• Before you go
• Dangers & annoyances
• In transit
• While you're there
Before you goPrevention is key to staying healthy while abroad. A little planning before departure, particularly for pre-existing illnesses, will save trouble later. See your dentist before a long trip, carry a spare pair of contact lenses and glasses, and take your optical prescription with you. Bring medications in their original, clearly labelled containers. A signed and dated letter from your doctor describing your medical conditions and medications, including generic names, is also a good idea. If carrying syringes or needles, be sure to have a doctor's letter documenting their medical necessity.
Insurance
If you're an EU citizen or from Switzerland, Iceland, Norway or Liechtenstein, the European Health Insurance Card will cover you for emergency health care or in the case of accident while in European Economic Area (EEA) countries, which include Denmark, Finland, Norway and Sweden.
Note that Greenland isn't part of the EEA but is covered by a separate reciprocal health-care agreement with the UK.
Citizens of other countries should find out if there is a reciprocal arrangement for free medical care between their country and the country visited. For travel to Arctic North America or Arctic Russia you should take out health insurance. If you do need health insurance, strongly consider a policy that covers you for the worst possible scenario, such as an accident requiring emergency evacuation. Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The former option is generally preferable, as it doesn't require you to pay out of pocket in a foreign country.
Recommended vaccinations
The World Health Organization (WHO) recommends that all travellers should be covered for diphtheria, tetanus, measles, mumps, rubella and polio, regardless of their destination. Since most vaccines don't produce immunity until at least two weeks after they're given, visit a physician at least six weeks before departure.
Online resources
The WHO's publication International Travel and Health is revised annually and is available online at www.who.int/ith. Other useful websites include www.mdtravelhealth.com (travel-health recommendations for every country, updated daily), www.fitfortravel.scot.nhs.uk (general travel advice), www.ageconcern.org.uk (advice on travel for the elderly) and www.mariestopes.org.uk (information on women's health and contraception).
Further reading
Health Advice for Travellers (currently called the 'T6' leaflet) is an annually updated leaflet by the Department of Health in the UK available free in post offices. It contains some general information, legally required and recommended vaccines for different countries, and reciprocal health agreements. Lonely Planet's Travel with Children includes advice on travel health for younger children. Other recommended references include Traveller's Health, by Dr Richard Dawood (Oxford University Press), and The Traveller's Good Health Guide, by Ted Lankester (Sheldon Press).
Dangers & annoyances
Theft in Greenland is rare, and violent crime mostly results from family feuds or broken relationships, both of which are highly unlikely to affect most short-term visitors. However, alcohol-fuelled fights, including volleys of beer bottles, are not uncommon in and around pubs, especially on pay-day Friday nights. Drunks can be scarily prone to inexplicable and violent mood swings, so be sensitive in bars and don't stay too late. Rampant sexually transmitted diseases (in 2002 gonorrhoea was more common than flu) should make you cautious about accepting the more intimate forms of Greenlandic hospitality.
Otherwise, most of the dangers found in Greenland come from nature. The perils are only severe if you're not properly prepared or if you ignore local advice. It's crucial to remember just how isolated you are. Twisting an ankle when hiking in the countryside could become a major catastrophe if nobody knows where you are: there's virtually no hope of anyone just wandering by. The conditions are extremely fickle, and you should be well prepared for cold and wet weather. Fog can descend suddenly, so while hiking you'd be wise to keep a stock of food and a survival bag in case you get caught and can't find your way back.
'If you don't fear the sea, you won't last a year in Greenland, ' say local fisherfolk. If people tell you that the sea is too rough to go out, believe them. Even if it means missing a key excursion, it's not wise to push a reluctant boatman to make an unsafe journey. Small boats are easily swamped in strong winds, and the seas are so cold that your chances of swimming even a short distance to shore would be tiny. Flotation suits give you a few extra minutes to contemplate death should your boat sink. Even if you do make it to land, the chances of being rescued before you become hypothermic are minimal. There is a lifeboat-style rescue service, but it comprises only four boats for all of Greenland. Even helicopter rescues can take several hours - as well as tens of thousands of dollars - to reach you.
Polar bears are very rare and they generally avoid humans. Where they are a hazard locals will advise you to carry a gun and might lend you one. If you're cornered by a bear when unarmed, try to keep your cool.
Be careful how you store food when camping, to avoid attracting foxes.
Major summer annoyances are clouds of mosquitoes, midges and mini-flies, which seek out eardrums, shoot up nostrils and make kamikaze attacks on eyeballs. They're at their worst in July, especially on wilderness hikes, when a head-net is virtually essential. Head-nets are widely sold for around Dkr40, some designs working best when worn over a baseball-style cap. Insects are curiously absent in sheep-farming areas, and fortunately few seem to come indoors. At night you'll rarely be bothered, and by mid-September most have disappeared.
In transit
Deep Vein Thrombosis (DVT)
Blood clots may form in the legs during plane flights, chiefly because of prolonged immobility - the longer the flight, the greater the risk. The chief symptom of DVT is swelling or pain of the foot, ankle or calf, usually but not always on just one side. When a blood clot travels to the lungs, it may cause chest pain and breathing difficulties. Travellers with any of these symptoms should immediately seek medical attention.
To prevent the development of DVT on long flights you should walk about the cabin, contract leg muscles while sitting, drink plenty of fluids, and avoid alcohol and tobacco.
Jet lag & motion sickness
To avoid jet lag (common when crossing more than five time zones), try drinking plenty of nonalcoholic fluids and eating light meals. Upon arrival, get exposure to nat- ural sunlight and readjust your schedule (for meals, sleep and so on) as soon as possible.
Antihistamines such as dimenhydrinate (Dramamine) and meclizine (Antivert, Bonine) are usually the first choice for treating motion sickness. A herbal alternative is ginger.
While you're there
Availability & cost of health care
Good health care is readily available, and for minor, self-limiting illnesses pharmacists can dispense valuable advice and over-the-counter medication. They can also advise when more specialised help is required. The standard of dental care is usually good; however, it is sensible to have a dental checkup before a long trip.
In Greenland and Arctic Scandinavia health care is excellent. Many smaller settlements do not have a resident doctor, but local nursing stations are generally very well equipped and staffed with specially trained nurses qualified to deal with most problems. For serious illness or emergencies a medical evacuation is generally necessary and can be exorbitantly expensive. Make sure your insurance covers you for this.
Infectious diseases
Tick-borne encephalitis is spread by tick bites. It is a serious infection of the brain, and vaccination is advised for those in risk areas who are unable to avoid tick bites (such as campers, forestry workers and ramblers). Two doses of vaccine will give a year's protection; three doses up to three years.
Rabies is a viral infection of the brain and spinal cord that is almost always fatal. Rabid dogs and foxes are found in Arctic areas, and you should be very wary of any animal acting strangely. The rabies virus is carried in the saliva of infected animals; if an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately.
Although tuberculosis is increasingly common in Arctic communities the disease is only spread through prolonged close contact with an infected individual.
Traveller's diarrhoea
In most Arctic areas tap water is safe, but it's best to always check with a local. If you're unsure you should boil, filter or chemically disinfect (with iodine tablets) any water you drink. Eat fresh fruits or vegetables only if cooked or peeled; be wary of dairy products that might contain unpasteurized milk. Make sure meats are properly cooked, and avoid buffet-style meals. If a restaurant is full of locals the food is probably safe.
If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution such as dioralyte. A few loose stools don't require treatment, but if you start having more than four or five stools a day you should start taking an antibiotic (usually a quinoline drug) and an antidiarrhoeal agent (such as loperamide). If diarrhoea is bloody, persists for more than 72 hours or is accompanied by fever, shaking, chills or severe abdominal pain, you should seek medical attention.
Giardia
Giardia is an intestinal parasite that lives in the faeces of humans and animals and is normally contracted through drinking water. It is one of the most common parasitic infections in humans in Arctic regions. Problems can start several weeks after you've been exposed to the parasite, and symptoms may sometimes remit for a few days and then return; this can go on for several weeks or even longer.
The earliest signs are a swelling of the stomach, followed by pale faeces, diarrhoea, frequent gas and possibly headache, nausea and depression. If you exhibit these symptoms you should visit a doctor for treatment.
Hypothermia & frostbite
Proper preparation will reduce the risks of getting hypothermia. Even on a warm day in the Arctic the weather can change rapidly. Take waterproof garments and warm layers, and inform others of your route.
Acute hypothermia follows a sudden drop of temperature over a short time. Chronic hypothermia is caused by a gradual loss of temperature over hours.
Hypothermia starts with shivering, loss of judgement and clumsiness. Unless rewarming occurs, the sufferer deteriorates into apathy, confusion and coma. Prevent further heat loss by seeking shelter, wearing warm, dry clothing, drinking hot, sweet drinks and sharing body warmth.
Frostbite is caused by freezing of and subsequent damage to bodily extremities. It is dependent on wind-chill, temperature and length of exposure. Frostbite starts as frostnip (white, numb areas of skin) from which complete recovery is expected with rewarming. As frostbite develops, the skin blisters and becomes black. Loss of damaged tissue eventually occurs. Wear adequate clothing, stay dry, keep well hydrated and ensure you have adequate calorie intake to prevent frostbite. Treatment involves rapid rewarming. Avoid refreezing and rubbing the affected areas.
Insect bites & stings
As the surface of the Arctic tundra melts it becomes waterlogged as the permafrost prevents water from draining. Couple this with the warmer temperatures of summer, and you've got a perfect breeding ground for insects. Arctic mosquitoes can be ferocious and can be the bane of your existence on a summer trip up north. Bring strong DEET-based insect repellent and a head-net, and wear long-sleeved shirts and long trousers.
Bees and wasps cause real problems only to those with a severe allergy (anaphylaxis). If you have such an allergy, carry EpiPen or similar adrenaline injections.
Travelling with children
All travellers with children should know how to treat minor ailments and when to seek medical treatment. Make sure the children are up to date with routine vaccinations, and discuss possible travel vaccines well before departure, as some vaccines are not suitable for children under a year old.
Remember to avoid contaminated food and water. If your child has vomiting or diarrhoea, lost fluid and salts must be replaced. It may be helpful to take rehydration powders for reconstituting with boiled water.
Children should be encouraged to avoid and mistrust any dogs or other mammals because of the risk of rabies and other diseases.
Sexual health
Condoms are widely available across the Arctic. When buying condoms, look for a European CE mark, which means they have been rigorously tested. Keep them in a cool, dry place or they may crack and perish.
Emergency contraception is most effective if taken within the next 24 hours after unprotected sex.
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