Cambodia

[Therealsouthstander]

Thinking about doing an organised trip to Cambodia in February. This is the only way I can get the wife to participate.
We did one in Vietnam in the Mekong Delta region earlier this year.. We had an unbelievable experience and pretty much saw the real Vietnam away from the tourists..

The trip in Cambodia starts in Siem Reap and takes in Angkor Wat ,Kirirom national park Phnom Penh and Sihanouk Ville..

Should be a decent trip but was wandering if anyone had done it before and do you recommend it ?

Many thanks..

[simonhill]

I've cycled in Cambodia a few times and really like the place. It's not as vibrant as Vietnam and the people are much gentler. A different kind of experience but very enjoyable.

Angkor is wonderful and worth the trip on its own.

An organised tour costs many times more than DiY but if its the only way you can go then do it.

Enjoy

[Therealsouthstander]

Hi Simon

Yeah I'd much rather do it ourselves but the Mrs insists we have a guide..

I've been reading that Maleria is widespread in rural Cambodia !! Did you take ani Maleria tablets ? Was wondering how the side effects affects cycling everyday...


Many thanks

[simonhill]

Disclaimer: I am not a Dr and can only tell you what I do.

It depends when you go. Most probably it will be the dry season and mossies aren't much of a problem. Far more problem from the dust. Be prepared to wear long pants in the evening and use deet spray. To be honest I never do either unless I am actually being bitten. I don't normally take any meds now as I am out here too often.

You may find the missus gets bitten more than you.

Also you are unlikely to be going to the highest risk areas which are in the north east and west on the borders in the jungle - what is left of it.

Not sure what drugs are recommended. I have used larium. It felt toxic and gave me very vivid but tedious dreams. Although not always dreams!! One night I thought I was watching guns, bomb, etc when I got up for a pee. No one else heard so I guessed it was larium. Found out a few days later it was guerillas attacking the city.

Other drug is doxycycline an antibiotic. Side effects can be sensitivity to sun. My main problem was made me feel queasy unless I took it with, I mean WITH food.

Malarone is the best drug, but they try to stop people using it as resistance is being built up. It's expensive and I have never taken it.

Normal advice is to see your Dr, but doubt he knows much about rural Cambodia. Lots of research on sites like WHO is worthwhile.

[simonineaston]

...saw telly prog, the other day when presenter ate insects. He went specifically to Cambodia to do this. He enjoyed the fried crickets the primary school kids ate for lunch, as did they (the kids, not the crickets, who I imagine were pretty p***ed off with the whole arrangement). He later went to a cricket farm where they oversee cricket reproduction and pointed out that their carbon-footprint as far as a source of protein is concerned is waaaay better than that of cattle. Personally if someone offered me choice of say, steakNale pie or a bowl of deep-fried crickets I would probably choose the former, but that's not to say the latter isn't yumptious - let us know, won't you...
Edit: I feel I ought to say that the idea of small brown crunchy-on-the-outside / squidgy-yummy-on-the-inside as food feels rather unintuitive, not say positively revolting however, I have to add that I am currently munching my way through a bag of peanut M&Ms which kind of fits the above description...

[simonhill]

I've eaten grasshoppers. They were fine. The only problem for me was that they were deep fried and a bit too greasy. Also the bowl I was given was a bit too big and I felt obliged to try to eat them all.

As a Seasider, I also eat shrimps, cockles, etc. What a funny lot us Brits are!!

[Psamathe]

...Normal advice is to see your Dr, but doubt he knows much about rural Cambodia. Lots of research on sites like WHO is worthwhile.

Dr/nurse has access to information from government advisory groups, kept up to date and probably compiled in consultation with other similar bodies from other countries e.g. CDC (US) http://www.cdc.gov/malaria/travelers/country_table/a.html http://www.cdc.gov/malaria/travelers/index.html. Such organisations give advice to a pretty detailed level incl. risks/presence in particular regions/towns (if relevant).

Many online web sites have information that may not have been updated for a bit, so better to go to those who can access the official advice to be sure (as they will get the info about infection, resistance, etc. first).

The GP practice I use runs a travel clinic a couple of times a week (it's just one of their nurses but they ry and group all the travel vaccinations/advice together at the same time for some reason). Might be you can phone them to get the advice you need rather than having to go in for an appointment.

(I'm giving personal opinion here and NOT advice as I am in no position to give advice).

Ian

[Therealsouthstander]

Thanks for the replies.

As far as the infected areas go.Our route is

Siem Reap and Angkor

Banteay Srei and one thousand Lingas

Phnom Penh via Tonle sap lake

Chombok and Kirirom national park

Sihanouk Ville

Ream national park

Not sure if these are high risk areas...?


As far as the food - Earlier this year while touring Vietnam we ate Balut - which is duck fetus..

Never ever again

And you say us Brits are a funny lot...


* Edit to add - We are travelling in February ( Dry season )

[simonineaston]

I've eaten grasshoppers.
As a Seasider, I also eat shrimps, cockles, etc. What a funny lot us Brits are!!

Quite so - "Insects of The Sea"! Delish

[hamster]

If in any doubt take malaria tablets. Malaria is a serious disease and the side-effects are trivial compared to the consequences of contracting it. I lived some years in the tropics and we in the western world are out of touch with how nasty diseases can be. I lost a colleague to Dengue while living in Singapore.

I used Avlochlor & Paludrine, but that was 15 years ago and advice may have changed. I had no side-effects whatsoever although Avlochlor is undoubtedly the nastiest-tasting thing I have ever swallowed. Remember to continue taking the tablets for a month (or as guided) after returning home.

[Psamathe]

If in any doubt take malaria tablets. Malaria is a serious disease and the side-effects are trivial compared to the consequences of contracting it....

Also, always used to be the case (and I suspect it still is) that you start taking the pills before you depart and keep taking them after you return. I believe the times are different for different drugs but last time I had to take them I had to start a week before departure and finish 4 weeks after return. I understand people have caught malaria "after their return" because they get home, feel fine, outside the risk area (e.g. in the UK) and stop taking the pills and they catch malaria.

Ian

[hamster]

Exactly, the treatment needs to continue for the entire lifecycle of the parasite to ensure they are all killed off. Stop early and a few survivors then multiply. Good point about starting beforehand - you need to get the antimalarial levels up inside your system before arriving.

[simonhill]

Obviously if you decide to take antimalarials you should follow the recommended regime for the drug which is for x time before going and y time after, I would have thought that should go without saying.

Nonetheless, if you go to the CDC website listed above, you can use it towards helping you make a sensible decision, similar to what I do. I already said, search out reputable websites although the CDC seems pretty all encompassing.

It lists Cambodia as being low risk. You will also find things to take into account, eg are you going into the wilds, will your accom be air con. It also has maps and locations of towns, etc. Much more detailed than I remember. From these you can do a risk analysis.

It also lists the drugs that are effective now, rather than 15 years ago. They are the 3 I mention, but UK names are different from US ones. All have costs and side effects and are effective in different areas. Unfortunately due to localised resistance, the old days of just taking Paludrine are long gone.

You can go to your Dr or nurse for advice, but my experience is that they will just read it off a general list. I doubt if your 8 minute appointment will give them time to do the necessary research. My guess is that their list will say not needed because most tourists only go to a few relatively safe places.

Once you have weighed the pros and cons, then you will need to see a Dr for a prescription if you decide to go down the drug route. Hopefully you can show him what you want and why from your research.

A recent examp!e: I had a problem getting my typhoid booster because it wasn't recommended on their list. The fact that I travel rough and remote and have to eat whatever is available didn't matter, it wasn't recommended for the next two countries I was visiting so I couldn't have it. Managed to get a friendly nurse to give it to me during general health check.

I'm afraid it's mainly down to you. I think that more one off short term visitors take or worry about anti malarias, most frequent visitors don't, in fact can't. Although complacency is obviously a danger.

Remember, its not only malaria, you want to make sure you are up to date with all your basics, eg polio.

Although to be honest if you survived the Vietnamese bus drivers, I can't think malaria should worry you!!