ABDF

Hi everybody!

I thought I’d write a few words (ha!) about some medical issues here, such a malaria, vaccinations, over-the-counter drugs, etc. I’m also tacking on some words about toiletries at the end.

I think that when we Westerns travel to the non-West, the biggest thing we’re scared of is malaria. There is justification in this, as it kills millions each year. But dealing with malaria is relatively simple, if you have the resources. As Westerners we do, so we can avoid it; the poor of the world don’t and that’s why they get it. When I was in Kenya, I saw malaria all the time, although I didn’t meet anyone who died of it. One of my volunteer group did get it, and suffered for a week in a hospital.

So there is the issue of malaria in Sri Lanka, and what to do about it.

The first thing is to asses the malaria situation here. I’m happy to say that there has been an ongoing anti-malaria program in Sri Lanka for some time now, and that it is proving quite successful. Last year (2007) only 119 cases were reported. Even if you assume only 50% of cases were reported, that’s still pretty good. This is nation-wide, and includes territory under Tiger control. In fact, health initiatives are the only area in which the government and the rebels cooperate and communicate; childhood immunizations, for example, have been very successful in both parts of the country, as has the eradication of polio, to name just a couple.

So the risk of actually contracting malaria is very low, but still exists. Therefore it’s up to each of us to decide what protective measures to take.

Of course the best way to avoid malaria is to not get bitten by mosquitoes. While impossible to do 100%, it’s easy to get 99% coverage.

For example, when you come here, bring mosquito repellent. It must have a DEET percentage of 60% or more; anything less doesn’t seem to work well. I use Jungle Juice, which is 99% DEET, and about $6 a bottle. DEET is hard on the skin, so my recommendation is to just get one bottle at first. Test a little on a patch of skin. You will inevitably feel a slight tingling or burning sensation. That’s normal. However, if you break out or anything, you’re allergic to DEET, so wash it off and don’t bother buying any more. Personally, when I use Jungle Juice, I use it on my arms and feet only, and cover up everything else. This makes the bottle last longer (about a month), and since my feet and arms has the toughest skin, less likely to do damage. The problem is that you can easily sweat repellent off, and unless you’re aware and regularly re-applying, you’ll get bitten. So it’s imperfect.

The other obvious measure is to cover up. Here in Sri Lanka, the mosquitoes are wimps. They don’t seem to be able to bite through even the thinnest of material (unlike in Kenya, where they were big and aggressive) so if you cover up with something, you’ll be fine. So I always wear a shirt. I also only wear pants, as my legs seem to be very tempting targets. My feet are the biggest attraction of all, perhaps because they are the sweatiest and smelliest part, and I’d say 90% of total insect bites (not just of mosquitoes) are on my feet. Therefore I wear socks a lot, which greatly amuses my Sri Lankan friends. As mosquitoes are most active at sunset and into the evening, I especially try to wear socks then. Since I’ve started wearing socks, the number of all kinds of insect bites has gone down to almost nil. So bring some socks.

I use a mosquito net at night, as you’ve probably read. You might want to consider bringing one. They don’t take up much luggage space and are light. Many hotels provide mosquito nets. Others, however, might not and so an extra one could prove handy. If you decide to get one, I recommend the tent-style ones. They only need one tie, whereas the rectangular ones need several. Get a double bed sized one, as its better too have too much netting than not enough. At REI they run about $35-40.

In the past year or so, I've noticed mosquito nets at Arpico, a Colombo superstore. There are branches all around town. The mostly have the big square canopy style nets that hang of a suspended frame, which isn't optimal when you're traveling about. But sometimes you can find the other types of net as well. They retail for up to 1,000 rupees (around $10) and so are much cheaper than what you can get in the States.

Now comes the controversial issue of malaria pills. They are prophylaxis only, and will help control any infection, but not cure it.

There are two ways to take the pills. One kind is taken daily, the other weekly. You have to start two weeks before your trip, take them regularly, and then for two more weeks after the trip is over. Their effectiveness is a bit limited, as malaria keeps evolving to survive the new drugs we throw at it. To be honest, I don’t know if any of the resistant forms have been found in Sri Lanka; I’m sure the info is on the internet.

Fansidar (I think I spelled it right) was once very effective but this has declined somewhat. I recommend you stay away from it, as it’s a sulpha drug, and many people are fatally allergic to sulphas.

I will confess that I don’t take the pills. There are a couple of reasons why this is less foolish than it sounds. First, I don’t know anyone here, local or foreign, who has ever contracted malaria. In Kenya, EVERYONE I met had contracted the disease several times by their mid-20s. Second, it’s easy to mess up on the pill taking, and if you forget and skip a dose, even if you resume right away, the overall protective effect is diminished. This is especially true with the weekly pill. And past experience has taught me that I’m lousy about remembering the pills. Third, the pills are way expensive. The last batch I bought was for my four months after the tsunami. At a discounted rate, it cost me over $600 for the weekly pill. Now perhaps with insurance it might be cheaper; I don’t know. The price between daily and weekly is negligible; per pill, the daily is cheaper, but you have to buy more of them. Lastly, although this doesn’t apply to me but it’s worth mentioning, some people are very allergic to the pills.

It’s a decision each of us has to make for ourselves. Me, I’m comfortable with mine, given the facts and statistics. I’m not going to advise you either way; it’s up to you.

While on the topic of meds, I’d like to briefly talk about what you should bring versus what you can get here if the need arises.

I suggest you bring some sort of sleeping aid. It will help you sleep on the plane to and fro. I also find I need them for a couple of days after arrival. This is because Sri Lanka is 13.5 hours ahead of my home state of California, and when its bed time, no matter how tired I may feel I just can’t get to sleep.

You are almost assured of getting the runs when you first arrive; I’m pleasantly surprised that I didn’t this time (2008). You might want to bring Imodium. It’s available here, but trust me, when it first hits you don’t want to spend time going to the pharmacy to get some. You want it NOW.

And heartburn medication, if you need it. Personally, I find my acid reflux disappears entirely; I have yet to take a single pill since my arrival. But everyone is different.

I have not seen Midol, or other similar menstruation medications, not that I’ve looked specifically. But just in case, I’d bring it from home.

They do not sell sunscreen in Sri Lanka, unless at the big tourists resorts. But I’ve never been to them.

Other than that all the basics are easily available here; headache meds, antibiotics (Panadol is the big brand here), stomach meds, etc. So are Band-Aides, bandages, and the like. Obviously, you should bring any drugs you may need if you have a specific medical condition; if any are prescription, bring a copy of the doctors’ prescription with you in case you are asked for proof that you’re allowed to have them.

Don’t overload yourself with meds. I did that when I first came here, not knowing what was available, and as a result I lugged around a very heavy sack full of all sorts of pills, bandages, salves, and the like, and after three months ended up leaving most of them behind, unused, when I returned to the States. So my advice for packing meds is the same as everything else; pack only what you need, and pack light.

On that theme, let me touch on toiletries, which are not meds but sort of related. The soap and shampoo here is fine; I’ve never tried the conditioner. Keep hair products to a bare minimum, and don’t bother with the hair dryer; you’ll find it a pain in the ass, and they have different current here anyway. The antiperspirant/deodorants are lousy, so bring your own. I haven’t tried the local toothpaste. Toilet paper is also widely available. Baby wipes are not, so bring ‘em if you want ‘em.

And while on the subject of the nether regions, a lady informant tells me that sanitary pads are available and up to Western standards, even having wings. She also reports that while tampons are available, they lack applicators. So be aware. Both products are available in larger chain stores such as Food City and Arpico, but if you're going to a rural area they could be hard to find; plan accordingly.

Well, that’s all I can think of offhand. If I forgot anything or you have questions, let me know.