Travel Insurance and Emergencies

It is very important that you get the correct travel insurance policy and check the fine print for exclusions before you travel. It may be possible to change or upgrade a policy even if you travelling, but in general you can only purchase a “Travel Insurance” policy in your home country.

Medical Evacuation in an Air Ambulance is both very expensive (minimum $40,000 from Siem Reap to Bangkok), but is also complicated and will require payment upfront or approval from an insurance company. Also your personal and medical details will need clearance from the relevant authorities- you may need your passport and next of kin details. If you are staying in Siem Reap for a more than a few weeks you might want to pre-register your insurance policy with the international hospital, so in case of an emergency most of the work has been done.

The biggest cause of major disability and death is Road Traffic accidents, and these are most likely to be fatal in developing countries like Cambodia. There is no formal ambulance service, and ambulance personnel are not trained paramedics. Treatment is public hospitals is very poor, and is not advised.

Take sensible precautions when on the roads. Check every direction before crossing -expect the unexpected at all times! When travelling in a vehicle it may be worth checking if the driver is drunk and wear a seat-belt if possible. If on a bike wear a helmet.

 

Drugs and Alcohol

Travelling can liberating and exciting, and for many travellers this is the first time away from home- however there are hidden dangers especially compounded if using or misusing alcohol or drugs. In South-East Asia alcohol is cheap and bars open all day and night; excessive drinking can lead to accidents, assaults including rape, mental health problems and physical complaints like gastritis. Street drugs are most definitely illegal in Cambodia, but local authorities may turn a blind-eye, which can give the impression that the penalties are not severe- they are! Beware police have been known to set up traps for the unwary travellers. Street drugs also vary in purity- some drugs like heroin can be more pure than back home and there have been a number of deaths in Cambodia from accidental overdose. Drug use, especially amphetamines and ketamine, can also cause severe mental health problems and make persons vulnerable to assault and imprisonment.

 

Gastrointestinal problems

These are a significant cause of minor illness and can include bacterial, viral and parasitic causes. Traveller’s diarrhoea is very common, and can present with abdominal pain and fever. Many cases of simple diarrhoea can be managed with simple rehydration with electrolyte powder and paracetamol for fever and pain.

Blood in the stool is always an important sign and indicates dysentery.  Typhoid is endemic here, it’s a very unpleasant illness that is both difficult to diagnose and potentially life-threatening.  Typhoid vaccination offers some protection but only last 3 years.

Facilities to diagnose infections are limited in Cambodia and the normal labs in Siem Reap can only do a limited analysis and are limited by the training the staff have. I would be wary about taking the reports are face value.

 

Tropical diseases

Malaria

Malaria is endemic in Cambodia though probably the only main risk is near the densely forested areas on the Thai, Lao and Vietnamese borders, Preah Vihear, Rattanakiri, Pursat and Koh Kong provinces. Malaria prophylaxis is not required in Siem Reap including the Temples park or in the urban centres like Phnom Penh. 

Most important is to avoid getting bitten by mosquitos, both day and night time. Covering up the arms and legs, using bed-nets and might and DEET insect repellent can helps.

Malaria prophylactic medication is not 100% effective, and any high fever more than 7 days after being in a malaria prone region should prompt getting a malaria blood test.

 

Dengue Fever

In the past few years there have been epidemic rates of infection in the wet season, and worldwide this disease is spreading further into more temperate climates.. Dengue is transmitted by a type of mosquito active in the daytime and which is mainly found in urban areas, so avoiding getting bitten during the day is also important. There is no vaccine or prophylactic medication for Dengue so prevention of bites is paramount.

Symptoms include high fever, headache, muscle pains and sometimes a rash. Rarely Dengue shock or haemorrhagic complications occur.

 

Japanese Encephalitis

This is transmitted by a mosquito active in the evening in rural areas. The usual host is pigs, though it can in the rainy season be spread to humans. The risk os infection is 1 per 1000-5000 with the young and elderly being at most risk.

For most people infected this will be a mild illness, but 1 in 100 will develop severe neurological complications of which 30% will die.

We stock the Japanese Encephalitis Vaccine "IMOJEV" (see Services & Vaccines)

 

 

Scrub Typhus / Flea-born typhus

This is a Rickettsial infection spread by fleas that infest wild rats living in scrub or grassland. A simple antibiotic can prevent or treat this.

 

Avian Influenza or “Bird Flu”

Avian influenza are now endemic in South-east Asia, and there have now been many confirmed human cases in Cambodia, though it is a rare disease and one that can not be transmitted from person to person (at least it is very difficult). It is contracted when in close contact with infected birds such as duck or chickens and can be contracted when handling or butchering infected animals. In susceptible humans it is a rapidly progressive illness that has a high mortality.

 

Sexually Transmitted Infections

STI’s are on the rise again worldwide. This includes bacterial infections like gonorrhoea, chlamydia, syphilis. Viral infections such as genital herpes, viral hepatitis B and C, as well as HIV and genital warts, and in addition parasitic infections such as trichomonas, scabies and ‘crabs’. Most infections are spread through close genital contact so condoms are important, but also many can be spread through unprotected oral sex.

 

Prevention by using condoms is very important, but also remember that vaccination for Hepatitis B is effective and in some cases post-exposure treatment can be given for HIV and Hep B. Other infections if not treated early can also cause damage and in some cases infertility in both men and women. If you would like more information on booking an appointment with Dr Ferguson about this go to the Services & Vaccines page.