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Belarus - Health and safety
No specific vaccinations are required for Belarus, although it is recommended that travellers should be up to date with the following to remove the risk of contracting contagious diseases: tetanus, diphtheria and polio, which can be given as the all-in-one vaccine Revaxis. Other vaccines that may be recommended include hepatitis A, hepatitis B, rabies, tick-borne encephalitis and tuberculosis. Hepatitis A vaccine (Havrix Monodose or Avaxim) comprises two injections given about a year apart. The course costs about £100, but may be available on the NHS; it protects for 25 years and can be administered close to the time of departure. This should be considered for the following: longer-stay or frequent travellers; backpackers; those staying with or visiting the local population; intravenous drug users; men who have sex with men; travel at a time of a current hepatitis A outbreak. Hepatitis B vaccination should be considered for longer trips (two months or more) or for those working with children or in situations where contact with blood is likely, eg: playing contact sports. Three injections are needed for the best protection and can be given over a three-week period, if time is short, for those aged 16 or over. Longer schedules give more sustained protection and are therefore preferable if time allows. Hepatitis A vaccine can also be given as a combination with hepatitis B as ‘Twinrix’, though two doses are needed at least seven days apart to be effective for the hepatitis A component, and three doses are needed for the hepatitis B part. Three doses of rabies vaccine are needed over a minimum of 21 days as a full preexposure course. This then changes the post-exposure treatment, making it simpler and more readily available. While rabies vaccine is not the cheapest (typically around £57 per dose), it does last at least ten years unless you are working as a vet abroad when yearly boosts or blood tests are advised.
Tick-borne encephalitis can be encountered outdoors in Belarus and particularly in heavily forested areas, where the undergrowth is dense. It is caused by a virus and is usually spread by bites from ticks that are infected with it. The disease can be serious with a 10–15% chance of lasting neurological problems. The mortality rates vary depending on the type of virus but range from 1% to 20%. Anyone liable to go walking in late spring or summer when the ticks are most active should seek protection. Tick-borne encephalitis vaccine (Ticovac) is available in the UK in an adult and paediatric form. Two doses given at least 14 days apart, though ideally a month, give about 90% protection. If sustained cover is needed then a third dose should be taken 5–12 months later. Whether or not you have the vaccine, preventative measures are also very important. When walking in grassy and forested areas, ensure that you wear a hat, tuck your trousers into socks and boots, have long-sleeved tops and use tick repellents containing DEET. It is important to check for ticks each time you have been for a long walk. This is more easily done by someone else. Don’t forget to check your head and in particular behind the ears of children. Ticks should ideally be removed as soon as possible, as leaving ticks on the body increases the chance of infection. They should be removed with special tick tweezers that can be bought in good travel shops. Failing that you can use your fingernails by grasping the tick as close to your body as possible and pulling steadily and firmly away at right angles to your skin. The tick will then come away complete as long as you do not jerk or twist. If possible douse the wound with alcohol (any spirit will do) or iodine. Irritants (eg: Olbas oil) or lit cigarettes are to be discouraged since they can cause the ticks to regurgitate and therefore increase the risk of disease.
Go as soon as possible to a doctor as tick immunoglobulin should be available for treatment if you have not had the vaccine. Any redness around the bite should also stimulate a visit to the doctor. As some vaccine courses take time to be given, ensure that you visit your doctor or travel clinic well in advance of your trip.
Tuberculosis (TB) is common in Belarus with an incidence of under 40 cases per 100,000 people. The disease is spread through close contact with infected sputum or through eating unpasteurised dairy products. Vaccination may be considered for those under 16 who are living or working with the local population for three months or more. Tuberculin-negative individuals under 35 years of age should be considered for vaccinating if they are at risk through their occupation. The vaccine becomes less effective with age so over-35s can only be considered if they are at very high risk of disease.
Radiation is still present in Belarus following Chernobyl, but with sensible precautions – such as not drinking local water or eating dairy produce, mushrooms and fruits in and around the clearly marked exclusion areas most affected by the fallout – the risk of radiation-related health problems is extremely slight. HIV/AIDS Cases of HIV and AIDS have seen exponential growth throughout eastern Europe and Belarus is no exception. The profile of the social group that is most at risk includes those who actively engage in sexual activity (not only through prostitution) or abuse drugs. The very clear advice for travellers to Belarus is no different from that which applies to travellers the world over. Don’t have unprotected sex (and the best advice is to buy condoms or femidoms before you leave home to guarantee quality), avoid multiple sexual partners and don’t share needles. If you notice any genital ulcers or discharge, get treatment promptly since these increase the risk of acquiring HIV. If you do have unprotected sex, visit a clinic as soon as possible; this should be within 24 hours, or no later than 72 hours, for post-exposure prophylaxis.
Animals should always be approached with the utmost caution, even in urban areas, where dogs live a very outdoor life and strays often roam the streets in packs, cavenging for food. They are prone to carry disease, rabies being the most obvious risk, and you can never guarantee that they won’t attack. Instances of rabies have been steadily increasing in Belarus over the years; by way of example, the number of cases climbed steeply from 27 in 1996 to 1,628 in 2006 (when there were two human fatalities). Most cases have been reported in foxes but numbers are also increasing in racoons. Rabies can be contracted by a bite, scratch or simply getting saliva on your skin or into your eyes, nose or mouth from any infected mammal (eg: bats, dogs, racoons, etc). The animals may look perfectly well so it is not possible to tell whether they are infected or not. First scrub the wound with soap and running water for around 10 to 15 minutes, then apply an antiseptic or alcohol if you don’t have any antiseptic. Seek medical treatment as soon as possible. If you have not had the preexposure course of rabies vaccine then you need to have five doses of vaccine over 28–30 days and at the beginning of treatment you may also need a dose of rabies immunoglobulin (RIG). RIG is in worldwide shortage, very expensive and very unlikely to be available in Belarus, meaning you would need to evacuate as soon as possible. If you have had all three doses of the pre-exposure course then you don’t need RIG at all and only two further doses of vaccine are needed to be given within three days of each other – unless you are immunosuppressed, when you would still need five doses of vaccine post exposure. The rabies vaccine is likely be available in Belarus, but even if it is not then it will be far easier to obtain than RIG so it is still worth having the vaccine before you go. The bottom line here is not a pleasant one; if untreated, rabies is almost 100% fatal and also a terrible way to die.
The best advice is never to drink water directly from the tap, although boiled tap water will present no risk. Bottled water, both carbonated and still, is available in abundance wherever food and drink is sold, and will be widely used in every home.
On the law of averages, you are likely to pick up a dose of diarrhoea sometime, but obvious measures like thoroughly washing your hands with soap at every opportunity will help. Better still, use an alcohol hand rub, which then eliminates the risk of infection from contaminated water. If you do get it, be sure to take as much clear fluid as possible to facilitate the rehydration process. Rehydration salts in sachets or tablets are also a good idea to rebalance any salts lost in the diarrhoea. Remedies such as Imodium can be used on their own when needed, and they can also be used if you are also taking a short-term antibiotic treatment such as rifaximin, azithromycin or ciprofloxacin. These medicines are only available on prescription so you will need to consult with your GP or travel clinic expert. If you are unlucky enough to develop a fever with the diarrhoea or notice blood or slime in the stool then seek medical help as soon as possible, as longer courses of antibiotics may well be needed.
Local health care
The standard of health care available in Belarus is generally below that which might be expected in the UK and the USA. The state endeavours, under significant economic limitations, to provide comprehensive medical support to its citizens. It is usually the case that medical staff, particularly doctors, display very high standards of professionalism and commitment. They are extremely well trained, but there is a chronic shortage of equipment, materials and medicines. I have visited many hospitals boasting gifts of equipment from other nation states in Europe, where instruction manuals, if available, are in a foreign language and where post-delivery support simply does not exist. Thus no training in the use of equipment is available, no spares are supplied and repairs cannot be undertaken. Drugs and medicines supplied by donor countries are often out of date. There is no free medical treatment for foreign visitors, so it is essential to ensure that you travel with comprehensive health cover and that you take all sensible precautions against exposure to risk. If you are normally on any medication, ensure you take adequate supplies with you to cover your trip.
Travel Clinics and health information
A full list of current travel clinic websites worldwide is available on [web] istm.org. For other journey preparation information, consult [web] travelhealthpro.org.uk (UK) or [web] wwwnc.cdc.gov/travel (US). Information about various medications may be found on [web] netdoctor.co.uk/travel. All advice found online should be used in conjunction with expert advice received prior to or during travel.
As a result of the highly visible militia – or police – presence on the streets there is very little crime or antisocial behaviour in Belarus, and even less that is likely to have an impact on visitors from abroad. The country is governed by a strong presidential system, with security forces that are extremely loyal to it. Historically, the authorities have shown little tolerance for opposition politicians, activists and supporters. Where events organised by opposition groups take place, there is generally heavy-handed use of the security forces to disperse and intimidate. As such, you should studiously avoid all demonstrations and rallies. At all other times, just exercise common sense and vigilance, respect people that you encounter on your way, and be alert to the possibility of mugging, pickpocketing and theft from vehicles and hotel rooms, without the need to exercise any greater care than you would at home. Don’t be ostentatious with your money or place yourself in a position of vulnerability in higher-risk areas like train or bus stations and marketplaces. It is also a good idea to be on guard when drinking with people you have just met. On the streets, however, you are very unlikely to see evidence of petty crime or even antisocial behaviour such as alcohol-fuelled violence, the scourge of town centres at home. Taxis are safe, even in the suburbs and rural areas, but you should never pay up front. To put things in perspective, I have never encountered a single crime incident during all of my time in Belarus. I have never heard of anyone else, visitor or local, who has been the victim of crime. I have been out walking at night on my own and taken solo taxi rides after dark, both in well-known areas and those that are less so. Indeed, I have no hesitation in saying that you are much more likely to be treated with kindness, courtesy and unconditional hospitality than as a target for crime. If you ask for directions in the street, the likelihood is that the person you approach will go out of their way to take you where you want to go. In 17 years of visiting this country I have never felt vulnerable, at risk or insecure. So just be sensible, but don’t allow feelings of insecurity to deny you the opportunity of interacting with local people.
There is much apocryphal talk and rumour about Mafia-style organised crime, which probably owes much to tales that originate in neighbouring Russia and Ukraine. Even if true, mobsters will have little or no interest in foreign travellers who stay well away from their ‘business’. In the unlikely event that you become a victim of crime, always pause briefly before acting and think things through. If you are travelling with a tourist agency or staying in a hotel, report the crime to the agency and the hotel first. If your passport is stolen, contact your embassy immediately. Only then should you file a police report. Experiences with the local militia can be mixed and it pays to remember that, as a foreigner, you may be treated with just as much suspicion as likely miscreants, if not more. Scams and swindles are on the increase, although again, you are unlikely to encounter any of them. But take great care every time you use a debit or credit card and never let it out of your sight. ATMs at banks are safe but as people living in the West already know, increasingly sophisticated means of reading and decoding cards are in operation in Europe and Russia, so Belarus may be next. And you should never, under any circumstances, agree to change money other than through a bank, currency-exchange bureau or reputable hotel. By Western standards, most people in Belarus have pitifully meagre financial resources at their disposal and travellers from Europe and the USA are seen as fabulously wealthy. In relative terms, they are. Bear this in mind at all times and be studiously discreet with your money, to avoid placing temptation before locals who can only dream of having the amounts routinely found in your wallet. If anything, the greatest risk of all will be encountered before you even arrive, through access to services requiring payment over the internet. Be very cautious of entrusting your personal details, financial or otherwise, to local sites that profess to be secure. Try to make all your arrangements through reputable agencies with appropriate bonding and insurance.
Women travelling together should not expect to encounter harassment, as two or more local women without male company is a not uncommon sight in bars and restaurants in the big cities. Single women should exercise caution, however. On your own you might find that you are approached for ‘business’ by potential ‘clients’. Hotel lobbies are notorious for this, where members of staff and prostitutes who are their associates work closely together to ensure that all available ‘business’ comes their way. Any woman who is not known in these establishments is viewed with the greatest suspicion and even hostility.
As with everything else in a new destination, female travellers should exercise obvious caution and take the same precautions they would in their own country. It’s all a matter of common sense. Avoid being on the street alone late at night, particularly in badly lit or secluded areas. Try not to take cab rides alone in the dark with small taxi firms, but instead always look for signs and phone numbers on taxis, together with formal identification papers for the driver before you step inside. Be alert in subways. Don’t go out at night without being sure of where you are going to sleep and how you are going to get there. It’s always best to ensure that someone knows where you are and when you expect to be back. In any situation, try to act with confidence but not aggression. A show of helplessness might be viewed as vulnerability. Be careful about accepting drinks from people that you have only just met. And it is never a good idea to accept the invitation of a lift or a coffee. Be wary of travelling alone on overnight trains, as you will have no choice as to your companions in your allotted sleeping compartment (even in first class you will not have the luxury of sleeping alone). But again, Belarusian hospitality is likely to come to the fore. You will most likely encounter interesting and sociable companions (male and female), without there being any question of an uncomfortable, claustrophobic or threatening atmosphere.
Travellers with disabilities
Wheelchair users will find that Minsk is not the most accessible of cities, and other cities and towns even less so. Things are slowly changing for the better, but staff in the tourism trade are generally not used to taking care of visitors with specific needs. You will find that increasing numbers of hotels, restaurants and museums have disabled access and facilities, but you should not assume that this will be so. Always check ahead and don’t expect people to proactively anticipate the support you might require. Sadly, disability awareness still has some way to go and staff are likely to be caught unaware without prior knowledge of a visitor’s specifiic needs. But if you are travelling with one of the major tourist agencies and they are advised of your requirements in advance, you can expect to have your needs accommodated. On the metro system, only the newly constructed stations are wheelchair-friendly. A word on travel insurance: these days, consumers have a huge variety of insurance providers from which to choose, most of whom offer a broad range of cover to anticipate most situations that might arise (subject, of course, to exceptions and caveats). All of us have insurers of choice, which probably means that we have existing policies to cover our individual needs. It always pays to shop around, of course, and in addition to the obvious big players there are also a number of bespoke providers specialising in the provision of insurance for disabled and older travellers or to cover pre-existing medical conditions.