India (Frommer's, 4th Edition) (28 page)

VACCINATIONS
You will almost certainly be advised to be vaccinated against
hepatitis A,
cholera, tetanus,
and
typhoid;
also make sure your polio immunization is up to date. Longer-stay visitors should consider getting the hepatitis B and meningitis vaccinations as well. Note that travelers arriving from yellow fever–infected areas must have a yellow fever vaccination certificate.

PACKING A FIRST-AID KIT
Besides antidiarrheal medication, of which the most important are rehydration salts (available all over India as ORS—oral rehydration salts), it may be worthwhile to carry a course of antibiotics (such as Ciprofloxacin, which is widely available in India at a fraction of what you’ll pay back home) for
stomach-related illnesses.
It’s also worthwhile to take an antiseptic cream, and possibly an antibacterial soap (though the type of soap used matters less than vigilance: Wash your hands regularly, particularly before eating). Pack
prescription medications
in your carry-on luggage in their original containers with pharmacy labels, so they’ll make it through airport security. Also bring along copies of your prescriptions in case you lose your pills or run out (include the generic name; local pharmacists will be unfamiliar with brand names). Don’t forget an extra pair of contact lenses or prescription glasses or an extra inhaler.

COMMON AILMENTS

TROPICAL ILLNESSES
Besides malaria, India’s mosquitoes are also responsible for spreading untreatable dengue fever and virulent Japanese encephalitis. Again, the best advice is to avoid getting bitten in the first place. (See the tips below.)

MALARIA
Most doctors will advise you to take a course of antimalarial tablets, but as is the case elsewhere, the best prevention is not to get bitten. Malaria is a parasitic infection borne by the female Anopheles mosquito, and risks are greater in warm, wet areas (particularly during monsoon) and at night, when mosquitoes are at their most active. Cover all exposed skin with antimosquito creams (many effective creams are available in India) or sprays as evening approaches, and use repellent coils or electric plug-in mosquito repellents as a preventive measure at night, particularly in hotel rooms without air-conditioning. Note that some plug-in repellents can cause a mild throat irritation, in which case stick with creams. Wear loose, floppy clothes that cover as much skin as possible, but remember that mosquitoes sometimes do bite through thin clothing, so you may need to apply repellent on your clothes as well. Note that many travelers on antimalarial tablets suffer side effects including nausea, vomiting, abdominal pain, and even mild forms of psychosis and depression; ask your doctor to suggest an alternative antimalarial that you can take if you end up having serious side effects (but bear in mind that chloroquine is not an effective antimalarial for India).

SEXUALLY TRANSMITTED DISEASES & BLOOD INFECTIONS
Keep in mind that HIV and hepatitis B are transmitted not only through sexual contact, but by infected blood. This means that any procedure involving a used needle or a blade can be hazardous. Avoid getting tattoos or piercings, and steer clear of roadside barbers offering shaves (although we’ve noticed that many barbers do in fact use fresh, unused blades). For haircuts and procedures such as manicures and pedicures, stick to salons in upmarket hotels. Take the usual precautions if you are about to engage in any sexual activities—AIDS numbers are not well publicized, since the disease is widely associated with taboo and “anti-Indian behaviors,” but this is a huge and growing problem, and some doctors and NGO workers we have consulted suggest that India is on track to becoming the world’s worst-afflicted AIDS region.

DIETARY RED FLAGS & TUMMY TROUBLES
Many visitors to India fall victim to the ubiquitous “Delhi belly,” an unfortunate reaction to unfamiliar rich and spicy foodstuffs that can overwhelm the system and cause symptoms ranging from slight discomfort and “the runs” to extreme cases of nausea, fever, and delirium. To avoid this, simply be sensible. Adjust slowly; move on to spicy foods in small doses. You should also be on your guard about
where
you eat; if you have any fears at all, stick to the upmarket restaurants, usually those in five-star hotels—but do venture out to those recommended in this guide. Remember that uncooked vegetables or fruit can be hazardous if washed in water that has not been boiled, so peel all your own fresh fruit and avoid salads. Unless you’re in an upmarket hotel, don’t eat fruit that has already been cut—any water on the knife or on the skin of the fruit is likely to seep into the flesh. Be wary of undercooked meats—they may harbor intestinal worms—and stay away from pork unless you’re in a five-star hotel.

The first thing to bear in mind when diarrhea or nausea strikes is that your body is trying to cleanse itself, so only use an antidiarrhea medication (like Imodium) if you are desperate—about to embark on a long train journey, for example. Ideally, you should plan a few days of rest and cut back on all food except plain basics (a diet of boiled rice and bananas is ideal), and drink plenty of boiled water (or black tea) or bottled water with rehydration salts. If your tummy trouble doesn’t clear up after 3 to 4 days, consult a physician—you may be suffering from something more serious: a protozoa (amoeba or giardia) or a viral or bacterial infection.

WATER CONCERNS
More than anything else in India, the water is likely to make you ill. For this reason, you should not only avoid untreated drinking water, but be on your guard against any food product that is washed with water or has had water added to it. When buying tea (or
chai
) on the streets, for example, check that the cup is washed with hot water and even ask to dry it yourself—carry a small cloth or napkins so that you can remove any water from anything that is going to go into your mouth; alternatively, carry your own stainless steel cup everywhere you go. Use bottled water when you brush your teeth, and do not open your mouth in the shower. Do not have ice added to your drink unless you’ve been assured that it’s purified (as is typical of upmarket hotels and restaurants). Do be aware that in summer it is not uncommon for vendors selling
lassi
(a deliciously refreshing yogurt drink) to mix ice into their concoctions, and be exceptionally wary of enticing marketplace drinks such as freshly squeezed sugar-cane juice, which will be mixed with untreated water. If you purchase bottled water from roadside stalls, dodgy-looking shops, or small towns, check the seal on the cap and investigate the bottle for any signs of tampering. Also try to determine the age of the packaged water; if it looks like it’s been sitting on the shelf for too long, avoid it. The only exception to the bottled water rule may be if you are 100% sure the water has been boiled for 20 minutes, or if you have been assured that the water has been filtered or treated with reverse osmosis or some similarly effective process. Generally, where water is placed in your room in a jug or some such container it has indeed been treated and is drinkable. If you are in the slightest doubt, simply ask. The same goes for street food stalls in larger cities where there is awareness around the dangers of drinking untreated water—simply ask if the water is filtered or not. Remember not to clean wounds, cuts, or sores with tap water. Instead, douse and cleanse any open wound with antiseptic solution, cover it with an adhesive bandage, and consult a doctor if it doesn’t heal soon.
Note:
A large number of restaurants and hotels have begun to take the issue of plastic bottles and their impact on the environment very seriously. We all know and understand that water bottled in plastic is cause for environmental concern. We strongly suggest that you make an effort to cut down on the number of plastic bottles that make their way to India’s landfills (or rivers or valleys) by encouraging the use of treated water wherever possible—and give your support to businesses that do so.

BUGS, BITES & OTHER WILDLIFE CONCERNS
Remote areas are alive with insects and creepy-crawlies, but the greatest risk is malaria (see above). Wear shoes when trekking or in wet areas; you can be contaminated from worm-infested soil or mud, which can also be a source of microbial, bacterial, or hookworm infection. Leeches are a common problem in the rainforest regions. Do not try to pull them off your skin; dousing with salt does the trick. It’s possible to prevent this nasty experience by wearing special antileech “socks” and dousing your shoes with lime powder. You’re more likely to be bitten by a rabid dog or monkey than by a snake, spider, centipede, or sea creature, but it does occur: Wear thick trousers and boots when hiking, tread carefully, keep your eyes peeled, and in the unlikely event that you are bitten, try to get a good look at the animal so that medical staff knows what antivenin to use. And yes, get to a doctor or hospital as soon as possible. Animals are seldom treated as pets in India—as a general rule, steer clear of them, and should you be bitten, use antiseptic and consult a physician immediately.

Animal lovers beware:
India will horrify you if you have a real soft spot for animals. You will feel particularly sickened by the “dancing bears” in North India—sloth bears cruelly tethered and forced to perform for tourists—as well as severely malnourished dogs, feral cats, diseased pigs, and even cows, considered sacred, looking emaciated and chewing on plastic bags and cardboard for sustenance. If you can see someone to rant at, do, but for the most part you have to bear it.

RESPIRATORY ILLNESSES
The Indian health authorities have taken a relatively firm stance against illnesses such as H1-N1, but despite mandatory form-filling and cursory checks at airports, swine flu victims did turn up in various locations around the country. Authorities have implemented national campaigns to educate people around basic hygiene and preventative health measures to try to prevent the spread of mucus- and airborne bacteria and viruses, but it can be something of a losing battle in a country where throat clearing (often for phlegm) and spitting in public places can sometimes seems to be a national pastime. If you find yourself in enclosed spaces with groups of people, consider covering your mouth and nose with a cloth or handkerchief and wash your hands after making contact with any kind of surface, including someone else’s hands.

HIGH-ALTITUDE HAZARDS
We have flagged high-altitude concerns in the relevant chapters; if you are going into mountainous regions (particularly in the Himalayan regions like Ladakh and Spiti), be sure to acclimatize adequately (usually over 2 full days) and monitor your body for signs of illness (nausea, faintness of breath, dizziness, headaches). Avoid overexerting yourself and be cautious when consuming alcohol which tends to make a bigger impact at higher altitudes. Be sure to drink plenty of water as dehydration is anther symptom of high altitude sickness. Be aware that cooler temperatures at higher altitudes can make you oblivious to the heightened impact of the sun—take adequate precautions against sunburn (see below).

SUN/ELEMENTS/EXTREME WEATHER EXPOSURE
Carry high-SPF sunscreen and use it liberally. It’s also advisable to wear a hat or cap during the day, and try to avoid midday sun wherever possible. In the cities, pollution often cloaks the high-level exposure, so keep that hat on. Remember that in the high-altitude Himalayan regions, you can experience cold weather and chilly winds while being burnt to a cinder. During the monsoons, certain regions can become impossible to traverse because of flooding. Orissa, Tamil Nadu, and Andhra Pradesh are prone to cyclones in November and December. Keep abreast of conditions by following weather reports.

POLLUTION
Air pollution levels in many Indian cities are very high and contain high levels of suspended particulate matter. This is mostly from vehicles, but in places like Varanasi it is compounded by the use of diesel generators. The best thing to do is to always carry a cotton handkerchief with you to hold over your mouth and nose as a mask to breathe through until you are past the offending area. India is also plagued by noise pollution, and most visitors are usually shocked at how often drivers blare their horns. There’s really nothing you can do other than accept that honking is usually a necessary precaution to avoid smashing into people, stray dogs, cattle, and all kinds of other obstacles (including cars).

WHAT TO DO IF YOU GET SICK AWAY FROM HOME

Don’t panic. Medicines are widely and easily available in India. You can even describe your problem to your hotel concierge or receptionist and he or she will arrange for the necessary medication to be dropped off, doing away with possible translation problems. Pharmacies and pharmacists hand out pills and antibacterial medication upon request—even those that would require a prescription back home. (This is not always a good thing; if possible, consult a physician before resorting to over-the-counter drugs. Also beware of
being given incomplete courses of antibiotics.) There are hospital listings for major cities in each chapter, but it’s best to consult your hotel concierge regarding the best medical attention in town, particularly if you’re in a more remote area. In fact,
do not solicit the assistance of anyone who is unknown to your hotel.
Well-documented scams operating in certain tourist destinations involve prolonging your illness in order to attract large payouts from your insurance company. If you or someone you are traveling with needs hospitalization, shell out for a well-known private one, and if you’re able to travel, head for the nearest big city. Advise your consulate and your medical insurance company as soon as possible.