FAQ (and not so FAQ)

Health

Most recent update: March 14, 2007

1.) What are the major health concerns in respect to diseases?
2.) What vaccinations should I get before traveling to Cambodia?
3.) Any advice on anti-malarials?
4.) Is there anything else I can do to protect myself from these illnesses?
5.) What's a good hospital?
6.) Is there any local health insurance available to foreigners?
7.) Is counterfeiting a problem with prescription drugs?
8.) Do I need a prescription to obtain drugs?
9.) What drugs are available over the counter?
10.) How about other drugs?
11.) Should I worry about SARS or bird flu?

NOTE: The answers to questions 1 - 4 were generously provided by Dr. Caroline Nixon, a British doctor and frequent visitor to Cambodia.

Q: What are the major health concerns in respect to diseases?

A:  People worry about catching exotic tropical diseases in Cambodia, but the commonest problems are traveller's diarrhoea, sunstroke, and dehydration. Of the tropical diseases, malaria is the chief concern. The only place that is free of malaria is Phnom Penh. Angkor IS a malarial area, though Ratanakiri and the Western provinces present a greater risk. Dengue fever is more common though less serious (but jolly unpleasant). There is a small risk of Japanese encephalitis and filariasis.

Q: What vaccinations should I get before traveling to Cambodia?

A: First make sure you are up to date for the standard things. like tetanus, diptheria and polio. Typhoid and hepatitis A are also recommended. Optionalextras for frequent or long stay travellers, especially if staying in rural areas, are rabies and Japanese encephalitis.

Q: Any advice on anti-malarials?

A: Firstly, make sure you get proper up to date medical advice from a doctor experienced in travel medicine. Secondly, remember that no antimalarial is 100% - so don't forget to protect yourself from mosquito bites even if you are taking them.

You have two choices of antimalarials for Cambodia. Most people take doxycycline. You need to take 100 mg daily from 2 days before you enter the malarial area until four weeks after you return. This drug is a tried and tested medication with a good safety record and is usually well tolerated. It can sometimes cause increased sensitivity to sunlight, but this is usually not a problem with common sense use of sunscreens. The worst side effect is indigestion and heartburn, which can be severe if taken on an empty stomach, or just before going to bed. It's best taken with a meal. Doxycycline should not be taken by children under 12, or by pregnant women. It can interact with the contraceptive pill, so get advice from your doctor if this is relevant.

Your other choice is the newer Malarone. This also needs to be taken daily, starting 2 days before entering the malarial area, and continuing for 7 days after. It is usually well tolerated, though can have gastrointestinal side effects. It's a newer drug in the malaria prevention repertoire, and reports are beginning to come in of other side effects such as sleep disorder. It is at present extremely expensive. Some people elect not to take antimalarials, relying on anti bite measures instead. Make sure you are fully acquainted with the risks before deciding on this strategy.

Q: Is there anything else I can do to protect myself from these illnesses?

A: Good hygiene will help a lot. Drink only bottled water, and use bottled water to clean your teeth. Wash your hands before eating; try and use restaurants that look reasonably clean. Fruit and vegetables should be washed or peeled. Only take ice in your drinks if it's the tubes or cubes - crushed ice may have been chipped off a big block of ice that has been kept in unsanitary conditions.

Protecting yourself against mosquito bites is crucial to prevent many of the diseases mentioned above. This means using an effective repellant (ie DEET, or one of the newer eucalyptus based products) day and night, and sleeping under a net, or in a screened room. Use a good sunscreen, cover your skin, try to get out of the sun during the hottest part of the day, and keep your fluid intake up.

HIV and hepatitis B & C are prevalent in Cambodia (over 40% sex workers are HIV positive) Transmission of these and other sexually transmitted diseases is reduced but not eliminated by the use of a condom .

For excellent and up to date advice about traveller's health issues, visit these web sites:

http://www.masta.org/about/index.html

http://www.cdc.gov/travel/

and specifically for Cambodia: http://wwwn.cdc.gov/travel/destinationCambodia.aspx

Q: What's a good hospital?

A: Bumrungrad is an excellent hospital. Too bad it's in Bangkok. But if you have a serious health problem Bangkok is the place you want to be.

Quality health care is available in Cambodia but it's not comprehensive and it tends to be quite expensive compared to Thailand. In Phnom Penh there is the Naga Intl Clinic (No. 11, Street 254, 011-811-175 and 012-767-505), SOS Clinic (023-215-811, near the old US embassy on street 51, aka $O$), Tropical & Travellers Medical Clinic (Dr. Gavin Scott - well versed on tropical illnesses and STDs and the like, No. 88, Street 108, 012-898-981), and the American Medical Center (Cambodiana Hotel, 023-991-863 and 012-891-613). The main hospital in Phnom Penh is Calmette Hospital which is best avoided, especially at night when staff can be particularly scarce and disinterested. Also, they will happily let you die on their doorstep if you lack the needed funds for your treatment.

In Siem Reap the brand new Angkor International Hospital claims to bring international health care to Cambodia. The hospital is owned and operated by the same company which owns BNH, Samitivej, and the Bangkok Hospitals, the first two of which are considered among the best in Thailand. I've seen the facility and it is certainly light years ahead of anything else in town but so too are the prices. Bring your insurance or bring your visa card. The hospital is located on Highway 6 near the airport turn-off.

The Naga Intl. Clinic seems to have been at least partially absorbed by the new hospital (same owners) though I did see a banner last week on an adjacent building so maybe they will continue to operate as a seperate entity.

The Le Srey Vina Clinic is a cheaper (and closer to town) option. It's owned by a western-trained Cambodian woman whose services have come in with favorable reports from expats, though you're most likely to be seen by one of her assistants.\

The Angkor Hospital for Children, as its name suggests, is geared for treating children, but in an emergency they'll fix you up as they can - $50 donation if it's a basic service, $100 if it's a more complicated matter.

The SOS Clinic in Phnom Penh has a doctor on-call in Siem Reap (023-216-911) and can handle evacuations.

The Kantha Bopha/Jayavarman VII charity childrens' hospitals do not treat foreigners or adults under ANY circumstances. Don't even try.

Stay away from the provincial hospitals. Even the staff tends to avoid them.

Evacuation to Bangkok is still the best course of action as I'm of the opinion (and an opinion which I am far from the only one promoting) that health care in Bangkok is one of the best bargains in the world. Bangkok is a place people are evacuated to not from. There are two hospitals I use, both of which offer services of an international standard at a cost which is a fraction of what one would pay in the USA. These hospitals are Bumrungrad Hospital on Sukhumvit Soi 3 and BNH Hospital on Soi Convent which is between Silom and Sathorn, the latter of which I entrusted with the birth of my first child in May 2005, and remains my preferred facility as it's a lot smaller and more personable than Bumrungrad. Samitivej is also an excellent hospital but located a little further down and out Sukhumvit Road.

If it matters to you, the downside is that these hospitals are private, for profit (Bumrungrad is listed on the Stock Exchange of Thailand) hospitals and despite their bargain fees (by US standards), are rather expensive by Thai standards and many Thais, not having insurance, cannot avail themselves of these facilities.

Q: Is there any local health insurance available to foreigners?

A: There are several companies offering expatriate health insurance in Cambodia. I don't know much of the details as their websites are useless, but one carrier is Forte Insurance. There was Indochine Insurance but the government-operated Caminco, under various err, strategies, forced them out of existence. If you opt for coverage with a Cambodia-based carrier make sure it covers evacuation and care in Thailand (or Singapore or Hong Kong) because if you have a major problem that's where you'll want to be.

I have insurance with a Thailand provider, BUPA/Blue Cross, which I pay about $1300 a year for my entire family - self, wife, and infanst son. And that's right $1300 a YEAR (not month)!!!, however some say it still does not offer enough coverage if I were to have a very serious problem and I really should be looking at a policy with premiums about double what I pay now. Still, it's better than nothing and does give me access to first class medical service in Bangkok, offers worldwide coverage, and includes a provision for emergency evacuation to Bangkok from Cambodia (or from anywhere). The main disadvantage is that the coverage is based on Thailand medical fees which are very cheap. Hence, when I have used medical services in Cambodia the insurance covered a smaller percentage of the fees than if I had received treatment in Thailand.

The one caveat with BUPA/Blue Cross is that it requires you to furnish an address in Thailand to receive coverage.

Q: Is counterfeiting a problem with prescription drugs?

A: Although there are counterfeit drugs floating around, most pharmacies in Cambodia (at least in Phnom Penh, Siem Reap, and other provincial capitals) dispense legitimate medication. If there's anything dodgy about the medication it's more likely how the medicine was obtained and how it's been stored rather than the medicine itself.

My advice, and a western doctor agreed it's reasonably sound advice, is that you do not accept any medication without inspecting all the packaging. Check the blister packs for a lot number and expiration date and than match these numbers with the numbers on the box. If a pharmacy tries to hand you a bag of pills with no packaging or disappears to the back to fill your order, refuse the drugs. I have seen counterfeit medication and it was almost ludicrous in its shoddy packaging - no lot numbers, no identifiable manufacturer, nothing.

In Siem Reap, the Psah Chas pharmacy has always been reliable. They are located directly opposite Psah Chas and just across the street from the Ivy Bar, two stores down from CD World. Don't confuse them with the other pharmacy in the middle of the block. Another well-stocked facility is the Preah Vihear pharmacy on Highway 6, north side, about a kilometer or so east of the stone bridge. There is also a whole line of pharmacies across the street from the Siem Reap Provincial Hospital, try Pharmacy Kanya first.

U-Care has a branch in Siem Reap near the Old Market and aside from having a generous supply of toiletries, they also are a well-stocked pharmacy. However, as U-Care is an international brand, I doubt they would be as liberal as many of the local pharmacies in distributing pain-killers or sedatives you might want.

In Phnom Penh there are several pharmacies on the block east of the south side of the Central Market that I've never had problems with, one in particular is called Vimon. A lot of expats use the pharmacy next to the Lucky Market on Sihanouk Blvd. The Pharmacie de la Gare on Monivong near the train station is a reputable business but they are probably the only place in Phnom Penh that tries to maintain some kind of western ethic in the dispensation of drugs and they won't hand over whatever pain-killers or sedatives you want (though just about any other place will).

Q: Do I need a prescription to obtain drugs?

A: Absolutely not. A vast majority of pharmacies will give you whatever you want no questions asked.

Q: What drugs are available over the counter?

A: Basically everything. Sedatives like Xanax and Valium are widely available. In the pain-killer department codeine is available with paracetamol (Tylenol) under various names, Codalgin, Dafalgan, etc. in 8 mg, 15 mg, and 30 mg sizes. Further up the line morphine sulfate is sold in time-release capsules, 10 mg, 30 mg, 60 mg are available, but it's relatively expensive compared to the codeine mixtures and not all pharmacies carry it. In recent times, some of those that do carry morphine have become more reluctant to dispense this drug unless they know you, but it's still not hard to track down. A seven-pack of 10mg capsules is $6 and a seven-pack of 30mg capsules is $17. A few pharmacies have in the past stocked liquid morphine and provided syringes to go with it. Codeine mixtures are quite readily available. A package of twenty Codalgin Forte (30 mg codeine with 500 mg paracetamol, similar to Tylenol 3) tablets is $2.50. Inquiries for oxycontin made at a number of pharmacies, including some of the more liberally-stocked stores, produced only puzzled looks followed by comments of "never heard of it, what is it?", or, "never seen it, but give me a few days, I'll find you some." Ketamine is another drug that was once fairly easily obtained at pharmacies, but has lately become more difficult to locate. Everybody's favorite drug, Viagra, is sold everywhere, prices between $7 and $10 per 100 mg pill. Cheaper generic versions of sildenafil citrate from India are also available. Watch for counterfeiting with Viagra. Viagra and its copycats are also available in many convenience stores... next to the condoms.

Q: How about other drugs?

A: Are you referring to stuff that's over the counter in the west or illegal stuff? Standard OTC stuff (cold remedies, aspirin, stuff for a bellyache, etc.) are easily found in pharmacies, supermarkets, and some convenience stores.

If it's illegal drugs you want, yes, they're here, too, and that question is addressed in the Miscellaneous and Legalities sections.

Should I worry about SARS or bird flu?

A: What are you, a friggin' imbecile or something? Why not worry about slipping in the bathtub, crashing your car, getting struck by lightning, having your neighbor's dog bite you on your rear, getting a blister on your finger, a corn on your toe, an abscess on your nose? Worry if there is or was life on Mars and what will the fundamentalists do? Worry about world peace and whirled peas, the right to bear arms and the right to arm bears. Worry about dark influences on your children, dark shadows in the night, dark rings under your eyes, dark days of summer's past. Worry about the rise in crime, the fall of the dollar, the rise of the tides, the fall of legends. Worry for your sins of youth and the transgressions of time slipped away. Worry about education reform, election reform, health care reform. But don't worry about SARS or bird flu. Unless you're a civet in China or a chicken in Vietnam.

That said, If the H5N1 virus does mutate it will reach every corner of the globe, so it won't matter whether your here of there. But that hasn't happened yet. In the meantime you are ten times more likely to catch the bubonic plague than bird flu. If you don't believe me you can look it up on the CDC or WHO websites and check the figures for the number of cases worldwide.

This also not to say we should dismiss the threat of H5N1, we should not. But the fact remains that HERE TODAY, there is no direct threat from bird flu and until this situation changes, there is no reason to stay away.

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