Travel Advisory – Goa

Dr. José Colaço

* This Advisory is only a guide. Please contact your personal physician or local Area Health Centre for definitive advice at least two months before the time of travel.

* This rather large list is not meant to discourage anyone from visiting Goa. These are the same precautions one would take for a visit anywhere in the world, especially in the tropics.

Goa is one of the most popular tourist destinations in the world. While the tourists are likely to be staying on the beaches, most Goans will be visiting their families and staying in the villages, which are still, clean, peaceful and beautiful places to be in. As far as the beaches and beach resorts are concerned, it depends; on the beach and the beach resort. Most beach resorts are quite good and reasonable, but some are great only in the brochures that travel agents display. It is good to ask previous visitors to Goa about the resorts they stayed at.

In general, I would recommend that first time visitors to Goa, avoid the hot and rainy months i.e. March to October. The monsoon season brings a beautiful green look to Goa and its lovely rice fields but also, added chaos on the roads, power cuts and mosquitoes. So, unless you have to do otherwise, visit Goa between November and February.

The following advice is more relevant to the Goan ‘visitor’ who is returning home for the holidays.

Most Goans will be traveling via Mumbai aka Bombay. The first sight of this city can be an unnerving and a shocking experience. Expect it to be extremely crowded and polluted. If you have to stay in Mumbai, it is wise to find 5-star accommodation – even though some of Airport hotels are pricey and yet quite inadequate. Of the Airport five Star hotels, the Leela and the Holiday Inn are the ones I would recommend.

If possible, try and avail of some of the London-Goa charters. The flights are usually cramped and the service basic, but at least one does not have to deal with the chaos, filth and pollution of Mumbai (Bombay).

Goa is fast catching up with many other Indian cities – as far as disorganization and filth is concerned. But this state of chaos is mainly in the cities and towns. The villages are, as yet, unperturbed.

The following are among the diseases, presently prevalent in Goa : Malaria, TB, Typhoid, Infectious Hepatitis, Amoebiasis, Salmonella infections ( other than typhoid), travelers’ diarrhoea and sexually transmitted diseases including AIDS and Hepatitis B. The strike rate in Goa, for Cholera, Dengue fever and Japanese Encephalitis is low, at the moment. The following preventive measures should allow one to have an excellent holiday: It is important to remember that one’s absence from a particular area for a reasonable amount of time, reduces the level of the antibodies necessary to fight the infections, endemic to that region. Hence, the folks at home may be able to tolerate small doses of infected material but the same may be disastrous for the visitor.

1. Food : Do not eat ANY uncooked stuff i.e. salads, green and coconut chutneys, bhel-puri, pani-puri. Avoid mayonnaise and mayonnaise containing dishes e.g cole slaw and fish-mayonnaise. If you are truly keen on fish-mayonnaise, carry your own bottle of ‘mayo’ to Goa . Fresh green coriander, that exotic and delightful herb, is best used in cooking – and not garnishing. Despite all the extolled virtues of Potassium Permanganate in ‘killing the germs’ on raw vegetables, it is safer to peel the tomatoes and cucumbers before consumption. The universal recommendations regarding the handling of chicken and eggs, apply. Until adequately cooked, chicken & eggs and the hands & kitchen implements, which come into contact with them, are important sources of salmonella infections. Remember to wash hands, knives and the cutting board with hot water and soap – before touching any other food.

2. Drink : Avoid drinking unboiled water, lassi, yogurt and yogurt-drinks, milk shakes or roadside ‘limboo-sodh’ ( lime juice and club soda ). Always carry and drink bottled water or Pepsi / 7-up / Coca Cola / Fanta etc, if traveling. At eateries and restaurants, if you must drink water, ask for ‘boiling’ water. Remember that ice is made from water and as such, is a potential source of infection.

3. Watch how food and drink is stored, served and contaminated : By flies and human hands. Over the years, Goa has seen a degeneration in the customary cleanliness and HANDS appear to contaminate food!! Insist on being served by tongs, spoon or fork, and refuse food served by hand. Flies, the other major transporters of disease can and will contaminate food, drinking cups and straws .

4. Malaria, Dengue and Japanese Encephalitis : All three conditions are spread by mosquito bites. Prevention is effected best by protection against mosquito bites. Mosquito nets at night, insect repellents( DEET)( lower concentration DEET for children) and appropriate clothing are important methods of avoiding mosquito bites. This is of paramount importance in certain areas of Panjim, Margao, Vasco, Mapuça and the major beach areas. Be sure to commence malaria-prophylaxis before you leave for Goa. Contact a physician in your present locale, to prescribe the necessary & available medications . The medications should be continued until after return from India. There is no known method of avoiding Dengue fever at the moment, save avoiding mosquito bites. It is a good idea to shut all windows just before dusk. That is the time, the mosquitoes are most likely to enter the house. Once in the house, they will continue their biting activity throughout the night. A tulsi plant, in the vicinity, is a good mosquito-repellant measure.

Malaria : Please contact a physician in your locale to prescribe the necessary an available medications. These medications should be started before leaving for Goa and should be continued until after return from Goa. Malaria can present with what appears to be a flu-like illness. Any traveler who, develops such an illness up to one year post-visit to Goa, should seek evaluation for malaria. While Goa is considered to be ‘a low-risk area’ for contracting Malaria, there has been an increase in the number of recently reported cases from the State. Chloroquine-resistant malaria is now found in Goa . Hence, travelers should consult their physician about the drugs Malrone, Mefloquine( Lariam), Doxycycline or Fansidar. GTA presently recommends the use of Malarone.

Malarone is available in Adult and Pediatric formulations and is taken one dose daily (with food) starting 1-2 days before travel, taken daily during travel, and continuing daily for 7 days after leaving the malaria region. At this moment, GTA is unable to recommend the use of Malarone in children under one year of age, and in women who are pregnant or breastfeeding. Lariam: The normal adult dose is One tablet (250mg) taken once a week (on a full stomach), commencing a week before travel to Goa until 4 weeks post-departure from Goa or as the case may be, any Malaria-endemic area. The drug has a few rare but serious side effects. Individuals with neurological or psychiatric problems or allergy to Lariam should consult their physician for an alternative. Doxycycline (on a full stomach) – begin 2 days before arrival in Goa and continue daily until 28 days after departure from India. Doxycycline is not recommended in children under age 8 years and in breastfeeding mothers. In the case of Fansidar, please advise your physician about any “Supha’ allergies. GTA awaits the results of trials being conducted using Chloroquine and Azithromycin.

Dengue Fever : occurs mainly in clusters, and is more common in residential areas / colonies. There is no vaccine currently available for the prevention of this disease. Mosquito bite control measures are paramount.

Japanese Encephalitis : read in item 12

Leptospirosis : read in item 12

5. Poisonous snakes and scorpions : If you live in rocky areas, there are snakes and poisonous scorpions to deal with. The problem is acute in the hot summer months and less in the cooler months. Children, however, have the knack of being in the wrong place at the wrong time. They will need constant monitoring particularly in rocky and grassy / wooded areas . If traveling at night in dark areas – use shoes and full-length jeans; and carry a flash light. Just in case the odd viper is in your path.

6. Rabies : This disease is sporadically found among stray and wild dogs. It is a very good idea, to stay clear of any unknown dogs.

7. Swimming : Unfortunately, some of the beaches of Goa are polluted while others have deceptively placid waters with strong under-currents – esp. Betul, Baga & Calangute beaches. Even if you are a good swimmer, swim with care.

8. Avoid promiscuous behaviour : anywhere in the world! Remember the same deadly Sexually Transmitted Diseases – including AIDS and Hepatitis B, found elsewhere in the world, are also found in Goa.( please read next item )

9. Illicit drugs : Heroin, hashish are among the drugs peddled on the beaches and in the villages of Goa. As a rule, Goans are not involved in the use of drugs. Please Avoid drugs!!. This part of the message is particularly directed to young tourists from Europe and the mid-East. They appear to be consistently oblivious of the health and legal repercussions of getting mixed with illicit drugs and those who use them.

10. Avoid ‘highways’ at night :The truck drivers going south are usually drunk in the evening hours and drive very badly. The roads in Goa and the lighting at nights is not particularly suited for two-wheelers. Long journeys on two-wheelers are quite dangerous. Drunken behaviour, recently, is also being displayed by a number of visitors especially from North India and the UK. It is wise to stay clear of them, even though, at times, their abusive speech and behaviour drives one to the limit of patience.

11. Health care : There several, well qualified and trained general physicians and specialists in Goa. With few exceptions, they practice in the towns and cities. The village-based medical practice is basic. The care at the Goa Medical College Hospital in Bambolim and at some private hospitals in Panjim, Candolim, Vasco, Mapuca and Margao is good. The former Santa Casa de Misericordia Hospital in Ribandar as well as the Asilo Hospitals in Margao and Mapuça are sub-standard. In short : Do not cause yourself to be ill in Goa – anywhere, for that matter.

12. Inoculations : Assuming that all the immunizations of childhood are completed, immunization is recommended against Tetanus, Polio, Hepatitis A&B. Vaccination should also be considered against Japanese Encephalitis, Typhoid, Cholera and Meningococcal infections. If a stop-over is planned in Africa, the yellow fever vaccine is recommended.

Typhoid fever : is transmitted usually through contaminated food and water (watch the pani-puri). This disease is common and the risk of contracting infection can be lowered by following the food and water precautions listed above. There are two vaccines currently available for the prevention of typhoid fever. The oral vaccine is available in the form of a capsule to be taken every other day for 4 doses. A booster is required every 5 years. The injectable vaccine ViCPS is administered once every two years. It is important to note that the efficacy of the vaccine is not 100% and that the precautions should be followed meticulously.

Cholera : a severe diarrhoeal disease transmitted mainly through contaminated water and food. The strike rate for Goa at this moment is low and once food and water safety precautions are followed, vaccination against cholera becomes ‘very optional’ unless a trip to the Ganges area is planned.

Hepatitis A : is a viral infection usually transmitted through uncooked food, water, shellfish and ice. The risk for this infection is high. For short-term protection, a dose of Immunoglobulin ( IG ) is recommended. But for a prolonged stay, it is advisable to avail of the vaccination against this disease. There are two vaccines currently recommended : Havrix and Vaqta. Please contact your local physician and seek advice about what is available in your country and what dosage is recommended.

Hepatitis B : is mainly transmitted through sexual activity and upon receiving inadequately screened blood. The incidence of Hepatitis B in India is high and vaccination is strongly recommended. The vaccination schedule should be commenced at least 6 months before the planned departure to India in order to complete the full schedule of immunization. It is important to remember that contact with infected individuals who have open skin lesions, also may result in infection.

Hepatitis E: Like Hepatitis A, this virus is spread through contaminated food or water. It appears to affect adults more than it affects children, and recovery without chronic liver disease is the norm. Fatalities are rare except in women who contract the infection during pregnancy. This infection is endemic in India, though significant infections were not reported in Goa prior to this 2003 outbreak. At this moment, no vaccine is available for prevention of Hepatitis E.

Meningococcal disease : causes a severe infection of the brain. Vaccination is advised particularly if the port of entry is New Delhi. This disease which is more prevalent in the Northern part of India, occurs year around.

Japanese Encephalitis : is more common in rural rice-field areas and occurs mainly during the monsoon season. It causes a severe swelling of the brain called encephalitis. While there is no drug to treat the disease a vaccine JE-VAX is available for the prevention of this disease. There has recently been a serious outbreak of this disease in North Central India. Travelers are advised to either be vaccinated against this disease or avoid the region altogether. At this moment, the risk of contracting this disease in Goa is small.

Vaccination should be seriously considered for individuals planning to reside in the rural areas especially during the monsoon season. The vaccine is administered in 3 doses. Pregnant women and individuals with a history of multiple allergies should not be administered this vaccine.

Leptospirosis : is a bacterial disease associated with wild and domestic animals. It causes severe symptoms including fever, headache, chills, muscle aches, vomiting, jaundice and a rash. It is easily treatable with antibiotics like Penicillin and Doxycycline. It is primarily an occupational disease that affects those whose occupation involves contact with animals, especially rats. Individuals who walk barefoot through infected puddles ( as after monsoon flooding ) are at risk. This condition is found all over the world and visitors to Goa are NOT at special risk of contracting this disease.

13. Paedophilia : Of late, Goa has received some attention, albeit unwelcome, relating to this totally abhorrent crime by tourists against children. Almost every single paedophile identified so far, has been from Europe. If you are a paedophile, please do not practice it in Goa or on Goans . . . or anywhere, for that matter. They are virulently opposed to it and have been sensitized to this offence.

Goa is one of the most beautiful places in the world. There are several magnificent churches, temples, waterfalls, beaches, mosques and historical places of interest. However, the part of Goa you will enjoy the most is its people, food and music. No place on earth can truly duplicate the experience of Goa – not now – not ever.

Have a safe flight…a good trip and do let us know, how your trip was.

J.Colaço, MD

Reproduced per kind permision of The Goan Forum