Medical Advice for Travelers to Indonesia:
Disease Concerns and Health Precautions
Indonesian government official health requirements
Proof of yellow fever vaccination for all travelers over 1 year of age who have traveled through infected areas.
In this country, the availability and uptake of immunizations is so dismal such that epidemic diseases have not yet been controlled and periodic outbreaks continue to threaten the lives and health of Indonesian citizens on a regular basis. Other diseases remain endemic due to natural or manmade environmental factors. Therefore specific precautions, including but not limited to immunizations, are necessary to reduce the substantial health risks.
All standard immunizations should be current, including MMR (measles, mumps and rubella) and DT (diphtheria and tetanus). In addition, the following are recommended:
- Hepatitis A
- Hepatitis B
- Rabies (depending on location and occupational risk)
- Adult polio booster
- Japanese B encephalitis (in certain areas)
- Malaria prophylaxis
One of the most important things that a parent can do for their child is to make sure that they have all their routine childhood vaccinations. It's the most effective way of keeping them protected against a range of serious and potentially fatal infectious diseases. In a country such as Indonesia where access to international standard of healthcare can be limited the importance of immunizations cannot be overstated. Tragically children who do not have access to immunization programs still die or suffer from chronic illness from vaccine preventable diseases.
Schedules for routine vaccinations vary slightly in timing between different countries, and we suggest following the schedule from your country of origin (which can usually be found on that countries health ministry website) or on the websites below. Additional vaccinations that are recommended for patients residing in Indonesia include: Hepatitis A (can be given from 12 months of age), typhoid, Japanese Encephalitis and Rabies. BCG is included in most routine schedules for at risk children, and certainly residing in Indonesia where tuberculosis is endemic would be considered an indication for this vaccination.
For further reliable and detailed information about immunizations, vaccination schedules and vaccine preventable diseases please refer to the following websites:
Insect-borne illnesses that must be considered include:
- Dengue fever and Dengue hemorrhagic fever
- Filariasis (in some rural areas)
- Japanese B encephalitis risk - (rural and some resort areas, including Bali)
- Malaria (excluding urban areas)
- Scrub typhus
Loose, light clothing protects against insects. When in long grass, tuck trousers into socks. Avoid wading through swamps and brushing against jungle flora. Liberal use of insect repellent on your ankles, cuffs, collar and waist will help reduce bites.
Ticks (small, eight-legged insects which feed off blood) are an increasing source of infection worldwide. Some transmit serious infections, but all leave a bite which can easily be infected by other micro-organisms. When forcibly or incompletely removed, remnants of the tick's mouthparts are prone to causing infection in the bite. Backpackers and campers should exercise additional caution in tick-infested areas such as forests.
Simple personal protective measures can greatly reduce the risk of being bitten by the anopheles (malaria-carrying) mosquito. Because of its nighttime feeding habits, malaria transmission occurs primarily between dusk and dawn (whereas the dengue-carrying mosquito tends to bite in daylight).
Mosquitoes are found worldwide, as all varieties breed in or near water that is stagnant or slow-moving. The female mosquito is the only one that bites, as she requires a blood meal in order to be able to lay her eggs. Furthermore, she may acquire new disease organisms through biting which may be transmitted to subsequent bite victims. The importance of mosquitoes in the transmission of disease is illustrated by the fact that there are over 50 important diseases transmitted by female mosquito bites, including malaria, dengue fever, Chikungnya, Japanese B encephalitis, yellow fever, and a variety of forest and jungle fevers.
Urban mosquitoes breed in pools of standing water such as empty tin cans, old tires and water-filled tire tracks, coconut shells, and saucers under domestic pot plants. Rural mosquitoes breed in rice paddies, stagnant ponds and slow-moving streams. Control of mosquito-breeding sites is very important, especially those close to human habitation as mosquitoes usually have a flight range of less than one kilometer from where they hatched.
Other useful precautions include:
- changing the water in flower pots once a week after a thorough washing
- avoiding trays with standing water for plants
- scrubbing plant trays weekly to get rid of any mosquito eggs
- cover all water containers and any objects that can trap rain water
- ensure that roof gutters are not clogged
- filling or draining areas of impounded water, except for aerated swimming pools and ornamental pools
- using larvicides or mosquito larvae-eating fish in waters that cannot be drained
- applying screens on doors and windows as well as mosquito nets on beds
These diseases are very common in Indonesia and include:
- Bacterial, parasitic and viral gastroenteritis / traveler's diarrhea (epidemic)
- Cholera (rare)
- Hydatid disease
- Parasitic intestinal worms and fluke
- Typhoid fever (common)
- Viral hepatitis
For information on HIV/AIDS in Indonesia, please visit the STDs page.
Other diseases that you may encounter/experience include:
Industrial plants and high pollution levels in urban areas may cause problems for asthmatics.
Local medical facilities
The standard of care given by most Indonesian medical facilities is not up to international standards. Not all drugs are available, and certain medical techniques are generally unknown or cannot be safely practiced. The national blood supply is reportedly screened for HIV and Hepatitis B (but not Hepatitis C). The usual international standards of sterile supply are not always adhered to, especially outside centers in urban areas. Needles, syringes and gloves which should be single-use are often reused due to economic necessity. Standards of medical and nursing care can fall below internationally acceptable guidelines. Ambulances may be poorly equipped, are not always staffed by paramedics, and in a medical emergency response times may leave something to be desired. Unless in an emergency, comprehensive medical care should be deferred until after exiting the country, if at all possible.
Most doctors and medical facilities will expect immediate payment for their services, perhaps suspecting that most travelers will ignore invoices sent after discharge. This often extends to a request for guarantee of payment before treatment starts. Indonesian service providers do not usually accept a guarantee of payment from overseas insurance or medical assistance agencies unless they have a local presence. It is wise to have sufficient funds in cash to meet predicted medical expenses, as few medical service providers will agree to take credit cards. Therefore, as well as adequate insurance protection, a traveler should carry or have rapid access to sufficient funds to pay for emergency and initial medical costs.
There are no reciprocal medical arrangements between the government of Indonesia and other countries.
Note: When in pain or apprehensive about the cause of mysterious symptoms, miscommunications and misunderstandings can greatly magnify concerns. If you are not reasonably adept in the language the doctor or nurse speaks, try to have an interpreter present. If this is not possible, you'll need a dictionary as well as a phrasebook; tourist-orientated language guides are fine for “where is the toilet?”, but lack the substance to describe pain and bodily functions adequately. If at all possible, while waiting or traveling to see the doctor work with your friends or an interpreter to compose a written summary of your symptoms in the local language.
Indonesian physicians communicate less with patients than expats are accustomed to, and may be insulted when patients ask questions about treatments or express a need for a second opinion.
There is a metropolitan ambulance service said to be operating in most Indonesian cities (the telephone number is 118). Do NOT rely only on this service in case of an emergency.
Foreign doctors are NOT allowed to practice in Indonesia. Some Indonesian doctors have pursued postgraduate training overseas.
More inforamton on medical facilities in Indonesia
All persons travelers to Indonesia should consult their health care providers about avoiding and treating avian influenza. Of particular importance is avoiding contact with sick or dead poultry, which goes double for children. Most human cases of H5N1 have occurred due to direct contact with sick/dead poultry. Be vigilant about food preparation and handling involving chicken or eggs, and wash hands thoroughly afterwards.
- Separate raw meat from cooked or ready-to-eat foods. Do not use the same chopping board or knife for preparing both raw meat and cooked food.
- Do not handle raw and cooked foods back-to-back without washing your hands in-between.
- Do not place cooked meat back on the same plate or surface it was on before cooking.
- Poultry products, including eggs and blood, should be cooked thoroughly. Egg yolks should not be runny or liquid. Influenza viruses are destroyed by heat, so cooking temperatures for poultry meat should be a minimum of 70°C (158° F).
- Wash egg shells in soapy water before handling and cooking and wash your hands afterwards.
- Do not use raw or soft-boiled eggs in foods that will not be cooked.
- After handling raw poultry or eggs, wash your hands and all surfaces and utensils thoroughly with soap and water.
- Pisahkan daging mentah dari makanan yang telah dimasak atau siap untuk dimakan. Jangan gunakan talenan atau pisau yang sama untuk memotong daging mentah dan makanan yang telah dimasak atau siap untuk dimakan.
- Jangan mengolah daging mentah maupun makanan yang telah dimasak tanpa mencuci tangan terlebih dahulu.
- Jangan meletakkan daging yang telah dimasak ke wadah atau piring tempat daging tersebut diletakkan waktu sebelum dimasak.
- Semua makanan dari produk unggas, termasuk telur dan darah unggas, harus dimasak sampai matang. Kuning telur tidak boleh dibiarkan cair. Oleh karena virus influenza akan mati pada suhu yang panas, daging unggas harus dimasak hingga mencapai 70ºC (158ºF).
- Cucilah kulit telur dalam air sabun sebelum diolah dan dimasak, kemudian cucilah tangan sesudahnya.
- Jangan mencampurkan telur mentah atau setengah-matang ke dalam makanan yang tidak untuk dimasak.
- Setelah selesai mengolah daging unggas atau telur mentah, cucilah tangan serta seluruh peralatan masak sampai bersih dengan sabun dan air.
If you have any further questions about medical concerns in Indonesia, see the Ask the Experts.
We trust this information will assist you in making correct choices regarding your health and welfare. However, it is not intended to be a substitute for personalized advice from your medical adviser.
Our appreciation to International SOS, an AEA Company who has contributed this article in response to a growing need for medical advice for expatriates in Indonesia.
We also extend our thanks to the US Embassy which provided the information for the Avian Flu update in a warden alert.