Travel clinic

Travel across Rajasthan can be an unforgettable experience, but even in what is arguably India’s cleanest state, there lurk health risks worth preparing for, says Dr Jane Wilson-howarth

Dr Jane shares need-toknow health advice on visiting Rajasthan

‘Over 20,000 people die of rabies in India annually, and nearly all cases follow dog bites, so pre-departure rabies cover is worthwhile’

Although India offers travellers a wealth of experiences, it can also present some health issues, too. And while Rajasthan is one of the healthiest spots to visit on the subcontinent, as with any destination there are considerations to keep in mind.

SMOG & HEAT

Many travellers to Rajasthan pass though Delhi (or one of the other megacities), where traffic rules are ‘unusual’ – it may seem like there’s a complete lack of any system. Cars and motorbikes drive fast, other road users (including dogs and cows) are unpredictable, and crashes are many. Be sure to do a quick check of the state of any taxi you get into.

The big cities can also be very polluted, so anyone with a history of asthma, even if only as a child, would be wise to travel with an inhaler, just in case. Some people take pollution masks.

Once you arrive in Rajasthan, the air will feel healthier, but the summer can be fiercely hot. Those unused to the heat will take a couple of weeks to acclimatise, but after that you’ll sweat less, cope better and lose less salt.

In those first two weeks it is especially important to make a conscious effort to drink plenty, as thirst is a poor indicator of the body’s need for fluids. The best guide to hydration is the colour and quantity of urine: everyone – travelling or not – should pass a minimum of three good volumes of light-coloured urine per 24 hours. If peeing very frequently (say hourly), you are probably drinking too much, so moderate your intake and watch your output. If passing very small volumes of urine frequently, this suggests a bladder infection, and antibiotics will likely be needed, especially if there is blood and/ or pain at the end of the stream.

If your taste for salt increases, add more salt to your food – or fresh lime sodas. Consider also bringing a refillable water bottle; buying ‘mineral water’ only adds to the solid-waste disposal issues faced across the subcontinent, and indeed globally.

FEELING THE BITE

Astonishingly, over 20,000 people die of rabies in India annually (compared to a global total of over 55,000, reports the World Health Organisation). Nearly all cases follow dog bites. Pre-departure rabies cover is a worthwhile investment, especially as a full course of rabies vaccine (and a booster) should give immunity for life.

Even if covered, it is obviously desirable to avoid bites; and if threatened by dogs, it is best to face them, speak calmly and stoop down and pick up a rock. Most dogs will back off if they think you are armed with such missiles. Running is the worst thing that you can do.

Dozens of snake species are found across Rajasthan. Several are magnificently marked but, to the untrained eye, it isn’t easy to distinguish species and telling the difference between a deadly saw-scaled viper and a non-venomous sand boa requires skill and light.

Snakes largely hunt from dusk, so aren’t easy see by torchlight. Large, brown rat snakes are often active during daylight hours and are commonly seen all over the subcontinent, but they are

harmless. That said, it is best to avoid bites by being properly shod and by wearing long, loose trousers, especially from twilight on – when snakes start hunting.

This advice helps avoid insect bites, too, and reduces the chance of acquiring one of the five major mosquito-borne infections present across India. But because Rajasthan has less surface water than other regions, the danger is reduced here: the malaria risk in particular is low but not absent; dengue is a possibility; chikungunya and zika are likewise present; and Japanese encephalitis also occurs here.

The peak transmission season is during the monsoon. Remember that the dengue vector is a day-biter, so cover up if you begin noticing bites, especially while relaxing in an idyllic hotel garden – or move away from the shade. Do also bring plenty of repellent and research your particular risks.

Those with ongoing health challenges should discuss their travel plans with their doctors; for example, people who lack a spleen are at increased risk of dying if they contract malaria. Those recovering from cancer treatment may need to be reimmunised and will have reduced immunity to infections that others would fight off.

STOMACH WOES

India has quite a high hit rate for all the filth-to-mouth diseases, from travellers’ diarrhoea to dysentery, as well as the enteric fevers (typhoid and paratyphoid). Shun salads as these are readily contaminated during growing and aren’t easily decontaminated by washing, even in clean water.

The gastroenteritis risk is greatest immediately before and during the monsoon. I would recommend a course of three typhoid capsules before any trip to India. These are not very well known among GPS, and many travel clinics don’t offer them. GPS can provide a prescription so that the capsules can be dispensed by a pharmacy.

Typhoid injections only protect against typhoid but half of the cases of enteric fevers here are due to paratyphoid, which isn’t covered by the injection. Sadly, the capsules are only effective in people over the age of six, and the way that they are dispensed in the UK means they are only effective for a year.

And finally, do check up on what you may and may not do on entering India. A friend was recently arrested for innocently bringing in a satellite phone, not realising he had committed a crime in so-doing. The FCO site (https://tinyurl.com/ WL-FCO) is packed with good advice on such laws, as well as where it is and isn’t safe to venture.

Dr Jane Wilson-howarth is now based in the Kathmandu Valley from where she is blogging at www.wilson-howarth.com/blog

top tip Many GPS don’t know this, but they can issue an NHS prescription for three typhoid capsules that protect against both typhoid and paratyphoid.