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Travel health

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Over 1 million international visitors walk through the gates at Siem Reap airport every year but sadly not all have walked through the door of their travel health clinic. Recent literature shows that in 2010 only 36% of travellers visited a health professional for advice before setting off on their overseas adventure. It is highly important to us at Happy Kids Cambodia Inc. that anybody considering travelling to Cambodia and potentially visiting Jimmy's Village School, remain safe and in good health during their trip.

Siem Reap, where Jimmy's Village School is located, is in the north west of Cambodia. This region has a monsoon climate with three distinct seasons a rainy, a dry, and a cooler season. Temperatures don't often vary a great deal but intensity and duration of rain is what differentiates the seasons. The National Adaptation Program of Action (NAPA) has reported climate change is expected to increase frequency and intensity of floods causing a rise in the spread of vector-borne and water-borne diseases. 
This highlighting the need for all travellers to please visit an appropriately qualified travel health professional prior to your departure. 


Recommended Vaccines
P
lease speak to your treating doctor or travel health consultant about the following vaccines:
  • Hepatitis A
  • Hepatitis B
  • Typhoid
  • Tetanus, Whooping cough and diphtheria 
  • Measles, Mumps and Rubella
  • Chicken Pox
  • Influenza
  • Polio
  • Rabies 
  • Japanese Encephalitis 
  • Malaria (tablets)
How you catch the diseases
Contaminated food or water: Hepatitis A, Travellers diarrhoea Cholera and Typhoid 
Mosquito bites: Malaria, Dengue Fever and Japanese 
Encephalitis

Animals: Rabies
Contaminated soil: Tetanus
Human to human transmission: Influenza, Chickenpox, Measles, Mumps, Rubella, Hepatitis B, Hepatitis C, Sexually Transmitted Infections, Travellers Diarrhoea, Hand foot and mouth disease and HIV/AIDS.

**Please also keep in mind fungal infections are frequently reported due to humid conditions and intestinal parasites from undercooked meat  or bites on the skin from fresh water snails are common.

Malaria

Malaria is caused by a protozoan parasite and is transmitted from person to person by the bite of an anopheles mosquito during the hours of dusk until dawn. Malaria alone contributed to 42 000 deaths in South East Asia during 2012. There are several types of malaria in Siem Reap including plasmodium falciparum accounting for an occurrence rate of 86%, plasmodium vivax 12% and plasmodium malariae 2%. P.Falciparum, the most serious and often fatal, shows symptoms as soon as 14 days after the infectious bite and can easily be mistaken for symptoms of a common cold.  Similarly P.Vivax and P.Malariae, which are rarely fatal, can present with the same symptoms however travellers present anywhere from 12 days to months after travel. This is related to the fact that dormant liver stage parasites known as hypnozoites caused by P.Vivax and P.Malariae can reactivate causing relapses months or even years after the initial infection.

Signs and symptoms
  • fever
  • headache
  • back pain
  • vomiting
  • diarrhoea
  • cough 
  • abdominal cramps    

Unfortunately since the introduction of anti -malarial tablets, resistance especially in South East Asia has been noted therefore even if prophylaxis is followed diligently malaria may not be completely preventable. 
  
Current first-line anti malarial tablets for travellers to Cambodia include Atovaquone + Proguanil (250/100) daily for 1-2 days prior to leaving and 7 days post returning from malaria endemic areas. Alternatively, Doxycycline 100mg daily or Mefloquine 250mg once a week can be taken however these drugs require the traveller to continue taking the medication 4 weeks post leaving the malaria endemic area which has shown to be the stage when compliance decreases dramatically. 
**These drugs are recommended over others due to Chloroquine resistance in some parts of the world including Cambodia. 

Along with the mentioned anti-malarial drugs, travellers should be aware of personal protective measures that can decrease the risk of mosquito bites. 
  • USE repellents containing N-diethyl-3-methylbenzamide (DEET). 
  • WEAR long sleeved light coloured tops, pants and adequate footwear. 
  • SLEEP in air-conditioned areas or inside pyrethriod impregnated nets. 


Insurance
If you are seriously injured or ill, urgent healthcare may not be available to you especially in rural areas therefore its important to choose your insurance policy carefully to ensure it includes everything you may need. 


Importantly due to the healthcare system in Cambodia tourists that need specialised medical or dental care will likely need to be flown to Bangkok, so please ensure your policy covers Medical , Dental and Aeromedical Evacuation costs. 


We are unable to recommend one company over the next as everyones insurance needs are different but at a minimum ensure the policy includes medical evacuation. Please be aware that many insurance policies do NOT cover pregnancy, motorcycle accidents, speedboat accidents or injury resulting from high risk activities.


Travellers Diarrhoea 

If your travelling from a developed country to any developing country chances are you will experience travellers diarrhoea and Cambodia is no different. So... 

What is travellers diarrhoea (TD)? 
TD is defined as the presence of loose bowel motions on at least three occasions within a 24-hour period starting shortly after travelling overseas.  Enterotoxigenic E. coli (ETEC) is the most common cause of TD globally, however Camylobacter and Salmonella from eating undercooked meat are important contributors to the 20-50% of tourists experiencing TD whilst abroad.    


Lower sanitation and faecal-oral route transmission means behaviours such as hand hygiene (including the use of hand sanitiser where soap is not available) is paramount among other things. Importantly if you get diarrhoea don't stress. More often than not it is something that will be mild and pass by itself. Dehydration is the main danger and simple practices such as keeping up your fluids, avoiding alcohol, increasing hand hygiene and sticking to a bland diet will assist you in a speedy recovery. 

  1. Avoid tap water
  2. Avoid undercooked meat or fish, salad washed in tap water, ice and already peeled fruit 
  3. Avoid delicacies such as pig liver sausages or game meats.

     "Boil it, peel it, 
  cook it or forget it!"
 

Antibiotic therapy has been shown to decrease the duration and intensity of TD however keep in mind fluid replacement and some toilet time should be your first choice. IF however your stools are bloody or associated with a fever/confusion the Department of Health recommends you seek medical attention.

Medical Care
Health care in Cambodia unfortunately do not meet international standards. In Siem Reap there are only a few internationally run clinics and hospitals that are able to provide basic medical care. This highlighting the need to obtain comprehensive insurance cover prior to departing  from your country. Locally owned pharmacies supply over the counter medications however the quality can vary greatly so pack your medical kit at home. 


It is highly recommended that your medical kit contains things such as 
  • your regular medication, 
  • pain relief, 
  • antihistamines, 
  • cold and flu tablets, 
  • oral rehydration such as hydrolyse,
  • insect repellent containing DEET, 
  • sunscreen, 
  • anti fungal cream, 
  • water purification tablets, 
  • eye drops,
  • Ear drops and/or plugs
  • hand sanitiser, 
  • antiseptic cream, 
  • bandaids 
  • bandages.
Hospitals in Cambodia

Transport
Most commonly transport around Siem Reap is via tuk tuk, motorcycle, bicycle, sometimes cars or on foot. Due to increased poverty, safety features such as helmets, seat belts or maintenance of vehicles  is often overlooked increasing the risk of injury. Statistics show motorised vehicles are the number one killer of tourists overseas not only when they are on them but also when they are walking. Footpaths are often not maintained or non existent so pay attention to the traffic around you and remember outside of Australia pedestrians don't have right of way. 
Furthermore remembering to wear your seatbelt/helmet and choosing newer less crowded modes of transport may decrease your chance of injury.

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Useful links
  • World Health Organisation 
  • Lonely Planet 
  • Centre of disease Control and Prevention
  • Smart traveller 
Burwood Travel Clinic
Travel Doctor Melbourne
Siem Reap City map
Entry and Exit Requirements
You will need a valid passport and a tourist visa which usually lasts for 1 month after your arrival into Cambodia. These can be obtained at the airport or online for a small fee. If your planning to buy it at the airport make sure you take a passport sized photo with you. Please see link below for further details.

Visa Website
** please note this service is intended solely for the provision of travel health advice to the traveller gained from research to encourage engagement in pre-travel health services. Wanderlust Travel Medicine and affiliations does not accept liability for any DIRECT, INDIRECT, INCIDENTAL, SPECIAL or CONSEQUENTIAL DAMAGES, or LOST PROFITS that may result directly or indirectly from the use or inability to use the web site and/or any other web sites which are linked to this site. The information contained herein is neither intended to dictate what constitutes reasonable, appropriate or best care for any given health issue, nor is it intended to be used as a substitute for the independent judgment of a physician for any given health issue.**
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