Health & Safety

Staying Healthy

Travelers in Panama should have no problem staying healthy, as standards of hygiene are high, and tap water is safe to drink in most areas. Those with sensitive stomachs will want to drink bottled water when outside major hotels and cities. The most common health problems that affect travelers in Panama are sunburn and mosquito bites. Illnesses that once ravaged humans in the Tropics, such as yellow fever and malaria, are no longer epidemic in Panama. Viral infections and other illnesses are described in "Common Ailments," below. All travelers should be up-to-date on their tetanus immunizations, and receive a Hepatitis A vaccination.

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 current information about health concerns in Panama, 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. The website 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 clinics overseas at the International Society of Travel Medicine (www.istm.org).

General Availability Of Healthcare

Hospital quality in Panama City is on a par with that of the United States (most doctors are U.S.-trained), but medical service here is far more economical, and this fact has spawned a curious new "Health Tourism" industry. Major cities such as David have at least one high-quality hospital, but in small towns, a medical clinic may be the extent of healthcare facilities in the area, and more serious cases must be treated in Panama City.

English-speaking doctors are very common in Panama -- your embassy can provide you with a list if you request one.

Vacation Goal: A Tan, A Little Sightseeing, A Nose Job -- One of the fastest-growing sectors in worldwide travel is health and medical tourism, a term that has begun popping up in countries whose medical care and facilities are comparable to those in the U.S. or Europe, but that offer services at a fraction of the price. Health and medical tourism can apply to simple procedures such as having your teeth fixed or corrective laser eye surgery, or more serious procedures such as gastric bypass surgery, reproduction assistance, or "extreme makeovers" performed by a battery of plastic surgeons and dentists. On average, the cost is about 50% less than in the U.S. -- cataract surgery, for example, costs $2,500 in Panama and $6,000 in the U.S. And recuperation in a country that offers a warm climate, a lot of natural beauty, and a high-quality tourism infrastructure is part of the draw.

Interested travelers can check out the new John Hopkins-affiliated state-of-the-art Hospital Punta Pacifica, located at Calle 53 in Bellavista (tel. 263-5287), one of the best facilities in all of Latin America. Or try Pana-Health, a consortium of first-rate medical and dental specialists who have teamed up to offer foreigners a central location for information about procedures and easy planning. Most of its members have studied and trained in North American universities and hospitals, and therefore English is widely spoken, and Pana-Health employs the same techniques and technology found in the U.S. Plus Pana-Health can even plan your entire trip for you: As long as you book your own plane ticket, they'll arrange to pick you up from the airport, reserve your hotel room and doctor's appointments, plan city tours, and even book entertainment. For more information, check out their website at www.pana-health.com, or call tel. 305/675-7306 in the U.S., or 223-6766 in Panama.

Common Ailments

Tropical Illnesses -- Travelers have a low risk of contracting a tropical disease while in Panama. Yellow fever, the mosquito-borne disease that decimated canal workers in the late 19th and early 20th century, is no longer epidemic and vaccinations are not required.

Governmental bulletins from the Centers for Disease Control (CDC) recommend that travelers planning to visit Bocas del Toro, Darién, or the San Blas Archipelago protect themselves against malaria -- yet cases of malaria are not common and mostly afflict rural citizens who live in remote areas, such as Ngöbe-Buglé Indian tribes. You might consider an antimalarial prophylaxis if you plan to spend extended periods in the jungle in the aforementioned areas. Malaria is a parasite that lives in red blood cells and is transmitted by the female anopheles mosquito. The symptoms are cycles of chills, fever, and sweating, sometimes accompanied by headache, backache, and vomiting. Check with your doctor for updated news about malaria outbreaks and what medication is best for the region you plan to visit (mosquitoes in the Darién, for example, are resistant to the commonly used chloroquine).

More common is dengue fever, an infectious disease caused by an arbovirus transmitted by daytime mosquitoes. Symptoms of the disease appear suddenly and include a high fever, chills, swollen and painful eyes, a headache, and severe aches in the legs and joints -- the reason dengue is commonly referred to as "breakbone fever." Symptoms last a week, and though most people recover fully, weakness and fatigue can continue for several weeks. Dengue fever outbreaks have been reported during the past few years in the Bocas del Toro and Colón provinces, mostly affecting locals who live near pools of stagnant water.

The most effective prevention against malaria and dengue fever is to protect yourself against mosquito bites

Dietary Distress -- Hepatitis A is a highly contagious viral disease and one of the most common travel-related infections in the developing world. It's transmitted by eating contaminated food, by fecal-oral contact, or by contact with unsanitary conditions. Outbreaks usually occur in poor regions such as the Colón Province, where more than 50 cases were reported in early 2006 due to a contaminated aqueduct and poor food-handling practices. Hepatitis A symptoms range from mild to severe, and can include fever, nausea, and jaundice; cases are normally resolved without complications. The vaccination is safe and effective, and is recommended for anyone traveling to Panama.

Leptospirosis is a disease caused by contact with animals infected with leptospires, or by ingesting, or swimming in, water contaminated with animal urine. It causes fever, chills, headache, muscle aches, vomiting, and diarrhea. Travelers become sick from between 2 days to 4 weeks after exposure to the bacteria, the catch being that it can often be misdiagnosed without a blood or urine sample. If you experience the aforementioned symptoms, contact your doctor, who can treat leptospirosis with antibiotics such as penicillin.

The most common illness that affects tourists is TD, or traveler's diarrhea, caused by microbes in food and water and typically affecting persons from a country with a high standard of sanitation traveling to an area with a less-advanced system of sanitation. In addition to diarrhea, affected persons may experience nausea and headaches. To prevent TD, avoid foods or beverages from street vendors that look iffy, avoid eating raw or undercooked meat and seafood, and drink bottled water when outside major hotels and restaurants.

Bugs, Bites & Other Wildlife Concerns -- Panama is replete with bugs that bite, including chiggers, sandflies (also called no-see-ums, or chitras), mosquitoes, ticks, and ants. It is very important that you protect yourself against mosquitoes that may or may not carry a disease such as dengue fever. Mosquitoes are endemic, and in mountain ranges they can leave particularly large welts. Ticks are found mostly in the Darién jungle area during March and April. Chiggers leave a tiny bump that can itch for 2 weeks; but the gross-out factor is that these immature nymphs burrow into your skin -- you notice the bite after they've left. Chitras live in sand, and are more active during sunrise and sunset -- but they can bite at any time of the day.

Panama City is the only area of the country where you won't have to worry too much about getting bitten. Otherwise, spray yourself with insect repellent every day, even if you are just stepping out for dinner at an outdoor cafe. In the jungle, wear long pants (tuck them into your socks) and give your ankle area and all exposed areas a coat of repellent that has at least 30% DEET. Some travelers soak their clothing with the insecticide Permethrin (some companies now sell adventure wear presoaked with Permethrin) to repel bugs. Above all, bring along a bite-soothing, anti-itch product like Sting-eeze.

Panama is home to many poisonous snakes such as the pit viper, the fer-de-lance, and the patoca, but bites are rare. Nevertheless, protect yourself by wearing high boots if you're walking in remote jungle, and keep alert, scanning the trail in front of you. If you're bitten, cutting X-shaped gouges and sucking out the venom is old-fashioned nonsense that won't work; instead, remain calm (panic speeds the venom's diffusion), wash the wound with soap and water if you can, try to identify the species, and seek emergency medical help.

Tropical Sun -- The blistering, equatorial sun can burn your skin faster than you think -- even on a cloudy day. Limit your exposure or apply, liberally, a high-factor sunscreen. The sun is especially strong from 11am to 2pm.

Sunstroke, or heatstroke, can afflict travelers in the Tropics when humidity interferes with the cooling of an overheated body. Sunstroke can be serious, so rest and cool off if you begin to feel dizzy or have a headache. Drink plenty of fluids to keep dehydration at bay.

What To Do If You Get Sick -- 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. Carry the generic name of prescription medicines, in case a local pharmacist is unfamiliar with the brand name.

For travel abroad, you may have to pay all medical costs upfront and be reimbursed later.

Staying Safe

Panama is one of the safest countries in Latin America, with a few exceptions. The ragged port town of Colón is dangerous day and night, except in the Colón 2000 cruise-ship and Zona Libre (Free Zone) areas. The northeastern region of the Darién Province near the Caribbean Sea is highly dangerous due to incidents of kidnapping, murder, and drug-running by Colombian guerrilla and paramilitary groups who have crossed the border into Panama. Other regions of the Darién are home to several lodges that are in a no-risk area.

Panama City is safe, with low to moderate crime occurring mostly in neighborhoods such as El Chorrillo and Curundú; these neighborhoods should be avoided if possible. El Chorrillo surrounds Casco Viejo, to which visitors should take a taxi instead of walking. Panama City is a modern, clean city, yet a very visible poor underclass lives in run-down neighborhoods that feature prominently in the city's west side. As with any urban area, visitors should be alert, exercise caution when taking money out of an ATM, and not walk around with large sums of cash.

Visitors headed for the beach should be extremely cautious when swimming or surfing in both the Pacific and Caribbean oceans, where there are strong riptides. Often there are no warning signs; and tour guides rarely advise their clients of dangerous areas. Remember, no matter what happens, stay calm, and swim parallel to the shore and out of the current.

Drugs are easy to buy in Panama, but stiff penalties apply to anyone caught with illegal substances.

For current security information about Panama, check the U.S. Department of State's Travel Advisory website at http://travel.state.gov.

Dealing With Discrimination

Panama is a melting pot of races and religions, and in general Panamanians are a tolerant society. Still, Panamanians of African descent and indigenous groups have voiced concerns about racism in the workplace, part of which led to a new anti-discriminatory law put into effect in 2005.

Ecotourism

You can find eco-friendly travel tips, statistics, and touring companies and associations -- listed by destination under "Travel Choice" -- at the TIES website, www.ecotourism.org. Ecotravel.com is part online magazine and part ecodirectory that lets you search for touring companies in several categories (water-based, land-based, spiritually oriented, and so on). Also check out Conservation International (www.conservation.org) -- which, with National Geographic Traveler, annually presents World Legacy Awards (www.wlaward.org) to those travel tour operators, businesses, organizations, and places that have made a significant contribution to sustainable tourism.

For information about the ethics of swimming with dolphins and other outdoor activities, visit the Whale and Dolphin Conservation Society (www.wdcs.org) and Tread Lightly (www.treadlightly.org).