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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.

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 Health Care

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. 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.

The most likely illness you'll face in Panama is traveler's diarrhea from unfamiliar foods or drinks. Even though the water in Panama is perfectly safe to drink almost everywhere, travelers with very delicate stomachs may want to stick to bottled water. Also, those with delicate stomachs may want to stick to moderate and high-end restaurants, and avoid raw vegetables and pealed fruits.

If you're traveling to the tropical lowlands or jungle areas, be sure to pack plenty of bug repellent with a high percentage of DEET, especially if you'll be hiking or spending most of your time outdoors. There's been a spike in Dengue cases in the last few years, and the last thing you want is to have your trip ruined by a tropical disease. Also, if you'll be traveling in the Darien or another heavily forested area, bring light, long sleeved clothing to avoid bug bites.

Most drugs can be bought over the counter at any pharmacy in Panama, and many prescription-only drugs in the U.S are sold over the counter in pharmacies. Headache, anti-diarrheal, and other common OTC mediations are readily available at all pharmacies

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. However, if you're traveling to the Darién, Bocas del Toro, or other remote tropical destinations, you may want to consider getting vaccinated against yellow fever.

Governmental bulletins from the Centers for Disease Control (CDC) recommend that travelers planning to visit Bocas del Toro, Darién, or the San Blas Archipelago be vaccinated 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 vaccination against malaria 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 vaccine is best for the region you plan to visit (mosquitoes in the Darién, for example, are resistant to the common vaccine 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 their mouths into skin pores or hair follicles -- 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 Away from Home

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.

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.