Healthcare in Laos is so poor as to be virtually nonexistent; the average life expectancy is just 57. Malaria and other mosquito-borne diseases are rife, and you’ll need to take a number of precautions to avoid contracting these, especially if you plan on spending long periods of time in rural regions. The nearest medical care of any competence is in neighbouring Thailand; if you find yourself afflicted by anything more serious than travellers’ diarrhoea, it’s best to head for the closest Thai border crossing and check into a hospital.
Plan on consulting a doctor at least two months before your travel date to discuss which diseases you should receive immunization against. Some antimalarials must be taken several days before arrival in a malarial area in order to be effective. If you are going to be on the road for some time, a dental check-up is also advisable.
While there are no mandatory vaccinations for Laos (except yellow fever if you are coming from an infected area), a few are recommended. Hepatitis A, typhus, tetanus and polio are the most important ones, but you should also consider hepatitis B, rabies and Japanese encephalitis. All shots should be recorded on an International Certificate of Vaccination and carried with your passport when travelling abroad.
Hepatitis A is contracted via contaminated food and water and can be prevented by the Havrix vaccine which provides protection for up to ten years. Two injections two to four weeks apart are necessary, followed by a booster a year later. The older one-shot vaccine only provides protection for three months. Hepatitis B is spread via sexual contact, transfusions of tainted blood and dirty needles. Vaccination is recommended for travellers who plan on staying for long periods of time (six months or more). Note that the vaccine can take up to six months before it is fully effective.
Rabies can be prevented by a vaccine that consists of two injections over a two-month period with a third a year later and boosters every two to five years. If you haven’t had shots and are bitten by a potentially rabid animal, you will need to get the jabs immediately.
Japanese encephalitis, a mosquito-borne disease, is quite rare, but doctors may recommend a vaccination against it. The course of injections consists of two shots at two-week intervals plus a booster.
The average traveller to Laos has little to worry about as long as they use common sense and exercise a few precautions. The changes in climate and diet experienced during travel collaborate to lower your resistance, so you need to take special care to maintain a healthy intake of food and water and to try to minimize the effects of heat and humidity on the body. Excessive alcohol consumption should be avoided, as the dehydrating effects of alcohol are amplified by the heat and humidity.
Good personal hygiene is essential; hands should be washed before eating, especially given that much of the Lao cuisine is traditionally eaten with the hands. Cuts or scratches, no matter how minor, can become infected very easily and should be thoroughly cleaned, disinfected and bandaged to keep dirt out.
Most health problems experienced by travellers are a direct result of something they’ve eaten. Avoid eating uncooked vegetables and fruits that cannot be peeled. Dishes containing raw meat or fish are considered a delicacy in Laos but people who eat them risk ingesting worms and other parasites. Cooked food that has been sitting out for an undetermined period should be treated with suspicion.
Stomach trouble and viruses
Most travellers experience some form of stomach trouble during their visit to Laos, simply because their digestive system needs time to adapt to the local germs. To deal with travellers’ diarrhoea, it is usually enough to drink lots of liquids and eat lightly, avoiding spicy or greasy foods in favour of bland noodle soups until your system recovers. The use of Lomotil or Imodium should be avoided, as they just prevent your body clearing the cause of the diarrhoea, unless long-distance road travel makes it absolutely necessary. Diarrhoea accompanied by severe stomach cramps, nausea or vomiting is an indication of food poisoning. As with common diarrhoea, it usually ends after a couple of days. In either case, be sure to increase your liquid intake to make up for lost fluids. It’s a good idea to bring oral rehydration salts with you from home. If symptoms persist or become worse after a couple of days, consider seeking medical advice in Thailand.
Blood or mucus in the faeces is an indication of dysentery. There are two types of dysentery and they differ in their symptoms and treatment. Bacillary dysentery has an acute onset, with severe abdominal pain accompanied by the presence of blood in the diarrhoea. Fever and vomiting may also be symptoms. Bacillary dysentery requires immediate medical attention and antibiotics are usually prescribed. Amoebic dysentery is more serious: the onset is gradual with bloody faeces accompanied by abdominal pain. Symptoms may eventually disappear but the amoebas will still be in the body and will continue to feed on internal organs, causing serious health problems in time. If you contract either type of dysentery, seek immediate medical advice in Thailand.
Hepatitis A, a viral infection contracted by consuming contaminated food or water, is quite common in Laos. The infection causes the liver to become inflamed and resulting symptoms include nausea, abdominal pains, dark-brown urine and light-brown faeces that may be followed by jaundice (yellowing of the skin and whites of eyes). Vaccination is the best precaution; if you do come down with hepatitis A, get plenty of rest and eat light meals of non-fatty foods.
Another scatological horror is giardia, symptoms of which include a bloated stomach, evil-smelling burps and farts, and diarrhoea or floating stools. As with dysentery, treatment by a physician in Thailand should be sought immediately.
Occasional outbreaks of cholera occur in Laos. The initial symptoms are a sudden onset of watery but painless diarrhoea. Later nausea, vomiting and muscle cramps set in. Cholera can be fatal if adequate fluid intake is not maintained. Copious amounts of liquids, including oral rehydration solution, should be consumed and urgent medical treatment in Thailand should be sought.
Like cholera, typhoid is also spread in small, localized epidemics. The disease is sometimes difficult to diagnose, as symptoms can vary widely. Generally, they include headaches, fever and constipation, followed by diarrhoea.
Malaria, caused by the plasmodium parasite, is rife in much of Laos. Symptoms include chills, a high fever and then sweats, during which the fever falls; the cycle repeats every couple of days. These symptoms aren’t so different to those of flu, making diagnosis difficult without a blood test; if you think you’ve contracted malaria, check into a Thai hospital immediately.
Vientiane is said to be malaria-free, but visitors to other parts of Laos should take all possible precautions to avoid contracting this sometimes fatal disease. Night-feeding mosquitoes are the carriers, so you’ll need to take extra care in the evening, particularly at dawn and dusk. High-strength mosquito repellent that contains the chemical compound DEET is a necessity, although bear in mind that prolonged use may be harmful. A natural alternative is citronella oil, found in some repellents. Wearing trousers, long-sleeved shirts and socks gives added protection.
If you plan on travelling in remote areas, bring a mosquito net. Most guesthouses provide nets but some of these have holes; gather up the offending section of net and twist a rubber band around it. Many hotels have replaced nets with screened-in windows, which is fine if the room door remains shut at all times, but doors are usually left wide open when maids are tidying up the rooms between guests. If you can’t get hold of a mosquito net, try pyrethrum coils which can be found in most markets and general stores in Laos.
For added insurance against malaria, it’s advisable to take antimalarial tablets. Though doxycycline and mefloquine are the most commonly prescribed antimalarials for Laos, the plasmodium parasites are showing resistance to the latter drug. While none of the antimalarials guarantees that you will not contract malaria, the risks will be greatly reduced. Note that some antimalarials can have unpleasant side effects. Mefloquine in particular can sometimes cause dizziness, extreme fatigue, nausea and nightmares. Pregnant or lactating women are not advised to take mefloquine.
Day-feeding mosquitoes are the carriers of dengue fever. The disease is common in urban as well as rural areas, and outbreaks occur annually during the rainy season. The symptoms are similar to malaria and include fever, chills, aching joints and a red rash that spreads from the torso to the limbs and face. Dengue can be fatal in small children. There is no preventative vaccination or prophylactic. As with malaria, travellers should use insect repellent, keep skin covered with loose-fitting clothing and wear socks. There is no specific treatment for dengue other than rest, lots of liquids and paracetamol for pain and fever. Aspirin should be avoided as it can aggravate the proneness to internal bleeding which dengue sometimes produces.
The Lao hot season, roughly March to May, can be brutal, especially in the lowlands. To prevent sunburn, fair-skinned people should wear sunblock and consider purchasing a wide-brimmed straw hat. UV protective sunglasses are useful for cutting the sun’s glare, which can be especially harsh during river journeys. The threat of dehydration increases with physical exertion. Even if you don’t feel thirsty, drink plenty of water. Not having to urinate or passing dark-coloured urine are sure signs that your system is not getting enough liquids.
Heat exhaustion, signified by headaches, dizziness and nausea, is treated by resting in a cool place and increasing your liquid intake until the symptoms disappear. Heatstroke, indicated by high body temperature, flushed skin and a lack of perspiration, can be life-threatening if not treated immediately. Reducing the body’s temperature by immersion in tepid water is an initial treatment but no substitute for prompt medical attention. Heat and high humidity sometimes cause prickly heat, an itchy rash that is easily avoided by wearing loose-fitting cotton clothing.
Critters that bite and sting
In Laos the bugs are thick, especially during the rainy season when they swarm round light bulbs and pummel bare skin until you feel like the trampoline at a flea circus. Fortunately, most flying insects pose no threat and are simply looking for a place to land and rest up.
Visitors who spend the night in hill-tribe villages where hygiene is poor risk being infected by scabies. These microscopic creatures are just as loathsome as their name suggests, causing severe itching by burrowing under the skin and laying eggs. Scabies is most commonly contracted by sleeping on dirty bedclothes or being in prolonged physical contact with someone who is infected. More common are head lice, especially among children in rural areas. Like scabies, it takes physical contact, such as sleeping next to an infected person, to contract head lice, though it may also be possible to contract head lice by wearing a hat belonging to someone who is infected.
The leeches’ most commonly encountered in Laos are about the size and shape of an inchworm, and travellers are most likely to pick them up while trekking through wooded areas. Take extra care when relieving yourself during breaks on long-distance bus rides. The habit of pushing deep into a bush for privacy gives leeches just enough time to grab hold of your shoes or trousers. Later they will crawl their way beneath clothing and attach themselves to joint areas (ankles, knees, elbows) where veins are near the surface of the skin. An anaesthetic and anticoagulant in the leaches’ saliva allows the little vampires to gorge themselves on blood without the host feeling any pain. Tucking your trouser-legs into your socks is an easy way to foil leeches. Wounds left by sucking leeches should be washed and bandaged as soon as possible to avoid infection.
Laos has several varieties of poisonous snakes, including the king cobra, but the Lao habit of killing every snake they come across, whether venomous or not, keeps areas of human habitation largely snake-free. Travelling in rural areas greatly increases the risk of snakebite, but visitors can lessen the chances of being bitten by not wearing sandals or flip-flops outside urban areas. While hiking between hill-tribe villages especially, take the precaution of wearing boots, socks and long trousers. If you are bitten, the number-one rule is not to panic; remain still to prevent the venom from being quickly absorbed into the bloodstream. Snakebites should be washed and disinfected and immediate medical attention sought – a challenge in most parts of Laos, making avoidance of the problem vital. Huge, black scorpions the size of large prawns lurk under the shade of fallen leaves and sting reflexively when stepped on, another solid reason to restrict flip-flop-wearing to urban areas. While the sting is very painful, it is not fatal and pain and swelling usually disappear after a few hours.
Animals that are infected with rabies can transmit the disease by biting or even by licking an open wound. Dogs are the most common carriers but the disease can also be contracted from the bites of gibbons, bats and other mammals. Travellers should stay clear of all wild animals and resist the urge to pet unfamiliar dogs or cats. If bitten by a suspect animal, wash and disinfect the wound with alcohol or iodine and seek urgent medical help; the disease is fatal if left untreated.
Sexually transmitted diseases
Prostitution is on the rise in Laos, and with it the inevitable scourge of sexually transmitted diseases (STDs). Gonorrhoea and syphilis are common but easily treated with antibiotics. Symptoms of the former include pain or a pus-like discharge when urinating. An open sore on or around the genitals is a symptom of syphilis. In women symptoms are internal and may not be noticed. The number of cases of AIDS is also rising in Laos, mostly the result of Lao prostitutes contracting HIV in Thailand.
Bring condoms from home; most sold in Laos are imported from Thailand, and are often defective.