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Tajikistan - Health and safety
With Dr Felicity Nicholson
Comprehensive travel insurance should be the first thing on your list when you contemplate travelling to Tajikistan. Choose a policy that includes medical evacuation (MEDEVAC) and make sure you fully understand any restrictions: it is not uncommon for insurance companies to exclude certain activities (including mountaineering) from cover. Leave a copy of the policy documents at home with someone you trust, and keep a copy of your policy number and the emergency contact number on you at all times.
Your GP or a specialised travel clinic will be able to check your immunisation status and advise you on any additional inoculations you might need. It is wise to be up to date on tetanus, polio and diphtheria (now given as an all-in-one vaccine, Revaxis, that lasts for ten years), typhoid and hepatitis A. Immunisations against hepatitis B and rabies may also be recommended depending on the duration of your stay and the sort of activities you will be undertaking. Hepatitis A vaccine (Havrix Monodose or Avaxim) comprises two injections given about a year apart, though you will have cover from the time of the first injection. The course typically costs £100 and, once completed, gives you protection for 25 years. The vaccine is sometimes available on the NHS. Hepatitis B vaccination should be considered for longer trips (two months or more) and by those working in a medical setting or with children. The vaccine schedule comprises three doses taken over a six-month period, but for those aged 16 or over it can be given over a period of 21 days. A minimum period of eight weeks is needed for those under 16 for the three injections. The rapid course needs to be boosted after one year. A combined hepatitis A and B vaccine, Twinrix, is available, though at least three doses are needed for it to be fully effective.
There is a risk of malaria, predominantly vivax, but some falciparum too, from June to October in the southern part of the country bordering with Afghanistan. Anti-malarial prophylaxis will be suggested to travellers visiting those regions during those months. The most likely regime is chloroquine and proguanil, but Malarone, doxycycline or mefloquine can be used as alternatives. Seek medical advice to see which is best for you.
While pharmacies in Tajikistan are numerous, especially in the main cities, and some are well equipped, you should still pack a first aid kit (a comprehensive kit is essential for trekkers and others visiting remote areas) and any prescription medicines you require.
If you are heading into the Pamirs it is important to be aware of the possibility of altitude sickness. Acute mountain sickness (AMS) can affect everyone – even really fit people – during a rapid ascent and staying more than 12 hours above 2,500m (8,203ft). It regularly afflicts those travelling along the Pamir Highway from Sary Tash. Altitude sickness is caused by acute exposure to low partial pressure of oxygen: in layman’s terms this means that the amount of available oxygen decreases as you ascend, to the point that the body has insufficient oxygen in the blood to continue functioning normally. Symptoms of mild altitude sickness include headaches, nausea, anorexia (lack or loss of appetite for food), insomnia and confusion, and can be minimised by taking time to acclimatise to the altitude. Many people recommend taking acetazolamide (Diamox) prophylactically to assist in acclimatising. Discuss this with your doctor or other health-care professional before you go. Even if you are taking Diamox, developing any symptoms which might be AMS means that you should descend at least 500 metres as soon as possible.
More serious forms of mountain sickness include pulmonary oedema (fluid on the lungs) and cerebral oedema (swelling of the brain). The first is characterised by a shortness of breath, dry cough and fever and the latter by a persistent headache, unsteady gait, confusion, delirium and loss of consciousness. These are both medical emergencies and need immediate evacuation and treatment by qualified professionals.
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.
At the time of going to press, all travel restrictions to Tajikistan have been lifted by the UK’s Foreign and Commonwealth Office (FCO); all parts of the country are accessible to foreigners. That said, localised violence in Dushanbe, the Romit Valley and along the border with Afghanistan in 2014 and 2015 has previously caused the FCO to suggest heightened vigilance when travelling in those areas of Tajikistan.
More seriously, in July and August 2012 foreigners were advised against all travel to GBAO, and in particular Khorog, following a security incident. Twenty-two British and Commonwealth nationals had to be evacuated from the area.
Dushanbe is considered relatively safe, but there have been occasional muggings and petty crime against foreigners. Instances of sexual assault, including rape, have been reported to consular staff, included suspected use of ‘date rape’ drugs. Take care not to leave drinks unattended, nor accept drinks from strangers.
There is a general threat of terrorism in Tajikistan, though foreigners are not currently thought to be a principal target. Incidents in Tajikistan in recent years include an explosion outside a restaurant in Dushanbe in March 2011, and the discovery of three abandoned vehicles containing improvised explosive devices in Sughd two months earlier.
Tajikistan is generally a safe place to travel, whether you are male or female. That said, you should exercise the usual personal safety precautions and dress modestly, especially in conservative rural areas. It is not culturally acceptable to wear revealing clothing (including shorts, vest tops, or T-shirts which reveal your stomach) in Tajikistan. If in doubt, look at what ordinary women are wearing on the street, and dress with commensurate modesty.
Unaccompanied women may receive unwanted attention in bars and clubs but this is usually deflected with a few terse words. If the harassment continues, alert the management or leave the premises and find a more pleasant alternative. Try to avoid physical confrontation, as alcohol-fuelled violence and being tailed home are not uncommon. There have been suspected cases where ‘date rape’ drugs have been used; keep a close eye on your drink, and do not accept drinks from strangers. Particular caution should be taken when hailing taxis: in Dushanbe phoning for a cab, or getting the establishment you are in to do this for you, is a safer option.
Homosexuality has been decriminalised in Tajikistan but there is, to our knowledge, no open gay scene in Dushanbe. Many people in Tajikistan are deeply conservative, especially when it comes to the issue of sexuality, and homosexuality is still often seen as a mental illness (a hangover from the Soviet period).
If you are travelling with a same-sex partner, you would be wise to refrain from public displays of affection and be cautious when discussing your relationship with others: it is often simplest to allow others to assume you are simply travelling with a friend. Double rooms frequently have twin beds, so asking for one room is unlikely to raise eyebrows in any case.
Travellers of colour
Travellers of African descent, and those with red or blond hair and very pale skin, tend to stand out while travelling through Tajikistan, despite millennia of cultural mixing in the region. You may be stared at on the street, or approached to have your photograph taken, especially in smaller towns and rural areas. Many of these interactions are out of curiosity and easily, even humorously, managed. However, alcohol-fuelled aggression is not uncommon, so try to avoid physical confrontation if possible.
Travelling with a disability
People with mobility problems will experience difficulty travelling in Tajikistan. Public transport is rarely able to carry wheelchairs, few buildings have disabled access, and streets are littered with trip hazards such as broken paving, uncovered manholes, and utility pipes. Hotel rooms are often spread over multiple floors without lifts and assistance from staff is not guaranteed. If you have a disability and are travelling to Tajikistan, you are advised to travel with a companion who can help you when the country’s infrastructure and customer service fall short.