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MEXICO
- HEALTH |
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It's always easier to become
ill in a foreign country
with a different climate,
different food and different
germs, still more so in a
poor country with lower
standards of sanitation than
you might be used to. Most
travellers, however, get
through Mexico without
catching anything more
serious than a dose of
Montezuma's Revenge. You
will still want the security
of health insurance, but the
important thing is to keep
your resistance high and to
be aware of the health risks
linked to poor hygiene,
untreated water, mosquito
bites, undressed open cuts
and unprotected sex.
What you eat and drink is
crucial: a poor diet
lowers your resistance. Be
sure to eat enough of the
right things, including a
good balance of protein
(meat, fish, eggs or beans,
for example), carbohydrates,
vitamins and minerals.
Eating plenty of fibre helps
to avoid constipation, while
peeled fresh fruit will keep
up your vitamin and mineral
intake although it might be
worth taking daily
multivitamin and mineral
tablets with you. It's also
important to eat enough - an
unfamiliar diet may reduce
the amount you eat, drink
plenty of fluids and get
enough sleep and rest, as
it's easy to become run-down
if you're on the move a lot,
especially in a hot climate.
The lack of sanitation
in Mexico is often
exaggerated, and it's not
worth being obsessive about
it or you'll never enjoy
anything. Even so, a degree
of caution is wise - don't
try anything too exotic in
the first few days, before
your body has had a chance
to adjust to local microbes,
and avoid food that has been
on display for a while or
not freshly cooked. You
should also steer clear of
salads and peel fruit before
eating it. Avoid raw
shellfish, and don't eat
anywhere that is obviously
dirty (easily spotted, since
most Mexican restaurants are
scrupulously clean) - street
stalls in particular are
suspect.
Vaccinations
There are no required
inoculations for Mexico,
but it's worth visiting
your doctor at least four
weeks before you leave to
check that you are
up-to-date with tetanus
, typhoid and hepatitis
A jabs. Those
travelling from the USA or
Canada will have to pay
for inoculations,
available at any
immunization centre or at
most local clinics. Most
GPs in the UK have a
travel surgery where you
can get advice and certain
vaccines on prescription,
though they may not
administer some of the
less common immunizations.
Travel clinics can be more
expensive, but you won't
need to make an
appointment. In Australia
and New Zealand,
vaccination centres are
less expensive than
doctors' surgeries. Most
clinics will also sell
travel-associated
accessories, including
mosquito nets and
first-aid kits.
Intestinal troubles
Despite all the dire
warnings, a bout of diarrhoea
("Montezuma's
Revenge", or simply turista
as it's invariably known
in Mexico) is the only
medical problem you're at
all likely to encounter.
No one, however cautious
they are, seems to avoid
it altogether, largely
because there are no
reliable preventive
measures. It's caused by
the bacteria in Mexican
food, which are different
from (as well as more
numerous than) those found
in other Western diets,
and is compounded by the
change in diet and
routine.
If you go down with a
mild dose of the runs
unaccompanied by other
symptoms, this will
probably be the cause. If
your diarrhoea is
accompanied by cramps and
vomiting, it could be food
poisoning of some
sort. Either way, it will
probably pass of its own
accord in 24-48 hours
without treatment. In the
meantime, it's essential
to replace the fluid and
salts you're losing, so
drink lots of water with
oral rehydration salts
- suero oral (brand
names: Dioralyte,
Electrosol, Rehidrat). If
you can't get these,
dissolve half a teaspoon
of salt and three of sugar
in a litre of water. Avoid
greasy food, heavy spices,
caffeine and most fruit
and dairy products; some
say bananas, papayas,
guavas and prickly pears
(tunas) are a help, while
plain yogurt or a broth
made from yeast extract
(such as Marmite or
Vegemite, if you happen to
have some with you) can be
easily absorbed by your
body when you have
diarrhoea. Drugs like
Lomotil or Imodium plug
you up - and thus
undermine the body's
efforts to rid itself of
infection - but they can
be a temporary stop-gap if
you have to travel. If
symptoms persist for more
than three days, or if you
have a fever or blood in
your stools, you should
seek medical advice.
Malaria and dengue fever
Malaria, caused by
a parasite that lives in
the saliva of Anopheles
mosquitoes, is endemic in
some parts of Mexico.
Areas above 1000m (such as
the capital) are
malaria-free, as are Cancún,
Cozumel, Isla Mujeres, and
all the beach resorts of
the Baja and the Pacific
coasts. Daytime visits to
archeological sites are
risk-free, too, but
low-lying inland areas can
be risky, especially at
night. It's a good idea to
take chloroquine (brand
names: Nivaquin, Resochin,
Avloclor, Aralen),
starting one week before
you arrive and continuing
for a month afterwards.
Chloroquine is unsuitable
for sufferers of various
complaints such as
epilepsy and psoriasis but
daily proguanil (brand
name Paludrine) can be
used in its place.
If you go down with
malaria, you'll probably
know. The fever, shivering
and headaches are like
severe flu and come in
waves, usually beginning
in the early evening.
Malaria is not infectious,
but can be dangerous and
sometimes even fatal if
not treated quickly. If no
doctor is available, take
600mg of quinine sulphate
three times daily for at
least three days, followed
by three Fansidar
(available from a local
pharmacy) taken together.
The most important
thing, obviously, is to
avoid mosquito
bites. Though active from
dusk till dawn, female
Anopheles mosquitoes
prefer to bite in the
evening. Wear long
sleeves, skirts or
trousers, avoid dark
colours, which attract
mosquitoes, and put
repellent on all exposed
skin, especially feet and
ankles, which are their
favourite targets. Plenty
of good brands are sold
locally, though health
departments recommend
carrying high-DEET brands
available from travel
clinics at home. An
alternative is to burn
coils of pyrethrum incense
such as Raidolitos (these
are readily available and
burn all night if whole,
but are easy to break in
transit). Sleep under a
net if you can - one that
hangs from a single point
is best (you can usually
find a way to tie a string
across your room to hang
it from). Special mosquito
nets for hammocks are
available in Mexico.
Another illness spread
by mosquito bites is dengue
fever , whose symptoms
are similar to those of
malaria, plus a headache
and aching bones.
Dengue-carrying mosquitoes
are particularly prevalent
during the rainy season
and fly during the day so
wear insect repellent in
the daytime if mosquitoes
are around. The only
treatment is complete
rest, with drugs to
assuage the fever.
The water
In a hot climate and at
high altitudes, it's
essential to increase water
intake to prevent
dehydration. Most
travellers, and most
Mexicans if they can, stay
off the tap water,
although a lot of the time
it is in fact drinkable,
and in practice impossible
to avoid completely: ice
made with it, unasked for,
may appear in drinks,
utensils are washed in it,
and so on.
Most restaurants and
licuaderías use purified
water (agua purificada),
but always check; most
hotels have a supply and
will often provide bottles
of water in your room.
Bottled water (generally
purified with ozone or
ultraviolet) is widely
available, but stick with
known brands, and always
check that the seal on the
bottle is intact since
refilling empties with tap
water for resale is not
unknown (carbonated water
is generally a safer bet
in that respect).
There are various
methods of treating
water while you are
travelling, whether your
source is from a tap or a
river or stream. Boiling
it for a minimum of five
minutes is the time-honoured
method, but it is not
always practical, will not
remove unpleasant tastes,
and is a lot less
effective at higher
altitudes - including much
of central Mexico, where
you have to boil it for
much longer.
Chemical
sterilization , using
either chlorine or iodine
tablets or a tincture of
iodine liquid, is more
convenient, but chlorine
leaves a nasty aftertaste
(though it can be masked
with lemon or lime juice),
and is not effective in
preventing such diseases
as amoebic dysentery and
giardiasis. Pregnant women
or people with thyroid
problems should consult
their doctor before using
iodine sterilizing tablets
or iodine-based purifiers.
Inexpensive iodine removal
filters are available and
are recommended if treated
water is being used
continuously for more than
a month or is being given
to babies.
Purification ,
involving both filtration
and sterilization, gives
the most complete
treatment. Portable water
purifiers range in size
from units weighing as
little as 60g, which can
be slipped into a pocket,
up to 800g for carrying in
a backpack. Some of the
best water purifiers on
the market are made in
Britain by Pre-Mac. For
suppliers worldwide
contact:
Pre-Mac International
Ltd, Unit 5, Morewood
Close, Sevenoaks, Kent
TN13 2HU (tel
01732/460333, fax 460222; www.pre-mac.com
).
Bites and stings
Biting insects can
be a nuisance. These
include bed bugs,
sometimes found in cheap
hotels - look for squashed
ones around the bed.
Sandflies, often present
on beaches, are only
small, but their bites,
usually on feet and
ankles, itch like hell and
last for days. Head or
body lice can be picked up
from people or bedding,
and are best treated with
medicated soap or shampoo.
Scorpions are
mostly nocturnal and hide
during the heat of the day
under rocks and in
crevices, so poking around
in such places when in the
countryside is generally
ill-advised. If sleeping
in a place where they
might enter (such as a
beach cabaña), shake your
shoes out before putting
them on in the morning,
and try not to wander
round barefoot. The sting
of some scorpions is
dangerous and medical
treatment should always be
sought - cold-pack the
sting in the meantime. Snakes
are unlikely to bite
unless accidentally
disturbed, and most are
harmless in any case. To
see one at all, you need
to search stealthily -
walk heavily and they will
usually slither away. If
you do get bitten or
stung, remember what the
snake or scorpion looked
like (kill it if you can),
try not to move the
affected part, and seek
medical help: antivenins
are available in most
hospitals.
Heat and altitude
problems
Two other common causes of
health problems are altitude
and the sun . The
solution in both cases is
to take it easy.
Especially if you arrive
in Mexico City, you may
find any activity
strenuous, and the thin
air is made worse by the
number of pollutants it
contains. Allow yourself
time to acclimatize. If
going to higher altitudes
(climbing Popocatépetl,
for example), you may
develop symptoms of Acute
Mountain Sickness (AMS),
such as breathlessness,
headaches, dizziness,
nausea and appetite loss.
More extreme cases may
cause vomiting,
disorientation, loss of
balance and coughing up of
pink frothy phlegm. The
simple cure - a slow
descent - almost always
brings immediate recovery.
Tolerance to the sun,
too, takes a while to
build up: use a strong sun
screen and, if you're
walking during the day,
wear a hat or keep to the
shade. Be sure to avoid
dehydration by drinking
enough (water or fruit
juice rather than beer or
coffee and you should aim
to drink at least three
litres a day), and don't
exert yourself for long
periods in the hot sun. Be
aware that overheating can
cause heatstroke ,
which is potentially
fatal. Signs are a very
high body temperature
without a feeling of
fever, accompanied by
headaches, disorientation
and even irrational
behaviour. Lowering body
temperature (a tepid
shower, for example) is
the first step in
treatment.
Less serious is prickly
heat , an itchy rash
that is in fact an
infection of the sweat
ducts caused by excessive
perspiration that doesn't
dry off. A cool shower,
zinc oxide powder and
loose cotton clothes
should help.
HIV and AIDS
Over 40,000 cases of AIDS
( SIDA ) have been
reported in Mexico, mostly
in the centre of the
country, and especially in
the capital. It is
estimated that a further
200,000 people are HIV
positive. While the
problem in Mexico is no
worse than in many other
countries, it is still a
risk and you should take
all the usual precautions
to avoid contracting it.
In particular, to
contemplate casual sex
without a condom would be
madness - carry some with
you (preferably from home;
if buying them in Mexico,
check the date and
remember that heat affects
their durability) and
insist on using them. They
will also protect you from
other sexually transmitted
diseases.
Should you need an
injection or transfusion,
make sure that the
equipment is sterile (it
might be worth bringing a
sterile kit from home);
any blood you receive
should be screened, and
from voluntary rather than
commercial donor banks. If
you have a shave from a
barber, make sure a clean
blade is used, and don't
submit to processes such
as ear-piercing,
acupuncture or tattooing
unless you can be sure
that the equipment is
sterile.
Hepatitis and other
diseases
Hepatitis A is
transmitted through
contaminated food and
water, or through saliva,
and thrives in conditions
of poor hygiene. It can
lay a victim low for
several months with
exhaustion, fever and
diarrhoea, and can even
cause liver damage. The
Havrix vaccines have been
shown to be extremely
effective; though
expensive (around US$150/£100
for a course of two
shots), if you have a
second shot within a year,
protection lasts for ten
years. Gamma globulin
vaccines are no longer
used as they are blood
products and there are
concerns with regard to
the transmission of new
variant CJD.
Symptoms by which you
can recognize hepatitis
include a yellowing of the
whites of the eyes,
general malaise, orange
urine (though dehydration
can also cause this) and
light-coloured stools. If
you think you have it,
avoid alcohol, try to
avoid passing it on, and
get lots of rest. It's a
good idea to go to a
pathology lab (most towns
have them) to get blood
tests before seeing a
doctor, who should then be
consulted in order to
monitor your recovery.
More serious is hepatitis
B , which is extremely
contagious and passed on
like AIDS through blood or
sexual contact. Doctors
advise hepatitis B
vaccinations for people
going on trips of over
eight weeks and they are
vital if you're planning
to work in a medical
setting or with children.
Ideally three doses are
given over six months but
if time is short, there
are other options which
take one-two months with a
booster given after a
year.
Typhoid and cholera are
spread in the same way as
hepatitis A. Typhoid
produces a persistent high
fever with malaise,
headaches and abdominal
pains, followed by
diarrhoea. Vaccination can
be by injection or orally,
but the oral alternative
is less effective, more
expensive and only lasts a
year, as opposed to three
for a shot in the arm. Cholera
appears in epidemics
rather than isolated cases
- if it's about, you
should know. It is
characterized by sudden
attacks of watery
diarrhoea with severe
cramps and debilitation.
The vaccination is no
longer given anywhere as
it is ineffective.
Immunizations against mumps
, measles , TB
and rubella are a
good idea for anyone who
wasn't vaccinated as a
child and hasn't had the
diseases. You don't need a
shot for yellow fever
unless you're coming from
a country where it's
endemic (in which case you
need to carry your
vaccination certificate)
and the polio vaccine is
no longer necessary as the
disease has been
eradicated from the
Americas.
Rabies exists in
Mexico and the rabies
vaccine is advised for
anyone who will be more
than 24 hours away from
medical help. The best
advice is simply to give
dogs a wide berth, and not
to play with animals at
all, no matter how cuddly
they may look. A bite, a
scratch or even a lick
from an infected animal
could spread the disease -
rabies is invariably fatal
once symptoms appear so if
you are bitten, assume the
worst and get medical help
as quickly as possible.
While waiting, wash any
such wound immediately but
gently with soap or
detergent and apply
alcohol or iodine if
possible. If you decide to
get the vaccination,
you'll need three jabs
spread over a four-week
period prior to travel.
Getting medical help
For minor medical
problems, head for the farmacia
- look for a green cross
and the Farmacia sign.
Pharmacists are
knowledgeable and helpful,
and many speak some
English. They can also
sell drugs over the
counter (if necessary)
that are only available by
prescription at home. One
word of warning however:
in many Mexican pharmacies
you can still buy drugs
such as Entero-Vioform and
Mexaform, which can cause
optic nerve damage and
have been banned
elsewhere; it is not a
good idea, therefore, to
use local brands unless
you know what they are.
For more serious
complaints you can get a
list of English-speaking doctors
from your government's
nearest consulate; big
hotels and tourist offices
may also be able to
recommend someone. Every
Mexican border town has
hundreds of doctors
experienced in treating
gringos ( dentists
, too), since they charge
less then their colleagues
across the border. Every
reasonably sized town
should also have a state-
or Red Cross-run health
centre ( centro de
salud ), where
treatment is free.
Travellers' first-aid kit
The items you might want
to carry with you,
especially if you're
planning to go trekking,
are:
Antiseptic cream
Insect repellent
Hydrocortisone/calamine
lotion or any of the
creams specifically
designed to take the itch
out of insect bites
Plasters/band aids
Water sterilization
tablets or water purifier
Lint and sealed
bandages
Knee supports
A course of flagyl
antibiotics
Imodium (Lomotil) for
emergency diarrhoea
treatment
Paracetamol/aspirin
(useful for combating the
effects of altitude)
Multi-vitamin and
-mineral tablets
Rehydration sachet
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