List of concerns with regard to a sudden move to Cambodia?

[DreadedDr]

Long-time K440 lurker and rarely jump into the anarchy that this forum can entertain me with, but thought I would for this one regarding infections and disease. Sorry for the length, but thought I would cover it.

What other posters have stated is quite right in relation to Malaria, Dengue and Rabies, but perhaps I can throw some further light onto this. Infectious disease can be boiled down to exposure levels in risk areas and generally luck for a healthy western adult. Developing nation citizens (under-resourced for the NGO PC sticklers) have very different immune profiles to developed nation citizens.

Rabies: Get vaccinated, pay the money. 100% death rate world wide and probably one of the nasty of diseases to die from. Your chances are very low of getting it by being a wise traveler/expat. Don't pat dogs/cats/bats/anything that bites, never feed with your hand (this is the usual method of infection for foreigners). If you get bitten, go straight to International SOS or Pasteur. Once symptoms kick-in it is too late. The vaccine does not make you immune, it buys you time...valuable valuable time. Repatriation of an infected body is a nightmare as they remain infectious; but more of a problem for the family than the individual. All regions of Cambo have rabid animals, albeit more than others. There are a fair few cases each year, but probably aren't widely known. There was shocker last year where multiple Cambods gotten bitten by same dog. Only one immediately got treatment the rest were all to arrogant (treatment was free). Only the treated victim and the families left behind tell the story now. If you ever suspect a dog is infected contact NaVRI or Pasteur.

Dengue: Everywhere including city; the mosquito prefers urban settings. 2016 will be a bad year for it due to mosquito cycles. Already seeing expected increase in cases, and the wet season hasn't started yet when it will really boom. Forget about the vaccine for a while, if you are somewhat healthy you should be ok. Almost all Cambo adults have been infected at some stage. The vaccine from Brazil (Rio) is reporting 100% efficacy: 1. Nothing is 100% 2. This study has one major flaw/limit: the people were infected with the exact strain the vaccine is made from and in this situation, the 100% was expected. You wont catch that particular strain and no data exists on its efficacy with SE.Asian (or non Rio strain). I wont go into, but this is the challenge of all vaccine development and might shed light on why people vaccinated against the flu still get severe illness from it. Three Dengue vaccines are coming online soon, and one of those is somewhat effective in SE.Asia (already successfully trialed in Philippines)

Malaria: Generally in rural areas especially deforested. Cambodia has massive treatment resistant levels; Pailin has the highest rates (one of?) in the world of the resistant form. Malaria (and Dengue) can come back to haunt you for a long time. I personally wouldn't bother with pre-meds (I would advise against long term use) unless sleeping in jungle, just get treated when infected. You will know when you are infected. Multiple types of Malaria exist and they require different treatments.

Japanese Encephalitis Virus: Without a doubt this is in every corner of the country. No treatment but vaccine preventable, one-shot, free for Cambo or ID card holders. All kids should be vaccinated and long-term visitors / expats. Pigs are amplifying host, mosquitoes transfer to humans; I *feel* that you can contract directly from pigs (who wont show signs); have never seen a pig test negative to exposure (virus might have passed but immune system has been exposed) after 6-weeks of age. Chances of infection from pig/mosquito is relatively low if you're not routinely exposed. Too many Cambo kids die of this or at least become severely impaired for life.

Hepatitis: Yep, plenty of it. Hep C huge and normal in Cambo adult population; cue diabetes and liver cancer. Again vaccines are available. Don't let your kids share cups/bottles at school. This should (maybe it is) be law in orphanages.

You could ignore every word of this and be entirely fine, or you could not. You could adhere to every precaution and still get sick. Prevention and treatment are the only options you have. Finally, and just in case i have freaked anyone out. Healthy Adults are the least likely to have serious symptoms. If you are a foreigner and do not have HIV or are not immuno-compromised, you are very unlikely to have serious complications, but I guarantee one person of that demographic will.

Health message over. Sorry. I go back to lurking.
Open to PMs if I can help in any way or point you in the right direction.

[alanclarke72]

White it, you are worrying far too much.

As others have said, crime is only a problem if you're silly and reckless. There is no need for you to hide in the guesthouse using their wifi. Stick your laptop in a pack, fling it over your shoulder and you will be fine. Thousands of people use their laptops in cafes.

I've never been sick in Cambodia so can't comment on that but I'm sure rabies is very very rare.

Visas are easy.

As for working as a tefler, who knows? I'm sure you will find work but it won't be well paid.

[DreadedDr]

[quote="alanclarke72"]
I've never been sick in Cambodia so can't comment on that but I'm sure rabies is very very rare.

Had a rabies case yesterday.

[alanclarke72]

Local or expat Dr?

[DreadedDr]

Local
Edit: suspected case...

[Lucky Lucan]

Great to have your input. I find your comment on Japanese Encephalitis vaccines interesting. I think people who have never been in the tropics much like the OP sometimes over-worry about the various diseases, but it's probably better to be over-cautious than to neglect the issue. I got plenty of vaccinations before traveling before, and before I moved here.
Since I've been here, I think like many foreign residents, I have become complacent. Just because you haven't been sick for a long doesn't mean you can't suddenly fall asunder from an easily preventable disease.
Peter who used to own this site is a good example. He seemed comfortable and healthy enough, ate very well and only drank lightly a couple of nights a week. Then he caught Typhoid. After a few nights in intensive care and a few thousand dollars bill he emerged a shadow of what he had been. He was always robust before, now he was weak. I believe this was one of the main factors behind his sudden death a year or two later, along with a certain amount of stress. This could all have been avoided.
Anyway, how often do you recommend getting updates on vaccines? Is there some kind of test you can get to check if they need updating?

[DreadedDr]

Thanks LL and glad you got something out of it.
There is no point-of-care or standard panel of tests to determine immunity you have acquired per se (TB an exception). You can order individual tests, but generally its much easier and cheaper to get another shot. Having a vaccination card is very helpful but this only tells you/GP what you've had and when, not if you are immune. My advice would be to talk to a well-informed GP who is experienced with the region and clearly knows what is needed (gov websites are over-board). If you live in PP and do not spend much time in the jungle: TB, Tetanus, JEV, Rabies and Hep shots. If you're a bit older, include the Flu shot.

To OP: No need to be scared of the tropics. Take the available precautions, but certainly be aware of the risks and don''t hesitate to seek medical advice. If something doesn't seem right (be proactive). If you're getting bitten by mozzies, do something about it: sleep with fan on or net, find the water source as they don't travel far. Somethings you can't do anything about but the odds are in your favour that you'll be alright. My first month I got attacked by a caterpillar - took me about 2-weeks to figure out what the hell had happened.

In regards to KiR. Did he have Typhoid?! I think Ticks are an underestimated critter. Those things are full of bacterial disease including Typhus (similar to typhoid) which we see heaps of in Northern Cambo. Rule of thumb: JEV in the south + typhus in the north.

[Lucky Lucan]

I'm pretty sure bit was Typhoid, as in the extreme Salmonella sort of thing. Not Typhus, the tick thing. He hadn't been in the boonies much in years when that hit him.
What's with this TB test/ vaccine?

[comfortablynumb]

Is it possible to just make up a disease and make up a vaccine to sell?

[Jack Smith]

OP - Jessy wants to know if you 'have girlfriend Cambodia already or not yet' ??

Oh no jessy got a bf already.

How old is he?

I pity the fool..

[vladimir]

dengue twice, once in Thailand, once here, 2nd time much milder
typhoid twice, confirmed by SOS
malaria never
Stay away from dirty restaurants/ street food, remember that dengue is transmitted by diurnal mosquitoes, so a net is almost useless against them

[MONEYBACKGUARANTEE]

You haven't lived until you've been beaten unconscious in the streets of Cambodia.

[On The Buses]

Why swap Japan for Cambodia? Could you work in Japan and chill in Cambodia during the quiet teaching months? That's some thing I have in the back of my own mind.

At least try to get a Permanent Resident visa before you jack Japan in - that way you've got an 'in' any time you want to go back.

Health / medical isn't such a big deal for young folks, who think they will live for ever, but I'm a fossil, rapidly falling apart at the seams. Without a hefty health insurance policy it would be folly for me to reside in Cambodia for any length of time.

[bipolar bear]

Why swap Japan for Cambodia?

And I think there you have it. What do you expect to get out of it, exactly?
Do the Pros and Cons List for staying or going to Cambodia before you do anything at all, would be my advice. It's a widely known technique for arriving at decisions but hardly anyone actually does it. Write that shit down in the columns. Weigh up whether getting on a plane from a first world country to a third world country is going to meet your needs both financially and emotionally.