Cambodia is rife with tropical diseases poised to strike. Erin Hale looks at how to avoid them and stay healthy all year round.
It started with aches and exhaustion. Last September, Australian Kimberley McCosker found it a daily struggle to get out of bed for a week until she realised something might be wrong. “It dawned on me after I walked up a flight of stairs and had to sit down because my legs were aching so much,” she recalls. “I went to the doctor that day and she knew straight away that it was dengue – although I got the blood test to be certain.”
Then came the high fevers, aches and shivers associated with the illness. “It got really bad a couple of days after that,” McCosker adds. “I was in bed for about two weeks, and at the start I was so weak I couldn’t sit up without someone helping me. My back muscles would ache and spasm and my arms would shake and collapse if I tried to push myself up into a sitting position.”
The worst part, she says, is that there is no “cure” – patients can only treat symptoms with painkillers and fluids at home, or hospital if the case is serious. However, as bad as McCosker’s story may sound, dengue is common in rainy season when excess water and poor drainage creates an ideal breeding ground for mosquitos, such as the aedes aegypti, which spreads dengue, to breed.
It is also active primarily during the day, when most people are paying less attention to mosquitos.
Dengue cases should be winding down with the end of rainy season, but McCosker’s experience is a reminder that even in Phnom Penh’s most innocuous spots there’s a health risk, thanks to Cambodia’s tropical climate and limited health infrastructure.
While dengue may be one of the most common examples of a mosquito-borne virus, it’s not the only one that can be found in Cambodia. The aedes aegypti mosquito also transmits chikungunya and zika. All three viruses have similar symptoms and can be confused with each other, according to Dr Som Leakhena, medical director at Khema Clinic in Phnom Penh, but a blood test can determine the difference.
Malaria is only a risk in rural areas as it is spread by the aedes anopholes mosquito, which prefers to breed in fresh water rather than stagnant pools. It’s found primarily in forested areas in Cambodia, according to the US Centres for Disease Control and Prevention (US CDCP), which recommends taking malaria chemoprophylaxis if visiting remote parts of Banteay Meanchey, Battambang, Kampot, Koh Kong, Odder Meanchey, Pailin, Preah Vihear, Pursat and Siem Reap province.
The global spread of zika has created some worry in Cambodia as cases of the virus have been confirmed in neighbouring countries. Zika, however, is endemic to Cambodia, which means there have been cases in the past with the last known outbreak in 2010, according to the US Embassy. Due to its history in Cambodia, the US CDCP reports that many Cambodians may be immune to the virus, although it is still a risk for most foreigners and pregnant women. Also noteworthy is the fact that it can be spread through sexual exposure.
There is no vaccination for zika, dengue or chikungunya, but there are preventative steps that can be taken to reduce the risk of infection says Lina Goldberg, author of Move To Cambodia: A Guide to Living and Working in the Kingdom of Wonder. “Practice good mosquito protection by wearing long pants and sleeves, and liberally dousing yourself in mosquito repellent,” is her advice. “Dusk is one of the worst times of day for mosquitoes, so I don’t leave the house at that time of day unless I’m coated in DEET.”
While cases of dengue should subside with the end of rainy season this month, Dr Leakhena warns that hot season will bring its own cycle of diseases. These include rotavirus, enterovirus, typhoid and cholera as well as other less severe gastrointestinal infections that can be spread through contaminated food, which is at higher risk during hot season due to poor hygiene and food safety practices.
Symptoms can resemble food poisoning in the beginning, but can quickly escalate into the danger zone from dehydration or high fever. They require antibiotics to cure so a visit to the doctor is important if symptoms seem exceptionally bad.
Children are most at risk from rotavirus, enterovirus and typhoid, and vaccines need to be updated annually, advises Dr Leakhena, along with regular childhood vaccines check with a GP for advice.
Goldberg has similar advice. “Generally, doctors suggest getting vaccinated for Hepatitis A, Hepatitis B, Typhoid, Japanese encephalitis – this one is not always recommended but if you get it, get it in Cambodia where it’s cheaper – and rabies,” she says.
Most vaccines need a booster every 10 years, and Goldberg advises staying up to date on the tetanus, diphtheria and pertussis vaccinations to help keep a clean bill of health.