INDOEX Logistic Bulletin: Health


General Information

Recent medical and dental exams should ensure that the traveler is in good health. Carry appropriate health and accident insurance documents and copies of any important medical records. It is adviseable to know your insurance policy regulations regarding air evacuation. Bring an adequate supply of all prescription and other medications including a spare pair of eyeglasses or contact lenses if necessary.

Although the water in the Maldives is derived from seawater desalination and rain water accumulation, it is advisable to drink only bottled beverages (including water) or beverages made with boiled water, and not to use ice cubes. Bottled water is readily available at local stores and hotels. Also, it is risky to eat raw seafood, rare meat or unpasteurized dairy products. Eat well-cooked foods while they are still hot and fruits that can be peeled without contamination. Avoid roadside stands and street vendors.

Swim only in well-maintained, chlorinated pools or ocean water known to be free from pollution. Wear clothing which reduces exposed skin and apply repellents containing DEET to remaining areas. Sleep in well-screened accommodations. Carry anti-diarrheal medication. Reduce problems related to sun exposure by using sunglasses, wide-brimmed hats, sunscreen lotions and lip protection. Drink a large amount of water to prevent dehydration.


Medical Facilities

Medical facilities are limited, and some medicine may be unavailable. The ADK Hospital, Henveiru, Soasun Magu, Male, phone: 31-3553 (10 lines); fax: 31-3554 seems to be more than adequate with regard to treating routine problems and capable of stabilizing a patient until medical evacuation is possible. Although doctors and clinics often require immediate cash payment for health services, ADK is willing to establish a billing system for Indoex project participants. Details of this arrangement will be developed and information made available in this Bulletin. (Indoex participants must make arrangements with their own health insurance providers to ensure coverage and billing details.) Medical insurance is not always valid outside one's own country. Supplemental coverage that specifically covers overseas treatment has proven useful in past experiments. Information on general health matters can be obtained from the U.S. Centers for Disease Control and Prevention at (+1) 404-332-4565, Internet: http://www.cdc.gov.


Specific Concerns

INDOEX participants who dive and who will also participate in research flights must be aware of elapsed time before and after dives. One of the resort islands, Bandos, does have a medical facility that is considered to be one of the best with regard to treatment of the "bends". They have a hyberbaric chamber and physicians who have had a great deal of experience with diving accidents. We hope not to take advantage of this facility.

Sun related problems including sunstroke, de-hydration, sunburns, etc.

Malaria -- very little to no risk in the Maldives.

Dengue Fever is a viral infection transmitted by mosquito bites. The mosquitoes are most active during the day, especially around dawn and dusk, and are frequently found in or around human habitations. The illness is flu-like and characterized by sudden onset, high fever, severe headaches, joint and muscle pain, and rash. The rash appears 34 days after the onset of fever. Dengue fever occurs sporadically in parts of the Maldives. Recently Sri Lanka has reported increased activity. The risk of infection is small for most travelers except during periods of epidemic transmission.

There is no vaccine for dengue fever therefore the traveler should avoid mosquito bites. Travelers should remain in well screened areas, use mosquito nets, and wear clothes that cover most of the body. Travelers should also take insect repellent with them to use on any exposed areas of the skin. The most effective compound is DEET (N,N-diethyl meta-toluamide), an ingredient in most insect repellents. However, DEET insect repellents containing DEET should always be used according to label directions and sparingly on children. Avoid applying high-concentration (greater than 35%) products to the skin, particularly on children, and refrain from applying repellent to portions of the hands that are likely to come in contact with the eyes and mouth. Pediatric insect repellents with 6-10% DEET are available. Toxic reactions or other problems have rarely developed after contact with DEET.

Travelers should also purchase a flying insect-killing spray to use in living and sleeping areas during the evening and night. For greater protection clothing and bednets can be soaked in or sprayed with PERMETHRIN, which is an insect repellent licensed for use on clothing. If applied according to the directions, permethrin will repel insects from clothing for several weeks. Portable mosquito bednets, repellents containing DEET, and permethrin can be purchased in hardware, back-packing, and military surplus stores.

TB, or tuberculosis, is a disease caused by bacteria called mycobacterium tuberculosis. The bacteria can attack any part of your body, but they usually attack the lungs. TB is spread through the air from one person to another. The bacteria are put into the air when a person with TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected.


Immunizations

These are recommendations not requirements. A final decision regarding immunizations will be based on the traveler's medical history, proposed itinerary, and duration of stay. We recommend that you consult with your personal physician regarding any immunizations.

Hepatitis A: Consider active immunization with hepatitis A vaccine or passive immunization with immune globulin (IG) for all susceptible travelers. Especially consider choosing active immunization for persons planning to reside for a long period or for persons who take frequent short-term trips to risk areas. The importance of protection against hepatitis A increases as length of stay increases. It is particularly important for persons who will be living in or visiting rural areas, eating or drinking in settings of poor or uncertain sanitation, or who will have close contact with local persons (especially young children) in settings with poor sanitary conditions. Note: There are two hepatitis A vaccines currently licensed in the United States: HAVRIX and VAQTA. For HAVRIX, adults (> 18 years) should be given two doses with the second dose administered 6 to 12 months after the first dose. For VAQTA, adults (> 17 years) should be given two doses with the second dose administered 6 months later. Travelers can be considered to be protected four weeks after receiving the initial vaccine dose.

Hepatitis B: Vaccination is advised for health care workers, persons anticipating direct contact with blood from or sexual contact with inhabitants, and persons planning extended stays of 6 months or greater (especially those who anticipate using local health care facilities, staying in rural areas, or having intimate contact with the local population).

Polio: A one-time booster dose is recommended for travelers who have previously completed a standard course of polio immunization. Refer to CDC guidelines for vaccinating unimmunized or incompletely immunized persons. Pregnancy is a relative contraindication to vaccination; however, if protection is needed, either IPV or OPV may be used, depending on preference and time available.

Typhoid: Vaccination should be considered for persons staying longer than 3Êweeks, adventurous eaters, and those who will venture off the usual tourist routes into small cities, villages and rural areas. Importance of vaccination increases as access to reasonable medical care becomes limited. Contraindications depend on vaccine type.


Requirements

Visitors to Maldives from Yellow Fever-infected areas should have a valid certificate against Yellow fever. Immunization against Cholera is not required. Some health authorities advise visitors to take preventive medication against malaria, but the incidence of malaria is extremely rare.


If you have questions or need clarification regarding information contained in these Bulletins, contact Ms. Diane Lask, JOSS, at (+1) 303-497-8684, lask@ucar.edu.


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Last modified: 17 August 1998