Health & Insurance

Travel Insurance

Check your existing insurance policies and credit card coverage before you buy travel insurance. You may already be covered for lost luggage, cancelled tickets, or medical expenses.

The cost of travel insurance varies widely, depending on the cost and length of your trip, your age and health, and the type of trip you're taking; but expect to pay between 5% and 8% of the vacation itself. You can get estimates from various providers through InsureMyTrip.com. Enter your trip cost and dates, your age, and other information for prices from more than a dozen companies.

Trip-Cancellation Insurance -- Trip-cancellation insurance will help retrieve your money if you have to back out of a trip or depart early, or if your travel supplier goes bankrupt. Permissible reasons for trip cancellation can range from sickness to natural disasters to the State Department declaring a destination unsafe for travel. (Insurers usually won't cover vague fears, though, as many travelers discovered when they tried to cancel their trips in October 2001.) In this unstable world, trip-cancellation insurance is a good buy if you're purchasing tickets well in advance -- who knows what the state of the world, or of your airline, will be in 9 months? Insurance policy details vary, so read the fine print and make sure that your airline or cruise line is on the list of carriers covered in case of bankruptcy. A good resource is Travel Guard Alerts, a list of companies considered high-risk by Travel Guard International. Protect yourself further by paying for the insurance with a credit card -- by law, consumers can get their money back on goods and services not received if they report the loss within 60 days after the charge is listed on their credit card statement.

Note: Many tour operators, particularly those offering trips to remote or high-risk areas, include insurance in the total trip cost or can arrange insurance policies through a partnering provider, which is a convenient and often cost-effective way for the traveler to obtain insurance. Make sure the tour company is a reputable one, however, and be aware that some experts suggest you avoid buying insurance from the tour or cruise company you're traveling with. They contend it is more secure to buy from a "third party" than to put all your money in one place.

For more information, contact one of the following recommended insurers: Access America (tel. 866/807-3982; www.accessamerica.com); Travel Guard International (tel. 800/826-4919; www.travelguard.com); Travel Insured International (tel. 800/243-3174; www.travelinsured.com); and Travelex Insurance Services (tel. 888/457-4602; www.travelex-insurance.com).

Medical Insurance -- For travel overseas, most health plans (including Medicare and Medicaid) do not provide coverage, and the ones that do often require you to pay for services upfront and reimburse you only after you return home. As a safety net, you may want to buy travel medical insurance, particularly if you're traveling to a remote or high-risk area where emergency evacuation is a possible scenario. If you require additional medical insurance, try MEDEX Assistance (tel. 410/453-6300; www.medexassist.com) or Travel Assistance International (tel. 800/821-2828; www.travelassistance.com -- for general information on services, call the company's Worldwide Assistance Services, Inc., at tel. 800/777-8710). For a budget option, get affordable travel insurance from Student Travel Agency (STA; tel. 800/781-4040 in North America; www.sta.com or www.statravel.com). It's not just for students.

Lost-Luggage Insurance -- On international flights (including U.S. portions of international trips), baggage coverage is limited to approximately $9.07 per pound, up to approximately $635 per checked bag. If you plan to check items more valuable than what's covered by the standard liability, see if your homeowner's policy covers your valuables or get baggage insurance as part of your comprehensive travel-insurance package. Some online budget-airlines will offer a low-cost travel insurance option, but don't expect it to cover much. Nowadays, with so many airlines restricting cabin luggage weight, it's best to travel with only your most essential valuables; besides, many items lost on board aren't covered by airline policies.

If your luggage is lost, immediately file a lost-luggage claim at the airport, detailing the luggage brand and contents. Most airlines require that you report delayed, damaged, or lost baggage within 4 hours of arrival. Scheduled airlines are expected to return found luggage directly to your hotel or destination, free of charge, but do not expect this service from budget airlines.

Staying Healthy

Thailand, like all Third World countries, poses a small risk to travelers. The same precautions for visiting tropical climes apply to the more remote areas of the Thai kingdom. Many health risks such as malaria, dengue fever, or SARS are seasonal. Ask healthcare professionals to supply you with the latest information about health risks specific to the region.

It is recommended that travelers have current immunizations for Hepatitis A, polio, and Tetanus. Rubella is normally given to youths to protect against the increasingly widespread TB virus; check that you are protected. Wounds heal slowly in heat and humidity, so watch out for infections; wash cuts promptly with iodine or saline solution, and keep them dry.

If you suffer from a chronic illness, consult your doctor before your departure. Anyone with epilepsy, diabetes, heart problems, or allergies should consider wearing a Medic Alert 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 Medic Alert's 24-hour hotline.

Pack prescription medications in your carry-on luggage (bearing in mind if these are liquid, they need to be declared to airport security under new carry-on laws) and carry prescription medications in their original containers, with pharmacy labels. Also bring along copies of your prescriptions in case you lose your pills or run out. Don't forget an extra pair of contact lenses or prescription glasses. Carry the generic name of prescription medicines, in case a local pharmacist is unfamiliar with the brand name.

General Availability of Healthcare -- Dispensaries and hospital facilities in Thailand, especially in urban centers, are generally good. In Phuket, hospitals are able to deal with holidaymakers, especially victims of the islands' many car and motorbike crashes. Smaller towns will usually have a basic clinic, but Bangkok is always the best bet.

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 are visiting and for lists of 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).

Common Ailments

Stomach Trouble -- Often the change in climate and diet will provoke diarrhea in travelers to Thailand. Upset stomachs are best avoided by sticking to bottled water at all times (Thai homes and hotels often don't have potable water), and drinking lots of it. Also be sure canned or bottled drinks are unopened, and wash your hands regularly, especially before eating.

It's useful to keep good anti-diarrhea medicine such as Imodium handy in your travel bag, plus a fruit-flavored electrolyte powder such as Dechamp to mix with water to prevent dehydration. Note: A roll of toilet paper or packet of tissues is mandatory, too; Thai toilets do not usually provide this. Pharmacies here such as Boots or Watson's have a wide range of Western brand drugs including Imodium. 7-Eleven stores sell single toilet rolls, ready-to-go electrolyte drinks such as Gatorade, as well as the familiar items and brands like aspirin, Tylenol, and Eno antacids.

While restaurant hygiene throughout the country is fairly good, be wary of street food and check ingredients for freshness and cleanliness. Watch that the cooks prepare food before you, and never eat anything that looks like it has been sitting around, including "fresh" fruit sitting on melting ice. Avoid anything raw from vendors. If you develop a condition that includes cramps and lasts more than 24 hours, find a doctor for possible antibiotic treatment.

Tropical Illness -- Hepatitis A can be avoided using the same precautions as for diarrhea. Most Asians are immune through exposure, but people from the West are very susceptible. Consider starting a course of vaccines at least 3 months before your trip.

Major tourist areas such as Bangkok, Phuket, Koh Samui, and Chiang Mai are generally malaria free. However, malaria is still a problem in rural parts, particularly territories in the mountains to the north and near borders with Cambodia, Koh Samet, and Koh Chang. When you're traveling to remote areas, start taking a malarial prophylaxis well in advance (most dosages start 4 weeks before travel) such as Malarone (a combo of Atovaquone and Proguanil) or Doxycycline -- but see a travel med specialist to confer and have him or her advise you on the potentially harmful side effects. Note that Mefloquine (sold under the name Larium) is no longer recommended for Thailand.

The best way to prevent malarial transmission or catching any other diseases listed here is to cover up with light-colored clothing, and wear long pants and sleeves after dark. Sleep with Permethrin-treated mosquito netting well tucked in and use repellents. And make sure your repellent contains a high percentage of DEET. If you develop a fever within 2 weeks of entering a high-risk area, be sure to consult a physician.

Dengue fever is now a major problem throughout Southeast Asia. Recent years have seen epidemics in the region. Similar to malaria, the virus is spread by a mosquito, but this one can bite during the day as well as at night. Symptoms are similar to flu, with high fever, severe aches, fatigue, and possible skin rashes or headaches, lasting about a week. Drink plenty of water and seek medical attention immediately if you experience these symptoms.

Japanese Encephalitis is a deadly viral infection that attacks the brain and is spread by a mosquito bite. Outbreaks have been known to occur in the region, so stay abreast of the most up-to-date CDC information. Like malaria and dengue, the best protection is to avoid being bitten, but seek medical attention if you develop symptoms like fever, severe aches, and skin rashes.

Bugs & Other Wildlife Concerns -- On jungle hikes in particular, wear long sleeves and trousers instead of shorts, which will protect not just against mosquito bites, but the ubiquitous ticks, leeches, nasty biting giant centipedes, and (rarely seen) snakes. In order to survive the heat and humidity, arm yourself with loose cotton pants, socks, and sturdy boots -- natural fibers are perfect for this terrain. Always try to minimize the chance of getting cuts and scrapes (they can get infected 10 times faster than back home). When venturing into thick jungle terrain, do so with a qualified guide and follow his or her example. Don't pick or touch plants unless the guide says it's safe.

Rabies is a concern in Thailand, as are bites from any stray animals -- infected or not. Temples house many mangy dogs because Buddhists believe their duty is to feed them. Most dogs are members of a pack and can get aggressive toward strangers of any kind. Occasionally, a rabid animal makes its way into the mix. Stay clear of all stray animals and seek medical attention immediately if you've been bitten. If you find yourself cornered, look for a stick to keep these mutts at bay. Bangkok has a rabies and snakebite help desk at tel. 02256-4214.

Avoid freshwater streams or lagoons, as they can be contaminated by chemicals or parasites. Sadly, lack of environmental regulations means sewage outlet pipes often pour into the sea or freshwater streams. Coral reefs pose minor risks from things like poisonous sea snakes, jellyfish, and sea urchins. Jellyfish burns can be alleviated simply by applying vinegar. In the case of any cuts or stings, try to clean with bottled water and apply an antimicrobial ointment or antihistamine if you have an allergic response. If you catch an ear infection, ear drops are sold in pharmacies, or mild boric acid or vinegar solutions can help.

Respiratory Illness -- The air in Bangkok at certain times of the year can be smog-laden and is especially bad on sidewalks, next to busy roads, or under the BTS. Anyone with respiratory issues such as asthma should carry both regular and emergency inhalers, though brands such as Seretide, Bricanyl, and Ventolin are available without prescription. SARS has been a problem here in the past, but more importantly, avian influenza, or bird flu, is a growing problem here and globally. The risk is greater in rural Thailand, where poultry is left to roam freely and in live markets -- which is most risky. To prevent getting the illness, avoid all contact with feces and never handle a bird of any species, dead or alive.

Coping with the Heat -- The symptoms for sunstroke or heat exhaustion are unbearable headaches, nausea, vomiting, dizziness, and extreme fatigue. Avoid it by drinking mineral (not purified) water, electrolyte drinks, or soda water regularly, but in small amounts, to replace minerals and increase hydration. An aspirin or Tylenol can help lower body temperatures. Expose yourself gradually to the heat; wearing a high SPF sunscreen and wearing a hat will prevent sunburn but not heatstroke. Low alcohol consumption, light meals, and eating food with minimal spiciness will help you to acclimatize much faster.

Use talcum powder after showering to avoid incapacitating heat rash, and only use clean, dry towels to avoid pervasive fungal growths like tinea or candida. Fast acting anti-fungal powders, creams, or suppositories such as Canesten (for tinea) and Diflucan (for yeast infections) are available in pharmacies without a prescription.

What to Do If You Get Sick in Thailand

Medical services in Thailand are good in cities, and high street dispensaries -- though unregulated -- sell most drugs, even those normally available only on prescription overseas. The pharmacist may have an almanac on the counter in English where you can check the different brand names of generic pharmaceutical products in your country, but always seek professional advice.

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

If you don't feel well, consider asking any hotel concierge to recommend a local doctor or clinic. Typically doctors see patients on a first-come, first-served basis unless there is an emergency. You may have to fill in a form telling of allergies or existing conditions before you see a physician. In only very grave cases will you be sent to the emergency room.

You'll need to get a taxi to the hospital (rohng pha yaa baan in Thai), since Thailand does not normally offer ambulance services. In an emergency, some embassies or consulates can offer basic advice.

Safety

Though many here follow pacifist Buddhist teachings, violent crime does exist and is especially common after drinking. Travelers can follow some basic precautions to stay safe, though.

Since pickpockets and scam artists work the tourist areas and pounce on friendly or naïve travelers, keep an eye on valuables in crowded places and be wary of anyone who approaches you in the street to solicit your friendship. However genuine the entreaty sounds, you will end up wasting precious time on "shopping tours" where your "guide" will collect a commission and keep you from getting where you'd like to go (or worse).

In general, even in big cities, single men and women are fairly safe as long as they stick to walking in brightly lit areas where there is plenty of life. Avoid public conflict, and you'll also do just fine. Making a Thai look weak or ridiculous means losing face, and that can mean very serious trouble; there were cases in 2007 of retribution meted by a gang of thugs, or the whole village. If, for whatever reason, you find tempers fraying, walk away. The tourist police hotline, tel. 1155, may not bring much joy if the police are friendly with your adversaries. Know you cannot win in any altercation: Every year a handful of gung-ho tourists injure themselves trying.

Thai police are some of the lowest-paid civil servants in the country, so it's not surprising that they have a reputation for harassment, intimidation, and bribery. Involving yourself in any way whatsoever (especially amorously) with a Thai cop is dangerous. There are many cases of lovelorn officers gunning down Thai and foreign girls (and/or their new boyfriends) who had previously flirted with their affections.

Driving is another all-too-obvious danger here. Many drivers in the country have bought their licenses and hence there is no attention given to speed limits or wearing seat belts. Driving a rental car here is not for the fainthearted; extreme caution should be taken and defensive driving skills are key. Every year Thai hospitals are full of banged, bruised, and mummy-wrapped travelers recovering from road accidents. For years, Thailand's annual road death statistics have defied belief, especially on the hilly islands of Phuket, Koh Samui, and Koh Chang, where even improved roads tempt drivers to their fates.

If you do get in an accident, keep in mind that Thais don't normally have insurance. If they don't flee the scene, they might try to negotiate a settlement. Local officials may actually hinder the situation, especially if the culpable faction can persuade them you are to blame. If you find yourself in this situation, take photographs of the scene and ask to get a copy of the IDs of those involved.

Since the military coup d'état in September 2006, the political situation in Thailand has become quite unstable and there are rumors of further unrest as supporters of the ousted ex-prime minister Thaksin rally against the military powers. Most scenes of recent clashes have occurred around Bangkok's Sanam Luang district directly in front of Parliament.

At the time of writing, new elections had taken place on December 23, 2007, and despite a good turn out by former Thaksin supporters, the government will ultimately be obliged to form a coalition, working in tandem with the PPP (the pro-Thaksin party). Check up on new developments before traveling.

If there is a hint of trouble, many shops will close; in extreme cases (like the 2006 coup) local TV stations shut down. Stay off the streets and watch overseas satellite news for the latest developments, but do not be tempted to be part of history by joining the protests. If you remain indoors, it's unlikely you'll be caught up in any violence.

The far southern provinces of Yala, Narathiwat, and Pattani near the Malaysian border have seen increased sectarian violence between Thai Muslims and Thai military police. Thai institutions, schools, banks, and Buddhist temples have been targeted with small-scale bombs. The Thai government has come under international scrutiny for the brutal force used to quell uprisings. Avoid this area, or travel through it with care.

Thailand can offer illicit temptations that may seem harmless to naïve travelers. Yet the Thai government has zero tolerance of drug trafficking and use. Many people who think they are being offered a casual puff on a joint don't realize they are being set up; every year a few will end up never leaving the kingdom, serving a life sentence in a Thai jail cell. Prostitution is also illegal; read on for info on that.

Sex for Sale -- Prostitution in Thailand is illegal and yet every day you will see foreigners picking up Thai hookers of both sexes. Selling sex is not so much tolerated, but politely ignored. However, some travelers regard it as a tourist draw, especially when underage boys or girls are involved. These days the international police are hard on their tail; high-profile arrests are now not just common, but actively sought.

It is hard to get exact numbers for Commercial Sex Workers (CSW) in Thailand; the number fluctuates from 80,000 to 800,000, depending on the source. Due to the huge numbers involved and the dangers therein, Thailand has made significant steps to counter the spread of HIV/AIDS. Through education and the introduction of condoms, it has made efforts to stem the tide of new cases (though statistics are unreliable). A leading force in this effort is the Population & Community Development Association (PCDA), led by the courageous and innovative public health crusader, Senator Meechai Viravaidya.

The PCDA has enlarged the scope of its rural development programs from family planning and networks of distributing condoms to running seminars for CSW. In poor, uneducated, rural families, where sons provide farm labor, the sex trade has become an income-earning occupation for parents who sell their daughters to urban criminal gangs, often saying they will "go to a good job." They don't. They end up as sex slaves. Under international statutes, many are still minors; having sexual relations with them is equivalent to rape. It is a sorely misplaced myth to believe that CSW live a good life of fun and freedom. Addiction to drugs, alcohol, or physical abuse is commonplace. Rape is even more frequent. Girls contract STDs or fall pregnant, and scores of unwanted children -- many with HIV -- are dumped on orphanages.

Poor regulations and scheming between gangs and police do nothing to stop this. Though legislation coyly prohibits full nudity in most go-go bars, it just means the illegal backroom deals, kidnappings, rape, and the enslavement of children carry on behind closed doors, funded by the profits paid by the brothels' ignorant clientele.

If you choose to support prostitution, you are not only breaking the law, but you are also supporting the trafficking and abuse of women and men, including minors. You are putting your own life at risk from STDs and perpetuating a trade that ruins lives. It's not all fair play either: Numerous cases are known where tourists have been drugged in their hotel rooms by their sleeping partner. If they are lucky, they awake 2 days later to find all their valuables gone. There are a shocking number of stories about Western travelers found dead after a liaison with a CSW, but rarely will the newspapers report the full details.

Exercise caution in your dealings with any stranger. If, in spite of all these warnings, you decide to use the services of Thailand's CSWs, take proper precautions; carry condoms at all times, and check the person's ID. If you are in any doubt, walk away -- it could save your life.

Dealing with Discrimination

There is still a certain amount of institutionalized racism in old Siam and much pride is taken from the fact that no foreign power colonized the kingdom. Thai people are, superficially at least, tolerant, but not always accepting of Western ways. Foreign men with young Thai girlfriends can be viewed with deep distrust, and even distaste.

Thais follow a codified hierarchy, with wealth and status going hand-in-hand. Therefore, the richer Thai-Chinese who own and operate big businesses top the scale and people from Isan, the impoverished northeast of the kingdom, come way down in the ratings. Associating yourself with any Thai will, very often, put you at their level.

Caucasians are sometimes branded farang (a word that originally meant French, referring to the nation's earliest Western visitors). Farang is not necessarily a racist term, but yes, foreign tourists are ritually overcharged and some take this personally as a form of discrimination. Look at this from a Thai, not Western, perspective. Thais believe if you have more, you are expected to give more; the rule applies to Thais as well, regardless of your budget. As a farang you are automatically seen as wealthy in Thailand. Skills in bargaining will come in time, if you practice. Just remember that Thais really appreciate generosity, rather than someone who makes a big deal about haggling over a baht or two.