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Staying Healthy

Consult your doctor or local travel clinic concerning precautions against diseases that are prevalent in India. The following cautionary list may have you wondering whether travel is advisable at all. However, don't be alarmed: Millions of travelers leave India having suffered nothing more than an upset stomach -- even this small inconvenience should settle within a few days, your system the stronger for it.

General Availability of Health Care -- Contact the International Association for Medical Assistance to Travelers (IAMAT; tel. 716/754-4883, or 416/652-0137 in Canada; www.iamat.org) for tips on travel and health concerns in the countries you're visiting. The United States Centers for Disease Control and Prevention (tel. 800/232-4636; 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, also offers helpful advice on traveling abroad.

Vaccinations -- You will almost certainly be advised to be vaccinated against hepatitis A, cholera, tetanus, and typhoid; also make sure your polio immunization is up to date. Longer-stay visitors should consider getting the hepatitis B and meningitis vaccinations as well. Note that travelers arriving from yellow fever-infected areas must have a yellow fever vaccination certificate.

Packing a First-Aid Kit -- Besides antidiarrheal medication, of which the most important are rehydration salts (available all over India as ORS -- oral rehydration salts), it may be worthwhile to carry a course of antibiotics (such as Ciprofloxacin, which is widely available in India at a fraction of what you'll pay back home) for stomach-related illnesses. It's also worthwhile to take an antiseptic cream, and possibly an antibacterial soap (though the type of soap used matters less than vigilance: Wash your hands regularly, particularly before eating). Pack prescription medications in your carry-on luggage in their original containers with pharmacy labels, so they'll make it through airport security. Also bring along copies of your prescriptions in case you lose your pills or run out (include the generic name; local pharmacists will be unfamiliar with brand names). Don't forget an extra pair of contact lenses or prescription glasses or an extra inhaler.

Common Ailments

Tropical Illnesses -- Besides malaria, India's mosquitoes are also responsible for spreading untreatable dengue fever and virulent Japanese encephalitis. Again, the best advice is to avoid getting bitten in the first place.

Malaria -- Most doctors will advise you to take a course of antimalarial tablets, but as is the case elsewhere, the best prevention is not to get bitten. Malaria is a parasitic infection borne by the female Anopheles mosquito, and risks are greater in warm, wet areas (particularly during monsoon) and at night, when mosquitoes are at their most active. Cover all exposed skin with antimosquito creams (many effective creams are available in India) or sprays as evening approaches, and use repellent coils or electric plug-in mosquito repellents as a preventive measure at night, particularly in hotel rooms without air-conditioning. Note that some plug-in repellents can cause a mild throat irritation, in which case stick with creams. Wear loose, floppy clothes that cover as much skin as possible, but remember that mosquitoes sometimes do bite through thin clothing, so you may need to apply repellent on your clothes as well. Note that many travelers on antimalarial tablets suffer side effects including nausea, vomiting, abdominal pain, and even mild forms of psychosis and depression; ask your doctor to suggest an alternative antimalarial that you can take if you end up having serious side effects (but bear in mind that chloroquine is not an effective antimalarial for India).

Sexually Transmitted Diseases & Blood Infections -- Keep in mind that HIV and hepatitis B are transmitted not only through sexual contact, but by infected blood. This means that any procedure involving a used needle or a blade can be hazardous. Avoid getting tattoos or piercings, and steer clear of roadside barbers offering shaves (although we've noticed that many barbers do in fact use fresh, unused blades). For haircuts and procedures such as manicures and pedicures, stick to salons in upmarket hotels. Take the usual precautions if you are about to engage in any sexual activities -- AIDS numbers are not well publicized, since the disease is widely associated with taboo and "anti-Indian behaviors," but this is a huge and growing problem, and some doctors and NGO workers we have consulted suggest that India is on track to becoming the world's worst-afflicted AIDS region.

Dietary Red Flags & Tummy Troubles -- Many visitors to India fall victim to the ubiquitous "Delhi belly," an unfortunate reaction to unfamiliar rich and spicy foodstuffs that can overwhelm the system and cause symptoms ranging from slight discomfort and "the runs" to extreme cases of nausea, fever, and delirium. To avoid this, simply be sensible. Adjust slowly; move on to spicy foods in small doses. You should also be on your guard about where you eat; if you have any fears at all, stick to the upmarket restaurants, usually those in five-star hotels -- but do venture out to those recommended in this guide. Remember that uncooked vegetables or fruit can be hazardous if washed in water that has not been boiled, so peel all your own fresh fruit and avoid salads. Unless you're in an upmarket hotel, don't eat fruit that has already been cut -- any water on the knife or on the skin of the fruit is likely to seep into the flesh. Be wary of undercooked meats -- they may harbor intestinal worms -- and stay away from pork unless you're in a five-star hotel.

The first thing to bear in mind when diarrhea or nausea strikes is that your body is trying to cleanse itself, so only use an antidiarrhea medication (like Imodium) if you are desperate -- about to embark on a long train journey, for example. Ideally, you should plan a few days of rest and cut back on all food except plain basics (a diet of boiled rice and bananas is ideal), and drink plenty of boiled water (or black tea) or bottled water with rehydration salts. If your tummy trouble doesn't clear up after 3 to 4 days, consult a physician -- you may be suffering from something more serious: a protozoa (amoeba or giardia) or a viral or bacterial infection.

Water Concerns -- More than anything else in India, the water is likely to make you ill. For this reason, you should not only avoid untreated drinking water, but be on your guard against any food product that is washed with water or has had water added to it. When buying tea (or chai) on the streets, for example, check that the cup is washed with hot water and even ask to dry it yourself -- carry a small cloth or napkins so that you can remove any water from anything that is going to go into your mouth; alternatively, carry your own stainless steel cup everywhere you go. Use bottled water when you brush your teeth, and do not open your mouth in the shower. Do not have ice added to your drink unless you've been assured that it's purified (as is typical of upmarket hotels and restaurants). Do be aware that in summer it is not uncommon for vendors selling lassi (a deliciously refreshing yogurt drink) to mix ice into their concoctions, and be exceptionally wary of enticing marketplace drinks such as freshly squeezed sugar-cane juice, which will be mixed with untreated water. If you purchase bottled water from roadside stalls, dodgy-looking shops, or small towns, check the seal on the cap and investigate the bottle for any signs of tampering. Also try to determine the age of the packaged water; if it looks like it's been sitting on the shelf for too long, avoid it. The only exception to the bottled water rule may be if you are 100% sure the water has been boiled for 20 minutes, or if you have been assured that the water has been filtered or treated with reverse osmosis or some similarly effective process. Generally, where water is placed in your room in a jug or some such container it has indeed been treated and is drinkable. If you are in the slightest doubt, simply ask. The same goes for street food stalls in larger cities where there is awareness around the dangers of drinking untreated water -- simply ask if the water is filtered or not. Remember not to clean wounds, cuts, or sores with tap water. Instead, douse and cleanse any open wound with antiseptic solution, cover it with an adhesive bandage, and consult a doctor if it doesn't heal soon. Note: A large number of restaurants and hotels have begun to take the issue of plastic bottles and their impact on the environment very seriously. We all know and understand that water bottled in plastic is cause for environmental concern. We strongly suggest that you make an effort to cut down on the number of plastic bottles that make their way to India's landfills (or rivers or valleys) by encouraging the use of treated water wherever possible -- and give your support to businesses that do so.

Bugs, Bites & Other Wildlife Concerns -- Remote areas are alive with insects and creepy-crawlies, but the greatest risk is malaria . Wear shoes when trekking or in wet areas; you can be contaminated from worm-infested soil or mud, which can also be a source of microbial, bacterial, or hookworm infection. Leeches are a common problem in the rainforest regions. Do not try to pull them off your skin; dousing with salt does the trick. It's possible to prevent this nasty experience by wearing special antileech "socks" and dousing your shoes with lime powder. You're more likely to be bitten by a rabid dog or monkey than by a snake, spider, centipede, or sea creature, but it does occur: Wear thick trousers and boots when hiking, tread carefully, keep your eyes peeled, and in the unlikely event that you are bitten, try to get a good look at the animal so that medical staff knows what antivenin to use. And yes, get to a doctor or hospital as soon as possible. Animals are seldom treated as pets in India -- as a general rule, steer clear of them, and should you be bitten, use antiseptic and consult a physician immediately.

Animal lovers beware: India will horrify you if you have a real soft spot for animals. You will feel particularly sickened by the "dancing bears" in North India -- sloth bears cruelly tethered and forced to perform for tourists -- as well as severely malnourished dogs, feral cats, diseased pigs, and even cows, considered sacred, looking emaciated and chewing on plastic bags and cardboard for sustenance. If you can see someone to rant at, do, but for the most part you have to bear it.

Respiratory Illnesses -- The Indian health authorities have taken a relatively firm stance against illnesses such as H1-N1, but despite mandatory form-filling and cursory checks at airports, swine flu victims did turn up in various locations around the country. Authorities have implemented national campaigns to educate people around basic hygiene and preventative health measures to try to prevent the spread of mucus- and airborne bacteria and viruses, but it can be something of a losing battle in a country where throat clearing (often for phlegm) and spitting in public places can sometimes seems to be a national pastime. If you find yourself in enclosed spaces with groups of people, consider covering your mouth and nose with a cloth or handkerchief and wash your hands after making contact with any kind of surface, including someone else's hands.

High-Altitude Hazards -- If you are going into mountainous regions (particularly in the Himalayan regions like Ladakh and Spiti), be sure to acclimatize adequately (usually over 2 full days) and monitor your body for signs of illness (nausea, faintness of breath, dizziness, headaches). Avoid overexerting yourself and be cautious when consuming alcohol which tends to make a bigger impact at higher altitudes. Be sure to drink plenty of water as dehydration is anther symptom of high altitude sickness. Be aware that cooler temperatures at higher altitudes can make you oblivious to the heightened impact of the sun -- take adequate precautions against sunburn .

Sun/Elements/Extreme Weather Exposure -- Carry high-SPF sunscreen and use it liberally. It's also advisable to wear a hat or cap during the day, and try to avoid midday sun wherever possible. In the cities, pollution often cloaks the high-level exposure, so keep that hat on. Remember that in the high-altitude Himalayan regions, you can experience cold weather and chilly winds while being burnt to a cinder. During the monsoons, certain regions can become impossible to traverse because of flooding. Orissa, Tamil Nadu, and Andhra Pradesh are prone to cyclones in November and December. Keep abreast of conditions by following weather reports.

Pollution -- Air pollution levels in many Indian cities are very high and contain high levels of suspended particulate matter. This is mostly from vehicles, but in places like Varanasi it is compounded by the use of diesel generators. The best thing to do is to always carry a cotton handkerchief with you to hold over your mouth and nose as a mask to breathe through until you are past the offending area. India is also plagued by noise pollution, and most visitors are usually shocked at how often drivers blare their horns. There's really nothing you can do other than accept that honking is usually a necessary precaution to avoid smashing into people, stray dogs, cattle, and all kinds of other obstacles (including cars).

What to Do If You Get Sick Away from Home

Don't panic. Medicines are widely and easily available in India. You can even describe your problem to your hotel concierge or receptionist and he or she will arrange for the necessary medication to be dropped off, doing away with possible translation problems. Pharmacies and pharmacists hand out pills and antibacterial medication upon request -- even those that would require a prescription back home. (This is not always a good thing; if possible, consult a physician before resorting to over-the-counter drugs. Also beware of being given incomplete courses of antibiotics.) There are hospital listings for major cities in each chapter, but it's best to consult your hotel concierge regarding the best medical attention in town, particularly if you're in a more remote area. In fact, do not solicit the assistance of anyone who is unknown to your hotel. Well-documented scams operating in certain tourist destinations involve prolonging your illness in order to attract large payouts from your insurance company. If you or someone you are traveling with needs hospitalization, shell out for a well-known private one, and if you're able to travel, head for the nearest big city. Advise your consulate and your medical insurance company as soon as possible.

It's likely you'll have to pay all medical costs upfront 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.

Pack prescription medications in your carry-on luggage, and carry them in their original containers, with pharmacy labels -- otherwise they won't make it through airport security. Carry the generic name of prescription medicines, in case a local pharmacist is unfamiliar with the brand name.

Safety

Considering its poverty and population size, India enjoys an amazingly low incidence of violent crime, and the vast majority of visits to India tend to be trouble-free. That said, the usual rules apply -- no wandering around back alleys at night, for example, no flashing of valuables or wads of cash. Foreign visitors may be targeted by corrupt cops looking to get a handsome bribe or payoff, so you'd best steer clear of any suspicious behavior such as purchasing illegal drugs. If you're caught, even with marijuana, there is a good chance that you could be thrown in prison. If you're involved in a car accident, have your hotel manager report the incident immediately. Avoid provocative debates and arguments where alcohol may be involved. Exercise caution during festivals and religious processions, where crowds are usually overwhelming and can become unruly.

Terrorism & Civil Unrest -- The ugly multipronged assault by Pakistani-trained gunmen on Mumbai in November 2008 (known in India as 26/11) devastated not only two of the city's most celebrated luxury hotels, but also targeted several other key tourist spots, including the historic Victoria Terminus train station. Indian authorities have taken these attacks -- and earlier incidents, such as the bombing of Mumbai commuter trains on July 2006, and the bombing of the Indian Parliament in December 2001 -- to heart, and security has been visibly beefed up not only in Mumbai but in key centers around the country. This has meant that India is in fact a great deal safer than before. The exception to this is the northernmost state of Jammu and Kashmir, where the terrorist organization Harakat Ul Mujahideen has issued a ban on Westerners, including tourists. With the exception of the eastern district of Ladakh, avoid travel in this volatile and unsafe war-torn region, no matter what tour operators and tourist offices have to say; regular terrorist attacks continue to occur in Kashmir, and civilians are often targets. Travelers should also exercise extreme caution when undertaking treks and travel to remote parts of Ladakh, where solo travelers are not permitted and can potentially be targeted by terrorist factions; in isolated cases, unaccompanied trekkers have been kidnapped or simply disappeared. Travelers to Goa and Himachal Pradesh should stay clear of any drug-related activity -- the trade has begun to attract nasty criminal elements. Travel to the northeastern states of Assam, Manipur, Nagaland, Tripura, and Meghalaya remains risky due to sporadic incidents of ethnic insurgent violence. These areas -- and Kashmir -- have not been included in this guide.

Almost anywhere in India, communal violence can occur without advance warning, but such incidents rarely involve foreigners, and thus far there have been no attacks by Indians directed against Americans or other foreigners. That said, the threat here -- as anywhere in the world -- should not be ignored completely: Exercise vigilance and caution if you find yourself near any government installations or tourist attractions that might be regarded as potential terrorist targets; avoid political demonstrations, read the local papers, heeding any relevant reports and travel advisories. Access up-to-the-minute travel warnings at www.travel.state.gov. U.S. citizens can also contact the U.S. Embassy or the nearest U.S. Consulate for more information about the current situation in areas you plan to visit.

Crime -- India is one of the safest destinations in the world when it comes to violent assault or threat, but petty crime, like pickpocketing, can be a problem. Apply common sense at all times. Don't carry wallets prominently; and keep a firm hand on purses (women have reported having their purse straps cut or purse bottoms slit). Don't wear flashy jewelry or carry around other valuables. Most hotels have in-room electronic safes where you should stash valuables, including passports and most of your cash. Be discreet about your money, and never take out large wads of cash in public; exercise modesty at all times. Solo travelers are at greater risk of becoming victims of crime; unless you're relatively streetwise, touring India alone may be more pain than pleasure. But know that it is as a victim of a scam that you are most at risk, which at least hurts nothing but your pocket and your pride.

Discrimination

Africans, African Americans, and other black travelers may sometimes face discrimination, particularly in smaller towns or nightclubs in larger cities, though this is not widespread. Some blacks and travelers from other Asian countries have also faced racist name-calling in India, usually from groups of young men in the street, completely ignorant of difference, and who are best ignored. Single female travelers do need to be careful

Warning: Surviving Scams & Con Artists

In India, scamming is an art form -- and you, the tourist, are a prime target. Although it's okay to have a heart, don't fall into the costly pit of naiveté. Politeness is likely to be your enemy. If someone tells you upfront that he's not interested in your money, the warning bells should begin to sound; 9 times out of 10, a casual conversation or unintentional tour will end with a request for payment. Remember: Don't pay for services you have not requested. And when you do ask for help, ask if there's going to be a demand for money at the end, and decide on a help fee upfront. Rude as it seems, often the only way to get rid of a persistent tout, beggar, or con artist is to ignore him and keep walking without pause. Here then is a guide to India's most common scams:

  • Street touts -- Touts operate under guises of initial friendship, wanting to practice their English or making promises of cheap accommodations or shopping. Often (but not always), the initial kindness turns sour when you don't comply with a suggestion that you buy something or check in at a crummy hotel. When browsing a street or market, you will be accosted by what appears to be the owner of the shop but is in fact one of a host of men to whom shopkeepers pay a commission to bring you inside -- "to look, no buy, madam." Since scam artists know that foreigners rely on hired transport, you also need to be particularly wary when considering car hire, taxis, guides, sightseeing tours, or travel agents. The rule is: Never jump into a deal.
  • "Official" unofficial operators -- Even more annoying than the slippery-tongued con artists of the street are those who operate under the guise of perceived legitimacy by calling themselves "travel agents" or "tour operators" -- and a sign saying "government-approved" often means anything but. Before purchasing anything, you need to know in advance what the going rate is, and preferably deal with someone who comes recommended by this guide or a reputable operator recommended by your hotel. Time allowing, shop around.
  • Dealing with drivers -- Taxi drivers are notorious for telling passengers that their hotel does not exist or has closed for some reason. Never allow yourself to be taken to a hotel or restaurant unless it is the one you've asked to be taken to (specified by exact name and address). Note that any successful establishment will soon have competition opening with a similar or almost identical name. Drivers also moonlight as restaurant and shop touts and receive a commission for getting you through the door. If a taxi driver is very persuasive about taking you to a particular shop, this is a sure sign that you're about to be taken for a ride. Taxi drivers often have meters that have been tampered with, or refuse to use fare-conversion charts issued by the city authority. Whenever you're suspicious about a driver's conduct, ask to be let out of the vehicle immediately, or seek the assistance of your hotel manager before paying the cab fare. When arriving at major airports and train stations, make use of prepaid taxis (the booths are clearly marked) whenever possible. Whenever you hire a local taxi, make sure that no one but the driver is riding with you. Even if you are just one person in the back seat, do not under any circumstances agree to allow the driver's friend to ride along. Get out and take another cab if necessary.
  • Bargains -- Beware of unmarked wares -- this means the goods are priced according to the salesperson's projection of your ability to pay. Also beware of the ultimate "bargain." Any deal that seems too good to be true, is. If this all sounds too tedious, head for the government shops, where goods are sold at fixed prices that are not a rip-off despite sometimes higher prices. But again, beware of imitations, such as Cottage Industries Exposition, often only marked "CIE," which are seriously overpriced outlets that cash in on the fame of the good-value government-owned Central Cottage Industries Emporiums.
  • Credit card fraud -- Beware of unscrupulous traders who run off extra dockets, then forge your signature. Never let your credit card out of sight.
  • Creating needs -- Sometimes a trickster will create your need for certain goods or services. One common Delhi scam is run by shoeshine boys who suddenly appear with their polishing equipment and point to your shoes which, when you look down, suddenly have poop on them. Of course he'll offer to clean it off for you, which you should refuse; the source of the poop is almost certainly the little guy himself or his accomplice.
  • Noting your notes -- Recognizing the insecurity that comes with dealing with an unfamiliar currency, swindlers will switch your Rs 500 note with a Rs 100 note and then claim that that's what you gave them. When handing out a fare or paying for a purchase, preferably give the whole amount together rather than handing over each note as you dig it up from your purse or pocket. Also, when you hand over a Rs 500 or Rs 1,000 note, state aloud how much it is.
  • Getting the goods on precious goods -- If you're shopping for silk carpets, ask the salesman to razor a small sample and light it with a match. Unlike wool, silk does not burn, it smolders. Tricksters will mix silk and wool -- which is why you'll need to ask for a sample across the whole color range. And don't fall for anyone who tries to persuade you to purchase precious stones on the premise that you can resell them at a profit to a company they supposedly know back home (a Jaipur scam). Note that gold is imported and therefore hugely overpriced, so cheap gold jewelry is exactly that.
  • Drugged foods and scam doctors -- Be wary when offered food or drink by a stranger. There have been isolated incidences of travelers being drugged or poisoned in order to rob them. Worse still, there are well-documented (though again isolated) accounts of these scammers who then recommend a fraudulent doctor, who will contact your medical insurance company and keep you ill while running up a substantial medical bill.

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.