Health & Safety

Staying Healthy

Staying healthy on a trip to Costa Rica is predominantly a matter of being a little cautious about what you eat and drink, and using common sense. Know your physical limits, and don't overexert yourself in the ocean, on hikes, or in athletic activities. Respect the tropical sun and protect yourself from it. Limit your exposure to the sun, especially during the first few days of your trip and, thereafter, from 11am to 2pm. Use sunscreen with a high protection factor, and apply it liberally. Remember that children need more protection than adults. I recommend buying and drinking bottled water or soft drinks, but the water in San José and in most of the heavily visited spots is safe to drink. The sections below deal with specific health concerns in Costa Rica.

If you suffer from a chronic illness, consult your doctor before leaving. For conditions such as epilepsy, diabetes, or heart problems, wear a MedicAlert identification tag (tel. 800/825-3785; www.medicalert.org), which will immediately alert doctors to your condition and give them access to your records through MedicAlert's 24-hour hot line.

Pack prescription medications in your carry-on luggage, and carry prescription medications in their original containers. Also bring along copies of your prescriptions in case you lose your pills or run out, and carry the generic name of prescription medicines in case a local pharmacist is unfamiliar with the brand name. And don't forget an extra pair of contact lenses or prescription glasses.

Contact the International Association for Medical Assistance to Travelers (IAMAT) (tel. 716/754-4883 or, in Canada, 416/652-0137; www.iamat.org) for tips on travel and health concerns in the countries you're visiting, and for lists of local, English-speaking doctors. The United States Centers for Disease Control and Prevention (tel. 800/311-3435; www.cdc.gov) provides up-to-date information on health hazards by region or country and offers tips on food safety. Travel Health Online (www.tripprep.com), sponsored by a consortium of travel medicine practitioners, may also offer helpful advice on traveling abroad. You can find listings of reliable medical clinics overseas at the International Society of Travel Medicine (www.istm.org).

General Availability of Health Care

Any local consulate in Costa Rica can provide a list of area doctors who speak English. The local English-language newspaper, the Tico Times, is another good resource. I've listed the best hospitals in San José in "Fast Facts: San José," in chapter 5; these have the most modern facilities in the country. Most state-run hospitals and walk-in clinics around the country have emergency rooms that can treat most conditions, although I highly recommend the private hospitals in San José, if your condition is not life-threatening and can wait for treatment until you reach one of them.

Common Ailments

Tropical Diseases -- Your chance of contracting any serious tropical disease in Costa Rica is slim, especially if you stick to the beaches or traditional spots for visitors. However, malaria, dengue fever, and leptospirosis all exist in Costa Rica, so it's a good idea to know what they are.

Malaria is found in the lowlands on both coasts and in the northern zone. Although it's rarely found in urban areas, it's still a problem in remote wooded regions and along the Caribbean coast. Malaria prophylaxes are available, but several have side effects, and others are of questionable effectiveness. Consult your doctor regarding what is currently considered the best preventive treatment for malaria. Be sure to ask whether a recommended drug will cause you to be hypersensitive to the sun; it would be a shame to come down here for the beaches and then have to hide under an umbrella the whole time. Because malaria-carrying mosquitoes usually come out at night, you should do as much as possible to avoid being bitten after dark. If you are in a malaria-prone area, wear long pants and long sleeves, use insect repellent, and either sleep under a mosquito net or burn mosquito coils (similar to incense, but with a pesticide).

Of greater concern is dengue fever, which has had periodic outbreaks in Latin America since the mid-1990s. Dengue fever is similar to malaria and is spread by an aggressive daytime mosquito. This mosquito seems to be most common in lowland urban areas, and Puntarenas, Liberia, and Limón have been the worst-hit cities in Costa Rica. Dengue is also known as "bone-break fever" because it is usually accompanied by severe body aches. The first infection with dengue fever will make you very sick but should cause no serious damage. However, a second infection with a different strain of the dengue virus can lead to internal hemorrhaging and could be life threatening.

Many people are convinced that taking B-complex vitamins daily will help prevent mosquitoes from biting you. I don't think the American Medical Association has endorsed this idea yet, but I've run across it in enough places to think that there might be something to it.

One final tropical fever that I think you should know about (because I got it myself) is leptospirosis. There are more than 200 strains of leptospires, which are animal-borne bacteria transmitted to humans via contact with drinking, swimming, or bathing water. This bacterial infection is easily treated with antibiotics; however, it can quickly cause very high fever and chills, and should be treated promptly.

If you develop a high fever accompanied by severe body aches, nausea, diarrhea, or vomiting during or shortly after a visit to Costa Rica, consult a physician as soon as possible.

Costa Rica has been relatively free of the cholera epidemic that has spread through much of Latin America in recent years. This is largely due to an extensive public-awareness campaign that has promoted good hygiene and increased sanitation. Your chances of contracting cholera while you're here are very slight.

Amoebas, Parasites, Diarrhea & Other Intestinal Woes -- Even though the water in San José and most popular destinations in Costa Rica is generally safe, and even though you've been careful to buy bottled water, order frescos en leche (fruit shakes made with milk rather than water), and drink your soft drink warm (without ice cubes -- which are made from water, after all), you still might encounter some intestinal difficulties. Most of this is just due to tender northern stomachs coming into contact with slightly more aggressive Latin American intestinal flora. In extreme cases of diarrhea or intestinal discomfort, it's worth taking a stool sample to a lab for analysis. The results will usually pinpoint the amoebic or parasitic culprit, which can then be readily treated with available over-the-counter medicines.

Except in the most established and hygienic of restaurants, it's also advisable to avoid ceviche, a raw seafood salad, especially if it has any shellfish in it. It could be home to any number of bacterial critters.

Tropical Sun -- Limit your exposure to the sun, especially during the first few days of your trip and, thereafter, from 11am to 2pm. Use a sunscreen with a high protection factor, and apply it liberally. Remember that children need more protection than adults.

Riptides -- Many of Costa Rica's beaches have riptides: strong currents that can drag swimmers out to sea. A riptide occurs when water that has been dumped on the shore by strong waves forms a channel back out to open water. These channels have strong currents. If you get caught in a riptide, you can't escape the current by swimming toward shore; it's like trying to swim upstream in a river. To break free of the current, swim parallel to shore and use the energy of the waves to help you get back to the beach.

Bees, Snakes & Bugs -- Although Costa Rica has Africanized bees (the notorious "killer bees" of fact and fable) and several species of venomous snakes, your chances of being bitten are minimal, especially if you refrain from sticking your hands into hives or under rocks in the forest. If you know that you're allergic to bee stings, consult your doctor before traveling.

Snake sightings, much less snakebites, are very rare. Moreover, the majority of snakes in Costa Rica are nonpoisonous. If you do encounter a snake, stay calm, don't make any sudden movements, and do not try to handle it. As recommended above, avoid sticking your hands under rocks, branches, and fallen trees.

Scorpions, black widow spiders, tarantulas, bullet ants, and biting insects of many types can all be found in Costa Rica. In general, they are not nearly the danger or nuisance most visitors fear. Watch where you stick your hands; in addition, you might want to shake out your clothes and shoes before putting them on to avoid any unpleasant and painful surprises.

What To Do If You Get Sick Away From Home

For travel abroad, you may have to pay all medical costs up front and be reimbursed later. Medicare and Medicaid do not provide coverage for medical costs outside the U.S. Before leaving home, find out what medical services your health insurance covers. To protect yourself, consider buying medical travel insurance.

Very few health insurance plans pay for medical evacuation back to the U.S. (which can cost $10,000 and up). A number of companies offer medical evacuation services anywhere in the world. If you're ever hospitalized more than 150 miles from home, MedjetAssist (tel. 800/527-7478; www.medjetassistance.com) will pick you up and fly you to the hospital of your choice virtually anywhere in the world in a medically equipped and staffed aircraft 24 hours day, 7 days a week. Annual memberships are $225 individual, $350 family; you can also purchase short-term memberships.

U.K. nationals will need a European Health Insurance Card (EHIC) to receive free or reduced-costs health benefits during a visit to a European Economic Area (EEA) country (European Union countries plus Iceland, Liechtenstein and Norway) or Switzerland. The European Health Insurance Card replaces the E111 form, which is no longer valid. For advice, ask at your local post office or see www.dh.gov.uk/travellers.

Safety

Although most of Costa Rica is safe, petty crime and robberies committed against tourists are endemic. San José is known for its pickpockets, so never carry a wallet in your back pocket. A woman should keep a tight grip on her purse (keep it tucked under your arm). Thieves also target gold chains, cameras and video cameras, prominent jewelry, and nice sunglasses. Be sure not to leave valuables unsecured in your hotel room. Don't park a car on the street in Costa Rica, especially in San José; plenty of public parking lots are around the city.

Rental cars generally stick out and are easily spotted by thieves. Don't leave anything of value in a car parked on the street, not even for a moment. Be wary of solicitous strangers who stop to help you change a tire or take you to a service station. Although most are truly good Samaritans, there have been reports of thieves preying on roadside breakdowns. Public intercity buses are also frequent targets of stealthy thieves. Never check your bags into the hold of a bus. If this can't be avoided, keep your eye on what leaves the hold. If you put your bags in an overhead rack, be sure you can see the bags at all times. Try not to fall asleep.