Travellers tend to worry about contracting infectious diseases when in the tropics, but infections are a rare cause of serious illness or death in travellers. Pre-existing medical conditions, such as heart disease, and accidental injury (especially traffic accidents) account for most life-threatening problems. Treatment for minor injuries and common traveller’s health problems is easily accessed in larger cities and on Bali but standards decline the more remote you get in Indonesia. For serious conditions, you will need to leave Indonesia.
It’s important to note what precautions you should take in Indonesia. In Batam, you will embrace the blazingly hot sunnyday with frequent wheather changes while in Bali your major concerns are rabies, mosquito bites and the tropical sun. Elsewhere in the country there are numerous important considerations. The advice we give is a general guide only and does not replace the advice of a doctor trained in travel medicine.
Before You Go
Be healthy and make sure all medications are packed in their original, clearly labelled containers. A signed and dated letter from your physician describing your medical conditions and medications (including generic names) is also a good idea. If you are carrying syringes or needles, be sure to have a physician’s letter documenting their medical necessity so that you have no trouble in carrying it on Indonesia check point.
Do a little research about the alternative of your medication which are available in Indonesia. If you happen to take any regular medication, bring double your needs in case of loss or theft. You can buy many medications over the counter without a doctor’s prescription, but it can be difficult to find antidepressants, blood-pressure medications and contraceptive pills.
It’s usually a good idea to consult your government’s travel health website before departure, if one is available:
- Australia (www.smartraveller.gov.au)
- UK (www.nhs.uk/nhsengland/Healthcareabroad)
- US (www.cdc.gov/travel)
Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. Even if you are fit and healthy, don’t travel without sufficient health insurance – accidents do happen. If you’re uninsured, emergency evacuation is expensive – bills of more than US$100,000 are not uncommon.
There is a wealth of travel health advice on the internet.
World Health Organization (www.who.int/ith) Publishes a superb book called International Travel & Health, which is revised annually and is available online at no cost.
MD Travel Health (www.mdtravelhealth.com) Provides travel health recommendations for every country.
Centers for Disease Control & Prevention (www.cdc.gov) This website also has good general information.
The only vaccine required by international regulations is yellow fever. Proof of vaccination will only be required if you have visited a country in the yellow-fever zone (primarily some parts of Africa and South America) within the six days prior to entering Southeast Asia.
Recommended items for a convenient personal medical kit (more specific items can be obtained in Indonesia if needed):
- antibacterial cream
- antihistamine – there are many options
- antiseptic (eg Betadine)
- DEET-based insect repellent
- first-aid items such as scissors, bandages, thermometer (but not a mercury one) and tweezers
- ibuprofen or another anti-inflammatory
- steroid cream for allergic/itchy rashes (eg 1% to 2% hydrocortisone)
- sunscreen and hat
- throat lozenges
- thrush (vaginal yeast infection) treatment
Specialised travel-medicine clinics are your best source of information; they stock all available vaccines and will be able to give specific recommendations for you and your trip. Most vaccines don’t produce immunity until at least two weeks after they’re given. Ask your doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all the vaccinations you’ve received.
Vaccination recommendations for Southeast Asia include the following for all travellers:
- Tetanus Single booster recommended if none in the previous 10 years.
- Hepatitis A Provides almost 100% protection for up to a year; a booster after 12 months provides at least another 20 years’ protection. Mild side effects such as headache and sore arm occur in 5% to 10% of people.
- Typhoid Recommended unless your trip is less than a week and only to developed cities. The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot.
- Rabies Three injections in all. A booster after one year will then provide 10 years’ protection. Side effects are rare – occasionally headache and sore arm. Essential for Bali, where there has been a rabies epidemic for years.
These vaccines are recommended if you are travelling beyond major cities, as well as Bali and Lombok:
- Hepatitis B Now considered routine for most travellers. Given as three shots over six months. Life-time protection occurs in 95% of people.
- Cholera An oral vaccine recommended for very remote travel.
- Japanese B Encephalitis Three injections in all. Booster recommended after two years. Sore arm and headache are the most common side effects.
- Meningitis Single injection. Recommended for long-term backpackers aged under 25.
Infectious Diseases In Indonesia
This serious bacterial infection is spread via food and water. Its symptoms are a high and slowly progressive fever, headache and possibly a dry cough and stomach pain. It is diagnosed by blood tests and treated with antibiotics.
HIV is a major problem in many Asian countries, and Bali has one of the highest rates of HIV infection in Indonesia. The main risk for most travellers is sexual contact with locals, prostitutes and other travellers.
The risk of sexual transmission of the HIV virus can be dramatically reduced by the use of a kondom (condom). These are available from supermarkets, street stalls and drugstores in tourist areas, and from the apotik in almost any town.
Japanese B Encephalitis
While this is a rare disease in travellers, many locals are infected each year. This viral disease is transmitted by mosquitoes. Most cases occur in rural areas and vaccination is recommended for travellers spending more than one month outside of cities. There is no treatment, and a third of infected people will die while another third will suffer permanent brain damage.
The risk of contracting malaria is greatest in rural areas of Indonesia although only Java’s main cities, Bali and the Gilis are considered malaria-free.
Two strategies should be combined to prevent malaria: mosquito avoidance and antimalarial medications.
Most people who contract malaria are taking inadequate or no antimalarial medication.
Travellers are advised to prevent mosquito bites by taking these steps:
- Use a DEET-containing insect repellent on exposed skin. Insect sprays and lotions such as Off are only reliably found in the areas with the least risk of malaria (eg Bali). Bring small containers of highly concentrated DEET repellent from your home country and follow the label directions carefully.
- Sleep under a mosquito net impregnated with permethrin.
- Choose accommodation with screens and fans (if not air-conditioned).
- Impregnate clothing with permethrin in high-risk areas.
- Wear long sleeves and trousers in light colours.
- Use mosquito coils.
- Spray your room with insect repellent before going out for your evening meal.
There are a variety of medications available (note that Artesunate and Chloroquine are ineffective):
- Doxycycline This daily tablet is a broad-spectrum antibiotic that has the added benefit of helping to prevent a variety of tropical diseases. Potential side effects include a tendency to sunburn, thrush in women, indigestion, heartburn, nausea and interference with contraceptive pills.
- Lariam (Mefloquine) Lariam has received much bad press, some of it justified, some not. This weekly tablet suits many people. Serious side effects are rare but include depression, anxiety, psychosis and having fits.
- Malarone A combination of Atovaquone and Proguanil. Side effects, most commonly nausea and headache, are uncommon and mild. It is the best tablet for scuba divers and for those on short trips to high-risk areas. It must be taken for one week after leaving the risk area.
The only sexually transmitted disease that can be prevented by vaccination, hepatitis B is spread by body fluids, including sexual contact. In some parts of Southeast Asia up to 20% of the population are carriers of hepatitis B.
Rabies is a disease spread by the bite or lick of an infected animal, most commonly a dog or monkey. Once you are exposed, it is uniformly fatal if you don’t get the vaccine very promptly. Bali has a major outbreak that dates to 2008. Cases have been reported across Indonesia.
To minimise your risk, consider getting the rabies vaccine, which consists of three injections in all. A booster after one year will then provide 10 years’ protection. The vaccines are often unavailable on Bali, so get them before you go.
Also, be careful to avoid animal bites. Especially watch children closely.
Having the pre-travel vaccination means the post-bite treatment is greatly simplified. If you are bitten or scratched, gently wash the wound with soap and water, and apply an iodine-based antiseptic then consult a doctor.
Those not vaccinated will need to receive rabies immunoglobulin as soon as possible. Clean the wound immediately and do not delay seeking medical attention. Note that Indonesia regularly runs out of rabies immunoglobulin, so be prepared to go to Singapore immediately for medical treatment.
A mosquito-borne disease that is very common in the local population, yet very rare in travellers. Mosquito-avoidance measures are the best way to prevent this disease.
This mosquito-borne disease is a major problem and Indonesia has one of the world’s highest infection rates. As there is no vaccine available it can only be prevented by avoiding mosquito bites. The mosquito that carries dengue bites day and night, so use insect avoidance measures at all times. Symptoms include high fever, severe headache and body ache. Some people develop a rash and experience diarrhoea. There is no specific treatment, just rest and paracetamol – do not take aspirin as it increases the likelihood of haemorrhaging. See a doctor to be diagnosed and monitored.
Otherwise known as avian influenza, the H5N1 virus has claimed more than 100 victims in Indonesia. Most cases have been in Java. Treatment is difficult and every few years it reappears.
A problem throughout the region, this food- and water-borne virus infects the liver, causing jaundice (yellow skin and eyes), nausea and lethargy. There is no specific treatment; you just need to allow time for the liver to heal. All travellers to Southeast Asia should be vaccinated against hepatitis A.
Traveller’s diarrhoea (aka Bali belly) is by far the most common problem affecting travellers – between 30% and 50% of people will suffer from it within two weeks of starting their trip. In over 80% of cases, traveller’s diarrhoea is caused by bacteria (there are numerous potential culprits), and therefore responds promptly to treatment with antibiotics.
Traveller’s diarrhoea is defined as the passage of more than three watery bowel actions within 24 hours, plus at least one other symptom such as fever, cramps, nausea, vomiting or feeling generally unwell.
Giardia lamblia is a parasite that is relatively common in travellers. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. The parasite will eventually go away if left untreated but this can take months. The treatment of choice is Tinidazole, with Metronidazole being a second-line option.
Loperamide (aka Imodium) is just a ‘stopper’ and doesn’t get to the cause of the problem. However, it can be helpful, for example, if you have to go on a long bus ride. Don’t take Loperamide if you have a fever or blood in your stools. Seek medical attention quickly if you do not respond to an appropriate antibiotic. Otherwise:
- Stay well hydrated; rehydration solutions such as Gastrolyte are the best for this.
- Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin will kill the bacteria quickly.
Air pollution, particularly vehicle pollution, is a problem in cities. In addition, smog from fires used to clear land for palm oil plantations blankets Sumatra in the dry season. If you have severe respiratory problems, speak with your doctor before travelling. This pollution also causes minor respiratory problems such as sinusitis, dry throat and irritated eyes. Consider masks, which more and more Indonesians are wearing.
- Never drink tap water in Indonesia.
- Widely available and cheap, bottled water is generally safe, however, check the seal is intact when purchasing. Look for places that allow you to refill containers, thus cutting down on landfill.
- Most ice in restaurants is fine if it is uniform in size and made at a central plant (standard for large cities and tourist areas). Avoid ice that is chipped off larger blocks (more common in rural areas).
- Fresh juices are a risk outside of tourist restaurants and cafes.
Insect Bites & Stings
During your time in Indonesia, you may make some unwanted friends.
- Bedbugs These don’t carry disease but their bites are very itchy. They live in the cracks of furniture and walls and then migrate to the bed at night to feed on you as you sleep. You can treat the itch with an antihistamine.
- Jellyfish Most are not dangerous, just irritating. Stings can be extremely painful but rarely fatal. First aid for jellyfish stings involves pouring vinegar onto the affected area to neutralise the poison. Anyone who feels ill in any way after being stung should seek medical advice.
- Ticks Contracted after walking in rural areas, ticks are commonly found behind the ears, on the belly and in armpits. If you have had a tick bite and experience symptoms such as a rash at the site of the bite or elsewhere, fever or muscle aches, you should see a doctor.
Most parts of Indonesia are hot and humid throughout the year. For most people it takes at least two weeks to adapt to the hot climate. Swelling of the feet and ankles is common, as are muscle cramps caused by excessive sweating. Prevent these by avoiding dehydration and excessive activity in the heat. Be careful to avoid the following conditions:
- Heat Exhaustion Symptoms include feeling weak; headache; irritability; nausea or vomiting; sweaty skin; a fast, weak pulse; and a normal or slightly elevated body temperature. Treatment involves getting out of the heat and/or sun, fanning the victim and applying cool wet cloths to the skin, laying the victim flat with their legs raised, and rehydrating with water containing one-quarter of a teaspoon of salt per litre. Recovery is usually rapid.
- Heatstroke A serious medical emergency. Symptoms come on suddenly and include weakness, nausea, a hot dry body with a body temperature of over 41°C, dizziness, confusion, loss of coordination, fits and eventually collapse and loss of consciousness. Seek urgent medical help and commence cooling by getting the person out of the heat, removing their clothes, fanning them and applying cool wet cloths or ice to their body, especially to hot spots such as the groin and armpits.
- Prickly Heat A common skin rash in the tropics, caused by sweat being trapped under the skin. The result is an itchy rash of tiny lumps. Treat by moving out of the heat into an air-conditioned area for a few hours and by having cool showers.
- Fungal Rashes There are two common fungal rashes that affect travellers. The first occurs in moist areas that get less air such as the groin, armpits and between the toes. It starts as a red patch that slowly spreads and is usually itchy. Treatment involves keeping the skin dry, avoiding chafing and using an antifungal cream such as Clotrimazole or Lamisil.
- Cuts & Scratches Easily infected in tropical climates, take meticulous care of any cuts and scratches. Immediately wash all wounds in clean water and apply antiseptic. If you develop signs of infection see a doctor. Divers and surfers should be careful with coral cuts as they become easily infected.
Divers and surfers should seek specialised advice before they travel to ensure their medical kit contains treatment for coral cuts and tropical ear infections, as well as the standard problems. Divers should ensure their insurance covers them for decompression illness.
Even on a cloudy day sunburn can occur rapidly, especially near the equator. Don’t end up like the dopey tourists you see roasted pink on Bali’s Kuta Beach. Instead:
- Use a strong sunscreen (at least factor 30).
- Reapply sunscreen after a swim.
- Wear a wide-brimmed hat and sunglasses.
- Avoid baking in the sun during the hottest part of the day (10am to 2pm).
In the tourist areas and large cities, sanitary products are easily found. This becomes more difficult the more rural you go. Tampons are especially hard to find.
Birth-control options may be limited, so bring adequate supplies of your own form of contraception.
Availability Of Health Care
It is difficult to find reliable medical care in rural areas, but most major cities now have clinics catering specifically to travellers and expats. These clinics are usually more expensive than local medical facilities, but are worth utilising, as they will offer a superior standard of care. Additionally, they understand the local system and are aware of the safest local hospitals and best specialists. They can also liaise with insurance companies should you require evacuation.
If you think you may have a serious disease, especially malaria, do not waste time – travel immediately to the nearest quality facility to receive attention.
Local medical care in general is not yet up to international standards. Foreign doctors are not allowed to work in Indonesia, but some clinics (such as those in Bali and Jakarta) catering to foreigners have ‘international advisors’. Almost all Indonesian doctors work at government hospitals during the day and in private practices at night. This means that private hospitals often don’t have their best staff available during the day. Serious cases are evacuated to Australia, Bangkok or Singapore.
In Jakarta, other large cities and Bali, pharmacies (apotik) are usually reliable. The Kimia Farma chain (www.kimiafarma.co.id) is good and has many locations nationwide. Be careful at small, local pharmacies, as fake medications and poorly stored or out-of-date drugs are common.
- Water Tap water is never safe to drink.