Welcome to Tabir! You're going to have a wonderful time and, potentially, a life-changing (in the best sense of the word) experience. Please read this, though, before you go, so you can prepare properly for your "adventure".
Although we have a dispensary at the Tabir, our range of medical supplies is quite limited. We will have some help from a camp physician, and I will be available for consult during the first tabir. There should be reasonable pharmaciesand hospitals (to deal with minor problems) in the area, as we are near Yalta.
REMEMBER: Ukraine is a developing nation in the lower half of the world's economies. Tourist facilities are not highly developed, and many of the goods and services taken for granted in other countries are not yet available.
Medical care is substandard throughout the country including in Kiev. Adequate evacuation coverage for all
travelers is a high priority.
(Consider buying a travel insurance policy; you can buy this through most travel agents,
or through Travel Guard International1 on line.) In the event of serious medical conditions every effort should be made
to go to Western Europe. Hospital accommodations are inadequate throughout the country and advanced technology is
lacking. Shortages of routine medications and supplies may be encountered. Persons discovered to be carrying
antiretrovirals will be denied entry at customs.
There is also a huge problem with counterfeiting, including medications. If you need or might possibly need
any medications, bring them with you.
General Health Precautions
Recent medical and dental exams should ensure that you are in good health, so get a quick check-up if you haven't had
one recently. Carry appropriate health and accident insurance documents and copies of any important medical records.
Bring an adequate supply of all prescription and other medications as well as any necessary personal hygiene items2,
including a spare pair of eyeglasses or contact lenses if necessary. (See checklist
Drink only bottled beverages (including water) or beverages made with boiled water. Do not use ice cubes or eat raw seafood or rare meat. Eat well-cooked foods while they are still hot and fruits that can be peeled without contamination. Avoid roadside stands and street vendors (unless the foods are deep fried and hot). Only pasteurized dairy products should be consumed.
Diphtheria occurs. Cases predominantly occur in urban areas, but increasing numbers have been reported in rural areas.
Shortages of vaccine, antibiotics and diphtheria antitoxin are contributing to the problem. While proof of diphtheria immunity is not required for travel, travelers to areas where diphtheria is occurring should be up-to-date for diphtheria immunization.
AIDS occurs; Ukraine is currently has one of the highest growth rates in Europe for new cases of AIDS, with approximately 1% of the population now HIV positive. The blood supply may not be adequately screened and/or
Most personal hygiene items, with the exception of dental floss, can now be easily obtained in Ukraine. However, it issimpler to bring most things with you, especially if you are particular about brands. Western brands can be found with a bitmore difficulty, and at fairly high cost. Then again, lypa soap and kropova herbal shampoos can be fun to explore.
single-use, disposable needles and syringes may be unavailable. When possible, travelers should defer medical treatment until reaching a facility where safety can be assured.
Lyme disease occurs, but diseases transmitted by insects are not generally a problem in this country, although flies and ticks do transmit leishmaniasis and tick-borne encephalitis. Personal protective measures are important when insect exposure is anticipated. Hikers should take protective measures against ticks, to protect against Lyme disease and othertick-borne diseases.
Avian influenza H5N1, excreted in large amounts in the droppings of infected birds, has been confirmed in this country in birds, including poultry, but not in humans. Although risk to travelers is minimal, avoid places where direct contact with birds and/or their secretions may occur, such as live animal markets and poultry farms. Well cooked chicken is safe to eat. Current influenza vaccines are not protective. Oseltamivir (Tamiflu) is effective. There have been no recent outbreaks.
Common colds, bronchial ailments, sinusitis, and intestinal flu are common.
Rabies occurs in wild animals, especially foxes, in rural areas.
March 6, 2006
: According to WHO, more than 17,000 cases of measles have been reported throughout Ukraine so far
this year, particularly in Kiev City and Kiev Oblast. Risk to non-immune travelers is significant; travelers are reminded
of the importance of adequate vaccination against measles.
(These recommendations are not absolute and should not be construed to apply to all travelers. A final decision
regarding immunizations will be based on the traveler's medical history,proposed itinerary, duration of stay and
purpose for traveling.) All routine vaccines (such as TD, MMR, polio, varicella, influenza and pneumococcal)
should be kept up-to-date as a matter of good health practice unrelated to travel!
: There are frequent epidemics in Ukraine. It is very important to be up-to-date on your diphtheria
immunization. Check with your physician to see if you are. This is usually given in combination with tetanus toxoid.
: Strongly consider active immunization with Hepatitis A vaccine or passive immunization with immune
globulin (IgG) if you have never had Hepatitis A. It is particularly important for persons who will be living in or
visiting rural areas, eating or drinking in settings of poor or uncertain sanitation, or who will have close contact with
local persons (especially young children) in settings with poor sanitary conditions. (Note: a member of our group came
down with a fairly severe case of Hepatitis A several years ago; it is common in Ukraine. PLEASE
getting this one.)
: Vaccination is advised for health care workers, persons anticipating direct contact with blood from or
sexual contact with inhabitants, and persons planning extended stays of 6 months or greater (especially those who
anticipate using local health care facilities, staying in rural areas, or having intimate contact with the local population).
All children are now being routinely immunized for Hepatitis B, so it is one you might consider getting as a general
: A one-time adult booster dose is recommended for travelers who have previously completed a standard course
of polio immunization. If you have not had polio vaccine since you were a child, a one-time booster is strongly
: A booster is needed if your last shot was more than five years ago. This is usually given as TD (tetanus and
: Vaccination should be considered for persons staying longer than 3 weeks, adventurous eaters, and those
who will venture off the usual tourist routes into small cities, villages and rural areas. The importance of vaccination increases as access to reasonable medical care becomes limited. (This one is not that important, in my opinion. Discuss with your doctor.))
This vaccine is now widely available. If you didn't have chicken pox as a child (check with your mother to
find out, if you don't remember), you may wish to consider getting this vaccine , as adult cases are much more severe
than childhood ones, and may be fatal.
: Once again, according to WHO, more than 17,000 cases of measles have been reported throughout Ukraine
so far this year, particularly in Kiev City and Kiev Oblast. Risk to non-immune travelers is significant; travelers are
reminded of the importance of adequate vaccination against measles. MAKE SURE YOU ARE UP TO DATE ON
Here is some other travel-related information that you may find useful Don't let it scare you, as most people have few if any problems when they travel. Being prepared with the facts can help may your trip smoother and more worry free!
The material below has been compiled or quoted verbatim from the consular Web sites of the United States (travel.state.gov), United Kingdom (www.fco.gov.uk/travel), Canada (voyage.dfait-maeci.gc.ca), and Australia (www.dfat.gov.au/consular/advice).
Most travelers do not encounter problems with crime while in Ukraine. Nonetheless, the country is undergoing a significant economic, political, and social transformation, and income disparities have grown sharply. As a result, visitors perceived to be wealthier are targets for criminals. Most street crime is relatively low level, but crimes involving small caliber firearms have been reported. Street crime ranges from wallet scams, simple pick pocketing and purse snatching, to muggings, armed robbery, or drugging unsuspecting victims at nightspots and bars (where they are then robbed). Cases of assaults in apartment building corridors and stairwells, and armed break-ins have also been reported.
Burglaries of apartments and vehicles represent the most significant threat to long-term residents. Although few cars are actually stolen, primarily because of increased use of alarm systems and security wheel locks, vehicular break-ins and vehicular vandalism are becoming more common. Avoid traveling alone, particularly via mass transit and at night.
Credit card and ATM fraud is widespread. Computer fraud is also becoming more common in Ukraine. Internet scams appear to be on the increase. (It is safe to use ATM cards; I use them all the time.)
A number of racially motivated assaults and incidents of harassment against persons of African or Asian ethnicity havebeen reported, including some perpetrated by Ukrainian law enforcement officials. There have also been a number of reports of harassment and intimidation directed against foreign businesspersons and interests. While these reports have become considerably less frequent in recent years, they have not ended.
Political demonstrations occur, some resulting in violence. Most occur in Kiev or larger cities. The threat from international terrorism is low in Ukraine.
Generally, roads in Ukraine outside major urban areas are in poor condition and poorly lit. Drivers often disregard traffic rules, are poorly trained, or drive without valid licenses. Defensive driving is a must. Many cars do not meet the safety standards common in other Western countries. Travel between cities at night and in winter can become extremely treacherous. Major roads, however, are drivable during daylight hours. There have been isolated reports of carjackings of western-made or foreign-registered cars. Roadside services, such as gas stations and repair facilities, are becoming more common, particularly on the main national and regional highways, but remain inadequate elsewhere. Travelers should plan accordingly. (WEAR YOUR SEATBELTS!!!!)
Driving under the influence of alcohol is strictly prohibited (zero tolerance). In the event of an accident, local police can be contacted at 02, ambulance services at 03, and the fire department at 01. Mobile phone coverage outside major cities is unreliable.
Car insurance is mandatory. Vehicles can be rented at some major hotels in Kiev and rental agencies in major cities. Drivers can be very aggressive, and they normally do not respect the rights of pedestrians, even at clearly marked pedestrian crossings. Pedestrians should also be aware of cars driving or attempting to park on sidewalks.
Use of official taxis is recommended. Taxis should be ordered through hotels or by calling 574-0574, 234-4444, 058, 238-8238, 246-1036, or 211-4444. Remain cautious on trains, especially overnight trains, since criminal acts can occur(i.e. robberies, muggings, and gassings). Make sure that the compartment door is securely closed (LOCK IT) from the inside. Traveling on public buses is inexpensive; however, they are usually overcrowded and not always in good condition.
The U.S. Federal Aviation Administration has assessed this country's civil aviation authority and determined that it does not provide safety oversight of its air carrier operators in accordance with the minimum safety oversight standardsestablished by the International Civil Aviation Organization.
The main ports are Izmail and Odessa on the River Danube. Services are available to the Russian Federation as well as to a number of cities on the Black Sea and the Mediterranean. A ferry service connects Sevastopol and Istanbul, Turkey.
Travelers must declare all cash and jewelry, regardless of value, upon entering Ukraine. Any undeclared items are subject to confiscation. (This was not true last summer--Luba
Under customs regulations, travelers may bring up to 10,000 U.S. dollars cash into Ukraine, or 50,000 dollars in traveler's checks, without special permission. When leaving the country, visitors are only allowed to take out a maximum of 1,000 U.S. dollars or as much cash as they declared upon entry. (Over 1,000 dollars the traveler must possess a copy the customs entry declaration.) (This is a bit outdated, too. You can't take out more money than you brought in, but I didn't need to fill out a declaration last year.
There are strict customs regulations and procedures regarding the export of antiquities and items of historical interest. "Historical interest" may mean any item produced before 1950.
The currency is the hryvnia (UAH). Ukraine is a cash economy. Travelers' checks and credit cards are gaining wider acceptance in larger cities. Even in Kiev, however, acceptance of credit cards is not nearly as widespread as in Westerncountries. Expect credit card use to be limited to better hotels, upscale restaurants, international airlines and the rapidlygrowing, but still select number of up-market stores. Customs regulations prohibit sending cash, travelers' checks, personal checks, credit cards, or passports through the international mail system. Customs authorities regularly confiscate these items as contraband. Changing Ukrainian currency or other currencies is legal only at banks, currency exchange desks at hotels, and licensed exchange booths; anyone caught dealing on the black market can expect to be detained by the local militia.
There are many banks and licensed currency exchange booths located in major cities. ATMs (a.k.a. Bankomats) are becoming available throughout Ukraine, particularly in Kiev and in other larger cities. In smaller cities and towns ATMs are still virtually non-existent. (Not true; many smaller towns now have them. Don't count on finding one in the selo, thought.
) Most ATMs disperse cash only in the local currency hryvnia. The difficulties of a currency shortage canbe avoided by coming to Ukraine with a sufficient supply of hard currency to cover necessary obligations. Funds may be transferred by wire; advances may be drawn on credit cards and travelers checks may be cashed at many locations.
Carry your passport at all times. Travelers should be prepared to show their documents to police upon demand. Ukraine does not recognize dual nationality. Dual national foreigners entering the country with a Ukrainian passport will be treated as Ukrainian citizens by local authorities. This may include being required to perform mandatory national service. (This is changing. Many members of the diaspora can now get Ukrainian citizenship.
Photographs should not be taken in the vicinity of government or military establishments.
Penalties for possession, use, or trafficking in illegal drugs can be severe. Homosexuality is legal and generally tolerated.
Fuel and electricity shortages are common in some provinces. Winter weather is snowy and cold. Abnormally high precipitation has caused some severe flooding in recent years.
The availability of travel and tourist services is uneven throughout the country, and Ukraine still lacks the abundance of many of the goods and services taken for granted in other countries. Travel will not normally be as comfortable as inmore highly developed countries such as those in Western Europe. There is a lack of safe, low cost lodgings such as youth hostels. Public facilities in Ukraine are generally not equipped to accommodate persons with physical disabilities.
U.S. Embassy: #10 Yuriv Kotsyubinsky St. 01901 Kiev (Tel.: 38-044-490-4000)
Note: This handout is based on the CDC website, the Shoreland website, and my experience and training in travel medicine.
Feel free to call me with any questions or concerns: Luba Petrusha248-360-4929e-mail: [email protected]
Check with your doctor to make sure you are up to date on the following immunizations:___Tetanus/Diphtheria___Polio___MMR (measles/mumps/rubella)___Pneumococcal___Varicella (chicken pox)
Strongly consider getting the following immunizations, if you have not had them yet:___Hepatitis A********___Hepatitis B
___immodium (loperamide)(we should have)
___appropriate antibiotic (prescription
; e.g. Floxin 400 mg., 6 tablets)(Can buy in Ukraine now very cheaply)
___other personal favorites
___Tylenol/aspirin/NSAID (something for those aches and pains)(we should have)
___cold preparation (if you have a personal favorite)
___your prescription medications
___list of prescription medications (in addition to meds, stored separately)
___eyeglass prescription & an extra pair
Water Treatment: This should not be a problem at the basa in Crimea
(consider one or more of the following if you will be where bottled water might not be available):
___heater, gas or electric (electric widely available in Ukraine)
Photocopies of documents:
___passport (photo page)
___immunization certificate (if you have one)
___credit cards (including emergency number)
___ATM card (including emergency number)
___hat for sun protection
___comfortable hiking footwear
___pocketknife (with corkscrew:)
___flashlight___alarm clock (battery operated) ___personal hygiene items (tampons, soap, shampoo, etc.)___security aids: money pouch or belt, locks
, including smaller bills ($1,5,10,&20) This is less important now, as there are money changing booths
everywhere, and ATMs in most places. (You can find one at each McDonalds, as well as a clean public restroom.)
But bring at least a few smaller denomination bills of $20.
4. TUBERCULOSIS INTRODUCTION Tuberculosis (TB) is an infectious, notifiable disease (meaning there is a requirement by law to report it to government authorities) caused by the bacterium Mycobacterium Tuberculosis. TB is present in many parts of the world and particularly Africa and South East Asia (1). In the 1930s, TB was one of the leading causes of death in the UK. After falling s
Introduction: The Treatment Dilemma . . . . . . . . . . . . . . . . . 1 1 The Many Faces of CFIDS . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Four Patients’ Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Distinctive Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Historical Backgro