Health advice for Mexico
Most travellers visit Mexico without catching anything more serious than a dose of "Montezuma’s Revenge". You will still want the security of health insurance, but the important thing is to keep your resistance high and to be aware of the health risks linked to poor hygiene, untreated water, mosquito bites and undressed open cuts.
Lack of sanitation in Mexico is much exaggerated, but a degree of caution is wise. Avoid food that looks like it has been on display for a while or not freshly cooked, and always peel fruit before eating it. Avoid raw shellfish, and don’t eat anywhere that is obviously dirty (easily spotted, since most Mexican restaurants are scrupulously clean). Salads are healthy, but think twice before eating them if you have a sensitive stomach. In general, keep an eye out for cleanliness of street stalls – beware of food that has been left out to breed germs rather than food that has been freshly cooked.
There are no required vaccinations for Mexico, but it’s worth visiting your doctor at least four weeks before you leave to check that you are up to date with tetanus, typhoid and hepatitis A shots, as well as a rabies shot and anti-malarial pills if you’re going to be in areas where they are recommended.
Diarrhoea
Diarrhoea ("Montezuma’s Revenge", or simply turista as it’s also known in Mexico) is the medical problem you’re most likely to encounter, and no one, however cautious, seems to avoid it altogether. If you go down with a mild dose unaccompanied by other symptoms, it may simply be due to your body being unfamiliar with the local bacteria, but if your diarrhoea is accompanied by cramps and vomiting, it could be food poisoning of some sort. Either way, it will probably pass of its own accord in 24 to 48 hours without treatment. In the meantime, it’s essential to replace the fluid and salts you’re losing, so drink lots of water. If you have severe diarrhoea, and whenever young children have it, add oral rehydration salts – suero oral (brand names: Dioralyte, Electrosol, Rehidrat). If you can’t get these, dissolve half a teaspoon of salt and three of sugar in a litre of water.
Avoid greasy food, heavy spices, caffeine and most fruit and dairy products; some say bananas, papayas, guavas and prickly pears (tunas) help, while plain yogurt or a broth made from yeast extract (such as Marmite or Vegemite, if you happen to have some with you) can be easily absorbed by your body when you have diarrhoea. Drugs like Lomotil or Imodium plug you up – and thus undermine the body’s efforts to rid itself of infection – but they can be a temporary stop-gap if you have to travel. If symptoms persist for more than three days, or if you have a fever or blood in your stool, seek medical advice.
Malaria and dengue fever
Malaria, caused by a parasite that lives in the saliva of female Anopheles mosquitoes, is endemic in some parts of Mexico. Areas above 1000m (such as the capital) are malaria-free, as are Cancún, Cozumel, Isla Mujeres and all the beach resorts of the Baja and the Pacific coasts. Daytime visits to archeological sites are risk-free, too, but low-lying inland areas can be risky, especially at night. According to the US-based Centers for Disease Control and Prevention (CDC) the main risk areas are Chihuahua, Chiapas, Durango, Nayarit and Sinaloa, with rare cases in Campeche, Jalisco, Oaxaca, Sonora, Tabasco and the municipality of Othon P. Blanco in the southern part of Quintana Roo, bordering Belize. Chloroquine (brand names: Nivaquin, Resochin, Avloclor, Aralen) is the recommended malaria prophylactic for travellers to Mexico; you need to start taking the pills one week before you arrive and continue for one month after you depart. Chloroquine is unsuitable for sufferers from various complaints such as epilepsy and psoriasis but daily proguanil (brand name Paludrine) can be used in its place. Consult a physician before beginning any course of medication; see wwwnc.cdc.gov/travel for more information on malaria in Mexico.
If you go down with malaria, you’ll probably know. The fever, shivering and headaches are like severe flu and come in waves, usually beginning in the early evening. Malaria is not infectious, but can be dangerous and sometimes even fatal if not treated quickly, so you should seek medical help immediately.
The most important thing, obviously, is to avoid mosquito bites altogether. Though active from dusk till dawn, female Anopheles mosquitoes prefer to bite in the evening. Wear long sleeves, skirts or trousers, avoid dark colours, which attract mosquitoes, and put repellent on all exposed skin, especially feet and ankles, which are their favourite targets. Plenty of good brands are sold locally, though health departments recommend carrying high-DEET brands available from travel clinics at home. An alternative is to burn coils of pyrethrum incense such as Raidolitos (these are readily available and burn all night if whole, but break easily). Sleep under a net if you can – one that hangs from a single point is best if you’re going to buy one (you can usually find a way to tie a string across your room to hang it from). Special mosquito nets for hammocks are available in Mexico.
Another illness spread by mosquito bites is dengue fever, whose symptoms are similar to those of malaria, plus a headache and aching bones. Dengue-carrying mosquitoes are particularly prevalent in urban areas during the rainy season and fly during the day, so wear insect repellent in the daytime if mosquitoes are around. The only treatment is complete rest, with drugs to assuage the fever – and take note that a second infection can be fatal.
Other bites and stings
Other biting insects can also be a nuisance. These include bed bugs, sometimes found in cheap (and, occasionally, in not so cheap) hotels – look for squashed ones around the bed. Sandflies, often present on beaches, are quite small, but their bites, usually on feet and ankles, itch like hell and last for days. Head or body lice can be picked up from people or bedding, and are best treated with medicated soap or shampoo.
Scorpions are mostly nocturnal and hide during the day under rocks and in crevices, so poking around in such places when in the countryside is generally ill-advised. If sleeping in a place where they might enter (such as a beach cabaña), shake your shoes out before putting them on in the morning, and try not to wander round barefoot. Some scorpion stings are dangerous and medical treatment should always be sought – cold-pack the sting in the meantime. Snakes are unlikely to bite unless accidentally disturbed – walk heavily and they will usually slither away. A fifth or so of Mexico’s snake species are venomous, the most dangerous being rattlesnakes (cascabel, found in the north), coral snakes (coralillo, found particularly in Guerrero, Oaxaca, Veracruz and Chiapas), and the nauyacas (found mainly in the south and the Yucatán). If you do get bitten or stung, remember what the snake or scorpion looked like (kill it if you can do so without receiving more bites), try not to move the affected part (tourniquets are not recommended due to dangerous risk of gangrene – if you do use one, it is vital to relieve it for at least ninety seconds every fifteen minutes), and seek medical help: antivenins are available in most hospitals. Black widow spiders also exist in Mexico; tarantulas are more fearsome-looking, but a lot less dangerous.
Altitude and heat problems
Two other common causes of health problems in Mexico are altitude and the sun. The solution in both cases is to take it easy. Arriving in Mexico City (2240m), in particular, you may find any activity strenuous, and the thin air is made worse by the high concentration of pollutants. Allow yourself time to acclimatize. If going to higher altitudes (mountain climbing, for example), you may develop symptoms of Acute Mountain Sickness (AMS), such as breathlessness, headaches, dizziness, nausea and appetite loss. More extreme cases may include vomiting, disorientation, loss of balance and coughing up of pink frothy phlegm. 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 or keep to the shade. Be sure to avoid dehydration by drinking enough (water or fruit juice rather than beer or coffee and aim to drink at least three litres a day), and don’t exert yourself for long periods in the hot sun. Be aware that overheating can cause heatstroke, which is potentially fatal. Signs are a very high body temperature without a feeling of fever, accompanied by headaches, disorientation and even irrational behaviour. Lowering body temperature (a tepid shower, for example) is the first step in treatment.
Less serious is prickly heat, an itchy rash that is in fact an infection of the sweat ducts caused by excessive perspiration that doesn’t dry off. A cool shower, zinc oxide powder and loose cotton clothes should help.
Hepatitis
Hepatitis A is transmitted through contaminated food and water, or through saliva, and thrives in conditions of poor hygiene. It can lay a victim low for several months with exhaustion, fever and diarrhoea, and can even cause liver damage. The Havrix vaccine has been shown to be extremely effective; with a booster after six months, protection lasts for ten years.
Hepatitis symptoms include a yellowing of the whites of the eyes, general malaise, orange urine (though dehydration can also cause this) and light-coloured stools. If you think you have it and are unable immediately to see a doctor, it is important to get lots of rest, avoid alcohol and do your best not to spread the disease. If medical insurance coverage is an issue, you can go to a pathology lab (most towns have them) to get blood tests before paying a greater amount to see a doctor.
More serious is hepatitis B, which is passed through blood or sexual contact, in the same way as HIV, but more easily. A hepatitis B jab is recommended if you will be in contact with those with weaker immunity systems, for example, working around medical patients or with children. Ideally three doses are given over six months but if time is short, there are other options that take one to two months, with a booster given after a year.
Other diseases
Typhoid and cholera are spread in the same way as hepatitis A. Typhoid produces a persistent high fever with malaise, headaches and abdominal pains, followed by diarrhoea. Vaccination can be by injection or orally, though the oral alternative is less effective, more expensive and only lasts a year, as opposed to three for a shot in the arm. Cholera appears in epidemics rather than isolated cases – if it’s about, you will probably hear about it. Cholera is characterized by sudden attacks of watery diarrhoea with severe cramps and debilitation. The vaccination is no longer given, as it is ineffective.
Immunizations against mumps, measles, TB and rubella are a good idea for anyone who wasn’t vaccinated as a child and hasn’t had the diseases, and it’s worth making sure you are covered for tetanus. You don’t need a shot for yellow fever unless you’re coming from a country where it’s endemic (in which case you need to carry your vaccination certificate).
Rabies exists in Mexico and the rabies vaccine is advised for anyone who will be more than 24 hours away from medical help, for example if going trekking in remote areas. The best advice is simply to give dogs a wide berth, and not to play with animals at all, no matter how cuddly they may look. A bite, a scratch or even a lick from an infected animal could spread the disease – rabies can be fatal, so if you are bitten, assume the worst and get medical help as quickly as possible. While waiting, wash any such wound immediately but gently with soap or detergent and apply alcohol or iodine if possible. If you decide to get the vaccination, you’ll need three shots spread over a four-week period prior to travel.
Getting medical help
For minor medical problems, head for a farmacia – look for a green cross and the Farmacia sign. Pharmacists are knowledgeable and helpful, and many speak some English. One word of warning however: in many Mexican pharmacies you can still buy drugs such as Entero-Vioform and Mexaform (both used to treat diarrhoea), which can cause optic nerve damage and have been banned elsewhere; it is not a good idea, therefore, to use local brands unless you know what they are. Note that the purchase of prescription drugs without a Mexican prescription is illegal; a US prescription will not suffice.
For more serious complaints you can get a list of English-speaking doctors from your government’s nearest consulate. Big hotels and tourist offices may also be able to recommend medical services. Every Mexican border town has hundreds of doctors (dentists, too) experienced in treating gringos, since they charge less than their colleagues across the border. Every reasonably sized town should also have a state- or Red Cross-run health centre (centro de salud), where treatment is free. Treatment at health centres should be adequate for minor problems, but for anything involving an overnight stay, go to a private hospital (for which your travel insurance should cover you).
What about the water?
In a hot climate and at high altitudes, it’s essential to increase water intake to prevent dehydration. Most travellers, and most Mexicans if they can, stay off the tap water. A lot of the time it is in fact drinkable, and in practice may be impossible to avoid completely: ice made with it, unasked for, may appear in drinks, utensils are washed in it, and so on.
Most restaurants and licuaderías use purified water (agua purificada), but always check; most hotels have a supply and will often provide bottles of water in your room. Bottled water (generally purified with ozone or ultraviolet) is widely available, but stick with known brands, and always check that the seal on the bottle is intact since refilling empties with tap water for resale is common (carbonated water is generally a safer bet in that respect).
There are various methods of treating water while you are travelling, whether your source is from a tap or a river or stream. Boiling it for a minimum of five minutes is the time-honoured method, but it is not always practical, will not remove unpleasant tastes and is a lot less effective at higher altitudes – including much of central Mexico – where you have to boil it for much longer.
Sterilization and purification
Chemical sterilization, using either chlorine or iodine tablets or a tincture of iodine liquid, is more convenient, but leaves a nasty aftertaste (which can to some extent be masked with lime juice). Chlorine kills bacteria but, unlike iodine, is not effective against amoebic dysentery and giardiasis. Pregnant women or people with thyroid problems should consult their doctor before using iodine sterilizing tablets or iodine-based purifiers. Too many iodine tablets can cause gastrointestinal discomfort. Inexpensive iodine removal filters are available and are recommended if treated water is being used continuously for more than a month or is being given to babies.
Purification, involving both filtration and sterilization, gives the most complete treatment. Portable water purifiers range in size from units weighing as little as 60g, which can be slipped into a pocket, up to 800g for carrying in a backpack.
Culture in Mexico
Mexicans are generally very courteous, and in some ways quite formal. It is common, for example, to address people as señor or señora, while being too brusque can give quite a bad impression.
Most Mexicans are also quite religious, and about three-quarters are Roman Catholic; you will often see little altars by the roadside, and many people cross themselves whenever they pass a church. It is wise to avoid open disrespect for religion unless you are sure of your company. While male travellers will find the country very easy-going, women may encounter a few difficulties arising from traditional Latin machismo.
Sexual harassment and discrimination
Machismo is engrained in the Mexican mentality and, although it’s softened to some extent by the gentler mores of indigenous culture, most women will find that a degree of harassment is inevitable.
On the whole, most hassles will be limited to comments (piropos, supposedly compliments) in the street, but situations that might be quite routine at home can seem threatening without a clear understanding of the nuances of Mexican Spanish. Avoid eye contact – wearing sunglasses helps. Any provocation is best ignored – Mexican women are rarely slow with a stream of retaliatory abuse, but it’s a dangerous strategy unless you’re very sure of your ground, and coming from a foreigner, it may be taken as racism.
Public transport can be one of the worst places for harassment, especially groping in crowded situations. On the Mexico City Metro, there are separate women’s carriages and passages during rush hours. Otherwise, if you get a seat, you can hide behind a newspaper.
Problems are aggravated in the big tourist spots, where legendarily “easy” tourists attract droves of would-be gigolos. Away from resorts and big cities, though, and especially in indigenous areas, there is rarely any problem – you may as an outsider be treated as an object of curiosity, and usually, such curiosity can also extend to friendliness and hospitality. On the whole, the further from the US border you get, the easier things will become.
The restrictions imposed on drinking are without a doubt irksome: women can now drink in cantinas, but even in so-called “ladies’ bars”, “unescorted” women may be looked at with suspicion. Even in the roughest places, you are unlikely to be refused service nowadays, but whether or not you would feel comfortable drinking there is a different matter.
Tipping
At expensive restaurants in tourist resorts, waiters and waitresses are used to American tipping levels (15–20 percent), but elsewhere levels are more like those in Europe (10–15 percent). In mid-range and upmarket hotels, you will be expected to tip chambermaids (a few dollars, depending on the standard of the hotel and the length of your stay) and porters (ten to twenty pesos or a dollar is fine). It is not usual to tip taxi drivers, but small tips are expected by petrol-station and car-park attendants and the bagboys at supermarkets (all of these will be happy with a few pesos of small change).
The craft tradition of Mexico, much of it descended directly from arts practised long before the Spanish arrived, is still extremely strong. Regional and highly localized specialities survive, with villages throughout the republic jealously guarding their reputations – especially in the states of Michoacán, Oaxaca and Chiapas, as well as the Yucatán Peninsula. There’s a considerable amount of Guatemalan textiles and embroidery about, too.
Crafts
To buy crafts, there is no need to visit the place of origin – shops in Mexico City and all the big resorts gather the best and most popular items from around the country. On the other hand, it’s a great deal more enjoyable to see where the articles come from, and certainly the only way to get any real bargains. The good stuff is rarely cheap wherever you buy it, however, and there is an enormous amount of dross produced specifically for tourists.
FONART shops, in major centres throughout Mexico, are run by a government agency devoted to the promotion and preservation of crafts; their wares are always excellent, if expensive, and the shops should be visited to get an idea of what is available. Where no such store exists, you can get a similar idea by looking at the best of the tourist shops.
Among the most popular items are: silver, the best of which is wrought in Taxco, although rarely mined there; pottery, made almost everywhere, with different techniques, designs and patterns in each region; woollen goods, especially blankets, which are again made everywhere, and sarapes from Oaxaca – always check the fibres and go for more expensive natural dyes; leather, especially tyre-tread-soled huaraches (sandals), sold cheaply wherever you go; glass from Jalisco; lacquerware, particularly from Uruapán; and hammocks, the best of which are sold in Mérida.
It is illegal to buy or sell antiquities, and even more criminal to try taking them out of the country (moreover, many items sold as valuable antiquities are little more than worthless fakes) – best to just look.
Markets
For bargain hunters, the mercado (market) is the place to head. There’s one in every Mexican town which, on the traditional market day, will be at its busiest with villagers from the surrounding area bringing their produce for sale or barter. Mercados are mainly dedicated to food and everyday necessities, but most have a section devoted to crafts, and in larger towns you may find a separate crafts bazaar.
Unless you’re completely hopeless at bargaining, prices will always be lower in the market than in shops, but shops do have a couple of advantages. First, they exercise a degree of quality control, whereas any old junk can be sold in the market; and second, many established shops will be able to ship purchases home for you, which saves an enormous amount of frustrating bureaucracy.
Bargaining and haggling are very much a matter of personal style, highly dependent on your command of Spanish, aggressiveness and, to some extent, experience. The old tricks (never showing the least sign of interest – let alone enthusiasm, and walking away, will always cut the price dramatically) do still hold true; but make sure you know what you want, its approximate value and how much you are prepared to pay. Never start to haggle for something you definitely don’t intend to buy – it’ll end in bad feelings on both sides. In shops there’s little chance of significantly altering the official price unless you’re buying in bulk, and even in markets most food and simple household goods have a set price (though it may be doubled at the sight of an approaching gringo).