Kyrgyzstan - Health and safety


Health
Safety

Health

With Dr Felicity Nicholson

Kyrgyzstan is a healthy place on the whole and although travellers should be prepared for any eventuality, you should not expect to fall ill here, excepting the odd bout of travellers’ diarrhoea. Nevertheless, all visitors to Kyrgyzstan should be in possession of adequate health insurance as state health care in Kyrgyzstan is rudimentary at best. Insurance is particularly important if such activities as trekking, horseriding or mountaineering are planned, and ideally should cover emergency medical repatriation.

A list of doctors, dentists and health clinics is provided in the Bishkek chapter. There are no compulsory requirements but the standard immunizations of tetanus, diphtheria polio and hepatitis A are all advised. Vaccination against typhoid may be recommended for longer stays or in poorer areas. Tuberculosis is all too common in Kyrgyzstan (there were 160 cases per 100,000 of the population in 2008). Vaccination is recommended for tuberculin naïve travellers aged 16 and under who will be staying for at least three months living and/or working with local people. Vaccination may also be considered on a case-by-case basis for those under 35 years of age who are at high risk through their work, eg: working in hospitals or other healthcare settings. It is also wise to avoid any unpasteurized dairy products as this is also a route of transmission.

There is a low-grade risk of malaria which is mostly due to Plasmodium vivax carried by female Anopheles mosquitoes. The risk is more common from June to October, mainly in areas bordering Tajikistan and Uzbekistan (Jalal-Abad, Batken and Osh provinces). Up-to-date advice on this situation and the need for prophylaxis should be sought from a doctor or travel clinic. At the time of writing, the risk is considered low enough to not need to take tablets but prevention with a DEET-containing insect repellent both day and night is always advised. In rural areas, and especially if cycling, dogs may be a nuisance and present the potential threat of rabies.

Although it is chlorinated, tap water is not of very good quality throughout the country and bottled or boiled water should be taken in preference. Thankfully freshly boiled tea is plentiful, abundant even, and perfectly safe to drink. Care should be taken with raw fruit and vegetables, particularly in the warmer months, and the standard recommendation to always peel or wash fresh fruit and vegetables is sound advice.

Cooked food such as meat stews that have cooled and have been standing around for a while may be more problematic, as might some of Kyrgyzstan’s dairy specialities such as kumys and kurut (dried yoghurt balls), which are sometimes plucked out of a horseman’s grubby pocket to be popped in the mouth of the appreciative visitor. Kumys – fermented mare’s milk – is generally not considered harmful (indeed many make claims to its health benefits), however, you should bear in mind that the fermentation process may not eliminate tuberculosis and it can upset the stomachs of those not used to its sour milk acidity and cause nausea and vomiting in the hapless visitor.

In the summer months, and particularly at altitude, some form of sun protection is essential in the form of a hat and/or sunscreen. Without this sunburn is likely, which causes not only discomfort but also dehydration and skin damage. The mountains may also bring problems of cold weather, too, and it is important to ensure that while trekking you have adequate food, clothing and warm sleeping bags.

Altitude sickness is an ever-present threat above an altitude of 2,500m. Usually a sudden increase in altitude just causes minor discomfort such as a shortness of breath, dizziness, a racing heartbeat, a mild headache and loss of appetite. These are normal symptoms that can be ameliorated to some extent by taking painkillers and drinking plenty of fluids. Alcohol should always be avoided at altitude, as should tobacco.

If you have these symptoms then discuss them with your guide. It may be adequate just to rest for a while but if they persist beyond a day or rapidly worsen, then the only solution is to descend to a lower altitude. Altitude sickness is fairly indiscriminate in terms of who it affects; youth and fitness are no guarantees of avoidance – in fact, perhaps even the opposite, as it is often those in a hurry who come down with it. The best way to avoid altitude sickness is to ascend as slowly as possible, and if trekking over high passes observe the time-honoured maxim: ‘walk high, sleep low’.

There is an excellent pdf booklet that can be found on the internet by looking up ‘Medex travel at high altitude’. All warm-blooded mammals can potentially carry rabies so it is wise to consider any bite, scratch or saliva into an open wound as a risk, even if the animal appears well. There is a ten-day period where the animal is infectious but is not displaying any symptoms. The first thing to do is thoroughly wash the wound with soap and running water for about 15 minutes. Apply an antiseptic afterwards if you have one and then get straight to medical help.

If you have not had any pre- exposure vaccine before travel then you will need a preformed antibody called rabies immunoglobulin (RIG) (ideally human but horse will do) and five doses of cellderived vaccine (HCDV/verorab/or PCEP) over 28 days. RIG is expensive and is often hard to come by which might mean that you need to evacuate to a country that has the supply. If you have had three doses of pre-exposure vaccine over a minimum of 21 days before travel then you no longer need RIG and just require two further doses of vaccine three days apart. Rabies vaccine is ideally advised for everyone, but certainly for those handling animals, for long-term travellers and for those who are more than 24 hours from medical help.

Travel clinics and health information

A full list of current travel clinic websites worldwide is available on www.istm.org. For other journey preparation information, consult www.travelhealthpro.org.uk (UK) or http://wwwnc.cdc.gov/travel/ (US). Information about various medications may be found on www.netdoctor.co.uk/travel. All advice found online should be used in conjunction with expert advice received prior to or during travel.

Safety

Theft

A few simple precautions will ensure that a visit to Kyrgyzstan is a safe and happy one. The countryside is mostly very safe in terms of human menace, although inebriated locals can sometimes be a nuisance. Larger towns, especially Bishkek, are another matter and caution should be taken after dark. At night the streets of all Kyrgyz towns and villages are generally pitch black with little – or nothing – in the way of street lighting and, putting the very real threat of tripping up over something to one side, there is a risk of mugging by locals whose resentment and coveting of the foreigner’s wealth is further fuelled by strong drink. It should never be forgotten that, compared with Europe and North America, Kyrgyzstan is a very poor country, and that most Western visitors walk around with more cash in their pockets than most Kyrgyz could possibly earn in a year.

Alcohol

An invitation to drink can be effectively the laying down of a gauntlet.

Alcohol undoubtedly poses a serious social problem throughout the central Asian region; a problem that first came with Russian colonial rule, was ignored and partly contained during the Soviet period, and has been exacerbated by poverty and a general lack of hope since independence. Remarkably, vodka is available more or less everywhere at rock-bottom prices, even where there is little in the way of food to buy.

Heartfelt Kyrgyz hospitality is a wonderful thing but in all-male company it can sometimes quickly turn into little more than a kamikaze drinking session. It is crucial that moderate imbibers realise there is no such thing as ‘a small one’, ‘a quick one’, or ‘just one for the road’. An invitation to drink can be effectively the laying down of a gauntlet. The guest will be expected to keep up with the other drinkers and will find it difficult to detach himself from proceedings once a session is under way. It is considered very bad form to turn down further drinks once engaged in a boozing session and refusal may be seen as a grave insult to the host.

The best policy for those lacking livers of steel is to politely refuse in the first place, perhaps making something up on health reasons. This will not be popular but it sets the tone and will be respected. If you start drinking, then you will be expected to continue to the dregs of the bottle … and then maybe another.

Women travellers

The outward face of women in the country – both Kyrgyz and Russian – is one of self-confidence, independence and even feistiness. Even if this is not really an accurate picture, women travellers face no particular dangers in Kyrgyzstan. Sexual harassment is thankfully rare but, even though Kyrgyzstan is far from being a strictly Islamic regime, it is still unwise to dress scantily and in a provocative manner, despite the many young Russian women in the cities who do just that.

Travellers with a disability

Apart from a few concessions in the capital, Kyrgyzstan has almost nothing in the way of facilities for disabled travellers. Exploring even Bishkek in a wheelchair would prove to be a challenge given the lack of ramps and poor condition of the pavements. On a more positive note, the majority of restaurants are ground-floor based, which is a slight advantage, and Bishkek’s top hotels at least have ramps and reliable lifts. However, outside of the capital it would be unwise to expect any facilities whatsoever. For those disabled travellers planning to visit Kyrgyzstan, hiring private transport and a guide through one of the agencies listed here is a virtual necessity.

Gay travellers

Sexual acts between persons of the same sex have been legal in Kyrgyzstan since 1998 but same-sex unions have no legal standing. Kyrgyzstan, although more tolerant than neighbouring Uzbekistan and Tajikistan where homosexuality is illegal, remains a conservative country and, while gay relationships may be tolerated, open displays of affection between those of the same sex are frowned upon and may provoke hostility.

Despite recent changes in the law homophobia is still commonplace and there have been some reports of blackmail of homosexuals by corrupt policemen. The north is generally more easygoing than the south, and Bishkek, where a small gay scene has developed with a couple of gay bars/clubs, is the most tolerant. An organisation called Labrys (http://labrys.kg), established in 2004, is dedicated to improving the lot of lesbians, bisexuals, gay men and transgender people in Kyrgyzstan. The age of consent in Kyrgyzstan is 16.

Travelling with a family

Like most people throughout the world, central Asians love children and travelling to Kyrgyzstan with a young family in tow will definitely win points in terms of popularity with the locals. Having said that, there may be some problems concerning hygiene with very young children, and the sometimes rather limited food available might prove problematic with those young travellers who are fussy about what they eat. The typical home cooking of homestays, with plentiful fruit, jams and baked goods, is likely to be more popular than standard restaurant fare. Independent travel in Kyrgyzstan can be hard work at times, with long, uncomfortable journeys that have few rest breaks.

This type of travel is probably too onerous for the average child; hiring a car with a driver would be a much better bet, allowing regular breaks and toilet stops (although probably not toilets) and the opportunity to stop whenever something of interest is seen. Most children will naturally love some aspects of the country like its horses, plentiful wildlife and colourful markets, and the beaches of Issyk-Kul are also likely to be popular with most young travellers. On the other hand, few children will patiently spend hours examining Silk Road monuments or archaeological sites, and even fewer will be willing to spend long hours energetically hiking in the hills.

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