HEALTH

Standards for hygiene and public health in Brazil are generally high (with the exception of small, often remote rural co mmunities that visitors are unlikely to come across). Before leaving, however, please check with your doctor or with the Centers for Disease Control ( www.cdc.gov ) for specific advisories, as information is constantly updated. Use common sense when eating on the street or in restaurants.

VACCINATIONS Before going check your vaccinations and get booster shots for tetanus and polio if required. Children ages 3 months to 6 years of age may be required to show proof of polio vaccination. One vaccination that is definitely required for Brazil is yellow fever. Outbreaks are sometimes reported in the Amazon, the Pantanal, Brasilia , or even Minas Gerais. Make sure you get an interna­ tional certificate of vaccination as Brazilian authorities sometimes require proof of vaccination for people going to or coming from an affected area. Travelers who have been to Columbia , Bolivia , Ecuador , French Guyana, Peru , or Venezuela within 90 days prior to their arrival in Brazil are also required to show proof of yellow fever vaccination. Please keep in mind that the vaccine takes 10 days to take effect.

DENGUE FEVER Dengue fever is a viral infection transmitted by mos­ quitoes. It's unfortunately common in Rio de Janeiro . It's characterized by sudden onset high fever, severe headaches, joint and muscle pain, nausea/vomiting, and rash. (The rash may not appear until 3-4 days after the fever.) Proper diagnosis requires a blood test. The illness may last up to 10 days, but complete recovery can take 2 to 4 weeks. Dengue is rarely fatal.

The risk for dengue fever is highest during periods of heat and rain, where stagnant pools of water allow mosqui­ toes to breed. Though it strikes most often in poorer communities, the disease of late has infiltrated Rio 's more affluent neighborhoods. There is no vaccine for dengue fever; symp­ toms can be treated with bed rest, flu­ ids, and medications to reduce fever, such as acetaminophen (Tylenol); aspirin should be avoided. The most important precaution a traveler can take is to avoid mosquito bites in dcngue-prone area. Try to remain in well screened or air-conditioned areas; use mosquito repellents (preferably those containing DEET) on skin and clothing, and sleep with bed nets. For up-to-date information on the status of dengue fever in Brazil , consult the Centers for Disease Control website ( www.cdc.gov ) before departing.

OTHER HEALTH CONSIDERA­ TIONS If traveling to the Amazon Or the Pantanal, a malaria prophylaxis (usually pills that you take daily) may I,e• recommended as well.

DRINKING WATER The tap water in Brazil is becoming increas­ ingly safe to drink. However, as a result of the treatment process it still ,locsn't taste that great and may leave tour stomach upset. To be on the safe side, drink bottled or filtered water (most Brazilians do). However, you t .+n certainly shower, brush your teeth, or rinse an apple with the water.

BRAZILIAN PHARMACIES If vou do wind up with traveler's tummy 0r some other ailment (upset stomach, diarrhea, sunburn, or rash), Brazilian pharmacies are a wonder. Each has a licensed pharmacist who is trained to deal with small medical emergencies and can make recommendations for treatment. The service is free and medication is fairly inexpensive. If you r.+kc medication that may need replacement while in Brazil, ask your doctor to write out the active ingredi­ rnts of the prescription, as many drugs rrc sold under different trade names in hr:+zil. Many drugs available by pre­ .t ription only in the U.S. and Canada are available over the counter in Brazil . While this is incredibly convenient, the downside is that Brazilians are the world's biggest pill-poppers who will happily "prescribe" drugs for them­ selves or their relatives or friends at the slightest whiff of sickness.

AIDS AND OTHER STDS According to recent U.N. statistics, Brazil has the dubious honor of rank­ ing third in the world for total num­ ber of people with HIV infections. An estimated 20% of those cases are women. Though condom usage is becoming more accepted-thanks in part to the examples shown in a num­ ber of popular nighttime soaps on TV-the unfortunate reality is that some people still won't use them, and AIDS and other STDs are still being spread. So be careful and be safe­ always insist on using a condom. Though condoms are readily available in Brazilian pharmacies, it's best to bring your own; brands are more reli­ able in North America and Europe . To purchase condoms in Brazil ask for camisinha (kah-mee-zeen-ya-literally a small shirt, it's the commonly used term for condom).

OTHER HEALTH CONSIDERA­ TIONS The Brazilian sun is very strong, particularly in summer (the North American winter, when most travelers from above the equator are quite pale). Sunscreen of at least SPF 15 should be applied frequently. Tourists rarely encounter snakes and are even more rarely bitten. You'll find ticks most everywhere in Brazil but the only place I considered them a nuisance was hiking in highland areas like the Chapada Diamantina inland from Salvador (see chapter 8) or the Chapada Guimaraes near Cuiaba . Thankfully, few if any reports of tick­ related diseases exist in Brazil . If a tick does latch its parasitic head onto you, remember to a put a match or ciga­ rette close to the tick's rear before you squish it; this will withdraw its head from your skin.

WHAT TO DO IF YOU GET SICK AWAY FROM HOME

If you worry about getting sick away from home, consider purchasing med­ ical travel insurance. In most cases, however, your existing health plan will provide all the coverage you need. Be sure to carry your identification card in your wallet.

If you suffer from a chronic illness, consult your doctor before your depar­ ture. For conditions like epilepsy, diabetes, or heart problems, wear a MedicAlert identification tag ((t 800/825-3785; www.medicalert. org ), which will immediately alert doctors to your condition and give them access to your records through MedicAlert's 24-hour hot line.

Pack prescription medications in your carry-on luggage. Carry written prescriptions in generic, not brand­ name, form, and dispense all prescrip­ tion medications from their original labeled vials. Also bring along copies of your prescriptions in case you lose your pills or run out.

If you wear contact lenses, pack an extra pair in case you lose one and a pair of eyeglasses as well. Don't forget sunglasses.

Contact the International Associa­ tion for Medical Assistance to Trav­ elers (IAMAT) (CC) 716/754-4883 or 416/652-0137). This organization offers tips on travel and health con­ cerns in the countries you'll be visiting, and lists many local English-speaking doctors. The United States Centers for Disease Control and Prevention (Z 800/311-3435; www.cdc.gov ) provides up-to-date information on necessary vaccines and health hazards by region or country (their booklet, Health Information for International Travel, is $25 by mail; on the Internet, it's free). When you're abroad, any local consulate can provide a list of area doctors who speak English (though it may be hard to find one with more than a basic knowledge of English, even in larger cities). If you do get sick, you may want to ask the concierge at your hotel to recommend a local docror-even his or her own. This will probably yield a better rec­ommendation than any 800 number would. If you can't find a doctor who can help you right away, try the emer­ gency room at the local hospital. Many emergency rooms have walk-in clinics for emergency cases that are not life-threatening. You may not get immediate attention, but you won't pay the high price of an emergency room visit (usually a minimum of $300 just for signing your name, on top of whatever treatment you receive).

INSURANCE

It's generally a good safety precaution to purchase travel insurance before you leave-because a simple sprained ankle or minor infection can throw a major health and scheduling wrench in your plans. However, check your existing insurance policies before you buy travel insurance to cover trip can­ cellation, lost luggage, medical expenses, or car-rental insurance. Many travel mishaps are covered by other insurance policies, so buying additional coverage makes little sense for most travelers. If you do decide to buy travel insurance, ask your travel agent about packages that combine the various types of coverage.

These days, most insurers offer comprehensive travel-insurance pack­ ages that provide coverage for any and all calamities: trip cancellation, med­ ical and dental emergencies, lost prop­ erty, and car-rental damage. The cost of travel insurance varies widely, depending on the cost of your trip, the length of your trip, your age and over­ all health, and the type of trip you're taking. Insurance for extreme sports or adventure travel, for example, will be offered at a different rate than that for, say, a cruise. Many insurers provide packages for specialty vacations (scuba diving, for example, or backpacking), and some, more dangerous activities may even be excluded from basic policies.

Your existing health insurance should cover you if you get sick while on vacation (though if you belong to an HMO, you should check to see whether you are fully covered when away from home). If you need hospi­ tal treatment, most health-insurance plans and HMOs will cover out-of­ country hospital visits and procedures, at least to some extent. However, most make you pay the bills upfront at the time of care, and you'll get a refund after you've returned and filed all the paperwork. Members of Blue Cross/ Blue Shield can now use their cards at select hospitals in most major cities worldwide ((?) 800/810-BLUE). For independent travel health-insurance providers, see below.

Some credit cards (American Express and certain gold and platinum Visa and MasterCards, for example) offer automatic flight insurance against death or dismemberment in case of an airplane crash.

For information, contact one of the following reputable insurers (all offer policies for trips to Brazil ):

•  Access America (Z 800/284­ 8300)

•  Travel Guard International (( JC 800/826-1300; www. travelguard.com )

•  Travel Insured International (Z 800/243-3174; www.travel insured.com )

•  Travelex Insurance Services (Z 800/228-9792; www. travelex-insurance.com )

SAFETY

Sometime in the 1980s Brazil began developing a world reputation for vio­ lence and crime. Rio especially was seen as the sort of place where walking down the street was openly asking for a mugging. Some of this was pure sen­ sationalism, but there was a good measure of truth as well. Brazil at the time was massively in debt to First World banks, and the combination of crippling interest payments and Inter­ national Monetary Fund austerity measures left governments at all levels with no money for basics, such as street lighting and police, much less schools and hospitals.

Fortunately, in the early '90s things began to turn around. The debt crisis eased, leaving governments with some discretionary spending, and with the advent of the 1992 World Environ­ ment Conference in Rio , Brazilians realized they had a serious image prob­ lem on their hands. Governments began pouring money back into basic services, starting with policing. Cops were stationed on city streets, on pub­ lic beaches, and anywhere else there seemed to be a problem, and the crime rate began to fall. At the same time governments began working on extending water and sanitation to some of the city's poorer residents in the favelas (shantytowns).

The decade-long expansion that fol­ lowed made massive new investments in tourism infrastructure feasible. Many cities got brand-new airports. A domestic tourism boom ensued, mak­ ing the protection of tourists even more of a political imperative. Nowa­ days, though still not perfect by any means, Rio , Sao Paulo , and Brazil 's other big cities have bounced back to the point where they're as safe as some large international cities.

That said, in large centers such as Sao Paulo , Rio , Salvador , and Recife , commonsense rules still apply. Don't flash your valuables. Always have a few small bills ready in your pocket or bag to avoid pulling out your wallet in public places. And though public transit is safe during the day and evening, watch for pickpockets when it gets really packed, and come night­ fall, use taxis instead. Be careful at night; stick to the main streets where there is traffic and other pedestrians, and avoid dark alleys. Statistically, of course, Rio and other big Brazilian cities still have unfortunately high crime rates. Most of that crime, how­ ever, takes place in the favelns and shantytowns of the far-off industrial outskirts and most of its victims are poor. Unless you go wandering into a hillside favela (not recommended), you're unlikely to be affected.