Living in the tropics is a great experience for a family but as well as adjusting culturally to a new country, we also have to help our bodies to adapt. This means paying particular attention to both yourself and your children's health. There are health hazards which are unfamiliar in our native countries, but few are really serious if they are watched out for and simple basic treatments applied.

Discuss with your Doctors any health issues that worry you about living in Bangkok and learn how the hospital system works so that in an emergency you are confident of the system that cares for you. Remember, it is usually easier to get to hospital by car or taxi than to try and call an ambulance in Bangkok.

Immunisations
Your child should follow the routine schedule for vaccination against measles, mumps and rubella (MMR), polio and diphtheria, pertussis and tetanus (DPT), Hepatitis B (EngerixB). These schedules vary slightly in timing from country to country. The vaccination schedule used here is usually the same as American schedule but check with your Paediatrician if you have just arrived to ensure your child does not miss a vaccine.

Common Health Problems in Tropics

Prickly Heat

Caused by blocked sweat glands. Keep the skin cool and clean, avoid scented soap on rashy areas. Wear cottons, not synthetics to absorb sweat. Calamine lotion like Caladryl or Caladramine can be applied.

Fungal Infection

Warm and humid climate of the tropics leads to excessive sweating which can cause fungal infections of the skin. It is characterized by hypo or hyper pigmented chronic patches on the skin with peripheral scaling and mild itching. It can be prevented by keeping the area dry and clean. Topical application of an antifungal cream like miconazole, clotrimazole or selenium sulphide suspension can be applied for treating such infection on a physicians advice.

Fever

Children are particularly susceptible to fevers usually caused by a common viral or bacterial infection. Fever is a symptom and not a disease, a result of body's defense fighting against infection. The underlying cause is often never detected but the fever must be treated promptly. If the fever is >100 F give the child paracetamol elixir in an appropriate dose, give him plenty of fluids and keep him in a cool environment using fans or air conditioning, never over cover the child with blankets. Undress the child and sponge with lukewarm water in case of high fever. If the fever fails to subside in 24 hours seek medical advice. Babies under 6 months of age with fevers should see the Paediatrician as soon as possible.

Illnesses Related to Poor Hygiene

Diarrhoea

Diarrhoea can be caused by viruses, bacteria and protozoa. Contaminated foods are the main cause. High-risk foods are: - shell fish, uncooked meats, salads, unpasteurised milk and milk products, water and food that has been mishandled. Some fish are unsafe even when cooked because of presence of toxins. Tropical reef fish, red snapper and sea bass can be unpredictable and sometimes toxic.

To Help Avoid Diarrhoea Follow These Simple Precautions: -

Ensure meat is thoroughly cooked. Refrigerate uneaten cooked foods immediately - do not leave them on a kitchen table to cool first.

Wash all fruits and vegetables carefully, particularly salad ones. Drink only bottled or boiled and filtered or chemically treated water. Give boiled bottled water only to your baby and pay particular attention to hygiene techniques when sterilizing baby equipment. Change sterilizing fluid daily. Remember the warm climate here means bacteria breed rapidly.
Diarrhoea causes excessive loss of water and salts from the body, children in particular can dehydrate quickly. Encourage them to drink as much fluid as possible, but avoid milk except breast milk. Dehydration should be prevented by giving soups, thin porridge, juice or even plain water. If there are no signs of improvement and there is a high purge rate, vomiting, signs of dehydration like decreased urine output, sunken eyes, a high temperature or a bloody diarrhoea consult your doctor immediately. If you are traveling it is useful to take sachets of rehydrating powder containing WHO approved formulae (available from pharmacies) with you. These rehydrating solutions should be prepared using boiled water in exactly in the same concentration mentioned on the sachet otherwise they can worsen the diarrhoea.

Worms and Parasites

Like diarrhoea, worms and parasites are usually contracted through contaminated food, excreta on food, in water or on the ground. Contact from dogs and cats whose excreta containing larvae can be introduced through the skin by walking barefoot.

Symptoms are variable but include general malaise, weight loss, loss of appetite, gut discomfort, colicky to vague abdominal pain, neurological and respiratory symptoms and sometimes skin lesions. Diagnosis is difficult as life cycles of many parasites are complicated and the parasite may not be easily found in stool tests.

Prevent contamination by thoroughly cooking meat, especially pork, hand washing, keeping children's hands out of their mouths, wearing shoes outside and having household pets regularly dewormed.

Viral Hepatitis

Hepatitis A is caused by a virus excreted in faeces and is a risk associated with poor hygiene. It presents as low grade fever, malaise, anorexia, yellow discoloration of eyes and urine, and clay color stool. it can be prevented by good hygiene (mentioned below). A simple method of washing your hand with soap and water before eating anything can be really helpful in its prevention. A effective vaccine for both active and passive immunization against Hepatitis A is also now available.

Refer to Vaccination Programmes - For Information on hepatitis vaccine (Harivix)

Points to consider for hygiene precautions include: -

Patronise large, well-run mineral water firms.

Always drink bottled water or boiled, filtered, chemically treated water. Chemical treatment with iodine provides better disinfection and if filters are used, choose a <1 micron filter. If it is has a coating of resin that releases iodine or a silver lining, it also helps in killing viruses.
It is better to drink from the can or bottle itself than in a container that may be contaminated. Remember that the ice added to the drink can be made of unsafe water and should be avoided.

Avoid small local ice-cream firms - stick to big reputable firms. 

If drinking fresh milk it must be pasteurised.

Avoid fly infested eating places.

Have your maids medically checked regularly and educate them in the importance of hand washing regularly, particularly prior to handling food and drink. If there are open wounds or cuts do not let them handle food, as if there is infection it can transfer and cause food poisoning.

Refrigerate all cooked foods, never leave food lying around on an open surface in the heat.
 

Animal Hazards

Rabies

Rabies is a viral infection of the central nervous system transmitted by contamination of a wound by the saliva of a rabies infected warm-blooded mammal. It is a major public health problem in many tropical countries with uncontrolled dog population. Thus it is highly endemic in South-East Asian countries like Thailand, Philippines and Vietnam.
For more information on Rabies, click here.

Jelly Fish Stings

Common in the rainy season and many are poisonous to touch. Contact with tentacles produces painful wheals on the body. Vinegar should be poured over the infected area. Do not rub the area and do not apply alcohol. If severe, seek hospital treatment.

Fish Stings

Stone fish on the sea bottom or rocks have poisonous dorsal spines which when trodden on can be extremely painful. Wash the area with water as hot as can be tolerated to increase blood circulation as this helps to disperse any toxins which are heat labile from the area. Seek medical advice.

Snake Bites

There are 7 common venomous snakes in Thailand. Snakebite gives rise to local swelling and gangrene. The general effects of a bite of a poisonous snake are drooping eyelids, paralysis of breathing, shock, muscle fasiculations, tingling and generalized edema. To treat, do not panic, symptoms take about an hour to appear. Immobilize the affected area with a sling or splint and put a pressure bandage proximal to the site of evenomation with optimal tightness such that a finger can be inserted beneath it. This impedes the superficial lymphatic flow of that region and thus prevents spread of the venom. Do not put a very tight tourniquet or interfere with the wound. Although most snakes are non poisonous seek for medical aid as soon as possible. (See list of hospitals and preferably go to the snake bite center at Chulalongkorn Hospital). Antivenoms are effective when given within 4hours of snake bite and should not be delayed for >12 hours. The decision to give the antivenom should be left to the medical personnel. Take note of the appearance of the snake and if possible kill the snake and take it with you.
For more information on snake bites, click here.

Mosquito Bites

Mosquitoes carry various potentially serious diseases ranging from Dengue Fever, Malaria, Japanese Encephalitis etc. Whilst Bangkok is safer than up country areas, it is advisable to treat mosquito with caution and try to prevent bites by using insect prophylaxis methods. This is particularly important when visiting mosquito rife areas in the rainy season when there are higher incidences of Malaria and Dengue Fever.

Children bitten by mosquitoes tend to scratch badly, apply antihistamine cream (i.e. Anthisan) to the bites to try to reduce itchiness and swelling, as open sores are more difficult to heal up and are easily infected.

Common Tropical Diseases

Malaria

Malaria is a preventable disease not seen in most developed countries but still continues to reach epidemic proportion in many countries in this part of the world. A parasitic disease caused by 4 species of Plasmodium protozoa, P.vivax, P.malariae, P.falciparum and P.ovale. Malaria although a treatable disease but sometimes can be a life-threatening illness which can prove fatal in just 24 hours (especially the falciparum malaria) or even a recurrent illness lasting for years (vivax and ovale malaria). Although the geographical distribution of malaria in Thailand has shrunken considerably over the last few years, travelers should attain all information about malaria risk before visiting an area as they form a high risk group having no immunity against the disease.
For more information on malaria, click here.

Dengue Fever

Dengue Fever is another mosquito borne disease that continues to be a major burden in the tropical and sub-tropical countries.  A viral disease transmitted by Aedes aegypti mosquito with no specific treatment or vaccine against it. Most cases of Dengue present as a nonspecific illness but it can prove to be a life threatening illness with up to 20-50%mortality. Over the last 15 years prevalence of Dengue fever has grown, involving newer geographic areas in the west also.
For more information on dengue fever, click here.

It must be stressed that this is only a simple guide to the common hazards to health in Bangkok and all people should consult their doctors regarding ill health, particularly when babies are young.