be assigned to the heap of ‘good intentions’ in most households, it starts off as being an ordered collection of things you might need and winds up as a box of bits and pieces, the scissors doing service in the bathroom cabinet.
However, I do think a small first aid kit is an essential item for a family holiday in Thailand because while the hotels and guesthouses are required by law to keep a first aid kit, they too are prone to the self same ‘good intentions’.
Don’t go out and buy one of those kits that looks like it belongs to in the back of a Land Rover driven by ‘Médecins Sans Frontières’ but do at least carry band aids, some bandages, a triangular bandage and the absolute must, sterilizing solution and very importantly, a thermometer. (Note you are not allowed to take a mercury thermometer on an aircraft - not on your person or in any of your baggage).
The sterilizing solution should be applied liberally to all and every cut or graze, I carry ‘Betadine’ in the first aid kit I have in my car.
There is a very important point to note about first aid kits, they are useless if you don’t know how to use them.
The best remedy for that is a first aid course and perhaps the second best is:
A Guide To First Aid, St John’s Ambulance Brigade.
Storage of Medicines in Thailand
There are two problems with storing medicines in Thailand, the first is obviously the climate, the temperature in most the tourist destinations seldom drops below 25 Deg C and can be a lot warmer than that, there is also the humidity that can climb into the 90~100% band. So keeping medicines cool and dry can be a problem.
My mother, who is diabetic, keeps her medicines in a thermos flask, and to keep the flask cold she puts a few cold coins out of the icebox in with her medicines.
The other problem is insects and particularly ants. Many children’s medicines still contain sugar as a natural ‘sweetener to the pill’. The ants of course love this and will find their way into almost any container.
We have always used a small plastic food container box to store medicines, the type with push down clasps on all four sides are best as they make a better seal to keep moisture and insects out. If nothing else, a plastic medicine box will keep all your medicines in one place.
Some Common Health Risks You Need to be Aware of
This is not meant to be a complete medical almanac of Thailand and its diseases, I’m not qualified to give that information, nor do I feel it is necessary for me to do so. I do however think there are a number of diseases and health risks that are sufficiently common that you need to be aware of them. So here goes, don’t be too put off by any of we as a family, have not suffered any of these, excluding the odd heat rash and fungal infection, but they are not dangerous and easily dealt with.
Health Home and Away
Please be aware that many illnesses take days, sometimes weeks to show symptoms, keep this in mind when you return from your travels and do mention your recent trip to Thailand if you or any member of your family are ill in the weeks and months after your trip. It is very unlikely that you will return with an illness but if you do it may not be one that your doctor at home has experience of, again, don’t go worrying about this but do keep it in mind.
Climate Related Illnesses
A hat is a must for all members of your family (though getting your child to wear it might not be easy).
And I’m sure you are all aware sun creams are essential; we use factor 30 sun creams and have never had a problem with sunburn. Good and reliable sun creams can be bought in Thailand cheaper than they are in the UK or Europe!
Wear a hat yourself and cover up, the heat is vicious and takes no prisoners.
A Shady Spot. Finding a shady spot can be difficult, especially on beaches; in the more touristy areas you will find beach umbrellas, although there may be as small charge. If you decide on a spot under the trees then do take care not to sit under coconut trees if they have nuts on them, they often fall off and often injure people. Palm trees regularly shed their palm branches, so be careful to check none of them look ready to fall. It’s the aged brown branches that are the most likely to drop off on you.
You share your desire to take shade with others, dogs will often sleep under trees and the tree itself may be home to ants or occasionally bees, just keep these points in mind when selecting somewhere to get out of the sun.
Tip: Beach side restaurants will very often let you occupy a table the whole day so long as you are eating and drinking from their menu. This is especially so of the small family run businesses.
Tip: If your child is still in a pushchair consider buying an umbrella shade that fits to the pushchair, the type that can be moved around to alter where the shade falls are a great way of keeping baby in the shade.
Dehydration is the loss of water from your body; it can be very dangerous, especially for very small children. The most common causes of Dehydration are loss of bodily fluids due to food poisoning, vomiting and diarrhoea.
Symptoms: Dry or sticky mouth, reduced perspiration, weakness and lethargy, weakness of muscles especially hand grip, and of course reduced and perhaps a stronger or deeper colour urine.
In very young babies the soft part of their scull may be flattened or convex (curved inwards).
Prevention: The first line of defence is to regularly drink small amounts of water; constant and steady intake of small amounts of water is far better than leaving it until you are thirsty and then drinking a whole bottle of water in one go.
If you are drinking plenty of water but you are still feeling week or perhaps even getting cramps then you may have lost too of much body salts, you can combat this with salt tablets or electrolyte drinks, which are widely available from pharmacies in Thailand. Avoid sports drinks (for example Lucazade Sport) as these contain a lot of sugar that can increase vomiting and hence increase the loss of body fluids.
Getting Help: Seek immediate medical help if a child under two years old has diarrhoea or vomiting.
Likewise if an older child older has diarrhoea and vomiting for longer than eight hours or and adult for more than twelve hours.
If you believe your child is suffering from dehydration or you feel the need to give your child electrolyte, go see a doctor.
As a comparison, we have never given our children electrolyte drinks and I have only very rarely felt the need for these isotonic drinks myself, perhaps only after a long cycle ride and I we non of us take any additional salt on any of our food.
Heat stroke is the most sever heat related illness; it can be lethal and is especially dangerous for small children and old people.
Heat stroke is a failure of your body to be able to control its temperature, the body temperature may rise rapidly, within less than half an hour, to temperatures that are dangerous.
The risk arises from being in the heat, and particularly if exercising in the heat.
Symptoms: Weakness of limbs, dizziness, feeling chilled when out of the heat, nausea, increased heart rate and breathing, confusion and possibly hallucinations, increased body temperature with no sweating.
First Aid: First aid is necessary because heat stroke can quickly develop to become dangerous. Call for a medical help or make arrangements to get the persons suffering heat stroke to a hospital. At the same time move the person indoors, remove their clothing and shower them with cold water, In Thailand cold water will still be relatively warm so wet their body and fan them to increase cooling. Bottled water from the fridge can be slowly over their legs or onto a towel on their backs. Place ice under armpits and groin. The object is to reduce the body temperature of the sufferer, do what you can to cool them down until medical assistance is at hand. “Cool down” means “Make them as cold as you can”.
Lay them on a bed with their legs slightly raised and fan them while wiping their body with a cold damp cloth. Monitor temperatures in the mouth not on the skin as it is the core temperature that is important.
Prevention: Heat stroke is a form of exposure, the prevention is to avoid the exposure. Schedule outdoor activities for the cooler part of the day, morning or evening. Drink regular amounts of water, wear hats, cover up against the heat, long sleeves and light colours. Be careful to keep an eye on each member of your group, a child who is quiet might be suffering early heat stroke.
The most dangerous time for heat stroke is 10:30~15:30 during this time you should avoid exercise and try to stay in the shade. I believe the most dangerous activities are boat trips and any kind of walking tours, in both instances you might not be able to get out of the sun.
Getting Help: It is essential that you perform first aid and get help at the same time, heat stroke can become dangerous in a matter of minutes so start the first aid and call a doctor or arrange transport to a hospital.
Ear infections are quite common in Thailand the causes are humidity and water born infection from swimming. They can develop to cause damage to hearing but more commonly can become a problem for the flight home.
Symptoms: Itching ears and possibly wet ore weeping ear canal.
Prevention: Thoroughly dry ears after swimming and showers, avoid swimming in fresh water, rivers etc. But do not use cotton buds to dry inside ears as these can further damage the outer ear and aggravate infections.
Getting Help: Minor ear infections can be treated by any clinic and will most likely involve the application of a topical antibiotic such as ‘Otosporin’, if oral medicine is or any procedure beyond syringing the ear is recommended get a second opinion.
Caution: Ear infections can give rise to ear damage during a flight, so it is probably good advice to check everyone’s ears two or three days before flying home.
Eye infections, in particular conjunctivitis, are very much more common than in temperate climates, the most common cause of eye infections is swimming pools and shared towels or face cloths.
Symptoms: The white part of the eye of the suffer will become red or pink and most commonly will hurt as if they have a piece of grit or sand in their eye. Less commonly the eye might be red but itch; this may be allergic conjunctivitis. Eyes may become sensitive to bright light.
Getting Help: As with ear infections the any clinic should be able to prescribe medication to cure this illness but if anything beyond eye drops is recommended seek a second medical opinion.
Contagiousness: Viral and Bacterial Conjunctivitis can be extremely contagious as it spreads through direct or indirect contact. The infected person must be very careful to constantly wash their hands with soap and water, don’t allow towel or face cloth sharing and if you and your children are sharing beds during your holiday don’t allow the infected person to share pillow cases.
There are a range of fungal infections that are common in Thailand’s tropical climate, all uncomfortable but easily cured. They are most common during the wet humid rainy season June ~ October and usually infect any part of the body that remains covered and moist; typically feet, armpits, genitals, waistbands or areas where clothing is tight against skin.
Symptoms: Redness or rashes, itching, particularly when showering with hot water. Vaginal fungal infections may be accompanied by discharges.
Prevention: Bath regularly and thoroughly dry skin, try not to wear enclosed shoes or clothing that does not allow your skin to breath, avoid elasticated waistbands and wear cotton or naturally fibres as opposed to man made materials.
Aggravation: Fungal infections are often aggravated by any number of chemicals we put on our skin - soaps, perfumes, detergents and mosquito repellents. I know from personal experience that biological washing powders can aggravate skin infections and for this reason we have always used non-biological washing powders.
Perfume free ‘baby’ soap and non biological washing powders are widely available in Thailand, but you may need to put a bag of wash powder in with you laundry if you want to be sure that the laundry are going to use non biological powders.
Getting Help: Self-treatment will generally cure most fungal infections, I have always used Canestan which is is readily available in Thailand and will cure most fungal infections. Read the instructions and if symptoms persist see a doctor.
Mosquitoes born Diseases
This is without a doubt one of the most frequent issues on which I am asked questions by families intending to visit Thailand.
Here are my thoughts on the matter. Oh and here is a Mosquito some of them are nearly as big as this!:
I start by disbelieving any official figures if such figures might affect tourism or investment. When I’m told there is no Malaria or Dengue fever, well perhaps there isn’t but better safe than sorry. Having said that, I do believe that worries over Malaria and Dengue fever are often unfounded, mosquitoes are not the problem most visitors fear them to be.
Malaria is not prevalent in the main tourist areas of Thailand, and certainly not in the cities. There are however mosquitoes everywhere and, disease aside, their bites alone are not at all pleasant, so if for no other reason than I hate being eaten alive, my first line of defence is to avoid getting bitten.
Most mosquitoes come out in the early evening for the two hours around dusk and fly close to the ground, I recommend staying indoors during the first hour before and after sunset. If you have to be outside during the mosquito hours then wear long trousers and socks rather than sprays and other chemical methods … if the chemicals kill or repel mosquitoes what are they doing to you?!
The repellent ‘DEET’ is by far the most popular but there are others and they can be found in many forms, sprays, wipes, sun tan creams all of which are widely and cheaply available in Thailand at all the places you are likely to visit.
Take a tip from the locals, if there are mosquitoes around, sit with your feet and legs off the ground, mosquitoes fly around close to the ground so keeping your feet up will avoid their flight path. It also makes it easier for you to swat them when they are biting your ankles.
You will have to take medical advice on the use of anti malarial medicines, we don’t take them because doing so for long periods is too dangerous, the side affects are too severe, and in truth of the hundreds of expats we know none have contracted malaria.
I know of one case in which an expat contracted Dengue fever, but he was working on a construction site that was little more than a swamp.
I believe the best advice on mosquitoes is as follows:
Avoid their bites by staying indoors during the time of day they are most prevalent (the hour before and the hour after sunset).
If you are outside during this time, cover your legs and ankles (Sorry girls, those summer frocks can only be worn if you accept the price of bites…Sorry lads, it’s going to be your fault).
Spray repellents where the mosquitoes are likely to strike, below your knees around your ankles
Make sure you keep your room doors closed and mosquito netting over windows and doors in place. Bathrooms are favourite haunt for mosquitoes, so keep the bathroom door closed.
Spray your room (and bathroom) with a bug killer when you go out for the evening, I recommend Bayer’s products, they are widely available in Thailand, cheap and effective. But like all chemicals reducing your exposure reduces the risks, no matter how safe they are meant to be, hence spray your room when you go out of an evening, not when you are in the room or just about to go to bed.
If you are taking a baby with you then buy a small mosquito netting, this can be draped over your baby when he/she is asleep and should be used at all hours, day or night.
If you are staying in budget accommodation then it might be worth you taking a mosquito net with you, or buying one when you arrive.
We have found the above measures to be both practical and effective for travel to all parts of Thailand, including the border areas and forests.
Repeating what I say about Anti Malaria tablets, we don’t take them the side effects are too severe and provided a few sensible measures are taken bites can usually be avoided. But do take medical advice and perhaps discuss the advice above with your doctor, he/she might have their own insights.
Malaria is carried by mosquitoes, see above.
Symptoms: Early symptoms include drowsy but trouble sleeping, irritable with loss of appetite followed by chills and rapid breathing and then a high fever perhaps over 40.6C (105F). The fever is followed by, intense sweating and a return to normal temperature. This may repeat over several days.
Other symptoms may be headaches, nausea and aches and pains all over the body, especially the lower back.
There may be no sings of insect bites.
Getting Help: Malaria can take between ten days and a month to develop after infection so the first thing to note is this is something you have to watch for during and after your holiday.
Malaria is also very dangerous and can be fatal. If you or your child exhibits any symptoms of chills, fever and intense sweating during or on the months after your holiday seek immediate medical help.
Dengue fever is carried by mosquitoes, see above, but there are two distinct differences in the risks when compared with malaria: Dengue fever is transmitted by a mosquito that bites during the day and dengue fever is most prevalent in cities.
Most dengue fever infections will pass much like a flue infection but in a small number of cases may progress to Dengue Hemorrhagic fever, which can be fatal.
Symptoms: The infection starts with a high fever, rash, severe headache, pain behind the eyes and extreme muscle and joint pain A common name for Dengue Fever is break-bone fever. The rash usually lasts for 3~4 days and the whole illness up to about ten days. Young children don’t usually show as severe symptoms as older children and adults. Bruising can be a sign of the more severe form of the disease.
Getting Help: Dengue fever can be fatal so it is extremely important that you seek medical help as soon as any of the above symptoms appear. Symptoms may take as long as 14 days after infection to appear so keep this in mind after you have returned from Thailand.
ASPIRN WARNING - Aspirin can greatly increase the dangers of Hemorrhaging for people suffering with the Dengue Fever - An example of when misunderstood symptoms and self medication can go really wrong.
Japanese Encephalitis is a viral infection carried by one species of mosquito, it is only found in Asia and then mainly in rural areas. The virus attacks the central nervous system, brain and spinal cord and can lead to death or paralysis.
Symptoms: The majority of people who contract Japanese Encephalitis will have very minor symptoms; their infection might even go undiagnosed and cause them no harm. Those who develop a more serious infection will have flu like symptoms, fever, chills, tiredness, headaches and perhaps nausea and vomiting. The infection might then develop to a serious brain infection.
Prevention: Preventative Inoculations are advised for Thailand (We have all had them) also, see advice on avoiding mosquito bites above.
Getting Help: Japanese Encephalitis can be fatal or cause sever lasting disability, it is therefore essential that you seek medical attention if anyone in your group develops any of the symptoms above. Symptoms may take as long as 14 days after infection to appear so keep this in mind after you have returned from Thailand.
Other Biting Things. (This is important)
I think it is very unlikely that you will see a snake during your holiday in Thailand but there are three other high risks: Dogs, Cats and Creepy Crawlies.
Rabies is rife throughout Thailand, so don’t touch any dog or cat. While the heat usually induces a state of lethargy in all creatures you should avoid dogs and cats in restaurants, they invariably wind up fighting over food while cute puppies and kittens will no doubt have a “watchful” mother waiting to bite anyone who goes near her babies.
Don’t encourage dogs and cats no matter how cute they look, if you don’t get bitten (See Rabies below) you might well wind up infested with flees or worse still worms.
Insects do not have the good sense to avoid you so as an alternative many sting, more than a few are poisonous.
As a matter of habit I bang my shoes a few times before putting them on. I have a friend who spent a few days in hospital after ‘discovering’ a scorpion in his boots, he regards it as one of life’s revelations but one he does not wish to repeat.
If you are going to beaches you might get bitten by sand flies. These nasty little fellows don’t hurt on the day they bite but you’ll get some ugly itchy sores a day or two later. You can spot them if you look closely at the sand on your legs, they are minute and coloured black. There is no real deterrent other than general insect repellent. The cure for the bites is to keep them clean, and not scratch. Sand flies seem to be most prevalent around the rainy season (June through October) and can be found on all the beaches I have ever been to in Thailand.
Rabies is a virus that is transmitted in the saliva of infected animals either via bites or liking open cuts and wounds. It is a very common disease in Thailand.
Added to which rabid animals become vicious and will bite people who go near them. Read what I have said above about biting things.
Symptoms in Animals: Why am I including this? Because you need to be aware of the symptoms in animals to prevent you from getting infected.
There are two groups of symptoms in animals: Viscous Rabies and Paralytic Rabies.
An animal with Viscous Rabies will constantly growl, bark or cry, and will be visibly agitated, there may be, but not always, be foaming around the mouth. The animal will attack if you go near it. Most people will have the sense to avoid an animal with viscous rabies.
An animal with Paralytic Rabies will look a far more pitiful sight, it will be listless, perhaps unable to lift its head and drooling, it may appear to be choking or have something stuck in its throat. You might be tempted to help this poor creature. Do Not even think of it.
Symptoms in Humans: Early Symptoms - Fever, headache, nausea, itching or burning around the bite wound, tiredness and listlessness, dilated pupils, sensitivity to light, sound or temperature changes, sore throat and increased saliva.
Advanced Symptoms Abnormal behaviour, anxiety, confusion and disorientation, delirium, hallucinations, insomnia, convulsions, hydrophobia (fear of water) characterized by severe throat spasms on seeing or trying to swallow water. Death by cardiac arrest of respiratory failure or paralysis leading to death.
Prevention: Stay away from all dogs, cats and animals read what I said above about biting things.
Getting Help: It is absolutely essential that if you are bitten or scratched by any animal in Thailand even if the animal has rabies vaccination tags that you take the following action. Even if the wound is not bleeding or the skin is not broken.
Immediately wash the wound or scratched area with soap and water, don’t go looking for soap, start washing with water straight away until you can get some soap (Any soap will do, washing up liquid, shampoo, anything!) Allow the wound to bleed, do not bind it unless there is really serious loss of blood.
Go straight to hospital and get medical treatment, you should do this as soon as the bite or scratch occurs.
Snakes are actually very shy creatures and will for the most part avoid being anywhere near humans, when they are it is usually due to rains having flooded the ground where they normally live, they then move to the dry areas where people live.
Symptoms: There are too many different symptoms for me to cover here, but be assured there are no land snakes in Thailand that are so poisonous that you can’t get help. There is a sea snake that, if it could bite you, would kill you before you got out of the water but it has such a small mouth that the only place it could bite you is in the skin between your fingers.
Prevention: Discuss this with your children. Avoid areas where snakes are likely to be, under buildings or in piles of bricks, wood, rubbish etc. Also avoid long grass or walking off footpaths.
If you or your children see a snake, do not go near it, many can dash over four or five meters far quicker than you can. Slowly walk backwards from the snake keeping your eye on it as you do so. Under no circumstances try to capture or handle as snake, no matter how small it is.
Getting Help: Go immediately to hospital. First Aid: Wash the bite with soapy water and allow it to bleed. Apply a loose bandage about 15 cms (6 Inches) above the bite to slow the spread of the venom, not too tight, you should be able to squeeze a finger under the bandage. Apply a bag of ice to the wound. Keep the bite area below the heart, if it is in the ankle, seat the victim in a chair (do not lay them down).
If at all possible try to get a look at the snake - but do not put yourself in danger to do so. The hospital will have picture or perhaps picked snakes for you to identify the cultprit against.
All Thai hospitals have staff trained and experienced in the treatment of snakebites and adequate supplies of anti venom serums.
Take note of this - If you or anyone in your family need treatment for a snake bite go to the very nearest hospital - regardless of if it is a Thai hospital or an international hospital - DO NOT WASTE TIME HEADING FOR A CLINIC.
There are two parasite groups that you need to be aware of, flees and worms. I don’t believe incidence of these is higher in Thailand than in the west but your exposure might be increased during your holiday.
There are two likely causes of worms, ingested food contaminated with worms and their eggs; Ground or water born worms entering through skin.
Symptoms: The Symptoms vary according to the worm but may include constipation or diarrhoea, asthma, skin blistering, itching, abdominal swelling, nervousness, listlessness and blood in stool.
Prevention: Peal all fruit before eating, wash salads thoroughly and do not eat uncooked or lightly cooked meets. Do not swim in fresh water and do not allow your children to run around without shoes.
Getting Help: If you suspect a worm infection seek medical advice, some of the ground and water born worms are not common outside of Thailand so keep this in mind when discussing this issue with your doctor back home.
Flees (Lice and Bed Bugs)
Flees can be a problem if you are staying in budget accommodation, they are not generally harmful in themselves but they can carry diseases.
Symptoms: Itching is of course the main symptom but they don’t always itch. Spots of blood on bed sheets are a sure sign of bed bugs. While lice will generally congregated in the thicker warmer hair around the back of the head and ears.
Prevention: If I am staying in budget accommodation I take my own sheet sleeping bag and pillowcase with me.
Getting Help: British doctors are now advising that the first treatment should be combing hair with a ‘lice comb’ (very fine comb) rather than chemicals. I’m not convinced, a good dose of an anti lice shampoo such as “Full Marks” will get rid of the bugs and remove the risk of bug born diseases.
Have you started itching while you read this? I’m itching while I write it!
I am not going to include the full A-Z of sexually transmitted diseases here, I don’t think it is necessary to repeat what is already said elsewhere and this is after all a guide for a family holiday. I have included something of a warning regarding sexually transmitted diseases in my chapter for Older Children, I must leave it you the parent to drive the message home.
Just take it as read that HIV/AIDS is endemic in Thailand and prostitution is embedded in Thai society, both the society of Thais and the society of visitors to Thailand.
You are not at risk of contracting HIV/AIDS in Thailand if you stay away from the high risk activities. Blood used in Thai hospitals is screened for HIV and staff in Thai hospitals, clinics and dentists are trained in the use and practice of best practice.
Body piercing and tattooing are high-risk activities in Thailand. If you are being shaved at a barbers insist that you see the barber change the blade.
There are three strains of hepatitis that are common in Thailand, Hepatitis A, B and C. Inoculations are available and advised for Hepatitis A and B, Hepatitis C can be avoided.
Provided good food and personal hygiene is practiced Hepatitis A should not be problem for you and your children, and I believe that the risk from types B and C should not be problem at all for young children, but you do need to discuss these very common and virulent diseases with older children.
Is spread through contaminated water, food or eating and drinking implements.
Symptoms: Mild fever, headache, muscular pain, tiredness, loss of appetite, nausea, vomiting or diarrhoea. Later urine becomes dark, stomach pains and jaundiced skin and eyes. There is no chronic illness arising from hepatitis A and once you have caught it you can not catch it again, but the illness can be debilitating and might run for as long as 9 months.
Prevention: immunisation is highly recommended. Wash all salads thoroughly or avoid salads if you are not sure if they are clean. Peal fruit before eating. Wash hands before eating and always after using the toilet.
Getting Help: The incubation period for Hepatitis A is 15~50 days so be aware of the symptoms in the months after your visit to Thailand. If any of the above symptoms arise seek medical help and explain your travel history to your doctor.
Is spread through body fluids, sexual contact, sharing drinking or eating implements and kissing. I regard strangers touching our children as a risk.
Symptoms: Mild fever, headache, muscular pain, tiredness, loss of appetite, nausea, vomiting or diarrhoea. Later urine becomes dark, stomach pains and jaundiced skin and eyes. Can lead to chronic liver disease or liver failure.
Prevention: immunisation is highly recommended. Avoid contact with people who may be infected. I really do think letting strangers hold, touch or kiss your children is a risk. In the context of a holiday in Thailand this means stopping Thais messing with your children. Body piercing and tattooing are high-risk activities in Thailand. If you are being shaved at a barbers insist that you see the barber change the blade.
Getting Help: The incubation period for Hepatitis A is 45~160 days (Average 90 days) so be aware of the symptoms in the months after your visit to Thailand. If any of the above symptoms arise seek medical help and explain your travel history to your doctor.
Is spread through some body fluids, sexual contact, sharing drinking needles.
Symptoms: Mild fever, headache, muscular pain, tiredness, loss of appetite, nausea, vomiting or diarrhoea. Later urine becomes dark, stomach pains and jaundiced skin and eyes. Can lead to chronic liver disease or liver failure.
Prevention: Thee is no immunisation for Hepatitis C. Avoid contact with people who may be infected. I really do think letting strangers hold, touch or kiss your children is a risk. In the context of a holiday in Thailand this means stopping Thais messing with your children.
Body piercing and tattooing are high-risk activities in Thailand. If you are being shaved at a barbers insist that you see the barber change the blade.
Getting Help: The incubation period for Hepatitis A is 14~180 days (Average 45 days) so be aware of the symptoms in the months after your visit to Thailand. If any of the above symptoms arise seek medical help and explain your travel history to your doctor.
W are currently checking our information on TB.
These diseases exist in Thailand at far higher levels than they do in the west, but they are all preventable with inoculations. If you have chosen not to inoculate your child then you should discuss that decision and your holiday plans with your doctor, see Inoculations above. The risks are so much higher in Thailand that your assessment of, risk from inoculation against risk from disease, needs to be reconsidered.
A personal Experience
My wife contracted Chicken pox while in Thailand, we were both blissfully unaware of the very serious nature of this disease in adults, it was what we regarded as a 'mild childhood disease'. My wife recovered fully after a very bad couple of weeks' illness, but the experience brought home to us how assumptions we make about diseases are often way off the mark.