Health-wise, travelling in Costa Rica is generally very safe. Food tends to be hygienically prepared, so bugs and upsets are normally limited to the usual “traveller’s tummy”. Water supplies in most places are clean and bacteria-free, and outbreaks of serious infectious diseases such as cholera are rare.
In general, as in the rest of Latin America, it tends to be local people, often poor or without proper sanitation or access to healthcare, who contract infectious diseases. Although Costa Rica’s healthcare is of a high standard, the facilities at its major public hospitals (thirty of which are affiliated to CAJA, the country’s social healthcare system) vary widely, and while some, such as the Hospital Nacional de Niños in San José, are very good, you are advised to use private hospitals and clinics where possible – and get extensive health insurance before you travel. The capital’s two excellent private hospitals (CIMA San José and Clinica Biblica;) are equipped to handle medical, surgical and maternity cases, and have 24 hour emergency rooms; the latter also has a good pediatric unit.
No compulsory inoculations are required before you enter Costa Rica unless you’re travelling from a country that has Yellow Fever, such as Colombia, in which case you must be able to produce a current inoculation certificate. You may, however, want to make sure that your polio, typhoid, diphtheria and hepatitis A and B jabs are up to date, though none of the diseases is a major risk. Rabies, a potentially fatal illness, should be taken very seriously if you’re going to be spending a significant amount of time in the countryside. There is a vaccine comprising a course of three injections that has to be started at least a month before departure and which is effective for two years – though it’s expensive and serves only to shorten the course of treatment you need. If you’re not vaccinated, stay away from dogs, monkeys and any other potentially biting or scratching animals. If you do get scratched or bitten, wash the wound at once, with alcohol or iodine if possible, and seek medical help immediately.
Costa Rica is just eight to eleven degrees north of the Equator, which means a blazing-hot sun directly overhead. To guard against sunburn take at least factor-15 sunscreen (start on factor-30) and a good hat, and wear both even on slightly overcast days, especially in coastal areas. Even in places at higher altitudes where it doesn’t feel excessively hot, such as San José and the surrounding Valle Central, you should protect yourself. Dehydration is another possible problem, so keep your fluid level up, and take rehydration salts (Gastrolyte is readily available) if necessary. Diarrhoea can be brought on by too much sun and heat sickness, and it’s a good idea to bring an over-the-counter remedy such as Imodium from home – it should only be taken for short periods, however, and only when really necessary (such as travelling for long periods on a bus) as extensive use leads to constipation and only serves to keep whatever is making you ill inside you.
The only areas of Costa Rica where it’s best not to drink the tap water (or ice cubes, or drinks made with tap water) are the port cities of Limón and Puntarenas. Bottled water is available in these towns; drink from these and stick with known brands, even if they are more expensive. Though you’ll be safe drinking tap water elsewhere in the country, it is possible to pick up giardia, a bacterium that causes stomach upset and diarrhoea, by drinking out of streams and rivers – campers should stock up on water supplies from the national parks waterspouts, where it’s been treated for drinking.
The time-honoured method of boiling will effectively sterilize water, although it will not remove unpleasant tastes. A minimum boiling time of five minutes (longer at higher altitudes) is sufficient to kill micro-organisms. Boiling water is not always convenient, however, as it is time-consuming and requires supplies of fuel or a travel kettle and power source. Chemical sterilization can be carried out using either chlorine or iodine tablets or (better) a tincture of iodine liquid; add a couple of drops to one litre of water and leave to stand for twenty minutes. Pregnant women or people with thyroid problems should consult their doctor before using iodine sterilizing tablets or iodine-based purifiers. Inexpensive iodine removal filters are recommended if treated water is being used continuously for more than a month or if it is being given to babies.
Malaria and dengue fever
Although some sources of information – including perhaps your GP – will tell you that you don’t need to worry about malaria in Costa Rica, there is a small risk if you’re travelling to the southern Caribbean coast, especially Puerto Limón and south towards Cahuita and Puerto Viejo de Talamanca. Around five hundred cases of malaria are reported annually, with about half of these being tourists, though numbers have dropped in recent years. If you want to make absolutely sure of not contracting the illness, and intend to travel extensively anywhere along the southern Caribbean, you should take a course of prophylactics (usually chloroquine rather than mefloquine), available from your doctor or clinic.
Dengue fever is perhaps more of a concern, although by no means a major one: some 20,000 cases were reported in an outbreak in late 2010 that affected San José and parts of the Valle Central, Guanacaste and the Pacific coast, in particularly the Osa Peninsula. Otherwise, most cases occur during the rainy season when the mosquito population is at its height. The symptoms are similar to malaria, but with extreme aches and pains in the bones and joints, along with fever and dizziness. On rare occasions, the illness may develop potentially fatal complications, though this usually only affects people who have caught the disease more than once. The only cure for dengue fever is rest and painkillers, and, as with malaria, the best course of action is prevention: to avoid getting bitten by mosquitoes, cover up with long sleeves and long trousers, use insect repellents (containing DEET) on exposed skin and, where necessary, sleep under a mosquito net.
Snakes abound in Costa Rica, but the risk of being bitten is incredibly small – there has been no instance of a tourist receiving a fatal bite in recent years. Most of the victims of Costa Rica’s more venomous snakes are field labourers who do not have time or the resources to get to a hospital (there are around five such deaths each year). Just in case, however, travellers hiking off the beaten track may want to take specific antivenins plus sterile hypodermic needles; if you’re worried, you can buy antivenin at the Instituto Clodomiro Picado, the University of Costa Rica’s snake farm in Coronado, outside San José (t 2229-0344, w icp.ucr.ac.cr), where herpetologists (people who study snakes) are glad to talk to visitors about precautions.
If you have no antivenin and are unlucky enough to get bitten, do not try to catch or kill the specimen for identification, as you only risk getting bitten again. Clean the wound with soap and water (do not try to suck out the venom), immobilize the bitten limb (do not apply a tourniquet) and get the victim to the nearest hospital as soon as possible.
In general, prevention is better than cure. As a rule of thumb, you should approach rainforest cover and grassy uplands – the kind of terrain you find in Guanacaste and the Nicoya Peninsula – with caution. Always watch where you put your feet and, if you need to hold something to keep your balance, make sure the “vine” you’re grabbing isn’t, in fact, a surprised snake. Be particularly wary at dawn or dusk – before 5.30am or after 6pm – though note that many snakes start moving as early as 4.30pm, particularly in dense cloudforest cover. In addition, be careful in “sunspots”, places in thick rainforest where the sun penetrates through to the ground or to a tree; snakes like to hang out here, absorbing the warmth. Above all, though, don’t be too alarmed: thousands of tourists troop through Costa Rica’s rainforests and grasslands each year without encountering a single snake.
HIV and AIDS
HIV and AIDS (in Spanish, SIDA) is present in the country (an estimated 9600 adults in Costa Rica are living with HIV), but isn’t prevalent. That said, the same common-sense rules apply here as all over the world: sex without a condom, especially in some of the popular beach towns, is a serious health risk. Condoms sold in Costa Rica are not of the quality you find at home; it’s best to bring them with you. Though hospitals and clinics use sterilized equipment, you may want to bring sealed hypodermic syringes anyway.