Staying Healthy

Hawaii is one of the healthiest states in the union. You do not need any special vaccinations or medications before you come here.

One thing you should know before you arrive is that Hawaii mandates health care insurance for all employees, so most medical facilities (hospitals, doctor's offices, and the like) are used to dealing with insurance companies, HMOs, and such. If you are uninsured, some doctors will not treat you. If you have medical insurance, be sure to bring your insurance card with you.

Pack prescription medications in your carry-on luggage. Carry written prescriptions in generic form, not brand name form, and dispense all prescription medications from their original labeled vials. If you wear contact lenses, pack an extra pair in case you lose one.

Common Ailments

Below are the types of "critters" we have on land in Kauai and at sea that you might run into and how to handle bites, scratches, and such.

On Land

As in any tropical climate, there are lots of bugs in Kauai. Most of them won't harm you. However, three insects -- mosquitoes, centipedes, and scorpions -- do sting, and they can cause anything from mild annoyance to severe swelling and pain.

Mosquitoes -- These pesky insects aren't native to Hawaii but arrived as larvae stowed away in the water barrels on the ship Wellington in 1826. There's not a whole lot you can do about them, except apply repellent or burn mosquito punk or citronella candles to keep them out of your area. If they've bitten you, head to the drugstore for sting-stopping ointments (antihistamine creams like Benadryl or homeopathic creams like Sting Stop or Florasone); they'll ease the itching and swelling. Most bites disappear in anywhere from a few hours to a few days.

Centipedes -- These segmented insects with a jillion legs come in two varieties: 6- to 8-inch brown ones and the smaller 2- to 3-inch blue guys; both can really pack a wallop with their sting. Centipedes are generally found in damp places, like under wood piles or compost heaps. Wearing closed-toe shoes can help prevent stings if you accidentally unearth a centipede. If you're stung, the reaction can range from something similar to a mild bee sting to severe pain; apply ice at once to prevent swelling. Visit a doctor if you experience extreme pain, swelling, nausea, or any other severe reaction.

Scorpions -- Rarely seen, scorpions are found in arid, warm regions; their stings can be serious. Campers in dry areas should always check their boots before putting them on, and shake out sleeping bags and bedrolls. Symptoms of a scorpion sting include shortness of breath, hives, swelling, and nausea. In the unlikely event that you're stung, apply diluted household ammonia and cold compresses to the area of the sting, and seek medical attention immediately.

Ocean Safety

Because most people coming to Kauai are unfamiliar with the ocean environment, they're often unaware of the natural hazards it holds. But with just a few precautions, your ocean experience can be a safe and happy one. An excellent book to get is All Stings Considered: First Aid and Medical Treatment of Hawaii's Marine Injuries (University of Hawaii Press, 1997), by Craig Thomas (an emergency-medicine doctor) and Susan Scott (a registered nurse). These avid water people have put together the authoritative book on first aid for Hawaii's marine injuries.

Seasickness -- The waters off Kauai can range from calm as glass to downright frightening (in storm conditions), and they usually fall somewhere in between; in general, expect rougher conditions in winter than in summer.

Some 90% of the population tends toward seasickness. If you've never been out on a boat or if you've gotten seasick in the past, you might want to heed the following suggestions:

• The day before you go out on the boat, avoid alcohol; caffeine; citrus and other acidic juices; and greasy, spicy, or hard-to-digest foods.
• Get a good night's sleep the night before.
• Take or use whatever seasickness prevention works best for you -- medication, an acupressure wristband, ginger root tea or capsules, or any combination -- before you board; once you set sail, it's generally too late.
• Once you're on the water, stay as low and as near the center of the boat as possible. Avoid the fumes (especially if it's a diesel boat); stay out in the fresh air and watch the horizon. Do not read.
• If you start to feel queasy, drink clear fluids like water, and eat something bland, such as a soda cracker.

Don't Get Burned: Smart Tanning Tips

Tanning just ain't what it used to be. Hawaii's Caucasian population has a higher incidence of the deadly skin cancer malignant melanoma than the population anywhere else in the United States. But none of us are safe from the sun's harmful rays: People of all skin types and races can burn when exposed to the sun too long.

To ensure that your vacation won't be ruined by a painful, throbbing sunburn, here are some helpful tips on how to tan safely and painlessly:

• Wear a strong sunscreen at all times, and use lots of it. Use a sunscreen with a sun-protection factor (SPF) of 15 or higher; people with a light complexion should use 30. Apply sunscreen as soon as you get out of the shower in the morning, and at least 30 minutes before you're exposed to the sun. No matter what the label says -- even if the sunscreen is waterproof -- reapply it every 2 hours and immediately after swimming.
• Read the labels. To avoid developing allergies to sunscreens, avoid those that contain para-aminobenzoic acid (PABA). Look for a sunscreen with zinc oxide, talc, or titanium dioxide, which reduce the risk of developing skin allergies. For the best protection from UVA rays (which can cause wrinkles and premature aging), check the label for zinc oxide, benzophenone, oxybenzone, sulisobenzone, titanium dioxide, or avobenzone (also known as Parsol 1789).
• Wear a hat and sunglasses. And make sure that your sunglasses have UV filters.
• Avoid being in the sun between 9am and 3pm. Use extra caution during these peak hours. Remember that a beach umbrella is not protection enough from the sun's harmful UV rays; in fact, with the reflection from the water, the sand, and even the sidewalk, some 85% of the ultraviolet rays are still bombarding you.
• Protect children from the sun, and keep infants out of the sun altogether. Infants under 6 months should not be in the sun at all. Older babies need zinc oxide to protect their fragile skin, and children should be slathered with sunscreen every hour. The burns that children get today predict what their future with skin cancer will be tomorrow.

If you start to turn red, get out of the sun. Contrary to popular belief, you don't have to turn red to tan; if your skin is red, it's burned -- and that's serious. The redness from a burn may not show until 2 to 8 hours after you get out of the sun, and the full force of that burn may not appear for 24 to 36 hours. During that time, you can look forward to pain, itching, and peeling. The best remedy for a sunburn is to get out of the sun immediately and stay out of the sun until all the redness is gone. Aloe vera (straight from the plant or from a commercial preparation), cool compresses, cold baths, and anesthetic benzocaine may also help ease the pain of sunburn.

If you've decided to get a head start on your tan by using a self-tanning lotion that dyes your skin a darker shade, remember that this will not protect you from the sun. You'll still need to generously apply sunscreen when you go out.

Stings -- The most common stings in Hawaii come from jellyfish, particularly Portuguese man-of-war and box jellyfish. Since the poisons they inject are very different, you need to treat each sting differently.

A bluish-purple floating bubble with a long tail, the Portuguese man-of-war causes thousands of stings a year. Stings, although painful and a nuisance, are rarely harmful; fewer than one in a thousand require medical treatment. The best prevention is to watch for these floating bubbles as you snorkel (look for the hanging tentacles below the surface). Get out of the water if anyone near you spots these jellyfish.

Reactions to stings range from mild burning and redness to severe welts and blisters. All Stings Considered recommends the following treatment: First, pick off any visible tentacles with a gloved hand, a stick, or anything handy; then rinse the sting with fresh or salt water; and finally apply ice to prevent swelling and to help control pain.

Hawaiian folklore advises using vinegar, meat tenderizer, baking soda, papain, or alcohol, or even urinating on the wound. Studies have shown that these remedies may actually cause further damage. Most Portuguese man-of-war stings will disappear by themselves within 15 to 20 minutes if you do nothing to treat them. Still, be sure to see a doctor if pain persists or if a rash or other symptoms develop.

Box jellyfish, transparent, square-shaped bell jellyfish, are nearly impossible to see in the water. Fortunately, they seem to follow a monthly cycle: 8 to 10 days after the full moon, they appear in the waters on the leeward side of the island and hang around for about 3 days. Also, they seem to sting more in the morning hours, when they're on or near the surface. The best prevention is to get out of the water.

Stings range from no visible marks to red, hivelike welts, blisters, and pain (a burning sensation) lasting from 10 minutes to 8 hours. All Stings Considered recommends the following course of treatment: First, pour regular household vinegar on the sting; this may not relieve the pain, but it will stop additional burning. Do not rub the area. Pick off any vinegar-soaked tentacles with a stick. For pain, apply an ice pack. Seek additional medical treatment if you experience shortness of breath, weakness, palpitations, muscle cramps, or any other severe symptoms. Again, ignore any folk remedies. Most box jellyfish stings disappear by themselves without treatment.

Punctures -- Most sea-related punctures come from stepping on or brushing against the needlelike spines of sea urchins (known locally as wana). Be careful when you're in the water; don't put your foot down (even if you have booties or fins on) if you cannot clearly see the bottom. Waves can push you into wana in a surge zone in shallow water (the wana's spines can even puncture a wet suit).

A sea urchin sting can result in burning, aching, swelling, and discoloration (black or purple) around the area where the spines have entered your skin. The best thing to do is to pull out any protruding spines. The body will absorb the spines within 24 hours to 3 weeks, or the remainder of the spines will work themselves out. Again, contrary to popular wisdom, do not urinate or pour vinegar on the embedded spines -- this will not help.

Cuts -- All cuts obtained in the marine environment must be taken seriously because the high level of bacteria present can quickly cause the cut to become infected. The most common cuts are from coral. Contrary to popular belief, coral cannot grow inside your body. However, bacteria can -- and very often does -- grow inside a cut. The best way to prevent cuts is to wear a wet suit, gloves, and reef shoes. Never, under any circumstances, should you touch a coral head; not only can you get cut, but you can also damage a living organism that took decades to grow.

The symptoms of a coral cut can range from a slight scratch to severe welts and blisters. All Stings Considered recommends gently pulling the edges of the skin open and removing any embedded coral or grains of sand with tweezers, or rinsing well with fresh water. Next, scrub the cut well under fresh water. Never use ocean water to clean a cut. If the wound is bleeding, press a clean cloth against it until it stops. If bleeding continues or if the edges of the injury are jagged or gaping, seek medical treatment.

Everything You've Always Wanted to Know about Sharks -- The Hawaii State Department of Land and Natural Resources has launched a website with more information than you probably wanted to know about sharks: www.hawaiisharks.com. The site has the biology, history, and culture of these carnivores, plus information on safety and data on shark bites in Hawaii.

Enjoying the Ocean & Avoiding Mishaps -- The Kauai Visitors Bureau has an excellent website (www.kauaiexplorer.com) to help you enjoy Kauai's beaches and stay safe in the marine environment. The site introduces visitors to the various beaches, points out any hazards, lists surf conditions, states whether the beach has a lifeguard, and includes a map.

What To Do If You Get Sick Away From Home

In most cases, your existing health plan will provide the coverage you need. But double-check; you may want to buy travel medical insurance instead. Bring your insurance ID card with you when you travel.

If you suffer from a chronic illness, consult your doctor before your departure. 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. Visitors from outside the U.S. should carry generic names of prescription drugs. For U.S. travelers, most reliable healthcare plans provide coverage if you get sick away from home. Foreign visitors may have to pay all medical costs upfront and be reimbursed later. For information on medical insurance while traveling please visit www.frommers.com/planning.