Most visitors enjoy Guatemala without experiencing any health problems. However, it’s always easier to become ill in a country with a different climate, food and germs – still more so in a poor country with lower standards of sanitation than you might be used to.

It’s vital to get the best health advice you can before you set off. Consult the websites mentioned for health precautions and disease prevention advice. Pay a visit to your doctor or a travel clinic as far in advance of travel as possible, and if you’re pregnant or likely to become so, mention this at the outset. Many clinics also sell the latest travel health products, including water filters and medical kits. Finally you’ll definitely need health insurance.

Once you’re there, what you eat and drink is crucial. In addition to the hazards mentioned under “Intestinal troubles” below, contaminated food and water can transmit the hepatitis A virus, which can lay a victim low for several months with exhaustion, fever and diarrhoea, and can even cause liver damage.

Vaccinations, inoculations and malaria precautions

There are no obligatory inoculations for Guatemala (unless you’re arriving from a “high-risk” area of yellow fever – northern South America and equatorial Africa). Nevertheless, there are several you should have anyway. Make sure you’re up to date with tetanus and typhoid vaccinations and consider having hepatitis A and tuberculosis (TB) jabs. Long-term travellers or anyone spending time in rural areas should think about having the combined hepatitis A and B and the rabies vaccines (though for a caveat on that).

Malaria is a danger in some parts of the country (particularly in the rural lowlands). It’s not a problem in the big cities, or anywhere over 1500m – which includes Antigua, Guatemala City, Chichicastenango, Lago de Atitlán, Quetzaltenango and virtually all of the western highlands. However, if you plan to visit any lowland areas, including Petén, Alta Verapaz and the Pacific or Caribbean coasts, you should consider taking a course of tablets.

The recommended prophylactic is chloroquine (inexpensive, available without prescription and safe in pregnancy); you’ll need to begin taking the pills a week before you enter an area where there’s a risk of malaria and continue for four weeks after you return. Malarone is an alternative drug, which you need start only two days before you go, though it’s not suitable for pregnant women or babies.

Whichever anti-malarial you choose, you should still take precautions to avoid getting bitten by insects: always sleep in screened rooms or under nets in lowland areas; burn mosquito coils; cover up arms and legs, especially around dawn and dusk when mosquitoes are most active; and apply insect repellent (with 25–50 percent DEET; but not to children under 2).

Also prevalent in some lowland areas (usually occurring in epidemic outbreaks in urban areas), dengue fever is a viral infection transmitted by mosquitoes, which are active during the day. Fever, aches and joint pain (its old name was “break-bone fever”) are often followed by a rash. Though most people make a full recovery after a few days, children are particularly at risk. There is no vaccine or specific treatment, so you need to pay great attention to avoiding bites.

Intestinal troubles

Despite all the dire warnings given here, a bout of diarrhoea is the medical problem you’re most likely to encounter. Its main cause is simply the change of diet: the food in the region contains a whole new set of bacteria, and perhaps rather more of them than you’re used to. If you’re struck down, take it easy for a day or two, drink lots of bottled water and eat only the blandest of foods – papaya is good for soothing the stomach and is crammed with vitamins. Only if the symptoms last more than four or five days do you need to worry. Finally, if you’re taking oral contraception or any other orally administered drugs, bear in mind that severe diarrhoea can reduce their efficacy.

Cholera is an acute bacterial infection, recognizable by watery diarrhoea and vomiting. However, risk of infection is extremely low in Guatemala (and symptoms are rapidly relieved by prompt medical attention and clean water). If you’re spending any time in rural areas you also run the risk of picking up various parasitic infections: protozoa – amoeba and giardia – and intestinal worms; these are quite common around Lago de Atitlán. These sound hideous, but once detected they’re easily treated with antibiotics. If you suspect you may have an infestation, take a stool sample to a good pathology lab and go to a doctor or pharmacist with the test results (see Heat and altitude problems).

More serious is amoebic dysentery, which is endemic in many parts of the region. The symptoms are similar to a bad dose of diarrhoea but include bleeding too. On the whole, a course of flagyl (metronidazole) will cure it.

Bites and stings

Taking steps to avoid getting bitten by insects, particularly mosquitoes, is always good practice. Ticks, which you’re likely to pick up if you’re walking or riding in areas with domestic livestock (and sometimes in forests), need careful removal with tweezers. Head or body lice can be picked up from people or bedding, and are best treated with medicated shampoo; very occasionally, they may spread typhus, characterized by fever, muscle aches, headaches and eventually a measles-like rash. If you think you have it, seek treatment from a doctor.

Scorpions are common; mostly nocturnal, they hide during the heat of the day – often in thatched roofs. If you’re camping, or sleeping under a thatched roof, shake your shoes out before putting them on and try not to wander round barefoot. Their sting is painful (rarely fatal) and can become infected, so you should seek medical treatment if the pain seems significantly worse than a bee sting. You’re less likely to be bitten by a spider, but seek medical treatment if the pain persists or increases.

You’re unlikely to see a snake, and most are harmless in any case. Wearing boots and long trousers will go a long way towards preventing a bite – tread heavily and they will usually slither away. If you do get bitten, remember what the snake looked like (kill it if you can), immobilize the bitten limb and seek medical help immediately; antivenins are available in most main hospitals.

Swimming and snorkelling might bring you into contact with potentially dangerous or venomous sea creatures. If you are stung by a jellyfish, clean the wound with vinegar or iodine.

Finally, rabies is present, but rare in Guatemala. The best advice is to give dogs a wide berth and not to play with animals at all. Treat any bite as suspect: wash any wound immediately with soap or detergent and apply alcohol or iodine if possible. Act immediately to get treatment – rabies can be fatal once symptoms appear. There is a vaccine, but it is expensive, serves only to shorten the course of treatment you need anyway and is effective for no more than three months.

Heat and altitude problems

Two other common causes of illness are altitude and the sun. The best advice in both cases is to take it easy; allow yourself time to acclimatize before you race up a volcano, and build up exposure to the sun gradually. If going to altitudes above 2700m, you may develop symptoms of Acute Mountain Sickness (AMS), such as breathlessness, headaches, dizziness, nausea and appetite loss. More extreme cases might cause vomiting, disorientation, loss of balance and coughing up of pink frothy phlegm. The simple cure – a slow descent – almost always brings immediate recovery.

Tolerance to the sun, too, takes a while to build up. Use a strong sunscreen and, if you’re walking during the day, wear a hat and try to keep in the shade. Avoid dehydration by drinking plenty of water or fruit juice. The most serious result of overheating is heatstroke, which can be potentially fatal. Lowering the body temperature (by taking a tepid shower, for example) is the first step in treatment.

Getting medical help

For minor medical problems, head for a farmacia – look for the green cross – there’s one in every town and most villages. Pharmacists are knowledgeable and helpful, and many speak some English. They can also sell drugs over the counter that are only available on prescription at home. Every capital city has doctors and dentists, many trained in the US, who speak good English. Your embassy will always have a list of recommended doctors.

Health insurance is essential and for anything serious you should go to the best private hospital you can reach. If you suspect something is amiss with your insides, it might be worth heading straight for the local pathology lab before seeing a doctor. Many rural communities have a health centre (centro de salud or puesto de salud), where health care is free, although there may only be a nurse or health worker available and you can’t rely on finding anyone who speaks English. Should you need an injection or transfusion, make sure that the equipment is sterile (it might be worth bringing a sterile kit from home) and ensure any blood you receive is screened.

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