You should start planning the health aspect of your trip well in advance of departure, especially if you’re having vaccines for things like rabies or Japanese encephalitis, which need to be administered over the course of a month. Vaccinations and medical advice are available from your doctor or – more conveniently but expensively – a specialist travel clinic. It’s also crucial to have adequate medical insurance.
Ensure that you’re up to date with the following standard vaccinations: diphtheria, tetanus, and hepatitis A. Other jabs you might consider are tuberculosis, meningitis and typhoid.
The best way to avoid falling ill is to look after yourself. Eat properly, make sure you get enough sleep and don’t try to cram too much strenuous activity into your holiday, especially in the first few days before you’ve acclimatized to the sun, water and food, and while you’re probably still suffering jetlag. Luckily, standards of medical care in Sri Lanka are good. Most doctors speak English and a significant number have trained in Europe, North America or Australia. All large towns have a hospital, and you’ll also find private medical clinics in Colombo. If you pay for treatment, remember to get receipts so that you can claim on your insurance policy. All larger towns have well-appointed pharmacies (signed by a red cross on a white circle) and can usually produce an English-speaking pharmacist. If stuck, any reputable hotel or guesthouse should be able to put you in touch with a local English-speaking doctor.
Water and food
Avoid drinking tap water in Sri Lanka. Although it’s generally chlorinated and safe to drink, the unfamiliar micro-organisms it contains (compared with what you’re used to at home) can easily precipitate a stomach upset. Also avoid ice, unless you’re sure that it’s been made with boiled or purified water. Mineral water is widely available, although always check that the seal hasn’t been broken – it’s not unknown for bottles to be refilled with tap water. Whatever precautions you take, however, you’re still likely to come into contact with local water at various points – your eating utensils will be washed in it, and it will probably be used without your knowledge in things like fruit juices – so it’s not worth getting paranoid about.
Though Sri Lankan standards of food hygiene are reasonable, it still pays to be careful, and the old travellers’ adage usually applies: if you can’t cook, boil or peel something, don’t eat it (although if you can’t peel something, you can always wash it thoroughly in purified water). Stick to hot food that has been freshly prepared. Avoid salads and anything which looks like it has been sitting uncovered for a while; short eats (see Vegetarian food in Sri Lanka) are particularly likely to be old and to have been poked by many fingers. The busier the establishment, the less probability that the food’s been sitting around all day. Obviously you’ll need to use your discretion: the buffet at a five-star hotel has more chance of being OK than a local café’s tureen of curry, which has been keeping the flies fat since dawn. Finally, remember that refrigerators stop working during power cuts, so unless you’re eating at a place with its own generator, avoid any food (including meat and ice cream) that might have been unfrozen and then refrozen.
Diarrhoea, dysentery and giardiasis
Diarrhoea remains the most common complaint amongst tourists visiting Sri Lanka. It can have many causes, including serious diseases like typhoid or cholera, but in the vast majority of cases diarrhoea is a result of contaminated food or drink and will pass naturally in a few days. Such diarrhoea is also often accompanied by cramps, nausea and vomiting, and fever in more severe cases.
You should seek medical advice if diarrhoea continues for more than five days or if there is blood mixed up in the faeces, in which case you could be suffering from giardiasis or amoebic dysentery. With giardiasis you may suffer stomach cramps, nausea and a bloated stomach. In amoebic dysentery, diarrhoea is severe, with bloody stools and fever. If any of the above symptoms apply, see a doctor.
Treatment
One of the biggest problems with diarrhoea, particularly in a hot country like Sri Lanka, is dehydration; it’s vital you keep topped up with fluids – aim for about four litres every 24 hours. If you’re having more than five bouts of diarrhoea a day or are unable to eat, take oral rehydration salts to replace lost salt and minerals. These can be bought ready-prepared in sachets from pharmacies and camping shops. Alternatively, you can make your own by mixing eight teaspoons of sugar and half a teaspoon of salt in a litre of purified water.
Coconut water is a good alternative, especially if you add a pinch of salt. Children with diarrhoea dehydrate much more quickly than adults, and it’s even more vital to keep them hydrated. If you have to go on a long journey where you won’t have access to a toilet, you can temporarily bung yourself up with a blocking drug like lomotil or loperamide, though these simply suppress symptoms and have no curative value. Whilst recovering, stick to bland foods (rice and yoghurt are traditionally recommended, and bananas help replace lost potassium) and get plenty of rest – this is not the moment to go rushing up Adam’s Peak.
Malaria
Sri Lanka was officially declared free of malaria by the World Health Organization (WHO) in 2016 after over three years without a single incidence of the disease being reported – a remarkable achievement. There’s no guarantee, of course, that the disease won’t reappear, although your doctor is unlikely to recommend you take anti-malarials at present.
Dengue fever
The mosquito-borne disease dengue fever, by contrast, remains a genuine concern. Dengue is particularly common in Colombo and along the west coast, with regular outbreaks following the southwest monsoon in October/November (one particular violent epidemic in the first half of 2017 saw 80,000 cases reported, with 215 deaths). There are four subtypes of dengue fever, so unfortunately it’s possible to catch it more than once. The disease is typically characterized by the sudden onset of high fever accompanied by chills, headache, a skin rash and muscle or joint pains (usually affecting the limbs and back, hence dengue fever’s nickname “break-bone fever”). The fever usually lasts three to seven days, while post-viral weakness, lethargy and sometimes depression can persist for anything up to several weeks. A rare but potentially fatal complication is dengue haemorrhagic fever (DHF), which is almost entirely confined to children under fifteen who have previously been infected with dengue fever.
There is no vaccine for dengue fever, which makes avoiding getting bitten in the first place all the more important, although unfortunately the mosquitoes that transmit dengue bite during the day, making them harder to guard against than malarial mosquitoes.