Hello Fellow travelers

I usu post on Europe or New Zealand boards but as we are considering a trip to Bali next May/June I wanted to get some help on a touchy subject.

We are middle aged travelers who have traveled in a lot of the "first world" but never in Asia. My DH has a chronic illnesds which affects his liver, so we have been loath to travel to paces where the water or bugs would be a huge issue.

However we have both wanted to go to Bali and as we get older we realize we should be talking thee more "dicey " trips (illness wise) before we get to be REALLY old...

THia's a long prologue to ask advice abotu how safe is Bali in terms of mosquitoes, food borne illnesses etc and how might we BEST arrange a trip to hotels etc where sanitation etc would be very good but isn't just some western hotel that could be anywherre? We are most concerned about mosquito borne illnesses but are concerned about the water as well.

We honeymooned in Mexico and stayed at locallly owned resorts, were very careful about water, fruit etc, didn't eat at food stalls etc and were fine. but that was 20 yeasrs ago..
Neither of us ever eats shellfish so we're not too worried about that.

After all this - is a trip to bali just too much to deal with given our concern about diseases? I have thought of going with a friend instead but it wouldn't be the same.

Any advice, web sites to look at etc would be much appreciated.

thanks

Difficult questions to answer. Just some thoughts for you to consider, no real answers.

Travel anywhere, or for that matter, eating out anywhere (even at home), is somewhat risky. The sickest I have ever been in my life from food has been in Japan, from a restaurant we used to go to often and that has a good reputation. I was hospitalized.

A few years ago in Bali, in spite of vaccination (granted, we had only had 2 out of the 3 doses so only about 80% protected), we all got Hepatitis A. Because of the vaccine, we apparently did not get as sick as we might have were we not vaccinated. This is a vaccine you should have I think as a rule as Hep A is not uncommon, even at home, and is easily spread via food.

Other experiences in Bali, Thailand, Cambodia, Singapore...we used to be super careful about where and what we ate, and always suffered from stomach trouble. I spent one flight returning home in the airplane bathroom vomiting and having diarrhea after a stay in Thailand where we ate only at the Peninsula hotel and one meal at an Outback Steakhouse (don't ask...).

In Cambodia this summer, we ate whatever we wanted, including sundried beef, wrapped in lettuce with tomato and dipped in something sauce, prepared by our guide's family for a picnic. No problems at all.

It seems you just cannot reliably predict when, where and why you will get sick from food. I know others have been super diligent and not gotten sick and swear by their rules...that's fine, and there is nothing wrong with being diligent. I just want to point out that it's not foolproof, and may actually depend on how your body reacts, how healthy you are to begin with, and even luck of the draw.

Mosquitos...there are plenty in Bali. Dengue Fever is a problem, and in spite of being a low risk for malaria, the risk is still there...though not high enough to warrant taking prophylaxis unless for your particular medical circumstances the risk involved with having malaria outweighs the risk of taking the medication to prevent it...discuss with doctor for sure. There isn't anything you can do to prevent Dengue other than not get bitten. So, if you use repellent diligently, are careful with keeping mosquitos out of your room, and avoid bites, you can pretty much feel confident that you won't get Dengue Fever or Malaria or Japanese Encephalitis or other mosquito borne illness.

There are hotels and resorts for all tastes and budgets. There is no shortage of top class hotels where you might feel comfortable...Four Seasons (2), Aman (2), Ritz Carlton, Bulgari, to name a few. You really don't need to spend that kind of money to get high quality accommodation, food and service, but the top places are nice, very, very nice. They command a high price for some very good reasons, one of which is the overall aesthetics, and another is for the service.

There are a couple of international clinics in Bali, the Bali International Medical Center http://www.bimcbali.com/ is one of them. Do understand, though, that any serious illness or injury will likely require evacuation to Singapore. Travel medical insurance that includes emergency evacuation is essential imo, and in your situation, a policy that can include the preexisting condition may be worth paying the premium for.

Bali is really special...we love it there. If you can go, I would highly recommend it. Do consult with both your regular doctor and a travel medicine specialist who is familiar with SEA issues. Be prepared for all possibilities, and have a plan for what to do should you or your husband fall ill.

thanks SO much,,,and a further question

is one season or other more likely to have mosquitoes?

You will find fewer mosquitoes along the coast, so you may want to stay at a beach hotel and visit inland during the day when there are fewer mosquitoes.

Use food and water precautions, make sure you have the appropriate vaccines. Take a look at www.cdc.gov/travel I feel it's the best travel medicine website and is the usual reference for Travel Med docs. I'd also recommend a visit to a travel medicine clinic before you go.

July, August, September are statistically drier, so in theory should have fewer mosquitos. The beach areas may have fewer, as Kathie says.

mztery, The problem with mosquito borne disease is that you only need to be bitten by one infected mosquito one time to contract dengue or malaria. In a tropical country like Indonesia there are a zillion mosquitos, no matter where you are beach, inland, 5 star or homestay, rainy or dry season, you are going to find mosquitos.

I've lived in Indonesia for 12 years and travel to Bali frequently. In my time here I've only ever known one acquaintance contract malaria and he suspects that his mosquito was Singaporean. Dengue and typhoid are more common though the cases have been mild. Motorcycle related accidents top the list of medical horror stories.

I'm not in the position to give you medical advice, but I think your focus really should be on risk. How much risk are you willing to accept and will knowledge of that risk ruin your holiday?

My personal opinion is go for it. Consult your doctor, take reasonable precautions (including taking out evacuation insurance) and have a good time.

The US Embassy in Jakarta and the Consulate in Denpasar maintain a large staff of experts in infectious disease.(I don't actually know if you are American; if not substitute your country. They are all interested in keeping their visiting nationals healthy.) I would write or call them and ask their opinion.

thanks to all

I am not personally worried about myself - I am in good health, am extremely scrupulous about DEET, insect repellent clothing etc. It is for my DH who might become extremely ill if he were to be bitten by a dengue infected mosquito. We both have Hep A and B vaccs already and would talk to our med specialists about any other vaccines needed. Malaria medication might be too hard on his system so we will have to see.

CDC is helpful but my question is specifically for anyone who knows abot Bali travel for tourists who have a chronic disease for which even a mild case of dengue fever or SARS or whatever might be extremely difficult. The closest analogy would be for someone with AIDS ,who but healthy and able to travel - what kind of precautions that person might need to take.

I've dealt with this situation.

IMO Bali is the place where you are most likely to be brought low by food based disease rather than the remote chance of Denghi or SARS. However, for an immuno-suppressed traveller with liver problems this can be just as much a worry. Actually more.

Staying at top end hotels goes a long way towards solving the food situation - but, as you see, isn't infallible - nothing is. But on the balance of probabilities you're as safe as houses eating in the top end places. If you can't bring yourself to believe this then don't go.

The heat, sun, humidity, the thick sultry air is wonderful, but for a first time visitor to Asia, let alone Bali, might be a shock. That's more likely to lay you low than anything.

IMO you're jumping in at the deep end, slightly. Not that that should stop you.

Take it in stages. Anxiety can easily ruin a trip. Asia is a big place. Bangkok, Singapore, K.L. will give you more than a taste without any of the grief.

Then, because I know you really want to, zoom down to Bali and stay at an Aman or Four Seasons for five days - then out. Take your risks, small though they are, in bite-sized chunks. Eat only in the resort. Drink only bottled water. A/C cars, sunscreen. Prebook everything so there's no added stress.

I think you'll be fine. You've got two options: stay at home or go out and face that fear. Bravo - I see you're doing the latter. It'll be the first of many trips.

A few additional thoughts: the high end resorts do go out of their way to be Balinese -- from architecture to food, to furnishings and service. You won't think you're in Chicago or Bangkok, for that matter. I know the 4S and would expect the Aman and others spray assiduously for mosquitos and as I'm highly allergic, I found what they did helped me. That said, it does just take one infected bite.