Bolivia //

Health

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Bolivia is one of the poorest countries in the Americas, and the public health system is extremely limited. Generally speaking, the larger the city or town, the better the medical care available is likely to be. In La Paz and Santa Cruz, English-speaking doctors trained overseas are fairly easy to find. Standards decrease rapidly the further you go from the cities, and in rural areas medical facilities are poor to non-existent. If you have a choice, private hospitals and clinics are better staffed and equipped than public ones. Make sure you have adequate health insurance before you leave home, as costs can mount rapidly, and remember to obtain itemized receipts of your treatment so that you can recover your costs.

You’ll find pharmacies (farmacias) in most Bolivian towns; in larger places they operate a rota system, with at least one staying open 24 hours a day. These sell a wide range of familiar drugs and medicines without prescription (many, for example, sell the morning-after pill), so for minor ailments you can usually buy what you need over the counter. For any serious illness, you should go to a doctor or hospital; these are detailed throughout the guide in the relevant city listings. Many Bolivians are too poor to afford modern medical attention, and most make frequent recourse to traditional herbalists, known as curanderos – the most famous are the Kallawayas from the Cordillera Apolobamba. In addition, the market of every town has a section selling curative plants, herbs and charms for the most common ailments.

Although Bolivia is home to some very unpleasant tropical diseases, you shouldn’t get too paranoid about contracting them: most are rare and pose more of a threat to poor locals with limited access to healthcare and clean water. Most serious illnesses can be avoided if you take the necessary precautions and make sure you have the right vaccinations before you go.

If you’re planning a long trip it’s worth consulting your doctor before you leave, as well as having a dental check-up before you go. Take an adequate supply of any prescription medicines you normally use and, if you wear glasses or contact lenses, carry a spare pair and a copy of your prescription.

It’s currently recommended that visitors to Bolivia have immunizations for hepatitis A, typhoid and yellow fever. Advice can change, however, so check with your doctor or a travel clinic at least two months before travelling so that there’s time to have any courses of injections you might need. You should also make sure your polio and tetanus vaccinations and boosters are up to date. In the case of yellow fever, make sure you get an international vaccination certificate: you may have to show this when entering an infected area or arriving in the Bolivian Amazon from Brazil or Peru, and a certificate is always required when travelling overland to Brazil from Bolivia. If you don’t have the certificate, you’ll have to have an inoculation there and then.

Water and food

Though the tap water in some cities and towns is chlorinated, it’s best to avoid drinking it entirely while in Bolivia. Bottled water, both mineral and purified, is sold throughout the country, though rarely consumed by Bolivians themselves: check the seals on all bottles are intact, as refilling is not unknown. Soft drinks, tea and coffee are also perfectly safe to drink, and more widely available.

There are several ways of purifying water while travelling, whether your source is tap water or a spring or stream. Boiling water for at least ten minutes is effective, though at high altitude water boils at below 100°C, so you should let it boil for twice as long. Chemical purification with iodine (yodo) tablets or tincture (available in camping shops at home and at pharmacies in Bolivia) is easier, and generally effective, though not all microbes are eliminated and the resulting taste leaves much to be desired (although you can buy neutralizing powder that improves the taste somewhat, and a squeeze of lemon is also effective). Note that pregnant women, babies and people with thyroid complaints shouldn’t use iodine. Portable water filters give the most complete treatment, but are fiddly, expensive and relatively heavy to carry.

Almost any kind of food served in any kind of restaurant can make you sick – even if the food is clean, the waiters’ hands may not be – but you can reduce your chances of contracting a stomach bug by avoiding certain things. Be wary of anything bought from street stalls, and avoid salads, unpasteurized milk and cheese, undercooked or reheated fish or chicken and anything that’s been left lying around where flies can get at it.

Diarrhoea and dysentery

However careful you are, the chances are that sooner or later you’ll suffer a bout of diarrhoea, sometimes accompanied by vomiting and stomach cramps. This is usually caused by contaminated food or water, and there’s not much you can do about it except drink plenty of liquid (but not alcohol or caffeine). Herbal teas like coca and camomile (manzanilla) can help with stomach cramps, and you should also replace salts either by taking oral rehydration salts or by mixing a teaspoon of salt and eight of sugar in a litre of purified water. “Blocking” drugs like loperamide (Imodium, Lomotil) are useful if you have to keep travelling when suffering from diarrhoea, but they only alleviate the symptoms temporarily and can actually make things worse if you have dysentery. Once you’re holding down liquid, eat bland food like rice, soup and crackers, but avoid spicy, fatty and fried food, dairy products, raw fruit and alcohol until you’ve recovered.

You should seek medical advice if your diarrhoea contains blood; if it continues for more than five days; if it’s accompanied by a high fever (over 39°C); if abdominal pain becomes constant; or if the symptoms continue for more than five days. If your diarrhoea contains blood or mucus, the cause may be either amoebic dysentery, bacterial dysentery or giardia. With a fever, it could be caused by bacterial dysentery, which may clear up without treatment. If it doesn’t, a course of antibiotics such as ciprofloxacin, tetracycline or ampicillin (consider taking a course of one of these with you if you’re going off the beaten track for a while) should do the trick, though they will reduce your natural resistance to future bouts.

Similar symptoms to bacterial dysentery persisting or recurring over a period of weeks could indicate amoebic dysentery, which can have serious long-term effects such as liver damage. This can be treated with a course of metronidazole (Flagyl) or tinidazole (Fasigyn), antibiotics that should not be taken with alcohol. Sudden, watery and bad-smelling diarrhoea, accompanied by rotten-egg belches and flatulence, is probably giardia, which is also treated with metronidazole or tinidazole. You should only take these drugs without consultation if there’s no possibility of seeing a doctor. The only sure way to tell what is causing your diarrhoea is to have a stool test, which can be arranged by doctors in most towns.

The sun

The sun can be strong in Bolivia, and serious sunburn and sunstroke are real risks. This is particularly true at high altitudes (where the temperature is not that hot but the thin air amplifies the harm done by ultraviolet rays), or when travelling by boat on rivers or lakes (where cool breezes disguise the effects of the sun as it is reflected off the water). Exposure to the sun can also increase your chances of developing skin cancer. Long sleeves and trousers protect your skin from the sun and reduce fluid loss, and you should use a wide-brimmed hat, decent sunglasses to protect your eyes and a high-factor sunscreen (fifteen or above) on all exposed skin. Sunblock and suntan lotion are available in pharmacies in the main cities, but they’re generally expensive, so it’s better to bring a supply with you from home. Sunscreen lip-balm is also worth using. Drink plenty of liquid, particularly if you’re exercising, to prevent dehydration, and consider adding extra salt to your food to compensate for the effects of excessive sweating.

Altitude sickness

Altitude sickness – known as soroche in Bolivia – is a serious and potentially life-threatening illness caused by reduced atmospheric pressure and correspondingly lower oxygen levels at high altitudes. It can affect anyone who normally lives at low altitude and ascends above 2500m, and thus is a danger across much of Bolivia, including most major cities. You’re most likely to be affected if you fly into La Paz from near sea level – the airport is at over 4000m, and almost everyone feels at least a touch of breathlessness.

Mild symptoms can include headache, insomnia, breathlessness, nausea, dizziness, loss of appetite, tiredness, rapid heartbeat and vomiting. The best way to avoid this is to ascend slowly, if at all possible, and allow yourself time to acclimatize. Avoiding alcohol and physical exertion and drinking plenty of liquid also help. Bolivians swear by coca tea (mate de coca) as a remedy, and this is available throughout the country; the prescription drug acetazolamide (Diamox) can also help with acclimatization. Normal advice is to ascend no more than 300m a day once over 3000m, so far as possible.

The symptoms of serious altitude sickness, also known as acute mountain sickness, are usually experienced only over 4000m. In this condition, fluid can build up in the lungs or brain, causing high-altitude pulmonary or cerebral oedema; left untreated, severely affected sufferers can lapse into unconsciousness and die within hours. Symptoms include loss of balance, confusion, intense headache, difficulty breathing and coughing up frothy, bloodstained sputum. Prompt and rapid descent is the only treatment, and you should seek immediate medical help.

Malaria and other insect-borne diseases

Malaria is fairly common in lowland regions of Bolivia, particularly the Amazon, and you should take anti-malaria tablets if you’ll be going anywhere below 2500m – the altitude limit of the mosquito that spreads the disease (though it’s uncommon over 1500m). Consult your doctor several weeks before you leave home to see which treatment is most suitable for you. Prophylactic treatment usually consists of chloroquine (Avloclor or Nivaquine) combined with proguanil (Paludrine); mefloquine (Lariam) is an alternative, particularly as chloroquine-resistant strains of malaria exist in Bolivia, but some nasty side effects have been reported. With both treatments, it’s crucial that you keep taking the tablets for four weeks after leaving malarial areas. Malaria symptoms include fever, joint pains, loss of appetite and vomiting; if you suspect you’ve caught the disease, see a doctor and get a blood test.

The best way to avoid malaria, yellow fever and other diseases spread by mosquitoes is not to get bitten in the first place. Try to wear long sleeves, trousers and socks, and sleep in a screened room or under mosquito netting, preferably treated with a repellent chemical. It’s also a good idea to put repellent on your skin: make sure it has at least 35 percent DEET content. It’s best to bring this with you from home, as it’s hard to come by, expensive and usually of poor quality in Bolivia.

Another insect-borne danger is American trypanosomiasis, or Chagas’ disease. This is spread by the bite of the vinchuca, also known as the assassin bug, a small flying beetle found mainly in thatched roofs and adobe walls in rural areas of the Cochabamba, Chuquisaca and Tarija departments up to elevations of about 3000m. The disease is fatal, though usually only after a number of years, and in some rural areas up to ninety percent of the human population are thought to be infected. The bite is usually painful and infection can be detected by a blood test; though the disease does respond to some drug treatments, the best defence is to try to avoid being bitten – if you do have to sleep under a thatched roof in affected regions, use a mosquito net.

Leishmaniasis is a gruesome protozoan disease spread by the bite of the sandfly, common throughout the Bolivian lowlands. The bites enlarge and ulcerate, causing large lesions that over months or years can spread to other parts of the body and eat the cartilage around the nose and mouth. Treatment involves a course of injections, available in some Bolivian hospitals; the only prevention is to avoid getting bitten. Less serious but still unpleasant is the human botfly, or boro, which lays its eggs on damp clothes or on the proboscis of a mosquito, which then transfers them to human flesh. When the eggs hatch, the larvae burrow under the skin, producing a painful lump as they grow. To remove them, cover with oil or Vaseline to cut off the air supply, then squeeze the larvae out.

Other health issues

Bolivia is home to a wide range of venomous snakes (viboras), some of which can be lethal. Most are more concerned with getting away from you than attacking, and, even if they do strike, there’s a good chance they won’t inject any venom. Wearing boots, watching where you step and put your hands, and making a lot of noise when walking through vegetation all reduce the chances of getting bitten. In the event of a snakebite, keep the victim still and get medical help as quickly as possible. If possible, kill the snake for identification. Stings and bites from other creatures such as spiders and scorpions are uncommon but can be very painful or even fatal. It’s a good idea to shake out your shoes and clothes before putting them on, and to check your bedclothes and under lavatory seats.

Rabies still exists in Bolivia and people do die from it. If you’ll be spending time in remote areas or in contact with animals, it’s worth having the vaccine, though all this does is buy you extra time to seek medical treatment. If you do get bitten by a dog, vampire bat or other wild animal, thoroughly clean the wound with soap and water followed by alcohol or iodine and seek urgent medical attention. The only treatment is a series of injections in the stomach, which must be administered as soon as possible; these are available in most Bolivian hospitals.

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