India Travel

Sikkim, and is nowadays regarded as the big killer in the subcontinent. It has a variable incubation period of a few days to several weeks, so you can become ill long after being bitten. Programmes to eradicate the disease by spraying mosquito-infested areas and distributing free preventative tablets have proved disastrous; within a short space of time, the Anopheles develop immunities to the insecticides, while the malaria parasite itself constantly mutates into drug-resistant strains, rendering the old cures ineffective.

It is vital for travellers to take preventative tablets according to a strict routine, and to cover the period before and after your trip. The drug used is chloroquine (trade names include Nivaquin, Avloclor and Resochin), usually two tablets weekly, but India has chloroquine-resistant strains, and you’ll need to supplement it with daily proguanil (Paludrine) or weekly Maloprim. In India chloroquine is easy to come by but proguanil isn’t, so stock up before you arrive. Unfortunately, the highly effective weekly anti-malarial Larium (Mefloquine), can cause horrible side effects (see below). Australian authorities are now prescribing the antibiotic Doxy cy dine instead of Mefloquine. As the malaria parasite can incubate in your system without showing symptoms for more than a month, it is essential to continue to take preventative tablets for at least four weeks after returning home: the most common way of catching malaria is by forgetting to do this.

Side-effects of anti-malaria drugs may include itching, rashes, hair loss and sight problems. In the case of Larium some people may experience disorientation, depression and sleep disturbance; if you’re intending to use Larium you should begin to take it two weeks before you depart to see whether it will agree with your metabolism, though normally you only need to begin taking anti-malaria medication a week before your departure date. If you plan on diving, you should perhaps avoid Mefloquine. as there is a worry about possible side effects fot divers.

Protection against malaria is absolutely essential. The disease, caused by a parasite carried in the saliva of female Anopheles mosquitoes, is endemic everywhere in India except high-altitude regions of Ladakh, Himachal Pradesh, Kashmir and Malarial symptoms

The first signs of malaria are remarkabh similar to a severe flu and may take month; to appear: if you suspect anything go to (hospital or clinic immediately. The shivering, burning fever and headaches come in waves, usually in the early evening. Anyone who develops such symptoms should get to a doctor for a blood test as soon as possible. Malaria is not infectious, but some strains are dangerous and occasionally even fatal when not treated promptly, in particular, the chIoroqume-resistant cerebral malaria. This virulent and lethal strain of the disease, which affects the brain, is treatable, but has to be diagnosed early. Erratic body temperature, lack of energy and aches are the first key signs.

Australia; Level 7,428 George St, Sydney 02/9221 7133; Level 2,393 Little Bourke St, Melbourne 03/9603 5788; Level 6,29 Gilbert Place, Adelaide 08/8212 7522; Level 6,247 Adelaide St, Brisbane 07/3221 9066; 5 Mill St, Perth 08/9321 1977. New Zealand: 1/170 Oueen St 09/373 3531; 6 Washington Way, Christchurch 03/379 4000. General info/health line: it 1902/261 560 (Australia). Inoculations/medications, area-specific advice, list of English-speaking doctors in India, first-aid/medical kits and post-travel examinations. A full rundown of their branches, along with general travellers’ health advice.

Auckland Hospital, Park Road, Grafton 09/797440. General traveller health advice. Travel-Bug Medical and Vaccination Centre, 161 Ward St, North Adelaide 08/8267 3544.Consultations, inoculations, first-aid/medical kits, post-travel examinations.

Travellers’ Immunization Service, 303 Pacific Hwy, Lind field, Sydney 02/9416 1348. Offers inoculations and general advice.

One of the chief concerns of many prospective visitors to India is whether the water is safe to drink. To put it simply, it’s not, though your unfamiliarity with Indian micro-organisms is generally more of a problem rather than any great virulence in the water itself.

As a rule, it is not a good idea to drink tap water, although in big cities it is usually chlorinated. However, you’ll find it almost impossible to avoid untreated tap water completely: it is used to make ice, which may appear in drinks without being asked for, to wash utensils and so on. Bottled mineral water is widely available and cheap. Always check that the seal is intact, as refilling bottles is not uncommon; some brands are better than others with Bister being the best, though you don’t always have a choice. Always crush bottles after use and dispose of them properly. Note that plastic is a real menace to the environment especially in fragile areas such as the mountains; try to recycle where possible, or purify your own water.

If you plan to go somewhere with no access to bottled drinks (which really only applies to travellers venturing well off the beaten track) you’ll need to find an appropriate method of treating water, whether your source is tap water or natural ground water such as a river or stream. Boiling it for a minimum of five minutes (longer at higher altitudes) is sufficient to kill micro-organisms, but is not always practical and does not remove unpleasant tastes. Chemical sterilization is cheap and convenient, but dirty water remains dirty, and still contains organic matter or other contamination. You can sterilize water by using chlorine or iodine tablets, but these leave a nasty aftertaste (which can be masked with lemon or lime juice). Pregnant women, babies and people with thyroid problems should avoid using iodine sterilizing tablets or iodine-based purifiers, or use an additional iodine-removal filter. The various kinds of filter only remove visible impurities and the larger pathogenic organisms (most bacteria and cysts); however fine the filter, it will not remove viruses.

Purification, a two-stage process involving both filtration and sterilization, gives the most complete treatment. The Aqua Pure Traveller water bottle (£34.99) has a filter top that turns contaminated water into safe, clean drinking water. Tested and approved by the London School of Hygiene and Tropical Medicine, it uses replaceable filters fo strain out even the smallest viruses and pathogens. Each one lasts for 350 litres, making it money saving as well as environmentally friendly. Available from most good outdoor stores and large pharmacies. Another supplier of water purifiers is Pre-Mac - for suppliers contact: Pre-Mac Ltd unit 5 Morewood Close, Sevenoaks, Kent TN13 2HU, England 01732/460333.

All Water Systems Ltd Unit 2018. Cifywest Business Campus, Faggart, Dublin, Ireland 01/466 0133.

Travel Medicine 351 Pleasant St. Suite 312, Northampton, MA 01060, US 31-800/872-8633.

Nomad Travellers Store and Medical Centre 3-4 Wellington Terrace, Turnpike Lane, London N8 0PX 020/8889 7014, 8889 9529.

140921 716/754-4883:40 Regal Rd, Guelph, ON N1K1B5S519/836-0102,

A nonprofit organization supported by donations, it can provide a list of English-speaking doctors in India, climate charts and leaflets on various diseases and inoculations. International SOS Assistance, PO Box 11568, Philadelphia, PA 19116 1-800/523-8930.

Members receive pre-tnp medical referral info, as well as overseas emergency services designed to complement travel insurance coverage.

Travel Medicine, 351 Pleasant St, Suite 312. Northampton, MA 01060 $ 1 -800/872-8633.

Sells first-aid kits, mosquito netting, water filters and other health-related travel products.

Travelers Medical Center, 31 Washington Square West, New York, NY 10011 212/982-1600. Consultation service on immunizations and treatment of diseases for people travelling to developing countries.

For up-to-the-minute information, make an appointment at a travel clinic. These clinics also sell travel accessories, including mosquito nets and first-aid kits. Information about specific diseases and conditions, drugs and herbal remedies is provided as well as advice from health experts. You could also consult the Rough Guide to Travel Health by Dr Nick Jones.

UK

British Airways Travel Clinics Operates several clinics located in London including 156 Regent St, London W1 020/7439 9584 (Mon-Fri 9.30am-5.15pm, Sat10am-4pm; no appointment necessary). There are appointment-only branches at 101 Cheapside, London EC2 020/7606 2977, and at the BA terminal in London’s Victoria Station 020/7233 6661. Call 01276/685040 for your- nearest clinic, or check out; BA operates around 28 regional clinics throughout the country. The clinics provide vaccinations, tailored advice from their online database and a complete range of travel health-care products.

Hospital for Tropical Diseases Travel Clinic, 2nd floor, Mortimer Market Centre, off Capper: Street, London WC1E 6AU (Mon-Fri 9anv5pm by appointment only; 020/7388 9600). A consultation costs £15 which is waived if you have your injections Here. Their recorded Health Line (09061/337 733; 50p per min) gives hints on hygiene and illness prevention as well as listing appropriate immunizations.

Malaria Helpline 24-hr recorded message: (10891/600 350; 60p per minute).

MASTA (Medical Advisory Service for Travellers Abroad), London School of Hygiene and Tropical Medicine. Operates a prerecorded 24-hour Travellers’ Health Line (t0906/822 4100,60p per min), giving written information tailored to your journey by return of post Nomad Pharmacy, surgeries 40 Bernard St, London, WC1 opposite Russell Square tube station; and 3-4 Turnpike Lane. London N8 (Mon-Fri. 9.30am-6pm 020/7833 4114 to book; appointment). Advice is free if you go in person, and the telephone helpline is 09068/633 414 (60p a minute). They can give information tailored to your travel needs.

TrailfindersNo-appointments-necessary immunization clinics at the 194 Kensington High St branch in London (Mon-Fn 9am-5pm except Thursto6pm, Sat9.30am-4pm: £020/7938 3999).

North America

Canadian Society for International Health, 1 Nicholas St. Suite 1105, Ottawa. ON K1N 7B7 613/241-5785. Distributes a free pamphlet, Health Information tor Canadian Travellers, containing an extensive list of travel health centres in Canada.

Centers for Disease Control 1600 Clifton Rd NE, Atlanta, GA 30333 404/639-3311. Publishes outbreak warnings, suggested inoculations, precautions and other background information for travellers. The website is very useful, as well as their international Travelers Hotline: (1/888-232-3228. International Association for Medical Assistance to Travellers (IAMAT), 417 Center St, Lewiston, NY

Below are items you might want to take, especially if you’re planning to go trekking -all are available in India itself, at a fraction of what you might pay at home:

Antiseptic cream, Insect repellent and cream such as, Anthisan for soothing bits, Plasters/band aids ,A course of Flagyl antibiotics ,Water sterilization tablets or water purifier ,Lint and sealed bandages , Knee supports ,Imodium (Lomotil) for emergency diarrhea treatment ,A mild oral anesthetic such as Bonjela for soothing ulcers or mild tooth the, Paracetamol/aspirin ,Multi-vitamin and mineral tablets, Rehydration sachets ,Hypodermic needles and sterilized skin wipes.

tion. Be fussier than usual about sharing things like drinks and cigarettes, and never share a razor or toothbrush. It is also inadvisable to go around barefoot - and best to wear flip-flop sandals even in the shower.

Advice on avoiding mosquitoes is offered under “Malaria” below. If you do get bites or itches try not to scratch them: it’s hard, but infection and tropical ulcers can result if you do. Tiger bairn and even dried soap may relieve the itching.

Finally, especially if you are going on a long trip, have a dental check-up before you leave home - you don’t want to go down with unexpected tooth trouble in India. If you do, and it feels serious, head for Delhi, Mumbai or Calcutta, and ask a foreign consulate to recommend a dentist,

A lot of visitors get ill in India, and some of them get very ill. However, if you are careful, you should be able to get through the country with nothing worse than a mild dose of “Delhi belly", an almost obligatory introduction to the country. The important thing is to keep your resistance high and to be very aware of health risks such as poor hygiene, untreated water, mosquito bites and undressed open cuts.

What you eat and drink is crucial: a poor diet lowers your resistance. Ensure you eat a balance of protein, energy, vitamins and minerals. Meat and fish are obvious sources of protein for non-vegetarians in the West, but not necessarily in India: eggs, pulses (lentils, peas and beans), rice and curd are all protein sources, as are nuts. Overcooked vegetables lose a lot of their vitamin content; eating plenty of peeled fresh fruit helps keep up your vitamin and mineral intake. With all that sweating, too, make sure you get enough salt (put extra on your food) and drink enough water. It’s also worth taking daily multi-vitamin and mineral tablets with you. Above all, make sure you eat enough - an unfamiliar diet may reduce the amount you eat - and get enough sleep and rest: it’s easy to get run down if you’re on the move a lot, especially in a hot climate.

It’s worth knowing, if you are ill and can’t get to a doctor that almost any medicine can be bought over the counter without a prescription.

Rough Guides now offers its own travel insurance customized for our readers by a leading UK broker and backed by a Lloyd’s underwriter. It’s available for anyone, of any nationality or age, travelling anywhere in the world.

There are two main Rough Guide insurance plans: Essential for basic, no-frills cover (£23.03 worldwide) for two weeks; and Premier- with more generous and extensive benefits (£28.79 worldwide). Alternatively, you can take out annual multi-trip insurance which covers you for any number of trips throughout the year (with a maximum of 60 days for any one trip) at £83.99 (worldwide). Unlike many policies, the Rough Guides schemes are calculated by the day, so if you’re travelling for 27 days rather than a month, that’s all you, pay for. If you intend to be away for the whole year, the Adventurer policy will cover you for 365 days from £160 (worldwide excluding USA and Canada) and £200 (worldwide including USA and Canada). Each plan can be supplemented with a ‘Hazardous Activities Premium” if you plan to indulge in sports considered dangerous, such as trekking, mountaineering, skiing or scuba-diving.

For a policy quote call the Rough Guide Insurance Line on UK freefone -7,0800 015 0906, US reefing 1-866/220 558 or, if you’re calling from outside Britain, on (S44/1243 621 046). ascertain whether benefits will be paid as treatment proceeds or only after return home, and whether there is a 24-hour medical emergency number. When securing baggage cover, make sure that the per-article limit - typically under £500 equivalent - will cover your most valuable possession.

If you need to make a claim, you should keep receipts for medicines and medical treatment and, in the event you have anything stolen, you must obtain an official police report. Bank and credit cards often have certain levels of medical or other insurance included; you may automatically get travel insurance if you use a major credit card to pay for your trip. Keep photocopies of everything you send to the insurer and don’t allow months to elapse before informing them. Write immediately and tell them what’s happened; you can usually claim later.

If you have a good all-risks home insurance policy it may cover your possessions against loss or theft even when overseas. Many private medical schemes such as BUPA or PPP also offer coverage plans for abroad, including baggage loss, cancellation or curtailment and cash replacement as well as sickness or accident.

Travellers from the US and Canada should carefully check their current insurance policies before taking out a new one. You may discover that you are already covered for medical and other losses while abroad. Holders of (SIC cards are entitled to be reimbursed for $3000-worth of accident coverage and sixty days of inpatient benefits of up to $100 a day for the period the card is valid.

In the light of the potential health risks involved in a trip to India - see opposite - travel insurance is too important to ignore. In addition to covering medical expenses and emergency flights, it also insures your money and belongings against loss or theft. A typical travel insurance policy usually provides cover for the loss of baggage, tickets and - up to a certain limit - cash or cheques, as well as cancellation or curtailment of your journey. Most of them exclude so-called dangerous sports unless an extra premium is paid: in India this can mean trekking, mountaineering, skiing, Whitewater rafting and scuba-diving, though probably not Jeep safaris.

Read the small print and benefits tables of prospective policies carefully; coverage can vary wildly for roughly similar premiums. Many policies can be chopped and changed to exclude coverage you don’t need - for example, sickness and accident benefits can often be excluded or included at will. If you do take medical coverage,

Mapland, 372 Little Bourke St, Melbourne, VIC3000 03/9670 4383

The Map Shop 16a Peel St, Adelaide. SA 500008/8231 2033

Perth Map Centre 884 Hay St, Perth, WA 6000308/9322 5733

Speciality Maps 58 Albert St. Auckland 3)09/307 2217

Travel Bookshop Shop 3,175 Liverpool St, Sydney, NSW 2000 302/9261 8200

Worldwide Maps and Guides 187 George St. Brisbane, OLD 4000 07/3221 4330

Mapworld, 173 Gloucester Street, Chnstchurch 303/374 5399, fax 03/374 5633,