Bali

Many West Australian travellers consider Bali to be one of the northern suburbs of Perth and it's a great place for a
relaxing tropical holiday - sun , sand, shops and surf. However everyone who's been knows of holidays ruined by Bali
Belly, dengue fever, tainted drinks, accidents, a monkey bite requiring a course of rabies shots or substandard
treatment in Bali hospitals. Behind the facade of 4-5 star resorts, hotels and villas, lies a developing country with poor
sanitation, infrastructure problems and environmental degradation.
The following information provides some broad and general guidelines about health risks and recommendations for
this destination. This should not be taken as a substitute for personal consultation with a doctor with experience in
travel health.

Most Common Health Issues for Bali

Travellers Diarrhoea (Bali Belly)
This is the one most travellers to developing countries experience sooner or later, with watery diarrhoea and sometimes
vomiting. It is caused by bacteria, such as E.coli, Campylobacter, Salmonella and Shigella. Careful food and drink choices (no tap
water), as well as hand hygiene, help in prevention. It is treated with rehydration if mild but if inconvenient, with a bowel
stopper such as loperamide (Gastrostop or Imodium) and if more severe or persistent with an antibiotic, which is best obtained
prior to travel rather than in Bali. We stock gastro kits containing all of these medications.

Dengue and Chikungunya

These mosquito born viruses cause nasty illness. Most cases of dengue diagnosed in Western Australia are from travellers
returning from Bali, with high fever, body aches, headaches and sometimes a rash. Occasionally serious complications occur.
Risk is higher in the wet season. Mosquito avoidance is the only prevention. There is no specific treatment but full recovery
usually occurs. Chikungunya is a similar virus but may cause chronic joint pains.

Accidents
Most accidents in Bali occur as a result of people doing things they wouldn't normally do, in an environment they may not be
entirely familiar with, often under the influence of alcohol. Examples include motorbike accidents without helmets, on poorly lit
/maintained roads, surfing injuries, near drowning, fights and assaults, twisted/broken ankles from potholes in footpaths, and
exhaust pipe burns.
Be sensible. Make sure your friends look after you if you are drinking, pack a first aid kit, make sure you take travel insurance
and keep an eye on travel alerts. Hospitals and doctors often require prepayment before operations or major medical
procedures in Bali. Decide whether you want to be treated there or get the first flight home for a higher standard of care (if
safe to do so). Sometimes medical evacuation back to Australia is the safest option although this generally needs to be
organised through your travel insurance.

STD's
Many travellers - young and old, male and female - put themselves at risk. Pack condoms and use them. Unfortunately, many
travellers are still caught out having sex with locals not realising they are sex workers expecting payment. Unprotected sex

carries a high risk of STD's, including HIV, Chlamydia, Gonorrhoea and Syphilis. Herpes and genital warts may still be
transmitted if condoms are used. See a doctor on return if you have put yourself at risk and abstain until you are given the all
clear.

Animal Bites
Rabies has only been a problem in Bali in recent years. Dog bites affecting Balinese locals account for most cases, but
theoretically any mammal can transmit the disease. Watch young children around animals closely. Dont carry food in, or avoid
altogether the monkey forest near Ubud, as weekly we see people who have been bitten or scratched by monkeys and then
require rabies shots. Immediate and thorough irrigation and cleaning of animal wounds, followed by a course of shots is
essential. See more below under Rabies.

Illicit Drugs
Just don't do it. We all know the consequences in Bali.

Tattoos
Apart from the obvious risk of blood borne viruses (Hepatitis B and HIV) from having tattoos done in less developed countries,
we often see nasty allergic reactions to temporary henna tattoos. Then there are the spelling mistakes.....

Alcoholic Beverages
Apart from the obvious risks of intoxication, there have been cases of poisoning in Indonesia, most notably in Bali and Lombok,
from alcoholic drinks adulterated with harmful substances, particularly methanol. Locals and foreigners, including Australians,
have died or have become seriously ill. Cases have usually involved local spirits and spirit-based drinks, such as cocktails, but
supposed brand name alcohol can also be adulterated. A number of deaths have also been reported after drinking adulterated
arak a traditional rice-based spirit.
You should consider the risks when consuming alcoholic beverages in Indonesia, particularly cocktails and drinks made with
spirits. Drink only at reputable licensed premises and avoid home-made alcoholic drinks. You should be aware that the labelling
on bottles may not be accurate and that substitution of contents can occur.

Travel Insurance
Essential

Security Alerts and Terrorist Threat

Check out the Australian Governments Smart Traveller website for the latest assessment.

Seeking Medical Help

BIMC ( Bali International Medical Centre ) have two hospitals/clinics in Kuta and Nusa Dua :
BIMC Hospital - Jalan By Pass Ngurah Rai, Kuta Badung, Bali, Indonesia +62 361 761263
BIMC Hospital - Kawasan BTDC Blok D Nusa Dua Bali 80363, Indonesia +62 361 3000911

Vaccinations
Routine Vaccinations for all travellers
All international travellers should be up to date or immune to the following as these are transmissable diseases which
may have serious complications:

Measles
Chickenpox
Influenza - especially for the elderly or those with underlying medical conditions

In addition a tetanus booster if more than 5- 10 years since last vaccinated is advisable to avoid having to get a booster
shot in Bali in the event of a tetanus prone wound

Recommended Vaccinations for most travellers to Bali

Hepatitis A is a food and water borne virus that infects the liver and causes jaundice. Many people in the developing
world have natural immunity, but travellers generally do not. The vaccine is very safe and effective, a single injection
providing immediate protection for 6-12 months, after which a booster shot provides long-term immunity.
Hepatitis B is a blood borne virus, but may also be sexually transmitted. Accidents, injuries and sometimes even medical
treatment in the developing world can expose travellers to this disease. Hepatitis B is highly infectious and can lead to
chronic liver disease and liver cancer. All children and young adults born since 1990 in Australia have generally been
vaccinated

Other vaccinations to consider

Rabies is a virus spread from infected animals to humans through bites, scratches and exposure to saliva. If not properly
treated and rabies develops, the disease if fatal. Travellers should avoid close contact with either wild, stray or domestic
animals; in particular dogs, cats, monkeys and bats. For travel to Bali, vaccination against rabies is often recommended for
those at particularly high risk, for example those working with animals, those touring/biking through rural areas or visiting
the monkey forest/temples.
Typhoid fever is a bacterial infection which is caught through ingesting contaminated food and water. Indonesia is one of
the higher risk destinations worldwide. Mortality is in the order of 1 in 10 in some settings. Resistance to common
antibiotics is also widespread so treatment has become more difficult.
Japanese Encephalitis, spread by the Culex mosquito,is a rare but very dangerous brain infection encountered in South
and South East Asia, extending as far north as Japan and Russia. There are now 2 very effective vaccines available. Risk is
mainly in rural areas, particularly in the wet season and near rice paddies. Vaccination should be considered for extended
travel in these areas, or short term travel to an area where there is a current outbreak.