domingo, 10 de marzo de 2013

Diseases, Vaccines and Hospitals

Vaccines and diseases

How many parasitic diseases are in India ? Am I at risk of getting sick? Should I get vaccinated befire I go? If I get sick, what I have to do?

I traveled for 10 years around India, accounting more than 60 months in the country, and since I studied parasitology in the university, I have been very interested and intrigued by the diseases of travelers.

We have not to get wrong: India is an unsafe country, with a system of zero wastewater treatment, with few sanitary facilities for the population. Epidemic spreads are frequent especially in monsoon season (June, July, August). They are the unsafer months for backpacking.

Should I not get vaccinated before I go? Of course (for legal reasons) you should always go to your doctor or better go to a hospital with Tropical Medicine department. They will put all the shots you need and give you advises.
I anyway give my opinion ( I get no responsabilities for that):

Worldwide, there are more than 300 parasitic,  bacterial and viral diseases, so it is impossible vaccination of all (in fact there are no vaccines for all).

Vaccines recommended for India (no mandatory):

-Typhus (and I have met two travellers with Salmonella Typhus in the mountains)
-Hepatitys A and B (E is more typical in India  but no vaccine) (A-B mix vaccine requires three shots, so you need a couple of months for full vactination)
-Rabia (the few street dogs in the pasta are florishing) The dogs in India, as regarded by tradition, are the reincarnation of thieves, so are hitted with sticks, are elusive and can bite if afraid  Be ware of them specially  in Varanasi, Jaipur, ... but in other areas is rare to see dogs.

Vaccination two days before going to India is a wrong practice. Vaccines will turn you a "little" sick and your defenses will be low, so you could get infected and ill starting the trip, along with the discomfort of getting tired and cancel the visits.

About prophylaxis for malaria (take strong medicines while traveling), I personally do not support them in India (is my opinion against the doctors and I am not responsible for your decision on the matter). Actually the danger usually comes with the arrival of monsoon (especially in June) as female mosquitos need blood instead sap to reproduct and then put the eggs in the mud and shallow ponds produced by the rains. In October, for example, mosquito bites are rare.
Indira Gandhi campaigned spraying DDT and drying the ponds in the 70s. Malaria was reduced from 100 million infected annually to anecdotal data.
As traveler we can get no risk, so please travel with a mosquito net or a big sheet sack: I usually buy a nice double cotton bed cover and fold it in two stitched.
I've only seen ill travelers from malaria (many very ill) comming back from the remote Andaman islands, and almost all of them were distracted by smoking joints lying on the hammocks watching the sunset while mosquitoes were bitting them continuosly. If you go to Andaman´s extreme the precautions and if you are not sure take profilaxis.
Also in the state of Bihar I have seen travelers with malaria (in Bodhgaya people want to meditate in the cooler evening, which is not a good idea).
Repellents do not usually work, the better are made with Citronella, and are sold in India named "Odomos", a cream with citronella to repel mosquitoes better than none you can buy back at home. It is nice to shower before sunset and apply the cream on ankles, wrists and neck, mosquitos usually bites more the two hours after sunset. Staying under the mosquito net in that time reading is not a bad idea.

The higher you go into the mountains the fewer mosquitoes you suffer.

What other diseases are usually  found:

The most typical among travelers is "Giardia". It is the number one among travelers, spreading it while moving from one place to another. It use to be treated with Tinidazole-metronidazole under medical prescription (causes nausea and bad feeling, even forbidden for pregnant women).
The symptoms for Giardia are very characteristic. The first days produces severe diarrhea as porridge with lots of gas and stomachache, after days it slow down and become chronic, it takes months to heal without medication and may not heal well, it is dangerous if gallbladder get infected.
By producing so much gas it embarrass the patient, not even seeking for help.
The person loses his appetite, because when you eat, after 20 minutes you starts to get nervous, start a discussion, you are altered in seconds, it goes fast, and suddenly felt a sharp pain in the mouth stomach and you must run to the bathroom, where it burst a strong fart and faeces fall like mashed potatoes ending with a disgusting feeling. After that the person is exhausted and just wants to rest. While passing the days the patient wants to eat less losing weight and may suffer a severe dehydration (very important to drink water and suck salt). This disease is responsible for travelers turn to slim figure so quickly in India ;)

To prevent Giardia, remember that like hepatitis A and E or Amebiasis (or cholera, typhoid, polio, etc) are diseases transmitted by faeces. The Indians wipe their ass after defecation with the left hand (impure) and some water. It's a shame not to use soap (could solve 80% of the diseases in India). If a person who has just defecated, touch your food and serve it to you, you are at great risk (and you will not know after a week). Many travelers are switch into indian "fashion" (one paper roll cost the same as a simple room), reinfecting themselves and their new friends. please use soap while washing properly your hands.

Bacterial and parasitic diseases should be treated as soon as possible with antibiotics or specific antiparasitic, so you should consult a doctor.

Viral diseases can not be treated (as the virus gets "inside" your cells), only the immune system can destroy them, and it takes days or weeks.
Hepatitis A and E are virus from faeces and contaminated food who damage the liver, only rest and eating zero fat diet and zero chemicals (colorants, preservatives, alcohol, drugs, etc.) can lead to a successful recovery of the damaged liver. I repeat: zero fat. (boiled rice with salt, boiled vegetables and potatoes, boiled lentils,bolied chickpeas, boiled chicken, tea, sugar, bread and tons of water, soy sauce can be added to the diet a few days later, fried is absolutlly forbiden), also zero oils zero fat, zero meat, zero fish, spices zero, zero eggs, zero butter, cheese, milk, coffee zero, zero alcohol, zero for almost everything!. You'll look like a model when after recovering.

As a resume: In India everybody have to worry and be cautious. Things to avoid: eating uncooked or unpeeled, food touched by dirty hands, always wash hands with soap before eating, avoid mosquitoes with mosquito net or sack odomos savanna and cream.
As a general rule in India eat in places craowded by locals instead the empty places near by. Queuing in India is a must, learn to be patient, is safer.

One last tip: if you have diarrhea, not take any medicines, let the body clean itself for one or two days (if no fever or other symptoms), drink plenty of water with salt and a some sugar (also if you put a squeeze of lemon to taste it you will just made a natural serum). If diarrhea persists on the third day, look for a doctor.


India is the largest producer on generic drugs and export thems to every country. The Ambani brothers (ninth planet's wealth), maintain their empire with the pharmaceutical industry.
So in India all medicines are very cheap , while those used in the domestic market are not the same quality as for export.
Only thing you will not find are sterile gauze and sterile bandages (take them from home).
For healing wounds takes: sterile gauze, oxigen water, betadine,bandages, strips, tweezers, a needle, a lighter.
Also: compressing bandages for sprains, paracetamol or ibuprofen for headaches, an antibiotic amoxicillin and metronidazole (need doctor's approval for both).


The Spanish insurance have proven over the years to be a scam for sure: you pay first and then we'll see, 50% end up in court to recover what you paid in advance for the Hospital. Think in India there is not a single representative of your insurance company, no one will come to help you, they have no idea about ​​the quality of the hospitals, and refuse to pay the hospital up front.
From other countries insurance policies seek advice from your own contry travellers.
In USA carry health insurance is almost mandatory, but hospitals in India are much cheaper than in Spain.
Public ones will attend you for free, charging only for medical tests (1 euro for radiography, for example 2008 price).
The private Hospitals vary greatly in price and quality.
A good hospital average price in Delhi is the .........................l (1km away from metro Karol Bagh), come from all over Asia for surgeries.
The famous Apollo Hospital for embassadors charges same prices as U.S.
There are good clinics (Fundations) in Manali, in Mc Leod (7 km), and more.
Public hospitals in Chandigarh and Jaipur are the best public India (somewhat dirty) Outside them you will be required to by sterilised syringes if needed.
There are small public hospitals throughout India, but most are terrifying, led by junior doctors, sent to the provinces and with little idea. They are good to seek advices , but do not even think to be internated in one of them (and do not authorize transfusions if you didnt take at least Hapatitis B vaccine), it is better and cleaner to be at a hotel and visit daily the hospital (in my opinion, take your own decisions or home doctor advices if you trust).

If you know other good hospitals in India do not hesitate to comment here.

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