Bali in Focus

Table of Contents

With its fantastic beaches and a rich and diverse culture, Bali is a popular travel destination in Indonesia. For a range of travellers it is a very popular place to have a relaxing and stress-free holiday. For younger people, keen to experience the party atmosphere and island nightlife, Bali has also become a popular destination to celebrate Schoolies week.

Despite its popularity, Bali is also home to several dangerous health issues and travellers should take care when travelling there. Here we look at three common health risks for travellers.

Bali Belly

Travellers to Bali often experience traveller’s diarrhoea, also known as Bali Belly. This infection of the gastrointestinal tract affects approximately 20-50% of people travelling to non-first-world countries.

The majority of Bali Belly cases are caused by bacterial infections as a result of poor sanitation and hygiene. Other causes include viral infections and parasites. The organisms that cause Bali Belly are easily passed from one person to another. This means one common source of contamination is from food prepared by a person with the infection.

Bali Belly can vary from a mild illness, causing abdominal bloating, pain and mild diarrhoea to a more severe form, which can include nausea, vomiting, significant diarrhoea and high temperatures. The symptoms should only last a few days but sometimes can persist for longer leading to dehydration that requires medical attention.

Here are some important precautions to help you keep Bali Belly at bay:

  • See your doctor at least 6-8 weeks before you travel and discuss recommended immunisations for Bali. You can get both hepatitis A and Typhoid through contaminated food and water in Bali. Vaccinations are available for these conditions. Your doctor may recommend other vaccinations, depending on your travel plans.
  • Talk with your doctor about anti-diarrheal medication and antibiotics to take with you. Taking probiotics may seem like a good idea, but there’s not enough evidence that this helps prevent travellers’ diarrhoea.
  • Pack oral rehydration fluids or salts, which are available at most pharmacies. These preparations contain electrolytes, which allow them to be more quickly absorbed than plain water. They can also help you to replenish salt lost in diarrhoea or vomiting.

While you are travelling:

  • Drink bottled water and avoid untreated tap water. Drinking or touching contaminated water can lead to vomiting and diarrhoea or other types of infection.
  • Avoid ice cubes, as these will be made with local water. This also means avoiding fresh fruit drinks, iced tea and iced coffee.
  • Brush your teeth using bottled or boiled water.
  • To disinfect water, boil it for at least one minute and then cool it. Water purification tablets (containing iodine or chlorine) are available, but these are sometimes ineffective against some organisms.
  • Ensure that all the food you eat is well cooked and hot. Cooked food that has been stored needs to be thoroughly reheated.
  • Avoid uncooked vegetables and salads, as they may have been washed in water that is contaminated. Eat only fruits that you can peel (bananas, mango, papaya) and skip fruit that is already cut up into slices (you don’t know how long it has been on display).
  • Avoid unpasteurised milk cheese and yoghurt, raw or undercooked meat, fish and shellfish.
  • Choose restaurants that are popular eating spots with lots of customers. These places are more likely to have a better turnover of foods and hygiene practices.
  • If you are tempted by food from street vendors, then watch it being made in front of you. That way you know the food is well cooked.

Methanol poisoning from alcoholic drinks

‘Arak’ is the moonshine of Bali. This alcoholic, rice-based spirit is unregulated, cheap and may contain methanol. Methanol is a chemical used to produce plastics, anti-freeze, paint and varnish remover. It is also a biofuel. As it is highly toxic it is not recommended for human consumption.

Methanol poisoning has been reported in travellers to various countries including Bali. Many deaths, including those of Australian travellers, have been reported from methanol poisoning. The symptoms of poisoning include fatigue, headache, nausea, blurred vision, changes in colour perception, flashes of light, tunnel vision and blindness. To prevent permanent disability or death, travellers must seek urgent medical attention.

Here are some ways you can limit your risk of methanol poisoning:

  • Be aware of symptoms of methanol poisoning and seek immediate medical attention if you suspect you or another traveller has been affected.
  • Stay away from illegal alcoholic drinks and drinks sold from market stalls. Instead, buy your drinks from licensed venues.
  • Check the labels on alcoholic drinks and avoid drinks where labels are missing, have typographical errors or broken seals.
  • To prevent drink spiking, buy your own drinks and watch them being poured.
  • Never leave your drinks unattended.

Rabies

Rabies is a preventable viral illness transmitted through the bite, saliva or scratch of an infected animal, such as a monkey, dog or bat. The rabies virus can affect the nervous system and can lead to death. Early symptoms of rabies include fever, headache, weakness, insomnia, confusion and later, paralysis, hallucinations, problems swallowing and death. Vaccination is available.

Here are some precautions to reduce the risk of rabies:

  • See your doctor at least 6-8 weeks before you travel and discuss the recommended immunisations. If you work with animals (e.g. vets, bat handlers, wildlife officers) and you will be working in Bali, consider getting a vaccination against rabies.
  • Get vaccinated if you plan to spend extended periods (more than a month) in high-risk regions for rabies.

While you are travelling:

  • Limit your potential exposure by avoiding contact with domestic or wild animals especially bats, dogs, cats and monkeys.
  • If you think you may have been exposed to rabies (whether you are vaccinated or not), wash the wound immediately with soap and water. Apply an iodine solution to the wound such as Betadine antiseptic ointment and seek immediate medical attention.

TOP 10 TIPS for keeping Bali Belly at bay

Bali Beach

With its fantastic beaches and rich and diverse culture, Bali remains one of Australia’s most popular travel destinations. It’s also one of the most dangerous. DFAT recommends you exercise a high degree of caution when travelling there. If your ticket is already booked, here are our top 10 tips for avoiding a health issue that can either be a mild inconvenience or land you in the hospital – Bali Belly or traveller’s diarrohoea.

Before you leave

1. See your doctor at least 6-8 weeks before you travel and discuss the recommended immunisations. You can get both hepatitis A and Typhoid through contaminated food and water, but vaccinations are available.

2. Talk with your doctor about anti-diarrheal medication and antibiotics to take with you. Taking probiotics may seem like a good idea, but there’s not enough evidence that this helps prevent travellers’ diarrhoea.

3. Pack oral rehydration fluids or salts, which are available at most pharmacies. These preparations contain electrolytes, which allow them to be more quickly absorbed than plain water. They can also help you to replenish salt lost in diarrhoea or vomiting.

Bali Belly is an infection of the gastrointestinal tract, which affects 20-50% of travellers to some degree. The majority of Bali Belly cases are caused by bacterial infections as a result of poor sanitation and hygiene. For example, you can catch Bali Belly from food prepared by a person with the infection.

While you’re travelling

4. Drink bottled water and avoid untreated tap water – this includes avoiding ice cubes, fresh fruits (unless you can peel them), iced tea and iced coffee.

5. Brush your teeth using bottled or boiled water.

6. To disinfect water, boil it for at least one minute and then cool it. Water purification tablets (containing iodine or chlorine) are available, but these are sometimes ineffective against some organisms.

7. Ensure that all the food you eat is well cooked and hot. Cooked food that has been stored needs to be thoroughly reheated.

8. Avoid unpasteurised milk cheese and yoghurt, raw or undercooked meat, fish and shellfish.

9. Choose restaurants that are popular eating spots with lots of customers. These places are more likely to have a better turnover of foods and hygiene practices.

10. If you are tempted by food from street vendors, then watch it being made in front of you. That way you know the food is well cooked.

In a mild form, Bali Belly can cause abdominal bloating, pain and mild diarrhoea. In a more severe form, symptoms can also include nausea, vomiting, significant diarrhoea and high temperatures, all of which should only last a few days. If your symptoms persist, it’s important to seek medical attention.

TOP 10 TIPS for staying healthy while travelling in Bali

Bali Temples

Before you leave

1. Read up on the latest DFAT travel advice, including the symptoms of rabies and methanol poisoning so you can seek immediate medical attention if you think you or another traveller has been affected.

2. See your doctor at least 6-8 weeks before you travel and discuss the recommended immunisations. If you work with animals (e.g. vets, bat handlers, wildlife officers) and you will be working in Bali, consider getting a vaccination against rabies.

3. Get vaccinated if you plan to spend extended periods (more than a month) in high-risk regions for rabies.

While you’re travelling

4. Avoid ‘Arak’ – the moonshine of Bali. This alcoholic rice-based spirit is unregulated, cheap to buy and may contain methanol, which is highly toxic.

5. Stay away from illegal alcoholic drinks and drinks sold from market stalls. Instead, buy your drinks at licensed venues.

6. Check the labels of alcoholic drinks and avoid drinks where the labels are missing, have typographical errors or broken seals.

7. To prevent drink spiking, buy your own drinks and watch them being poured.

8. Never leave your drinks unattended.

9. Rabies is a viral illness transmitted through the bite/saliva or a scratch of an infected animal. Limit your potential exposure to rabies by avoiding contact with domestic or wild animals, especially bats, dogs, cats and monkeys.

10. If you think you may have been exposed to rabies (whether you are vaccinated or not), wash the wound immediately with soap and water. Apply an iodine solution to the wound such as Betadine antiseptic ointment and seek immediate medical attention.

Both rabies and methanol poisoning are serious, yet preventable, conditions that can lead to death. In both cases, if you think you are affected, you will need urgent medical attention.

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References

http://www.who.int/environmental_health_emergencies/poisoning/methanol_information.pdf

http://smartraveller.gov.au/Countries/asia/southeast/pages/indonesia.aspx

http://www.methanol.org/safety/

http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home~handbook10part4~handbook10-4-16

https://wwwnc.cdc.gov/travel/destinations/traveler/none/indonesia

Advising travellers about management of travellers ‘diarrhoea. Australian Family Physician Vol 44, No 1-2, January-February 2015