HEALTH TIPS FOR TRAVELLER IN MYANMAR

1. INTRODUCTION

2. GOOD FAITH HEALTH CARE SERVICES

3. MEDICAL SERVICES AROUND MYANMAR & EMERENCY SERVICES

4. INTERNATIONAL MEDICAL CENTRE

HEALTH TIPS FOR TRAVELLERS IN MYANMAR

(1) MICROBIAL AND VIRAL INFECTION

• DIARRHOEA

• VIRAL HEPATITIS

• INTESTINAL WORMS

• CREEPING ERUPTION

• TETANUS(Lock-Jaw) & DIPHTHERIA

• TYPHOID FEVER

(2) VECTOR BORNE DISEASES

• MALARIA

• DENGUE FEVER

• TYPHUS

(3) SEXUALLY TRANSMITTED DISEASES

(4) ANIMAL AND INSECT BITES

• RABIES

• SNAKE BITE

• SCORPION

• WASPS AND BEES

• CORAL AND CORAL FISH

(5) INJURIES FROM ACCIDENTS

• DRIVING

• SWIMMING

• SCUBA DIVING

(6) OTHER THINGS TO CONSIDER
 

HEALTH TIPS FOR TRAVELLER IN MYANMAR

1. INTRODUCTION

Travel in Myanmar presented very few health problems for some visitors. It is best to bear in mind that here as with any tropical climate, abundant of life forms, exit those not found in temperate regions,including viruses and bacteria as well as poisonous snakes nd fishes.

We have compiled this small booklet,aimed at helping you to beware and avoid unnecessary health problems during your stay in Myanmar.

Many people from allover the world visited Myanmar. Most of them usually feel full of joy and healthy after seeing the sights and sounds of golden land of Myanmar.A small number of visitors, however do experience problems such as.
(1) Microbial and Viral infections
(2) Animal and insect bites.
(3) Injuries from accidents.
(4) Coral cuts and bites from stinging fish
(5) Old age visitors with previously contracted with underlying illness-eg:coronary or cardiac diseases, lung diseases, renal problems with diabetes or hypertension.
 

2. GOOD FAITH HEALTH CARE SERVICES

Good Faith Health Care Services with its head office situated in Yangon, 2 (A) Thukhawaddy street, Yankin Township,Yangon. Good Faith Health Care Services has been founded with the aim of providing primary health care, proper treatment,preventive measures and paramedical support and in all cases of medical distress we provide emergency health care services in any part of Myanmar, with medivac assistance programme.

3. MEDICAL SERVICES AROUND MYANMAR & EMERGENCY SERVICES

Whenever you are in Myanmar, Our GFHCS is available to help you in any kind of medical distress.

A network of GFHCS branches can deal with all routine medical problems from free consultation to specialist referrals and emergency medivac. An experience medivac team is also available to rapidly transferring patients from regional hospitals to specialized hospitals with active first aid and rapid transfer. If local medical facilities are,considered inadequate, we will arrange medical evacuation to the nearest appropriate hospital or medical centre outside the Union of Myanmar, Bangkok or Sigapore. Our 24 hours emergency services telephone numbers are (95- 1) 579086,663840,703800.
 

4. INTERNATIONAL MEDICAL CENTRE

Repatriation of medivac patients if local medical facilities are considered inadequate.

In Thailand 
(1) Bangkok General Hospital (BGH)
(2) Vibhavadi General Hospital (VGH)
(3) Central General Hospital (CGH)

In Singapore
(1) Mount Elizabeth Hospital Ltd.


 

HEALTH TIPS FOR TRAVELLERS IN MYANMAR

(1) MICROBIAL AND VIRAL INFECTIONS

This group probably afflicts the greatest number of people, mainly from intestinal infections resulting in mild diarrhoea. More serious are viral infections like hepatitis, haemorrhagic fevers, or AIDS.Travellers coming from or going to rural areas need to beware of (Vector borne disease) like malaria and dengue fever.

1. DIARRHOEA

Travellers require considerable care to,avoid "diarrhoea". If you do succumb to diarrhoea, its intensity will depend on how much contaminated food or drinks you consumed. If you get the 'runs' after eating lunch at one place,its not a good idea to go back there again for dinner.

To Minimize Your Risk 

(1) Eat food served steaming hot and cooked to order rather than food left out on trays or in chafing dishes. Among fruits, choose those that have to be peeled (like oranges) rather than those you consume with the skin intact (like grapes). Avoid eating over-ripe fruits. Choose boiled water or clean purified water and juices. A variety of local foods are spicy and, if not properly cooked or left over uncleaned dishes will be the best way to contract diarrhoea.
(2) Avoid salads, uncooked fresh vegetables,and all shellfish.
(3) Microorganisms clinging to people's hands are a major source of contamination. Don't eat any thing that has touched your hands or those of anyone else.
(4) Beware of eating food from street stalls.

Clinical features may be greatly depending on the causes, duration, type of infection and severity of the diarrhoea.History include the time, place and other circumstances of onset associated with abdominal pain or vomiting.

In all cases, diarrhoea is only a symptom and the underlying disorder should be specifically treated if possible.

Should you get a persistant case of diarrhoea, remember to drink lots of fluids as dehydration is a particular problem. It can be very serious and a physician should be contacted to recommend rehydration salts.You should also contact a physician anytime you pass blood, severe diarrhoea or vomiting.

2. VIRAL HEPATTIS

There are six different strains of Hepatitis some very serious and non any fun.Hepatitis is a virus that affects the liver,causing its enlargement, sometimes resulting in liver failure. Symptoms include fever,chills, headache, fatigue, decreased appetite,tenderness in the upper right abdomen, dark urine, light coloured faeces, and yellowed skin or eyes. Left untreated victims can fall into a coma and die.

The two most common forms are called Hepatitis A and B. Hepatitis A is' spread through food and water contamination once again, uncooked or raw shellfish and seafood along with raw vegetables are the likely sources. Symptoms develop about one month after exposure to the virus. Hepatitis B is more serious than Hepatitis A, resulting in chronic liver disease. It is spread through blood transfer rather than by eating. This can happen during medical, surgical, or dental procedures, during immunization with improperly sterilized syringes. While being tattooed or having a shave,or through sexual contact.

3. INTESTINAL WORMS

Worms are common in Myanmar and are contracted by eating contaminated food. Make certain your food is well- cooked, that there is no red left in the meats you eat, particularly with beef and pork. Lightly cooked or raw fish is a primary source of the Chinese liver Fluke. Worms, live in their hosts for many years and left untreated, can cause anemia; really heavy infections can lead to cardiac arrest.

There are seveIal different varieties common; Hook worm, roundworm, beef and pork tapeworms, hydatid cysts and angiostrongylus cantonensis. Hydatid cysts are contracted by stroking dogs; the larval eggs adhere to the dog's fur. For hydatid cysts there is no reliable drug treatment; they must be surgically excised from the liver where they most often occur. For the other worms, drug treatment is available and effective but requires a stool sample examination.
 

4. CREEPING ERUPTION (Larva Migrans and Larva Currens)

Some hookworm larva are able to penetrate human skin but can develop no further .They cause a syndrome known as creeping eruption characterized by itchy, red,moving worm-shaped trails, usually on the feet and legs. Larva currens produce a similar rash on the backside.

The worms are contracted by walking barefoot above the high tide line on beaches fouled by dogs, or sitting in a wet bathing suit in areas contaminated by dog faeces.

5. TETANUS (LOCK-JAW) & DIPHTHERIA

Tetanus, a bacterial disease, is a leading cause of death in tropical countries.The bacterial spores are found almost everywhere and are nearly indestructible,but they pose no threat except in the presence of wounds. Once contracted, symptoms arise 7-14 days later; tetanus is usually fatal because treatment is difficult. Diphtheria is caused by a bacillus that lives in people's throats and it's most common manifestations are there and as skin ulcers. It is very serious a toxin produced by the bacillus can cause paralysis. These diseases are easily prevented, however, through immunization and by following careful hygiene. Wash out small wounds with hydrogen peroxide and in case of deep, dirty wounds or animal bites,go for an immunization booster shot. Beware of tatooing, ear piercing, chronic ulcers and ear infections, all of which are avenues of infection for tetanus; avoiding coughing strangers and keeping clean will usually prevent diphtheria.

6. TYPHOID FEVER

This acute generalized infectious disease is characterized by high fever,bradycardia, rose-colored eruption and abdominal pain. It is caused by a bacillus ingested with food or water. It is the prototype of the severe enteric, salmonella infections. Anyone with these symptoms is dangerously infected and should seek immediate medical help.

(2) VECTOR BORNE DISEASES (Malaria, Dengue Fever, Typhus )

Except for Typhus, which is rare, these diseases are endemic in Myanmar.Moreover, visitors from other areas sometimes can bring them here.

1. MALARIA

Malaria is caused by a very small parasite which can only be seen under the microscope. It is passed from one human to another by the bite of some types of female mosquitoes that are carrying the parasite.
When a mosquito bites a person with malaria parasite, it sucks up a mixture of blood and malaria parasites into its stomach.The parasites take several days to develop inside the mosquito. The mosquito can then pass on the disease when it bites another person.
The parasites live, grow and multiply in the person's blood. In the blood they destroy the red blood cells and make the person very ill, causing fever and weakness.Malaria is a very dangerous disease.Sometimes it may become so severe that the patient can die in a few days if not treated properly. For this reason it is very important that any patient with malaria should give the correct treatment, as early as possible,preferably as soon as the first attack of fever occurs but no later than 12-24 hours after.
Malaria is one of the top leading priority diseases in Myanmar. Malaria Control Programme of Myanmar has been adopted to be in line with that of "THE GLOBAL MALARIA CONTROL STRATEGY" There are high risk areas usually prevalent throughout the year. Ecology is forest fringe foot-hill/hilJyforest/ forest clear cultivated areas. Moderate risk areas,ecology is either coastal or plain area. Either primary or secondary vectors are prevalent.Low risk area, ecology is plain area where secondary vectors are prevalent.Symptoms include fever, chills,sweating, severe headache, and abdominal pains. If you have these symptoms see a physician right away. If the parasite gets into the brain, causing cerebral malaria which is very fatal.However, the best prevention is simply use a good mosquito repellent, avoid perfumes and scented aftershaves, wear light coloured long-sleeved shirts, long pants, and shoes. At night, sleep with mosquito net.

2. DENGUE FEVER

Dengue is endemic throughout the tropic and subtropic. This virus spread by the Aedes aegypti mosquito. Symptoms include high fever, headache, joint and muscle pains; it is sometimes called ,breakbone fever'. There is no vaccine and the only prevention is mosquito repellent.Dengue is not uncommon and almost never fatal to young people in good health, but for older people, children or those with chronic debilities hospitalization is advisable.
 

3. TYPHUS

All four varieties of typhus cause fever, headache, and skin rash, but intensity of symptoms vary according to type.Mountain trekkers may be at higher risk. The disease is spread by biting mites that cling to scrub vegetation in secondary forests.Trekkers walking through the bush should wear a thick and mite repellent such as dimethyl phthalate rubbed into the skin every four hours. Effective treatment is available if started early enough in the illness; there is no vaccination.Many serious, life-threatening diseases are spread by insects. The careful traveller will always keep a good repellent nearby. Those who experience reactions to familiar over-the -co~nter preparations should seek medical advice, as should those entering areas known to be hazardous.
 

(3) SEXUALLY TRANSMITTED DISEASES (STD) and AIDS

The best way to avoid contracting either STD or AIDS is to avoid sex with strangers. Failing that, use' a latex condom from a reputable manufacturer. Certainly,risk does not arise from prostitutes alone suffice to say, engaging in unsafe sexual practices is risky. Signs of STD include vaginal and penile discharges and genital ulcers. If you have any such symptoms seek medical assistance immediately and refrain from sex until you do.
 

(4) ANIMAL AND INSECT BITES

The principal risk here is rabies from dog bites, but other animal and insects pose a threat as well.

1. RABIES

The time interval between the first bite and onset is usually about two months but can vary from a few days to years. The initial symptom is itching, tingling, or pain at the site of the healed bite. This proceeds to headache, fever, spreading paralysis with episodes of confusion, aggression,hallucination, and hydrophobia, of an inability to drink water, after onset the infection is fatal. Fortunately the incubation period allows time for treatment, so if you are bitten by an animal or strange humans,seek medical advice. Avoid stray dogs and beware of unusually tame behavior in wild animals because this is one of the early signs of the disease. Pre-and post-exposure vaccinations are available.
 

2. SNAKE BITE

The most poisonous snakes in Myanmar are,
(1) Russell's Viper (vipera)
(2) Cobra
(3) Krait
(4) Sea Snake
(5) Green Snake

The commonest site of bite is the lower part of the leg and second is forearm.
Prevention of Snake Bite
When going out -
1. At all times in snake infested areas look where you are stepping or sitting.
2. Wear of protective boots whenever possible. Some forms of protection to the hands and feet must be worn such as gloves, boots or thick jute bandaging especially during farming activities.
3. Snakes are likely to be present in tall grass, thick bushes, rocky places over grown with weeds ancient pagoda ruins.
4. Adequate light is necessary to see snakes.Carry a torch when going out at night.
5. Carry a stick and hit the ground in front before advancing in order that the vibrations so produced will scare snakes away.
6. On encountering a snake never provoke it. Provocation will lead to the snake biting in self defense. It is safer to stay perfectly still or back away slowly .In most instances the snake will move off. King cobras may be exceptions because of their aggressive nature.
7. Do not tease others with a dead snake. It might not be dead.
8. Dead snakes must be handled carefully using instruments. Injury like punctures by fangs have been known to cause envenoming.

First Aid Treatment
(a) Reassurance of the patient
(b) Wash and wipe the area bitten
(c) Compression and immob-ilization of the bitten limb
(d) Intramuscular administration of antivenom

3. SCORPIONS

These are sometimes, though rarely, a danger. To the extent that they pose a threat,it's mostly common in forest and danger to Ecotorism. If you are stung, as with snakes,remain calm, immobilize the effected area and get to a physician as quickly as possible.

4. WASPS AND BEES

About one person in two-hundred is severely allergic to bee or wasp venom. In such cases a bee sting can be fatal. Those at risk will notice progressively serious and widespread reactions with each successive sting. If you are stung by a bee, scrap the stinger out with a knife or fingernail and avoid grasping the pouch as this will inject more venom. People who are severely allergic should carry an identifying tag in case they are found unconscious, and should always carry equipment for self-administration of epinephrine, which will relieve symptoms; they should see a doctor as soon as possible.

5. CORAL AND CORAL FISH

A great number of different life forms living in the coral reefs are poisonous; the stonefish is exceedingly so, and can be lethal.None of them are aggressive, however, so the best thing to do is look but don't attempt to play with or even to touch coral dwellers. If you inadvertently scratch yourself on coral,the wound will probably prove more severe than it looks. This is because coral has a poison that aggravates the wound, and not infrequently little pieces of coral break off and cause further infection. Treat any coral wound, however small, as a serious matter and visit a doctor if necessary.
 

(5) INJURIES FROM ACCIDENTS

Statistically speaking, the most dangerous activity you are likely to engage in while visiting Myanmar is simply driving.Far and away the largest number of emergency room cases are road related.

1. DRIVING
Aside from the fact that here, in Myanmar, we keep to the right lane: meaning that left turns are against traffic, there are other aspects of motor vehicle operation sometimes surprising to the visitor.

Don't Become Another Statistic!

If you drive here, try to bear in mind the following;
(1) Drive slowly. Most accident happen to drivers travelling in excess of 65 kph on the highway and 30kph in built up areas.At low speeds, a driver can cope with sudden changes in the traffic situation.Remember, the faster you go, the harder you crash, and the more serious your injuries. Most insurance policies do not cover injuries sustained in motorcycle accidents.
(2) As a matter of practical common sense,larger vehicles have right-of-way. This means that, if a dump truck pulls into your lane travelling in the opposite direction because he wants to pass slower traffic, you should pull to the right. Also, at intersections with traffic circles, vehicles in the intersection have right-of-way; you must stop and let them enter your lane.
(3) Use your rear-view and side mirrors frequently to monitor the situation behind, and along side and pull to the right for faster vehicles trying to over-take you.
(4) Motorcyclists should use the right-shoulder motorcycle lane where availble, and always wear crash helmets.Watch out for dogs and other animals--if you hit one on a motorcycle, chances are you'll be hurt more than the dog!
(5) It rains here often, making roads slippery. This is especially dangerous for motorcyclists slowing to a stop at intersections. Beware of pot-holes hiding beneath puddles of water after heavy rains.
(6) Drive defensively. Put no faith in stop signs, traffic lights, or the rules of the road; honour them yourself, but don't be surprised when others don't. Fasten your seatbelts where provided.
(7) Don't allow yourself to become agitated by rude drivers; it's pointless and it only
aggravates an already chaotic situation on the roads. Another significant category of accidents to beware of are those involving watersports.
 

2. SWIMMING

The first thing to remember .is, don't drink and swim; almost half of all drownings occur after alcohol consumption. Another important fact is that you cannot swim against a current of more than one knot per hour. During the rainy season, strong currents likes this are common.

Don't swim out past the breakers when there is a big surf from May till 
November (rainy season); never swim when a red flag is flying. Uncertain swimmers
should stay out of deep water. Ear infections are common in tropical waters; prompt
medical attention should not be neglected as severe infection can cause permanent
damage. Use of ear plugs can prevent infection occuring.

3. SCUBA DIVING

Older, overweight, or unfit visitors should have a medical check-up including chest X-ray before undertaking this activity.If you have asthma, bronchitis, epilepsy, or heart disease; or if you've ever suffered severe head injury or had chest surgery , you are probably unfit to dive. Diabetics must use special caution.Before getting on your next flight,remember not to go scuba diving to a depth of more than 9 meters within three hours of boarding, or you may experience the bends while en route.

(6) OTHER THINGS TO CONSIDER

Aside from prece'eding list, there are a number of other precautions to bear in mind while visiting Myanmar.

1. HEAT STROKE
We may expect people to suffer from heat syndrome directly related to high temperature exposure such as heat stroke,heat exhaustion, heat cramps and heat syncope. Excessive sun exposure causes skin damage. Too much sun exposure causes skin cancer. A void burning by wearing a good sunscreen. For people with fair skin that
means a sunscreen with an SPF number 15 or above. Darker-skinned people and those who tan without burning can safely use lower numbers. If you do get a sunburn avoid sunbathing until the effects of the sunburn have ceased.Sudden cooling of the body, like bathing, after exposure to high temperature is harmful and may recipitate heat stroke.Actually prohibited bathing in river around mid-day during a heat wave in upper Myanmar as Mandalay, Bagan.Use protective cream and lotions to prevent sunburn. In Myanmar, people use Thanakha.
(1) Increase intake of water and salt to prevent heat stroke and heat exhaustion.Clothing must be loose fitting, changed frequently to reduce sweating.
(2) Fever in anyone visiting the tropics is a serious matter. If you or anyone near you come down with a fever, remember, it may not be a brief mild, self-limited illness. Seek medical attention for any persistent or severe fever, especially one associated with persistent diarrhoea,vomiting, or jaundice. 
(3) Those affected by motion sickness can minimize the effects by gazing at a stable external orientational reference. This means the horizon, if you are on a boat;or straight down the road, if you are in a car. Also, attempt to hold yourself rigidly to the thing that is moving, rather than allowing yourself to be tossed back and forth within it.
(4) Pregnant women should remember that most miscarriages occur during the first three months of pregnancy. This is therefore the most dangerous time to travel. Women in the last three months should avoid unnecessary medication,but vaccinations and anti-malarial drugs should still be taken where needed, under doctor advice. Remember to stay in the vicinity of a good hospital during the last three months of pregnancy. 
(5) Women travellers often find that their periods become irregular or cease while travelling. A missed period need not therefore be cause for alarm. A pregnancy check can easily be performed.
(6) Vaccinations-It is recommended that travellers to Myanmar have up-to-date vaccination against Tetanus, Polio, and Hepatitis- B; all children must be vaccinated and have proof. Other recommended vaccinations are for Hepatitis. None are required unless travellers come from yellow fever zones.
(7) Post- tropical check up-Persons who experienced illness during their trips through tropical areas, especially diarrhoea or fever, or who have been exposed to a high risk disease for even a short time should undergo a specific screening procedure before or after returning home. Long term travellers and expatriates living in the tropics should consider undergoing the same from time-to-time because examination often reveals a lurking, unsuspected disease.
 

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