Guide to Health Care in Spain
Almost all travelers will experience no health problems. Your main potential risks are likely to be sunburn, dehydration, foot blisters and insect bites, or mild gut problems at first if you are not used to olive oil.

Preparations

Immunizations
It is recommended you seek medical advice at least six weeks before travel. You may consider immunization against hepatitis A, you should have a tetanus-diphtheria booster if necessary, and you could think about hepatitis B vaccination if you might have sexual contact with the local population.

Health Insurance
Visitors from other EU countries and Norway, Iceland and Liechtenstein are entitled to free Spanish national health medical care on provision of an E111 form, which you must get from your home country before you leave your home country. You will probably have to pay some of the costs for medicines brought from pharmacies, even if a doctor has prescribed them (unless you are a pensioner), and for tests and procedures.
An E111 is no good for private consultations or treatment in Spain, which includes all dentists and some of the better clinics or surgeries, or for emergency flights home. If you want to avoid paying for all of these you will have to take out medical travel insurance. In Britain E111s are issued free at post offices. Just supply name, address, date of birth and National Insurance Number. You will be required to provide a photocopy of the E111 if you go for treatment, so it might be worthwhile getting a couple of copies when you get the form.
Many US health insurance policies stay in effect, at least for a limited period, if you are traveling abroad. Most non-European national health plans (including Australia's Medicare) don't, so you must take out special medical insurance.

Other Preparations
If you wear glasses take a spare pair and your prescription. If you need a particular medication carry an adequate supply, as it may not be available locally. Take a part of the packaging showing the generic name, rather than the brand, to make getting replacements easier. It's a good idea to have a legible prescription or letter from your doctor to show you use the medication legally.

Water
Domestic; hotel and restaurant tap water is safe to drink in most of Spain. However, Malaga is one place where many people prefer to play it safe by drinking bottled water. Safe bottled water is available everywhere, generally it costs anywhere between 60ptas and 125ptas for a 1.5L bottle in shops and supermarkets.

Medical services
For serious medical problems and emergencies, the Spanish public health service provides care to rival that anywhere in the world. Seeing a doctor about something more mundane can be less than enchanting, because of queues and obscure appointment systems, though you should get decent attention in the end. The expense of going to a private clinic or surgery often saves time and frustration: you'll typically pay between 3000ptas and 6000ptas for a consultation (not counting medicines). All dental practices are private in any case.
If you need to see a doctor quickly, or need emergency dental treatment, one way is to go along to the emergency (urgencies) section of the nearest hospital. Take along as much documentation as you can muster when you deal with medical services - passport, E111 with photocopies and insurance papers. Tourist offices, the police and your accommodation can all tell you where to find medical help, or how to call an ambulance. For an ambulance call 061 (Emergency numbers).
Pharmacies (farmacias) can help with many ailments. A system of duty pharmacies (farmacias de guardia) operates so that each district has one open 24 hours. When a pharmacy is closed, it posts the name of the nearest open one on the door. For the Puerto Banus region, the nearest 24 hour pharmacy is situated in San Pedro's main street.
Potential medical problems can be broken down into several camps. Firstly there are the problems caused by extremes of temperature and motion. Then there are diseases and illnesses caused through poor environmental sanitation, insect bites and stings or animal and human contact. Simple cuts, bites and scratches can also cause problems.
Self-diagnosis and treatment can be risky, so wherever possible seek qualified help. Although we do specify drug dosages in this section, they are for emergency use only. Medical advice should be sought where possible before administering any drugs. An embassy or consulate can usually recommend a good place to go for such advice. So can five-star hotels, although they often recommend doctors with five-star prices. (This is when that medical insurance really comes in useful!) In some places standards of medical attention are so low that for some ailments the best advice is to get on a plane and go somewhere else.

Sunburn
You can get sunburn surprisingly quickly, even through cloud cover. Use a sunscreen , a hat and barrier cream for your nose and lips. Calamine lotion is a good way to soothe mild sunburn. Protect your eyes with good quality sunglasses, particularly if you will be near the sand, sun or snow.

Prickly Heat
Prickly heat is an itchy rash caused by excessive perspiration trapped under the skin. It usually strikes people who have just arrived in a hot climate. Keeping cool but bathing often, using a mild talcum powder or even resorting to air-conditioning may help until you acclimatize.

Heat Exhaustion
Dehydration and salt deficiency can cause heat exhaustion. Take time to acclimatize to high temperatures and make sure you get sufficient liquids. Wear loose clothing and a broad-brimmed hat. Do not do anything too physically demanding. Salt deficiency is characterized by fatigue, lethargy, headaches, giddiness and muscle cramps; salt tablets may help, but adding extra salt to your food is better. Anhydrotic heat exhaustion, caused by an inability to sweat, is quite rare. Unlike the other forms of heat exhaustion, it is likely to strike people who have been in a hot climate for some time, rather than newcomers.

Heat Stroke
This serious, sometimes fatal, condition can occur if the body's heat-regulating mechanism breaks down and the body temperature rises to dangerous levels. Long, continuous periods of exposure to high temperatures can leave you vulnerable to heat stroke. The symptoms are feeling unwell, not sweating very much or at all and a high body temperature (39 to 41 degrees Celsius or 102 to 106 degrees Fahrenheit). Where sweating has ceased the skin becomes flushed and red. Severe, throbbing headaches and lack of coordination will also occur, and the sufferer may be confused or aggressive. Eventually the victim will become delirious or convulse.
Hospitalization is essential, but meanwhile get victims out of the sun, remove their clothing, cover them with a wet sheet or towel and then fan continually. Give fluids if they are conscious.

Fungal Infections
Fungal infections are occur more commonly in hot weather and are usually found on the scalp, between the toes or fingers, in the groin and on the body (ringworm). You get ringworm (which is a fungal infection, not a worm) from infected animals or by walking on damp areas such as shower floors. To prevent fungal infections wear loose, comfortable clothes, avoid artificial fibers, wash frequently and dry carefully. If you do get an infection, wash the infected area daily with a disinfectant or medicated soap and water, and rinse and dry well. Apply an antifungal powder like tolnifate (Tinaderm). Try to expose the infected area to air or sunlight as much as possible and wash all towels and underwear in hot water and let them dry in the sun.

Hypothermia
Too much cold is just as dangerous as too much heat, particularly if it leads to hypothermia. If you are trekking at high altitudes or simply taking a long bus trip over mountains, particularly at night, be prepared. In some countries (e.g. Tibet and Chile) you should always be prepared for cold, wet or windy conditions even if you're just out walking or hitching. Hypothermia occurs when the body loses heat faster than it can produce it and the core temperature of the body falls. It is surprisingly easy to progress from very cold to dangerously cold due to a combination of wind, wet clothing, fatigue and hunger, even if the air temperature is above freezing. It is best to dress in layers; silk, wool and some of the new artificial fibers are all good insulating materials. A hat is important, as a lot of heat is lost through the head. A strong, waterproof outer layer is essential, as keeping dry is vital. Carry basic supplies, including food containing simple sugars to generate heat quickly, and lots of fluid to drink. A space blanket is something all travelers in cold climates should carry.
Symptoms of hypothermia are exhaustion, numb skin (particularly toes and fingers), shivering, slurred speech, irrational or violent behavior, lethargy, stumbling, dizzy spells, muscle cramps and violent bursts of energy. Irrationality may take the form of sufferers claiming they are warm and trying to take off their clothes.
To treat mild hypothermia, first get the person out of the wind and/or rain, remove their clothing if it's wet and replace it with dry, warm clothing. Give them hot liquids - not alcohol - and some high-kilojoules, easily digestible food. Do not rub victims, instead allow them to slowly warm themselves. This should be enough to treat the early stages of hypothermia. The early recognition and treatment of mild hypothermia is the only way to prevent severe hypothermia, which is a critical condition.

Motion Sickness
Eating lightly before and during a trip will reduce the chances of motion sickness. If you are prone to motion sickness try to find a place that minimizes disturbance - near the wings on aircraft, close to amidships on boats, near the centre on buses. Fresh air usually helps; reading and cigarette smoke don't. Commercial antimotion-sickness preparations, which can cause drowsiness, have to be taken before the trip commences; when you're feeling sick it's too late. Ginger (available in capsule form) and peppermint (including mint-flavored sweets) are natural preventatives.

Jet Lag
The bags are packed, you've been to all the farewell parties, then you hop on a flight of over 18 hours' duration, to the other side of the earth, with transfers increasing the travel time to what feels like two days. You arrive at your destination not quite at your best, feeling headaches, nauseous, tired, dazed, somewhat confused and unable to stay awake yet unable to sleep. You've even lost your appetite for all that interesting food. That's jet lag, the curse of the 'time' traveler. Jet lag is experienced when a person travels by air across more than three time zones (each time zone usually represents a one-hour time difference). It occurs because many of the functions of the human body (such as temperature, pulse rate and emptying of the bladder and bowels) are regulated by internal 24-hour cycles called circadian rhythms.
When we travel long distances rapidly, our bodies take time (usually about three days) to adjust to the 'new time' of our destination, and we may experience fatigue, disorientation, insomnia, anxiety, impaired concentration and loss of appetite.
The direction of travel is a major factor. Heading east will disrupt the body more than heading west. This is because when traveling west you are essentially lengthening your `day', something your body can cope with for between 24 and 27 hours; traveling east, however, your `day' soon becomes shorter than 23 hours.
Travel stress is another factor: pre-travel parties, packing, separation from family and loss of security all take their toll. The flight itself creates many stressors such as dehydration, poor sleep, alcohol intake and long periods of inactivity. Once at the destination there are language, diet and climate stressors.
Ideally, you could minimize time-lag problems by sleeping and eating at times closer to the time of your destination before you leave, but in practice this is difficult. Instead you should minimize the pain of travel by taking plenty of rest before the flight and avoiding late nights and last-minute dashes for travelers' checks, passport etc. Try to select flight schedules that minimize sleep deprivation; arriving late in the day means you can go to sleep soon after you arrive. For very long flights (especially eastbound), try to organize a stopover and also try to minimize those three-hour transit stops.
During the flight, try to plan meals and sleep around the expected destination times. Drink plenty of water, try to exercise and avoid taking too much alcohol. Make yourself comfortable by wearing loose-fitting clothes and perhaps bringing an eye mask and ear plugs to help you sleep. Sleeping tablets may help regulate patterns, but be sure that they are short-acting - you don't want to be doped-out at the airport. On arrival, stimulate your body to the new time by eating and sleeping at the relevant local times. Exercise helps, and light walking is ideal. Many travelers report that exposure to sunlight after arrival also aids synchronization.
The medical world is looking at specialized hormones to ease jet lag, but this is still highly experimental. One promising development is stimulation by intense light pulses during the flight. This appears to rapidly synchronize the brain to the new time zone. Perhaps you may have to watch the in-flight movie, with light flashes included - a case of feeling bad to feel better, depending on the movie being screened.

Infectious & Diseases

Diarrhea
Simple things like a change of water, food or climate can all cause a mild bout of diarrhea, but a few rushed toilet trips with no other symptoms is not indicative of a major problem. Dehydration is the main danger with any diarrhea, particularly in children or the elderly as dehydration can occur quite quickly. Under all circumstances fluid replacement (at least equal to the volume being lost) is the most important thing to remember. Weak black tea with a little sugar, soda water, or soft drinks allowed to go flat and diluted 50% with clean water are all good. With severe diarrhea a dehydrating solution is preferable to replace minerals and salts lost. Commercially available oral dehydration salts (ORS) are very useful; add them to boiled or bottled water. In an emergency you can make up a solution of six teaspoons of sugar and a half teaspoon of salt to a liter of boiled or bottled water. You need to drink at least the same volume of fluid that you are losing in bowel movements and vomiting. Urine is the best guide to the adequacy of replacement - if you have small amounts of concentrated urine, you need to drink more. Keep drinking small amounts often. Stick to a bland diet as you recover.
Lomotil or Imodium can be used to bring relief from the symptoms, although they do not actually cure the problem. Only use these drugs if you do not have access to toilets e.g. if you must travel. For children under 12 years Lomotil and Imodium are not recommended. Do not use these drugs if the person has a high fever or is severely dehydrated.
In certain situations antibiotics may be required: diarrhea with blood or mucous (dysentery), any fever, watery diarrhea with fever and lethargy, persistent diarrhea not improving after 48 hours and severe diarrhea. In these situations gut-paralyzing drugs like Imodium or Lomotil should be avoided.
A stool test is necessary to diagnose which kind of dysentery you have, so you should seek medical help urgently. Where this is not possible the recommended drugs for dysentery are norfloxacin 400 mg twice daily for three days or ciprofloxacin 500 mg twice daily for five days. These are not recommended for children or pregnant women. The drug of choice for children would be co-trimoxazole (Bactrim, Septrin, Resprim) with dosage dependent on weight. A five-day course is given. Ampicillin or amoxicillin may be given in pregnancy, but medical care is necessary.

Hepatitis
Hepatitis is a general term for inflammation of the liver. It is a common disease worldwide. The symptoms are fever, chills, headache, fatigue, feelings of weakness and aches and pains, followed by loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored feces, jaundiced (yellow) skin and the whites of the eyes may turn yellow.
Hepatitis A is transmitted by contaminated food and drinking water. The disease poses a real threat to the western traveler. You should seek medical advice, but there is not much you can do apart from resting, drinking lots of fluids, eating lightly and avoiding fatty foods. People who have had hepatitis should avoid alcohol for some time after the illness, as the liver needs time to recover.
Hepatitis E is transmitted in the same way, it can be very serious in pregnant women.
There are almost 300 million chronic carriers of Hepatitis B in the world. It is spread through contact with infected blood, blood products or body fluids, for example through sexual contact, unsterilised needles and blood transfusions, or contact with blood via small breaks in the skin. Other risk situations include having a shave, tattoo, or having your body pierced with contaminated equipment. The symptoms of type B may be more severe and may lead to long term problems.
Hepatitis D is spread in the same way, but the risk is mainly in shared needles.
Hepatitis C can lead to chronic liver disease. The virus is spread by contact with blood usually via contaminated transfusions or shared needles. Avoiding these is the only means of prevention.

HIV/AIDS
HIV, the Human Immunodeficiency Virus, develops into AIDS, Acquired Immune Deficiency Syndrome, which is a fatal disease. HIV is a major problem in many countries. Any exposure to blood, blood products or body fluids may put the individual at risk. The disease is often transmitted through sexual contact or dirty needles - vaccinations, acupuncture, tattooing and body piercing can be potentially as dangerous as intravenous drug use. HIV/AIDS can also be spread through infected blood transfusions; some developing countries cannot afford to screen blood used for transfusions. If you do need an injection, ask to see the syringe unwrapped in front of you, or take a needle and syringe pack with you.
Fear of HIV infection should never preclude treatment for serious medical conditions.

Sexually Transmitted Diseases
Gonorrhea, herpes and syphilis are among these diseases; sores, blisters or rashes around the genitals, discharges or pain when urinating are common symptoms. In some STDs, such as wart virus or Chlamydia, symptoms may be less marked or not observed at all especially in women. Syphilis symptoms eventually disappear completely but the disease continues and can cause severe problems in later years. While abstinence from sexual contact is the only 100% effective prevention, using condoms is also effective. The treatment of gonorrhea and syphilis is with antibiotics. The different sexually transmitted diseases each require specific antibiotics. There is no cure for herpes or AIDS.

Tetanus, Diphtheria
All travelers should have had a booster dose within the last 10 years.
Tetanus is caused by a toxin released by a common dust or soil bacteria. It has a world-wide distribution. The toxin causes serious sometimes fatal disease. Diphtheria is a bacterial infection of the throat and occasionally skin. It also produces a toxin which can cause problems with the heart and central nervous system. It is spread from person to person by coughs and sneezes. It is also found world-wide.

Measles, Mumps, Rubella
Travelers under the age of 30 years should have their measles, mumps and rubella immunization complete. Those over 30 years are most likely to have long term immunity from previous exposure as a child.

Other Vaccine Considerations

Influenza Vaccine
The vaccine used to prevent influenza is a trivalent vaccine, usually with 2 strains of influenza A and 1 of B. The selection of suitable strains for the vaccine is made by a consultative expert group from World Health Organization based on predictions for strains circulating in the world and updated annually. The Australian vaccine is released each Autumn. Travelers to the northern hemisphere in the following winter may still derive benefit if the circulating strains remain similar.
The vaccine is given as a single dose. It is a killed vaccine and does not cause influenza.

Pneumococcal Vaccine ( Pneumovax 23)
This vaccine offers protection against the common strains of bacteria causing pneumoccal pneumonia. These bacteria are found world-wide. Vaccination is recommended for: - persons over 65 yrs age - persons who have had a splenectomy - persons with chronic illness

Cuts, Bites& Scratches
Wash well and treat any cut with an antiseptic such as povidone-iodine. Where possible avoid bandages and Band-aids, which can keep wounds wet.

Insects, Scorpions & Centipedes
Bee and wasp stings are usually painful rather than dangerous. However, in the people who are allergic to them severe breathing difficulties may occur and require urgent medical care. Calamine lotion or a sting relief spray will give relief; ice packs will reduce pain and swelling.
Scorpion stings are notoriously painful but Spanish scorpions are not considered fatal. Scorpions often shelter in shoes or clothing, so shake them out before you put them on when camping. Some Andalucian centipedes (escolopendras or ciempies) have a very nasty, but not fatal, sting. The ones to steer clear of are those composed of clearly defined segments, which may be patterned with, for instance, black and yellow stripes.
Also be aware of the hairy, reddish-brown caterpillars of the pine processionary moth (procesionarias), which live in discernible silvery nests in pine trees in many parts of Andalucia and have a habit of walking around in long lines. Touching the caterpillars' hairs sets off a severely irritating allergic skin reaction.
Mosquito and other insect bites can be a nuisance but Spanish mosquitoes don't carry malaria. You can avoid bites by covering your skin and using an insect repellent.

Snakes
The only venomous snake that is even relatively common in Spain is Lataste's viper (vibora hocicuda or viborade Lataste in Spanish). It's a triangular-headed creature, rarely more than 50cm long, and greg with a zigzag pattern.It lives in dry, rocky areas, away from humans. Its bite can be fatal and needs to be treated as soon as possible with a serum which state clinics in major towns keep in stock.
To minimize your chances of being bitten always wear boots, socks and long trousers when walking through undergrowth where snakes may be present. Don't put your hands into holes and crevices, and be careful when collecting firewood. If you suspect a venomous snake bite has occurred, immediately wrap the bitten limb tightly, as for a sprained ankle, and attach a splint to immobilize it. Keep the victim still and seek medical help, if possible with the dead snake for identification. Don't attempt to catch the snake if there is a possibility of being bitten again.

Bedbugs & Lice
Bedbugs live in various places, but particularly in dirty mattresses and bedding, evidenced by spots of blood on bedclothes or on the wall around the bed. Bedbugs leave itchy bites in neat rows. Calamine lotion or Stingose spray may help.
All lice cause itching and discomfort. They make themselves at home in your hair, your clothing or in your pubic hair. You catch lice through direct contact with infected people or by sharing combs, clothing and the like. Powder or shampoo treatment will kill the lice and infected clothing should then be washed in very hot water.

Ticks
You should always check your body if you have been walking through a tick-infested area (such as woodlands or fields in spring or summer), as ticks can cause skin infections and other more serious diseases. If a tick is found attached, press down around the tick's head with tweezers, grab the head and gently pull upwards. Avoid pulling the rear of the body as this may squeeze the tick's gut contents through the attached mouth parts into the skin, increasing the risk of infection and disease. Smearing chemicals on the tick will not make it let go and is not recommended.

Jellyfish
With their stinging tentacles, jellyfish (medusas) generally occur in large numbers or hardly at all, so it's fairly easy to know when not to go into the sea. Dousing in vinegar will deactivate any jellyfish stingers which have not 'fired'. Calamine lotion, antihistamines and analgesics may reduce the reaction and relieve the pain.

Leishmaniasis
This is a group of parasitic diseases found in many parts of the Mediterranean. Leishmania infantum, the strain found in Spain - mainly in country areas near the Mediterranean coasts - is a form of visceral leishmaniasis which is characterized by irregular bouts of fever, substantial weight loss, swelling of the spleen and liver, and anemia. It can be fatal for children under five and people with deficiencies of the immune system such as AIDS sufferers. It is transmitted when sandflies bite dogs carrying leishmaniasis, then bite humans. Avoiding sand fly bites is the best precaution: cover up and apply repellent. Sand flies are most active at dawn and dusk. The bites are usually painless but itchy. If you suspect leishmaniasis, seek medical advice as laboratory testing is required for diagnosis and treatment.

Keeping Healthy
Care in what you eat and drink is the most important health rule; stomach upsets are the most likely travel health problem (between 30 and 50% of travelers in a two-week stay experience this), but the majority of these upsets will be relatively minor. Don't become paranoid; after all, trying the local food is part of the experience of travel.

Water & Drinks
If in doubt, the number one rule is don't drink the water, and that includes ice. If you don't know for certain that the water is safe, always assume the worst. Reputable brands of bottled water or soft drinks are generally fine, although in some places bottles refilled with tap water are not unknown. Only use water from containers with a serrated seal - not tops or corks. Take care with fruit juice, particularly if water may have been added. Milk should be treated with suspicion, as it is often unpasteurised. Boiled milk is fine if it is kept hygienically and yoghurt is always good. Tea or coffee should also be OK, since the water should have been boiled. Remember to clean your teeth with purified water rather than straight from the tap.

Water Purification
The simplest way of purifying water is to boil it thoroughly. Vigorously boiling for five minutes should be satisfactory; however, at high altitude water boils at a lower temperature, so germs are less likely to be killed. Simple filtering will not remove all dangerous organisms, so if you cannot boil water it should be treated chemically. Chlorine tablets (Puritabs, Steritabs or other brands) will kill many pathogens, but not those causing giardia and amoebic cysts. Iodine is very effective in purifying water and is available in tablet form (such as Potable Aqua), but follow the directions carefully and remember that too much iodine can be harmful.
If you can't find tablets, tincture of iodine (2%) or iodine crystals can be used. Four drops of tincture of iodine per liter or quart of clear water is the recommended dosage; the treated water should be left to stand for 20 to 30 minutes before drinking. Iodine crystals can also be used to purify water but this is a more complicated process, as you have to first prepare a saturated iodine solution. Iodine loses its effectiveness if exposed to air or damp so keep it in a tightly sealed container. Flavored powder will disguise the taste of treated water and is a good idea if you are traveling with children.
Food
There is an old colonial adage which says: 'If you can cook it, boil it or peel it, you can eat it...otherwise forget it'. Salads and fruit should be washed with purified water or peeled where possible. Ice cream is usually OK if it is a reputable brand name, but beware of products bought from street vendors in developing countries and of ice cream that has melted and been refrozen. Thoroughly cooked food is safest but not if it has been left to cool or if it has been reheated. Shellfish, such as mussels, oysters and clams, and undercooked meat, particularly in the form of mince, should be avoided. Steaming does not make shellfish safe for eating. If a place looks clean and well run, then the food is probably safe. In general, places that are packed with travelers or locals will be fine, while empty restaurants are questionable. The food in busy restaurants is cooked and eaten quite quickly, and there is less chance that it has been sitting around for ages and then reheated.

Nutrition
If the food available is poor or limited, if you're traveling hard and fast and therefore missing meals, or if you simply lose your appetite, you can soon start to lose weight and place your health at risk. Make sure your diet is well balanced. Eggs, tofu, beans, lentils and nuts are all safe ways to get protein. Fruit you can peel (bananas, oranges or mandarins for example) is always safe and a good source of vitamins. Try to eat plenty of grains (rice) and bread. Remember that although food is generally safer if it is cooked well, overcooked food loses much of its nutritional value. If your diet isn't well balanced or if your food intake is insufficient, it's a good idea to take vitamin and iron pills.
In hot climates make sure you drink enough - don't rely on feeling thirsty to indicate when you should drink. Not needing to urinate or the passing of very dark yellow urine is a danger sign. Always carry a water bottle with you on long trips. Excessive sweating can lead to loss of salt and therefore muscle cramping. Salt tablets are not a good idea as a preventative, but in places where salt is not used much, adding salt to food can help.

Women's Health

Gynecological Problems
Sexually transmitted diseases are a major cause of vaginal problems. Symptoms include a smelly discharge, painful intercourse and sometimes a burning sensation when urinating. Male sexual partners must also be treated. Medical attention should be sought and remember in addition to these diseases HIV or hepatitis B may also be acquired during exposure. Besides abstinence, the best thing is to practice safe sex using condoms.
Antibiotic use, synthetic underwear, sweating and contraceptive pills can lead to fungal vaginal infections when traveling in hot climates. Maintaining good personal hygiene, and loose-fitting clothes and cotton underwear will help to prevent these infections.
Fungal infections, characterized by a rash, itch and discharge, can be treated with a vinegar or lemon-juice douche, or with yoghurt. Nystatin, miconazole or clotrimazole pessaries or vaginal cream are the usual treatment.

Pregnancy
It is not advisable to travel to some places while pregnant as some vaccinations normally used to prevent serious diseases are not advisable in pregnancy e.g. yellow fever. In addition, some diseases are much more serious for the mother (and may increase the risk of a stillborn child) in pregnancy e.g. malaria. Most miscarriages occur during the first three months of pregnancy. Miscarriage is not uncommon, and can occasionally lead to severe bleeding. The last three months should also be spent within reasonable distance of good medical care. A baby born as early as 24 weeks stands a chance of survival, but only in a good modern hospital. Pregnant women should avoid all unnecessary medication and vaccinations, and malarial prophylactics should still be taken where needed. Additional care should be taken to prevent illness and particular attention should be paid to diet and nutrition. Alcohol and nicotine, for example, should be avoided.