Health

While travelling to Russia does not pose serious health risks for the average traveller, it is not completely hassle-free. Food poisoning is the most common problem a foreigner may face, so watch what you eat and where you buy it. Avoid buying kebabs at stands that are located all over the cities, especially at train stations. The sanitation guidelines are rarely followed and the ingredients used are not always fresh. Be wary of dairy products and ice cream.

Tap water is safe to drink in Moscow after boiling, but it is best to drink bottled water everywhere else. Avoid ice cubes and use bottled water to brush your teeth, particularly in St. Petersburg. The water supply in St. Petersburg contains giardia, an intestinal parasite that can cause diarrhea, stomach cramps, and nausea. The gestation period is two to three weeks, so symptoms usually develop after an infected traveler has already returned home. The condition is easily treatable, but be sure to let your doctor know that you may have been exposed to this parasite. In Moscow and St. Petersburg, imported and domestic bottled water is widely available in shops. It's a good idea to buy a liter of this water whenever you can. Hotel floor attendants always have a samovar in their offices and will provide boiled water if asked. Many top-end hotels filter their water, but it's best to double-check with reception.

The Center for Disease Control and Prevention recommends visiting a doctor 4 to 6 weeks before your trip to get all the routine vaccines or boosters. Recommended vaccines include influenza, chickenpox, polio, mumps, rubella and diphtheria. Both tuberculosis and AIDS rates are much higher in Russia than in the rest of the developed world, so care needs to be taken to avoid getting both. Make sure you have your vaccinations updated and practice safe sex. Tick-borne encephalitis has occurred in Russia, so use insect repellant and wear pants and long-sleeved shirts if you plan to go into wooded areas. For more information, go on the CDC website (www.cdc.gov).

Besides a few private clinics in big cities that cater to foreigners and VIP's, the quality of healthcare in Russia is much worse than in most Western countries. Often equipment is old and the facilities are in need of renovation. Doctors are overworked and diagnoses can be unreliable. Healthcare at the private clinics could be costly if you don't have health insurance. You can pay from $50 to $200 for appointments at private clinics. Watch out for fake diagnosis of serious diseases that require costly medical procedures, a practice that is prevalent in private clinics. Do not go to a private clinic unless it has been recommended by a trusted source. If you do go to a private clinic and are diagnosed with a very serious illness, be suspicious if you are asked to make a large payment to start treatment right away. Both American Medical Center in Moscow (26/6 Prospekt Mira www.amcenter.ru 7495/933-7700) and American Medical Clinic in St. Petersburg (78 Moika Embankment www.amclinic.com 7812/740- 2090) are reliable, although pricey.

Pharmacies in Russia are plentiful and most pharmacies, called Aptekas, located in big cities stock at least some local version of basic medicine, such aspirin, Tylenol, paracetemol, and cold medicine. Big chain pharmacies such as 36.6 (www.366.ru) are your best bet, as reports suggest that up to a third of medicines sold at pharmacies in Russia are fake. The smaller, private pharmacies are more likely to sell counterfeit medicine than the large, known chains.