No inoculations are required for visiting Malaysia, although the immigration authorities may require a yellow-fever vaccination certificate if you have transited an endemic area, normally Africa or South America, within the preceding six days.
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It’s a wise precaution to visit your doctor no less than two months before you leave to check that you are up to date with your polio, typhoid, tetanus and hepatitis inoculations. Tap water is drinkable throughout Malaysia, although in rural areas it’s best to buy bottled water, which is widely available.
Levels of hygiene and medical care in Malaysia are higher than in much of Southeast Asia; with any luck, the most serious thing you’ll go down with is an upset stomach.
Travellers unused to tropical climates may suffer from sunburn and dehydration. The easiest way to avoid this is to restrict your exposure to the midday sun, use high-factor sun screens, wear sunglasses and a hat. You should also drink plenty of water and, if you do become dehydrated, keep up a regular intake of fluids. Rehydration preparations such as Dioralyte are handy; the DIY version is a handful of sugar with a good pinch of salt added to a litre of bottled water, which creates roughly the right mineral balance. Heat stroke is more serious and can require hospitalization: its onset is indicated by a high temperature, dry red skin and a fast pulse.
The most common complaint is a stomach problem, which can range from a mild dose of diarrhoea to full-blown dysentery. The majority of stomach bugs may be unpleasant, but are unthreatening; however, if you notice blood or mucus in your stools, then you may have amoebic or bacillary dysentery, in which case you should seek medical help.
Stomach bugs are usually transmitted by contaminated food and water, so steer clear of raw vegetables and shellfish, always wash unpeeled fruit, and stick to freshly cooked foods, avoiding anything reheated. However careful you are, food that’s spicy or just different can sometimes upset your system, in which case, try to stick to relatively bland dishes and avoid fried food.
Dengue fever and malaria
The main mosquito-borne disease to be aware of – and the chief reason to take measures to avoid mosquito bites – is dengue fever. The disease is caused by a virus spread by the Aedes aegypti mosquito (which has distinctive white marks on its legs) and there are periodic outbreaks, not just in rural areas but also in the major cities. Symptoms include severe headaches, pain in the bones (especially of the back), fever and often a fine, red rash over the body. There’s no specific treatment, just plenty of rest, an adequate fluid intake and painkillers when required.
Although the risk of catching malaria is extremely low, consider protection against it if you think you might be staying in remote parts of Borneo for some time. Most doctors will advise taking antimalarial tablets which, though not completely effective in protecting against the disease, do considerably lessen the risk and can help reduce the symptoms should you develop the disease. Bear in mind you have to start taking the tablets before you arrive in a malaria zone, and continue taking them after you return – ask your doctor for the latest advice.
Altitude sickness (or acute mountain sickness) is a potentially life-threatening illness affecting people who ascend above around 3500m. Symptoms include dizziness, headache, shortness of breath, nausea; in severe cases it can lead to a swelling of the brain and lungs that can prove fatal. In Malaysia it’s only likely to be relevant to those climbing Mount Kinabalu (4095m), and most people report only mild symptoms at this altitude. If you’re affected, there’s little you can do apart from descending to lower altitude, although certain prescription drugs may temporarily control the symptoms.
Cuts, bites and stings
Wearing protective clothing when swimming, snorkelling or diving can help avoid sunburn and protect against any sea stings. Sea lice, minute creatures that cause painful though harmless bites are the most common hazard; more dangerous are jellyfish, whose stings must be doused with vinegar to deactivate the poison before you seek medical help.
Coral can also cause nasty cuts and grazes; any wounds should be cleaned and kept as dry as possible until properly healed. The only way to avoid well-camouflaged sea urchins and stone fish is by not stepping on the seabed: even thick-soled shoes don’t provide total protection against their long, sharp spines, which can be removed by softening the skin by holding it over a steaming pan of water.
As for mosquitoes, you can best avoid being bitten by covering up as much as is practical, and applying repellent to exposed flesh. Note that most repellents sold locally are based on citronella; if you want a repellent containing DEET, which some say is more effective, it’s best to buy it at home. Rural or beachside accommodation often features mosquito nets, and some places also provide slow-burning mosquito coils which generate a little smoke that apparently deters the insects.
For many people, the ubiquitous leech – whose bite is not actually harmful or painful – is the most irritating aspect to jungle trekking. Whenever there’s been rainfall, you can rely upon the leeches to come out. Always tuck your trousers into your socks and tie your bootlaces tight. The best anti-leech socks are made from calico and available in specialist stores. If you find the leeches are getting through, soak the outside of your socks and your boots in insect repellent (see Combating leeches).
Venomous snakes are not that common, and any that you might encounter will usually slink away. If you are unlucky enough to be bitten then remain still and call for an ambulance or get someone else to summon help. If it’s one of your limbs that has been bitten, ideally a pressure bandage should also be applied to slow the spread of any venom present.
Pharmacies, clinics and hospitals
Medical services in Malaysia are excellent; staff almost everywhere speak English and use up-to-date treatments. Details of pharmacies and hospitals are in the “Directory” sections of the Guide for cities and major towns.
Pharmacies stock a wide range of medicines and health-related items, from contraceptives to contact lens solution; opening hours are the same as for other shops. Pharmacists can recommend products for skin complaints or simple stomach problems, though it always pays to get a proper diagnosis.
Private clinics can be found even in small towns – your hotel or the local tourist office will be able to recommend a doctor. In Malaysia a consultation costs around RM30, not including the cost of any prescribed medication; keep the receipts for insurance-claim purposes. Finally, the emergency department of each town’s general hospital will see foreigners for a small fee, though obviously costs rise rapidly if continued treatment or overnight stays are necessary.