Health, Special Concerns

Al que madruga Dios le ayuda. (God helps those who get up early.) ~ Spanish proverb

Costa Rica is the most modern and sanitary country of the Central American isthmus, so it presents few health worries. No shots are required, but if you’re traveling on to more remote sections of Central America – such as Guatemala, Panama, El Salvador or Honduras – a vaccination against hepatitis A is strongly recommended. Contaminated water is the common source; a shot of immune globulin gives adequate temporary protection.Adoctor friend of ours, who has vacationed in Central America for the past 25 years, recommends a hepatitis vaccine to all travelers regardless of where they go in the world – Cartago or Copenhagen.

. The Water

Outside of San José we drink bottled water to avoid intestinal infections. We learned, however, that nothing offers fail-safe prevention – not even bottled water. Some medical sources even suggest tourista (gastric distress) can be caused by a combination of other factors. Its symptoms, which mimic salmonella poisoning, may include any or all the following: nausea, diarrhea, vomiting, stomach cramps and low-grade fever. Purists suggest waiting it out for three or four days, but that’s hardly realistic if you’ve got only a week’s vacation and a gazillion things to do. So here’s our tried and true treatment.

If we’re in a budget hotel, the first thing we do when we start feeling bad (and it comes on very quickly) is upgrade to a hotel with air-conditioning – maybe even cable TV – and a comfortable bed. A couple of aspirin and plenty of sleep are called for. If we suffer frequent diarrhea and stomach cramps, we take the recommended dose of Imodium AD. Pepto Bismol relieves the symptoms as well, but takes longer. Drink plenty of bottled water, ter or Coca-Cola with lime. In severe cases, hydrating fluids such as Pedialyte, available at a local drugstore.

We also drink manzanilla tea (chamomile) with honey, a helpful folk remedy. Then we crank up the airconditioner, curl up and go to sleep. We repeat the Imodium if the diarrhea returns. In about 24 hours we’re usually feeling well enough to get back out and enjoy ourselves again – with some reservations. If you’ve had a bout of tourista, you may still feel a little weak, so take it easy and don’t over-exert yourself. For a few days you may also experience mild stomach cramps after eating. Eat light and cut out liquor and hot spices.

In all our visits, we’ve been sick only once, but it was a memorable occasion. We learned a lesson from it. If you’re really sick, go to a doctor (or pharmacist) and get an antibiotic. Don’t be shy about it. The US Public Health Service does not recommend taking any prophylactic medicines beforehand, but there are other ways to aid in prevention. Besides drinking bottled water, use it when you clean your teeth.

Peel fruit before consuming. In addition, we theorize that much of the bacteria that gives problems can be eliminated with frequent hand washing. The sensory delights of Costa Rica include touching new things, so a thorough hand scrub every chance you get is a good idea. You should have a fair number of chances because many restaurants offer a sink right in the dining room and it’s considered polite to wash before eating. Alternatively, use the antiseptic towelettes we recommended or consider taking along one of the new anti-bacterial sanitizing liquids, such as Purelle, available in the US.

. Other Health Concerns

Although getting sick is a prime concern of tourists, drowning is a major cause of death. Be extremely wary of rip tides when swimming on either coast. There are few lifeguards on the beaches here. Arip tide is like an underwater river pulling you out to sea. If you get caught in one, don’t panic. Swim parallel to shore until out of its grip.

Other worries of new tourists are snake bites. Although Costa Rica has a large number of poisonous snakes, most tourists aren’t in such wild areas that they’re in danger. The worst offender is the fer-de-lance, or terciopelo in Spanish, a particularly aggressive snake with a very poisonous bite. Stay on the path, wear leather boots in the wild, and go with a guide.

If you should have a severe medical problem, most hotels will arrange a visit to the clinic or will have an English-speaking doctor make a house call. Costa Rica’s doctors are well trained, so if you’re sick don’t wait until you get home to have someone look at you. Malaria and cholera are extremely rare, but they’re not to be fooled with if you display symptoms.

Dengue fever outbreaks (high fever and aches) have occurred in the past, spread by a daytime mosquito, and should be treated promptly. Use mosquito repellent in rural areas to aid in prevention. If you have any health problems after your return from Costa Rica, it may be wise to consult a physician.

You might also check with your medical insurance company to see if they cover expenses outside of the country. Most do, but very few will pay for emergency medical evacuations, sometimes called air ambulances. A list of companies that provide travel medical insurance can be found on the web at travel.state.gov/medical.html.

TRAVELERS WITH DISABILITIES

Unfortunately, few Costa Rican buildings, walks, curbs, buses or bathrooms are wheelchair-accessible, so travelers with disabilities have a hard time getting around. Even the terrain works against handicapped visitors – it’s all up and down.

FAUNA(Foundación Acceso Universal a la Naturaleza,.506/ 771-7482, www.chabote@racsa.co.cr) promotes tourism for people with disabilities and can help plan an itinerary. A Tico agency that specializes in day tours for those with handicaps is Vaya con Silla de Ruedas, in San Pedro (. 506/225-8561, vayacon@racsa.co.cr).

Prostitution

Prostitution is legal in Costa Rica but did not get much publicity – good or bad – until recent worries surfaced about the underground growth of “sex tourism.” Local and national authorities do not want the bad reputation or the social problems that go with that kind of tourism and organized trips for sex are strongly discouraged. Prosecutors crack down hard on underage exploitation and in 2001 the first American was arrested for just that.

Most prostitutes work out of select clubs, bars or escort services and remain relatively low key unless you’re looking for them. Even then, women wait to be approached and are not generally forward or aggressive. They are supposed to have a health card certifying recent medical check ups. Women from other countries have come for the money and some of the working Ticas have taken up the trade because of a lack of decent jobs available in Costa Rica’s sluggish economy. Homosexual prostitutes also work out of certain bars.

Regular cautions go to anyone who gets involved. Some robberies have been associated with the trade – especially with men who drink – and some streetwalkers have tested positive for HIV. If you indulge, use condoms and care.