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Staying healthy on a trip to Guatemala is predominantly a matter of being cautious about what you eat and drink, and using common sense. Know your physical limits, and don't overexert yourself. Respect the tropical sun and protect yourself from it. Limit your exposure to the sun, especially during the first few days of your trip and, thereafter, from 11am to 2pm. Use a sunscreen with a high protection factor, and apply it liberally. Remember that children need more protection than adults do. I recommend buying and drinking bottled water or soft drinks everywhere you travel in Guatemala. Those wishing to really stay on the side of caution should avoid any drinks with ice in them, as well as any raw fruits or vegetables that may have been washed in unsafe water. In general, fruits and vegetables that are peeled -- bananas, oranges, avocados -- are safe. The sections below deal with specific health concerns in Guatemala.

Before You Go

No specific vaccines are required for traveling to Guatemala. That said, many doctors recommend vaccines for hepatitis A and B, as well as up-to-date booster shots for tetanus.

Your existing health plan might provide the coverage you need, but double-check; you might 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. For conditions such as epilepsy, diabetes, or heart problems, wear a MedicAlert 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 MedicAlert's 24-hour hot line.

Pack prescription medications in your carry-on luggage, and carry prescription medications in their original containers. Also, bring along copies of your prescriptions in case you lose your pills or run out, and carry the generic name of prescription medicines in case a local pharmacist is unfamiliar with the brand name. And don't forget an extra pair of contact lenses or prescription glasses.

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 and lists of local, English-speaking doctors. The U.S. 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 overseas clinics at the International Society of Travel Medicine (www.istm.org).

General Availability of Healthcare

Guatemala's public healthcare system is overburdened, under-funded, and outdated. Massive strikes in the sector during 2006 only exacerbated the problem. Throughout the book, I've listed the nearest public hospital and, when available, private hospital or clinic. Still, when you're in Guatemala, your hotel or local embassy will be your best source of information and aid in finding emergency care or a doctor who speaks English. Most state-run hospitals and walk-in clinics around the country have emergency rooms that can treat most conditions. However, I highly recommend that you seek out a specialist recommended by your hotel or embassy if your condition is not life-threatening and can wait for treatment until you reach one of them.

Common Ailments

Tropical Illnesses -- Your chance of contracting any serious tropical disease in Guatemala is slim, especially if you stick to the well-worn tourist destinations. However, malaria and dengue fever both exist in Guatemala, so it's a good idea to know what they are.

Malaria is found in rural areas across the country, particularly in the lowlands on both coasts and in the Petén. There is little to no chance of contracting malaria in Guatemala City or Antigua. Malaria prophylaxes are available, but several have side effects, and others are of questionable effectiveness. Consult your doctor regarding what is currently considered the best preventive treatment for malaria. Be sure to ask whether a recommended drug will cause you hypersensitivity to the sun. Because malaria-carrying mosquitoes usually come out at night, you should do as much as possible to avoid being bitten after dark. If you are in a malarial area, wear long pants and long sleeves, use insect repellent, and either sleep under a mosquito net or burn mosquito coils (similar to incense, but with a pesticide).

Of greater concern is dengue fever, which has been spreading throughout Latin America since the mid-1990s. Dengue fever is similar to malaria, and is spread by an aggressive daytime mosquito. This mosquito actually seems to prefer populated areas, and dengue has occurred throughout the country. Dengue is also known as "bone-break fever" because it is usually accompanied by severe body aches. The first infection with dengue fever will make you very sick but should cause no serious damage. However, a second infection with a different strain of the dengue virus can lead to internal hemorrhaging and could be life-threatening.

Many people are convinced that taking B-complex vitamins daily will help prevent mosquitoes from biting you. I don't think the American Medical Association has endorsed this idea yet, but I've run across it in enough places to think that there might be something to it.

If you develop a high fever accompanied by severe body aches, nausea, diarrhea, or vomiting during or shortly after a visit to Guatemala, consult a physician as soon as possible.

Amoebas, Parasites, Diarrhea & Other Intestinal Woes -- Guatemala suffers from periodic outbreaks of cholera, a severe intestinal disease whose symptoms include severe diarrhea and vomiting. However, these outbreaks usually occur in predominantly rural and very impoverished areas. Your chances of contracting cholera while you're in Guatemala are very slight.

Other food and waterborne illnesses can mimic the symptoms of cholera and are far more common. These range from simple traveler's diarrhea to salmonella. Even though you've been careful to buy bottled water, order your licuado en leche (fruit shakes made with milk rather than water), and drink your soft drink warm (without ice cubes -- which are made from water, after all), you still might encounter some intestinal difficulties. Most of this is just due to tender northern stomachs coming into contact with slightly more aggressive Latin American intestinal flora. In extreme cases of diarrhea or intestinal discomfort, it's worth taking a stool sample to a lab for analysis. The results will usually pinpoint the amoebic or parasitic culprit, which can then be readily treated with available over-the-counter medicines.

Except in the most established and hygienic of restaurants, it's also advisable to avoid ceviche, a raw seafood salad, especially if it has any shellfish in it. It could be home to any number of bacterial critters.

In the event you experience any intestinal woe, staying well hydrated is the most important step. Be sure to drink plenty of bottled water, as well as some electrolyte-enhanced sports drinks, if possible.

Tropical Sun -- Limit your exposure to the sun, especially during the first few days of your trip and, thereafter, from 11am to 2pm. Use a sunscreen with a high protection factor, and apply it liberally. Remember that children need more protection than adults.

Riptides -- Most of Guatemala's Pacific coast beaches have riptides: strong currents that can drag swimmers out to sea. A riptide occurs when water that has been dumped on the shore by strong waves forms a channel back out to open water. These channels have strong currents. If you get caught in a riptide, you can't escape the current by swimming toward shore; it's like trying to swim upstream in a river. To break free of the current, swim parallel to shore and use the energy of the waves to help you get back to the beach.

Bees, Snakes & Bugs -- Although Guatemala has Africanized bees (the notorious "killer bees" of fact and fable), scorpions, spiders, and several species of venomous snakes, your chances of being bitten are minimal, especially if you refrain from sticking your hands into hives or under rocks in the forest. If you know that you're allergic to bee stings, consult your doctor before traveling.

Snake sightings, much less snakebites, are very rare. Moreover, the majority of snakes in Guatemala are nonpoisonous. If you do encounter a snake, stay calm, don't make any sudden movements, and don't try to handle it. As recommended above, avoid sticking your hand under rocks, branches, and fallen trees.

Scorpions, black widow spiders, tarantulas, bullet ants, and other biting insects can all be found in Guatemala. In general, they are not nearly the danger or nuisance most visitors fear. Watch where you stick your hands, and shake out your clothes and shoes before putting them on to avoid any unpleasant and painful surprises.

What to Do If You Get Sick away from Home

Any foreign embassy or consulate can provide a list of area doctors who speak English. If you get sick, consider asking your hotel staff or concierge to recommend a local doctor -- even his or her own. You can also try the emergency room at a local hospital. Many hospitals also have walk-in clinics for emergency cases that are not life-threatening; you may not get immediate attention, but you won't pay the high price of an emergency room visit.

Safety

Guatemala is a violent country, with gross civil injustice, extreme economic hardship, and frequent public unrest and protests. Guatemala still bears the wounds and ongoing effects of its brutal 30-year civil war. The police and judicial systems are far outmatched by the levels of crime and violence. However, most of this crime and violence is internal. Most of the popular tourist areas have a strong police presence, and the situation has improved in recent years. A specialized branch of the police force, POLITUR, has been created especially to deal with tourists and crimes against tourists. That said, robberies and pickpocketing are the greatest problem facing most tourists in Guatemala. Crowded markets, public buses, and busy urban areas are the prime haunts of criminals and pickpockets. Never carry a lot of cash or wear very valuable jewelry. Men should avoid having wallets in your back pockets, and women should keep tight grips on your purses. (Keep it tucked under your arm.) Thieves also target gold chains, cameras and video cameras, prominent jewelry, and nice sunglasses. Be sure not to leave valuables in your hotel room.

Rental cars generally stick out, and are easily spotted by thieves. Don't ever leave anything of value in a car parked on the street, not even for a moment. Also be wary of solicitous strangers who stop to help you change a tire or bring you to a service station. Although most are truly good Samaritans, there have been reports of thieves preying on roadside breakdowns. Public intercity buses are also frequent targets of stealthy thieves. Never check your bags into the hold of a bus if you can avoid it. If this can't be avoided, when the bus makes a stop, keep your eye on what leaves the hold. If you put your bags in an overhead rack, be sure you can see the bags at all times. Try not to fall asleep.

The local Maya people are very uneasy about having their picture taken. Many, in the more touristy areas, have parlayed this into a means of earning a few quetzales by charging to have their picture taken. In the more rural areas, a rude or disrespectful foreign shutterbug can earn the strong and sometimes vocal disdain of the local population. Always ask permission before taking photographs of people.

Political gatherings to protest current economic and social conditions are not uncommon. The most common form that will affect any tourist is road and highway blockades. There's really little you can do to avoid this; however, a fair amount of patience and some compassion will ease the bother and lower your stress levels. Many of these protests and blockades are announced in advance in the newspapers. If you have an important flight or connection, and you have a long ride to the airport, ask your hotel to check on any alerts, and be sure to leave plenty of time for your drive to the airport.

Insurance

Medical Insurance -- For foreign travel, most U.S. 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 might be necessary. 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).

Canadians should check with their provincial health plan offices or call Health Canada (tel. 866/225-0709; www.hc-sc.gc.ca) to find out the extent of their coverage and what documentation and receipts they must take home in case they are treated overseas.

Travelers from the U.K. should carry their European Health Insurance Card (EHIC), which replaced the E111 form as proof of entitlement to free/reduced cost medical treatment abroad (tel. 0845/606-2030; www.ehic.org.uk). Note, however, that the EHIC only covers "necessary medical treatment," and for repatriation costs, lost money, baggage, or cancellation, travel insurance from a reputable company should always be sought (www.travelinsuranceweb.com).

Travel Insurance -- The cost of travel insurance varies widely, depending on the destination, 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.

U.K. citizens and their families who make more than one trip abroad per year may find an annual travel insurance policy works out cheaper. Check www.moneysupermarket.com, which compares prices across a wide range of providers for single- and multi-trip policies.

Most big travel agents offer their own insurance and will probably try to sell you their package when you book a holiday. Think before you sign. Britain's Consumers' Association recommends that you insist on seeing the policy and reading the fine print before buying travel insurance. The Association of British Insurers (tel. 020/7600-3333; www.abi.org.uk) gives advice by phone and publishes Holiday Insurance, a free guide to policy provisions and prices. You might also shop around for better deals: Try Columbus Direct (tel. 0870/033-9988; www.columbusdirect.net).

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. Trip cancellation traditionally covers such events as sickness, natural disasters, and State Department advisories. The latest news in trip-cancellation insurance is the availability of expanded hurricane coverage and the "any-reason" cancellation coverage -- which costs more but covers cancellations made for any reason. You won't get back 100% of your prepaid trip cost, but you'll be refunded a substantial portion. TravelSafe (tel. 888/885-7233; www.travelsafe.com) offers both types of coverage. Expedia also offers any-reason cancellation coverage for its air-hotel packages. For details, 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).

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.