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Staying Healthy

While no vaccines are presently required, you may choose to take extra precaustions. Staying healthy is largely about keeping your eyes open and practicing good hygiene. Some rules of thumb: Drink only bottled water, and also use bottled water to clean your teeth. Wash your hands before eating. If soap and water are not available, use an alcohol-based hand gel (with at least 60% alcohol). Always try and use restaurants that look clean, and make sure that all food is properly cooked. Avoid dairy products, unless you know they have been pasteurized. Avoid eating street food if you can. Fruit and vegetables should be washed or peeled. Put ice in your drinks only if it's cubed or tubed (crushed ice may have been chipped off a big block that has been kept in unsanitary conditions).

Many of the other big health threats are borne on the wings of the whining, pesky, hovering mosquito. Protecting yourself against mosquito bites is crucial to preventing a variety of diseases, including malaria. This means using an effective repellent (with DEET, or one of the newer eucalyptus-based products) day and night, and sleeping under a net or in a screened or sealed room. Wear long trousers and a long-sleeved shirt if you are in a risky area.

Another problem in Cambodia can be the heat and the sun. Use a good sunscreen, cover your skin, try to stay out of the sun during the hottest part of the day, and keep up your fluid intake. If you can't avoid being in the sun, make sure you wear a hat. Keep properly hydrated with water (beer, soda, or tea does not do the job). It's a good idea to carry rehydration salts with you.

There are big problems with hepatitis and HIV in Cambodia (an estimated 40% of commercial sex workers are HIV-positive). If you are determined to put yourself in harm's way, then be sure to practice safe sex.

Ailments in Cambodia

Like many poor tropical countries, Cambodia is a host to a variety of ailments that with proper attention to hygiene and preventative measures the traveler will avoid getting.

Worms & Other Intestinal Parasites -- These can be a problem due to poor hygiene. Be careful where you eat and what you eat (especially if it is street food). Watch out for any meat that looks uncooked.

Giardia, Dysentery, & Salmonella -- These are contracted as a result of infected food and poor hygiene. Giardia is a parasite that, if you are infected, causes some fairly unsociable symptoms of flatulence with the odor of rotten eggs. It is treated through a course of prescription drugs, notably metronidazole (brand name Flagyl).

Dysentery -- Dysentery is an unpleasant condition involving stomach cramps, diarrhea (with blood and mucus in the stool), and fever. In amoebic dysentery, the parasites that cause it are dealt with through a course of metronidazole. Bacillary dysentery can be treated with antibiotics if very severe, but normally one gets through it in 1 to 2 weeks, during which remaining well hydrated is vital. Salmonella is also bacterial and symptoms begin with nausea and vomiting and progress to abdominal pains and diarrhea. Additional symptoms include fever, chills, and muscle pains, and it can last anywhere from several days to 2 weeks. There is no treatment, and you just have to get through it by making sure you stay hydrated.

Hepatitis A -- Hepatitus A is a viral infection of the liver, also contracted from bad food or water. The best way to avoid it is (if over 2 years old) to make sure you are vaccinated, stick to bottled water, and keep a good eye on what you eat. Symptoms include fatigue, fever, abdominal pain, nausea, diarrhea, loss of appetite, depression, jaundice, weight loss, and itching. Inoculation takes the form of a single shot and a booster after 6 months.

Hepatitis B -- Hepatitus B is contracted through contamination by infected blood. As with HIV, it is mostly contracted through sexual contact, blood transfusion, and contaminated needles. Other more everyday objects such as a razor or a toothbrush can also be a conduit. Vaccination, which takes the form of three shots over a 6-month period, is highly recommended.

Typhoid -- Typhoid is bacterial and transmitted through contaminated food. Typhoid can be life-threatening, particularly to children and the elderly. Early detection and a course of antibiotics will usually prevent complications. Symptoms include sustained fever, sweating, gastroenteritis, nonbloody diarrhea, and, in some cases, a rash of flat rose-colored spots. Antibiotics are commonly used to treat the disease. Vaccinations are available but are only 50%-to-80% effective. Nevertheless, the vaccine is recommended.

Japanese Encephalitis -- This is a mosquito-borne disease that is endemic to Southeast Asia. Symptoms include headache, fever, nausea, upset stomach, and malaise. Vaccination is recommended, particularly if traveling in rural parts of the country.

Cholera -- Cholera is a food- and waterborne disease. The main symptoms of infection are diarrhea and intense dehydration. Occasionally there are outbreaks in some parts of the country and vaccination is recommended.

Rabies -- Rabies is a disease transmitted through bodily fluids, mainly by a bite or contact with the saliva of an infected animal. In Cambodia, there is no shortage of ill-disciplined dogs, monkeys, and bats, all of which may transmit the disease. The symptoms of rabies are malaise, headache, and fever, while in later stages it includes acute pain, violent movements, uncontrolled excitement, depression, and the inability to swallow water or hydrophobia. If you get any kind of puncture wound from a potentially infected animal, it is important to seek treatment immediately. This consists of a series of vaccinations over a 1-month period. If you are planning to spend a lot of time in high-risk areas, you might want to consider preexposure vaccinations. These make postexposure treatment far simpler, reducing the number of shots required as well as preventing the need for rabies-immune globulin (which may not be available and would therefore require evacuation to Thailand). A vigilant eye should be kept on children, given that most of them have an abiding fascination with all creatures four-legged.

Malaria -- This is a biggie in Southeast Asia and still a serious threat. There are four strains of malaria and all are life threatening, cerebral malaria being the most serious. Malaria is caused by a one-cell parasite transmitted by the Anopheles mosquito. The parasite travels into the liver, lies dormant, and grows. Then symptoms occur when it enters the bloodstream. Symptoms include high fever, headaches, nausea, vomiting, dizziness, and confusion. Initial symptoms may appear the same as for a number of other conditions, including flu. If experiencing any of these symptoms, seek medical help immediately.

It may be advisable to take a prophylactic such as mefloquine (Lariam), the antibiotic doxycycline, or atovaquone/proguanil (Malarone). The problem is that all these drugs have quite severe side effects. Larium can cause severe and distressing mood swings. Malarone can cause diarrhea, insomnia, dizziness, headaches, loss of appetite, nausea, stomach pain, vomiting, and weakness. Doxycycline may cause the skin to have an intense sensitivity to sunlight, nausea, vomiting, upset stomach, and loss of appetite. The best thing you can do is to simply not get bitten. This means covering all exposed areas of skin, especially at dawn and dusk when the malarial mosquitoes are at their most active. Use a good mosquito repellent with DEET (or one of the newer eucalyptus-based products) in areas where malaria is a problem. Sleep under a mosquito net. If you have air-conditioning make sure your room is properly sealed.

Malaria is not a problem in major towns and cities, and is restricted to remote jungle areas. Unless you are traveling to these areas you are unlikely to have a problem. There is a very low malaria risk in the more remote quarters of the Angkor Wat complex, but not in Siem Reap town. Though you are not allowed to be around the temples at night (when malaria is a threat), you should be protected with repellent during your visit. As with land mines, malaria is mostly a problem in areas of former conflict such as Samlot or Phnom Malai. Most places that tourists visit are safe.

Tetanus -- Also known as lockjaw, tetanus is a disease contracted through contamination of wounds. It manifests itself through muscle spasms. You should be vaccinated against this and make sure your booster is up to date.

Dengue Fever -- Like malaria, dengue fever is a mosquito-borne disease. It is found in some parts of Laos, particularly at certain times of year. No vaccination or prophylactic is available. Again the answer is simply to avoid getting bitten.

HIV/AIDS -- AIDS is a very serious problem in Cambodia, especially among commercial sex workers. Some educated estimates put the percentage of sex workers infected as high as 40%. Since the early '90s, it has reached epidemic proportions. Transmittal occurs through infected blood, which primarily occurs from sexual contact, blood transfusions, or shared syringes. Avoid blood products unless absolutely necessary and practice sexual abstinence at best and safe sex as a next best.

What to Do If You Get Sick Away from Home

Medical care in Phnom Penh, Siem Reap, and Sihanoukville is rudimentary, to say the least. Most hospitals are not very good. There are private hospitals in Phnom Penh and Siem Reap, and if you are not in a major town you should head there. In both Phnom Penh and Siem Reap, there are a number of GPs and small clinics with a good reputation. They are very familiar with all the ailments common to Cambodia. You will have to pay upfront, but they will provide receipts for your medical insurance. Before your trip, make sure that you have adequate medical insurance that includes evacuation. Medical care in Cambodia is quite medieval and often overstretched, and you really don't want to be on the receiving end of it for very long. If something seriously untoward happens to you, then you will need to get to a hospital in Thailand. Medical care in Thailand is excellent and cheaper than the U.S. or Europe. Even so, for anything serious, bills can mount up to thousands of dollars quite quickly and you will need to be able to cover that.

Safety

Cambodia has a reputation for violence and lawlessness. Some of that reputation is well deserved, while some of it is simply history. Only a decade ago, guns were everywhere, city streets were dark at night, and robberies were commonplace. Cambodia has moved on vastly since then, but robberies still happen. Practice common sense and take the same precautions you would anywhere else.

The Khmer Rouge may be finished, but the land mines left over from the decades of conflict are still there. The good news is that unless you choose to go to more remote regions, particularly near the border with Thailand, then you will not be in mined areas (though Kompong Speu close to Phnom Penh remains a problem area). The area around Angkor Wat is cleared. If you do see the red "Danger. Mines!" sign, take it very seriously. Do not cross into an area fenced off by CMAC (Cambodian Mines Action Center), MAG (Mines Advisory Group), or the Halo Trust. The mines will take decades to clear, but the areas that are afflicted are now fairly well defined. As a general rule, when in the countryside stay on the path and don't wander into the fields or undergrowth.

Street robbery is still a problem in the cities of Cambodia, as it is elsewhere. Bag snatchings have been increasingly frequent. This is dangerous if you are pulled off the back of a motorcycle. If you are confronted by thieves in a potentially violent situation, do not attempt to resist. Simply do as they ask. The adage of the old days in Cambodia, "don't carry it unless you are prepared to lose it" still has some value at night. It is a bad idea to walk long distances by foot after dark. Don't leave valuables hanging from your shoulder where they can be easily seen or snatched. If you are in a tuk-tuk, keep your bag in the center of the vehicle. If you are riding on a motorcycle, keep your things wedged between you and the driver to avoid being pulled off the back of the bike if you are subject to a snatching. Stay on main roads at night if possible.

You might just get a taste of old-style Cambodian gun violence in certain nightclubs (particularly the Heart of Darkness in Phnom Penh). There have been a number of cases of well-connected young men going to nightclubs and starting trouble for recreation. If you smell trouble, back away or be conciliatory.

Last, be aware that the police are not your friends. They can be massively corrupt, so if you are in trouble contact your embassy first.

A Dark Side of Cambodia -- Sex tourism is a serious issue in Cambodia. Prostitution is endemic in every town and village, with all the attendant issues of trafficking, bonded labor, violence, coercion, and child abuse. In Phnom Penh and Sihanoukville, there are also districts modeled on the Thai sex tourism resort of Pattaya, with hostess bars and gaggles of rural Khmer women trying to make a buck. AIDS is prevalent here among sex workers, though the safe sex message has finally begun to sink in as the sheer prevalence of the virus caused many to see friends or family members die.

What is even more tragic is the reputation that Cambodia gained for pedophile tourism and the stark reality it represents. Children were and are bought and sold to both indigenous and foreign pedophiles. Sihanoukville gained a real reputation for this. It is alleged that organized pedophile rings paid off the police for their full cooperation.

These days, however, they often get jailed when caught and foreign governments are proactive in prosecuting those convicted of child molestation, even when they return home. The reality is found on billboards in Phnom Penh and Siem Reap: "Abuse a child in this country. Go to jail in your own." There are quite a number of foreign pedophiles serving sentences in Cambodia for the abuse of children. Cambodian jails are very unpleasant places indeed. The battle, however, is not yet won.

If you have founded suspicions of child abuse, call the confidential Childsafe Hotline on tel. 011/312-112 (www.childsafe-cambodia.org). There is also a national police unit hot line at tel. 023/997-919. Childsafe's advice is, "Whenever possible, we ask the caller to stay near the child until our team arrives to take appropriate action to protect the child." Do not contact the local police and do not confront the possible offender, however strong your feelings.

Note: This information was accurate when it was published, but can change without notice. Please be sure to confirm all rates and details directly with the companies in question before planning your trip.