Sri Lanka is less challenging from a health point of view than many other tropical countries: standards of hygiene are reasonable, medical care is of a decent standard and even malaria has now been largely eliminated. Nevertheless, the island does play host to the usual gamut of tropical diseases, and it’s important to make sure you protect yourself against serious illness.
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You should start planning the health aspect of your trip well in advance of departure, especially if you’re having vaccines for things like rabies or Japanese encephalitis, which need to be administered over the course of a month. Vaccinations and medical advice are available from your doctor or – more conveniently but expensively – a specialist travel clinic. It’s also crucial to have adequate medical insurance.
Ensure that you’re up to date with the following standard vaccinations: diphtheria, tetanus, hepatitis A and polio. Other jabs you might consider are tuberculosis, meningitis and typhoid.
The best way to avoid falling ill is to look after yourself. Eat properly, make sure you get enough sleep and don’t try to cram too much strenuous activity into your holiday, especially in the first few days before you’ve acclimatized to the sun, water and food, and while you’re probably still suffering jetlag. Luckily, standards of medical care in Sri Lanka are good. Most doctors speak English and a significant number have trained in Europe, North America or Australia. All large towns have a hospital, and you’ll also find private medical clinics in Colombo. If you pay for treatment, remember to get receipts so that you can claim on your insurance policy. All larger towns have well-appointed pharmacies (signed by a red cross on a white circle) and can usually produce an English-speaking pharmacist. If stuck, any reputable hotel or guesthouse should be able to put you in touch with a local English-speaking doctor.
There is more on Ayurveda, Sri Lanka’s remarkable home-grown system of holistic medical care, in our Beruwala account.
Water and food
Avoid drinking tap water in Sri Lanka. Although it’s generally chlorinated and safe to drink, the unfamiliar micro-organisms it contains (compared with what you’re used to at home) can easily precipitate a stomach upset. Also avoid ice, unless you’re sure that it’s been made with boiled or purified water. Mineral water is widely available, although always check that the seal hasn’t been broken – it’s not unknown for bottles to be refilled with tap water. Whatever precautions you take, however, you’re still likely to come into contact with local water at various points – your eating utensils will be washed in it, and it will probably be used without your knowledge in things like fruit juices – so it’s not worth getting paranoid about.
Though Sri Lankan standards of food hygiene are reasonable, it still pays to be careful, and the old travellers’ adage usually applies: if you can’t cook, boil or peel something, don’t eat it (although if you can’t peel something, you can always wash it thoroughly in purified water). Stick to hot food that has been freshly prepared. Avoid salads and anything which looks like it has been sitting uncovered for a while; short eats (see Vegetarian food in Sri Lanka) are particularly likely to be old and to have been poked by many fingers. The busier the establishment, the less probability that the food’s been sitting around all day. Obviously you’ll need to use your discretion: the buffet at a five-star hotel has more chance of being OK than a local café’s tureen of curry, which has been keeping the flies fat since dawn. Finally, remember that refrigerators stop working during power cuts, so unless you’re eating at a place with its own generator, avoid any food (including meat and ice cream) that might have been unfrozen and then refrozen.
Diarrhoea, dysentery and giardiasis
Diarrhoea remains the most common complaint amongst tourists visiting Sri Lanka. It can have many causes, including serious diseases like typhoid or cholera, but in the vast majority of cases diarrhoea is a result of contaminated food or drink and will pass naturally in a few days. Such diarrhoea is also often accompanied by cramps, nausea and vomiting, and fever in more severe cases.
You should seek medical advice if diarrhoea continues for more than five days or if there is blood mixed up in the faeces, in which case you could be suffering from giardiasis or amoebic dysentery.
One of the biggest problems with diarrhoea, particularly in a hot country like Sri Lanka, is dehydration; it’s vital you keep topped up with fluids – aim for about four litres every 24 hours (the colour of your urine is the best guide). If you’re having more than five bouts of diarrhoea a day or are unable to eat, take oral rehydration salts to replace lost salt and minerals. These can be bought ready-prepared in sachets from camping shops; alternatively, you can make your own by mixing eight teaspoons of sugar and half a teaspoon of salt in a litre of purified water. Coconut water is a good alternative, especially if you add a pinch of salt; flat cola or lemonade with a pinch of salt also work. Children with diarrhoea dehydrate much more quickly than adults, and it’s even more vital to keep them hydrated. If you have to go on a long journey where you won’t have access to a toilet, you can temporarily bung yourself up with a blocking drug like lomotil or loperamide, though these simply suppress symptoms and have no curative value. Whilst recovering, stick to bland foods (rice and yoghurt are traditionally recommended, and bananas help replace lost potassium) and get plenty of rest – this is not the moment to go rushing up Adam’s Peak.
If you have persistent diarrhoea, you may be suffering from giardiasis or amoebic dysentery. With giardiasis you may suffer stomach cramps, nausea and a bloated stomach. In amoebic dysentery, diarrhoea is severe, with bloody stools and fever. If any of the above symptoms apply, see a doctor.
The incidence of malaria in Sri Lanka has fallen dramatically in recent years – from over 200,000 reported cases in 2000 to just 736 in 2010 – although of course it’s always possible that the incidence of the disease may rise again in the future.
At present, the main risk areas are in the north and northeast (see the malaria maps at w fitfortravel.nhs.uk/destinations/asia-(east)/sri-lanka/sri-lanka-malaria-map.aspx and w cdc-malaria.ncsa.uiuc.edu). It’s recommended that you talk to your doctor or, even better, a travel health specialist, although be aware that different doctors and travel health resources may offer different, often conflicting advice.
If you do decide to take anti-malarial drugs, there are various options including the traditional combination of proguanil (Paludrine) plus chloroquine (trade names Nivaquin or Avloclor) – although some sources claim that chloroquine is no longer effective in the island. Alternative anti-malarials include doxycycline and Malarone (a combination of atovaquone and proguanil). The stronger mefloquine (Lariam) isn’t usually prescribed for Sri Lanka.
The disease itself has a typical incubation period of nine to sixteen days, sometimes longer – hence the importance of continuing with the medication once you get home. Initial symptoms are virtually indistinguishable from severe flu. If you think you might have malaria, have a blood test done as soon as possible.
Even if you’re on medication, it’s important to avoid being bitten, since no antimalarial offers total protection, and mosquitoes in Sri Lanka also transmit other diseases such as dengue fever and Japanese encephalitis. Malarial mosquitoes come out at dusk and remain active throughout the night. Standard avoidance techniques are to wear light-coloured clothing with long sleeves; use a repellent containing DEET on exposed parts of your body; and (if your room’s not air-conditioned) always sleep under a net. You might also want to spray your clothing with a permethrin spray; burning a mosquito coil in your room or putting one under the table while you eat is also recommended. An alternative to coils are the Pyrethroid tablets that you place on a tray and put in a plug; the electricity heats the tray and vaporizes the Pyrethroid. Citronella oil (available from many chemists in Sri Lanka) is also thought to be good for repelling mosquitoes.
More widespread than malaria, and equally serious, is the mosquito-borne disease dengue fever, regular outbreaks of which continue to plague the island, causing numerous fatalities. Dengue is a predominantly urban disease – Colombo is particularly at risk. As mosquitoes lay their eggs in water, dengue outbreaks tend to peak during or after periods of rain. There are four subtypes of dengue fever, so unfortunately it’s possible to catch it more than once. The disease is typically characterized by the sudden onset of high fever accompanied by chills, headache, a skin rash and muscle or joint pains (usually affecting the limbs and back, hence dengue fever’s nickname “break-bone fever”). The fever usually lasts three to seven days, while post-viral weakness, lethargy and sometimes depression can persist for anything up to several weeks. A rare but potentially fatal complication is dengue haemorrhagic fever (DHF), which is almost entirely confined to children under fifteen who have previously been infected with dengue fever.
There is no vaccine for dengue fever, which makes avoiding getting bitten in the first place (see Sun) all the more important. Unfortunately, the mosquitoes that transmit dengue bite during the day, making them harder to guard against than malarial mosquitoes. If you think you’ve contracted dengue fever, go to a doctor.
A third mosquito-borne disease is Japanese encephalitis (JE), a virus transmitted by mosquitoes which bite at night. It’s particularly associated with rural areas, as the virus lives in wading birds, pigs and flooded rice fields. JE is most prevalent following periods of heavy rainfall resulting in large areas of stagnant water.
JE is an extremely dangerous disease, with mortality rates of up to forty percent (though tourists are only rarely affected). As with malaria, you won’t contract JE if you don’t get bitten (see Rabies). Symptoms include drowsiness, sensitivity to light and confusion. An effective vaccine exists for JE (three shots administered over 28 days), though the standard advice is that it’s only worth considering if you’re travelling in high-risk areas during the monsoon for a period of over a month, especially if you’ll be spending a lot of time in the country and/or camping out a lot.
The potential health risks associated with the sun are easily underestimated – especially since a desire to soak up the rays is often a major reason to come to Sri Lanka in the first place. Sunscreen should always be applied to exposed skin when outdoors; young children are particularly vulnerable to burns and should be kept out of the sun at all times. Older kids should wear the highest factor sunblock and a hat. For all ages, eyes also need to be protected by proper sunglasses. If you do get sunburnt, take plenty of warm (not cold) showers, apply calamine lotion or aloe vera gel, and drink lots of water.
A common but minor irritant is prickly heat, usually afflicting newly arrived visitors. It’s caused by excessive perspiration trapped under the skin, producing an itchy rash. Keep cool (a/c is good), shower frequently, use talcum powder on the affected skin and wear loose (ideally cotton) clothing. At its worst, prolonged exposure to the sun and dehydration can lead to heatstroke, a serious and potentially life-threatening condition. Symptoms are a lack of sweat, high temperature, severe headaches, lack of coordination and confusion. If untreated, heatstroke can lead to potentially fatal convulsions and delirium. If you’re suffering from heatstroke, get out of the sun, get into a tepid shower and drink plenty of water.
Besides the risks of drowning (see Common scams), swimmers are also at a small potential risk of marine stings. Jellyfish are common, and some can inflict painful stings; coral scratches and cuts can also be painful (although more of a problem for the coral itself, which dies on contact). Occasionally people develop quasi-allergic reactions to stings; if you start to wheeze or swell up around the face, go to hospital immediately.
The other thing you need to think about is how clean the water is: beaches in the vicinity of town centres are obviously prone to pollution. In addition, parts of some beaches are filthy. Look out for broken glass, fishing hooks, syringes and other rubbish; dog shit is also common. If you cut your foot, disinfect it immediately and seek medical advice, since you may need a tetanus booster and/or a hepatitis B vaccine.
Hepatitis is an inflammation of the liver. The disease exists in various forms, though with a shared range of symptoms, typically jaundiced skin, yellowing of the whites of the eyes and a general range of flu-like symptoms. Hepatitis A and hepatitis E are spread by contaminated food and water. If you become infected, there’s little you can do except rest – unfortunately, it can take a couple of weeks or more to shake off the effects. The much more serious hepatitis B can result in long-term liver damage and liver cancer. Like the HIV virus, it’s spread via infected blood or body fluids, most commonly through sex or needle sharing. hepatitis C and D are similar.
You can (and should) be vaccinated against hepatitis A. The hepatitis B vaccine is usually only recommended to those at especially high risk, such as health-care workers. There are no vaccines for other types of hepatitis.
Rabies, an animal disease transmitted to humans by bites, scratches or licking is usually associated with dogs, but can also be transmitted by cats, monkeys, bats or any other warm-blooded animal. Rabies, once symptoms have developed, is fatal. You are at risk if you suffer a bite that draws blood or breaks the skin, or if you are licked by an animal on an open wound. Bites to the face, neck and fingertips are particularly dangerous.
Fortunately, a safe and effective vaccine exists (three shots over 28 days). Casual tourists on short holidays to the island may well feel that they are not sufficiently at risk to go through the hassle of a rabies vaccine, but if you’re going for a long period or are likely to be in close contact with animals, you might decide it’s worth the trouble. In general, Sri Lankan dogs are fairly well behaved, and it’s rare that you’ll encounter the sort of aggressive and unpredictable strays that you sometimes find in other parts of Asia.
Regardless of whether you’ve been vaccinated or not, if you’re bitten or scratched (or licked on an open wound) by an infected animal, clean the wound thoroughly with disinfectant as soon as possible. Iodine is ideal, but alcohol or even soap and water are better than nothing. If you’ve already been vaccinated, you’ll need two booster shots three days apart. If you haven’t been vaccinated, you will need to be given five shots of the rabies vaccine over 28 days (the first must be administered as soon as possible after you’ve been bitten), along with a single injection of rabies antibody serum.
Typhoid is a gut infection caused by contaminated water or food, and which leads to a high fever and diarrhoea. Oral and injected vaccines are available and usually recommended. A vaccination against meningitis is also available. This cerebral virus, transmitted by airborne bacteria, can be fatal. Symptoms include a severe headache, fever, a stiff neck and a stomach rash. If you think you have it, seek medical attention immediately. Sri Lanka has experienced occasional outbreaks of cholera, although this typically occurs in epidemics in areas of poor sanitation, and almost never affects tourists.
Initial symptoms of tetanus (“lockjaw”) can be discomfort in swallowing and stiffness in the jaw and neck, followed by convulsions – potentially fatal. The vaccination is a standard childhood jab in developed countries. Typhus is spread by the bites of ticks, lice and mites. Symptoms include fever, headache and muscle pains, followed after a few days by a rash, while the bite itself often develops into a painful sore. A shot of antibiotics will shift it.
Chikungunya fever is another mosquito-borne disease, outbreaks of which are sometimes reported in various parts of the country. Symptoms include fever, joint pains, muscle aches, severe headaches and a rash, usually lasting around a week – sometimes much longer. There is no vaccine, although the disease is hardly ever fatal.
Animals and insects
Leeches are common after rain in Sinharaja, Adam’s Peak and elsewhere in the hills. They’re difficult to avoid, attaching themselves to your shoes and climbing up your leg until they find flesh, and are quite capable of burrowing through a pair of socks. Once latched on, leeches will suck your blood until sated, after which they drop off of their own accord – perfectly painless, but not terribly pleasant. You can make leeches drop off harmlessly with the end of a lighted cigarette or the flame from a lighter, or by putting salt on them. Don’t pull them off, however, or bits of leech might break off and become embedded in your flesh, increasing the risk of the bite becoming infected.
Sri Lanka has the dubious distinction of having one of the highest number of snakebite fatalities, per capita, of any country in the world, and any form of bite should be treated as quickly as possible. The island boasts five species of poisonous snake, all relatively common, especially in northern dry zones; they include the cobra and the extremely dangerous Russell’s viper. Avoid wandering through heavy undergrowth in bare feet and flipflops; wear proper shoes or boots, socks and long trousers. If you’re bitten, you should wrap up the limb, as for a sprained ankle, and immobilize it with a splint – this slows down the speed at which venom spreads through the rest of the body; keeping as still as possible also helps. Popular advice recommends catching and killing the snake so that the doctor knows what type of antivenin to administer, although it’s unlikely you’ll be able to do this, and you’ll probably have to settle for a description of the creature. Unfortunately, reliable antivenins have not yet been developed for all types of snake – that for the Russell’s viper, for instance, has been developed from the Indian Russell’s viper, and is not always effective in treating bites administered by the Sri Lankan sub-species.
STDs, HIV and AIDS
Sexually transmitted diseases (STDs) are common in the chilled-out, uninhibited and scantily clad world of the average Sri Lankan tourist beach. Practise safe sex, or you might come home with an unwelcome souvenir of your visit.
Compared to other parts of Asia, Sri Lanka has relatively few reported HIV and AIDS cases – around 0.1 percent of the population. Again, there are obvious risks if you have unprotected sex. Contaminated needles are not considered a problem in Sri Lanka, so there’s no need to carry your own – but ask to have the packet opened in your presence if you want to check this for yourself. Contaminated blood poses a potentially greater risk – blood transfusions should only be accepted in an absolute emergency.