Going to Fiji? by Michael Dorso MD - Scuba Doc’s Comments on Health Care

I've fielded a few recent questions about health care in Fiji. What immunizations are recommended? What is the medical system like? Etc.

I have to preface my comments by advising my readers that I've never been there! Here are a few facts I've been able to glean from my research:

We American's are a bit spoiled. Fiji is a poor country. Gross domestic product is less than two billion dollars annually. The entire population is half of Sacramento's. Don't expect to find an ER complete with CAT scanner in every town. Having said that, care is adequate in most towns and influenced by Australian standards. They have a government medical system with basic care, minimal fees and long waits. A parallel "private system" offers care more similar to what we typically expect. Of course the fees are more like we expect as well. All care is cash based. Most institutions will accept major credit cards. I suspect that the nearest significant hospital (to our resort) will be in the capital city of Suva. A complicated illness requiring specialized care might require medical evacuation to some place like Sidney, Australia, or New Zealand.

This would be a god time to make sure your DAN insurance is valid! (Divers Alert Network) Have your DAN membership card in your wallet. (I even keep a copy of the pamphlet in my diver's log.) You will need it to obtain DAN's travelAssist worldwide emergency services. (Up to $100,000 coverage for evacuation for a medical emergency - even for non-diving emergency) Don't have DAN? Ask ECO Dive Center for help, or call 1-800-446-2671.

Advise your credit card company that you are going to Fiji and to anticipate cash withdrawals and even the possibility of significant bills from a hospital on the statement. They may refuse a request if they haven't been forewarned.

Make an appointment with your physician for an immunization update - more on this later.

Ask your pharmacist for an extra supply of your prescriptions - especially if you have the latest designer drugs. Most health plans allow early refills of meds for vacations. Be sure your name is on the bottles - especially narcotics to stay out of trouble. Plan to carry them on the plane with you. Don't show up at an international airport with unidentified pills in a plastic bag - unless your life has been a bit dull lately. By the way, Imodium smells like narcotics to a drug sniffing dog.

The good news: There are plenty of mosquitoes in Fiji, but no malaria!

The bad news: Fiji mosquitoes can give you DENGUE FEVER! Think of this as the flu from hell. It's a virus that gives your high fever - thus its name. It causes muscle aches and pains that are so severe, it has been dubbed "Break Bone Fever". The mosquitoes that carry Dengue can be active in daytime - usually in shaded areas. The usual mosquito precautions apply. There is no immunization available for this one.

Traveler's Diarrhea: The most likely thing that can wreck your holiday is always diarrhea. Its spread by what we docs affectionately call the "fecal oral route". Contaminated water, vegetables or ice is a common way to spread this. A cook who hasn't washed his hands after the bathroom can give it to you. Even sex plays a part.

What's a diver to do? Drink bottled water. Consider packing a small bottle of water purification tablets or a back pack filter. There are some diarrhea prophylactic meds to consider - more later. Eating a beautiful salad in a remote village is a good way to catch diarrhea. Eat fruit you can peel. Eat cooked veggies. The resort meals are usually safe.

Heat sickness: I once experienced this is Thailand after a couple days in country. The heat and humidity was amazing. I remember my second day there. After a death defying ride to the boat dock, I realized that I was becoming nauseated, weak, headache. There was a tiny hole-in-the-wall store on the dock where I managed to find three large bottles of Gator Aid. I guzzled the three bottles over the next few hours with remarkable improvement. Thereafter I made it a point to add extra salt with every meal - especially on the watermelon - yummy! Anticipate the same climate in Fiji. Scuba Doc's Recommended Immunizations

This is something you need to tend to before your leave town - the sooner the better. You body needs at least two weeks to build the necessary antibodies for protection.

Tetanus/Diptheria -Update this basic childhood shot. You need a booster every 10 years.

Hepatitis A - It's everywhere in third world countries. Usually the majority of locals have antibodies to this illness - meaning they have had the hepatitis A. Again, it's spread by the fecal-oral route, contaminated hands, flies. It requires only one shot at your doctor's office.

Hepatitis B - This is the big brother of Hep A. This is transmitted by needles: be it tattoos, immunizations, drug abuse or transfusions, even sexually. About 10% of patients with this disease will progress to a chronic hepatitis that slowly destroys their livers. Ten percent of those will go on to develop liver cancer later in life! This is a couple of shots, but you can get started now. Personally I believe that anyone receiving tattoos or piercing in a third world country is taking an unnecessary risk.

Polio - Consider this one. It's alive and well in some countries.

Influenza - It would be a shame to come down with flu during an expensive scuba trip! The flu vaccine for this year's season is just now coming on the market. Several drug store chains even give this one!

Yellow Fever: There is no yellow fever in Fiji. They will demand proof of immunization only if you are coming from a yellow fever area.

Typhoid Fever: This is a bacterial infection spread pretty much like traveler's diarrhea and hepatitis. It can be a deadly disease, usually with diarrhea late in its course. Fortunately it is treatable with antibiotics. Google: Typhoid Mary for an interesting story about this disease. You may have to contact public Health to find this vaccine. Google: Centers for Disease Control, typhoid immunizations for a list of travel clinics that can give you your shots.

Scuba Doc's Travel Kit, Checklist

Sun Protection: Sunburn is one of the greatest ways to spoil your trip

Sunscreen (Two bottles for a week aboard a boat)
Sunglasses
Consider a thin diving suit to protect against sun, jelly fish, coral, etc.
Sun hat (consider a spare - the wind can easily blow it off the boat)

Medications: Consult with your physician.

Cipro (For treatment of severe traveler's diarrhea) Prescription only.
Pepto-Bismol (for prevention of diarrhea: 2 chewable tabs 4 times daily while in country) Don't panic when your stools turn black.
Lomotil ( for mild diarrhea)
Pain Meds: such as Aleve, Motrin, Tylenol (maybe Vicodin)
Baby Aspirin - one daily on long flights to reduce risk of blood clots
Iodine tablets to treat tap water.
Afrin nasal spray for possible ear or sinus block
Sleeping pills or Melatonin to help on the long flights
Neosporin ointment
Swim Ear drops (to prevent infections in the ear canal)
Sea Sick Meds:

1. Meclizine 25 mg tablets (non-drowsy Dramamine) - you can buy a bottle of 100 tablets for less than $10.00 if you ask the pharmacist.
2. Scopolamine patches (behind the ear for big-time help) - prescription only.

First Aid supplies

Band-Aids (water proof, lots of them! You'll need to change them with every dive, and shower)
Bandages (gauze - squares and rolls, tape)
Ace Wrap
Tweezers
Scissors (Don't try to carry-on scissors or tweezers )

Mosquito Spray/repellant