Common Ailments in Armenia
Sunburn
Even in the winter, under cloudy skies and in higher elevations, you can get burned. At Lake Sevan, you may not know you are burned until you get back to your room and look in the mirror. The weather is deceptive: it is always cool in the evenings, and may not seem warm in the daytime, but Armenia’s higher elevation does not screen ultra-violet rays as much as lower altitudes. Strong sun screen is recommended, sun-block for sensitive skin, and covering up.

Prickly Heat
A rash that forms from trapped perspiration under the skin. It usually happens to people who have come from cooler places to hot climates. Don’t scratch, bathe often, use a mild talcum powder. Eventually you’ll feel better.

Heat Exhaustion
Heat Exhaustion is caused by a loss of salt and fluids from excessive sweating. Symptoms include headaches, fatigue, muscle cramps, sudden giddiness and feeling feint. Severe cases include diarrhea and vomiting, and can deplete salt and fluid levels. Drink plenty of water, salt food generously (Armenian food is generously salted) and take heat in small doses until you are acclimated.

Heat Stroke
This is a serious--sometimes fatal--condition marked by discomfort, little or no sweating and a dangerous rise in the body temperature (102° to 105°F / 39° to 41°C). When sweating stops the skin gets flushed. Severe, throbbing headaches, poor coordination, sometimes aggression or confusion also occurs, and eventually delirium or convulsions. Hospitalization is essential, but meanwhile get the victim out of the sun and remove clothing. Cover them with a wet sheet or towel and fan them constantly.

Fungus
Hot-weather fungal infections can occur on the scalp, between the toes or fingers (athlete’s foots), in the groin (jock itch) or under the arms. Even in cold weather, if you do not often bathe, and wear so much clothing you sweat, the same thing can happen. Ringworm is not a worm but a general surface fungus picked up from infected animals or from walking in damp places like on shower floors.

To prevent fungal infections wear loose, comfortable clothes, wear shower thongs in public showers, avoid artificial fibers, wash frequently and dry carefully. If you get one, wash the infected area carefully with a disinfected or medicated soap, dry well and apply an anti-fungal powder. Expose it the air as much as possible, wash towels and underwear in hot water and change them often. A natural aid used in Armenia is to soak in hot mineral baths. There are hundreds of them throughout the country, and as long as the water run off is good, you will not risk infecting others. The alternating mineral soak and lying out in the open air clears up the infection.

Cold
Too much cold is as dangerous as too much heat. Hikers and climbers run the risk of hypothermia, in which the body loses heat faster than it can make it and the body’s core temperature drops. It’s amazingly easy to go from chilly to too cold with a combination of wind, wet clothing (form rain or sweat), fatigue and hunger, even if the air temperature is well above freezing.

Symptoms are exhaustion, numbness (especially toes and fingers) shivering, slurred speech, clumsiness, lethargy, dizzy spells, muscle cramps, irrational behavior and violent bursts of energy. You may see them in someone else before you can in yourself.

To prevent hypothermia, dress in layers. Silk, wool and a few artificial fibers insulate well even when wet--cotton does not. A hat makes a big difference, as up to 30% of body heat can escape from the head when uncovered. A waterproof outer layer is important. Water and sugary snacks help to generate heat quickly.

To treat it, take shelter and replace wet clothing with dry clothing. Drink hot liquids (NOT alcohol) and eat high caloric, easily digestible food. In extreme cases it may be necessary to put the victim in a sleeping bag and get in with them. Do not rub a victim or get them near a fire. If possible give the victim a warm (not hot) bath.

Altitude Sickness
Reduced oxygen at high altitudes affects most people to some extent. Take it easy at first, drink lots of liquids and eat well. Even after you get acclimatized, you can get headaches or fatigued with too much exertion.

Symptoms usually go away after a few days, but in the higher elevations of Armenia, it may take a week or more. If you are very affected by altitude, the best treatment is to descend--even a few hundred yards can help. Continuing breathlessness, severe headaches, nausea, lack of appetite or a dry cough--sometimes with a frothy pink sputum--are cause for concern. Profound tiredness, confusion, lack of coordination and balance are real danger signs. Acute Mountain Sickness (AMS) can be fatal.

How high is too high? No one really knows the exact limit. Some people have died at 3000 meters, although 3500-4500 meters is when altitude sickness usually starts. In Armenia there are peaks greater than 3000 meters (8 are higher than 3500, and the highest point is Mount Aragats at 4090 meters). It’s wise to sleep at a lower altitude than the greatest height reached during the day.

Snake Bites (odzuh k’tzets)
If you are planning to hike in the woods, it is rare you will come across one, but you should bring a snake-bite kit. There is one extremely poisonous snake in Armenia, called giurza ("gee-oor-ZAH"), which habitates the cliffs and gorges around Garni, Geghard and other Southern areas. Opposed to some popular thinking, it IS necessary to get the venom out as soon as possible to minimize damage to the neural system. The poison works very fast, and can kill within an hour. If you are bitten, immediately tourniquet the limb between the bite and the core of the body, make two incisions (or two "X’s") with a razor blade or sharp clean knife across the bite marks and begin sucking the venom out. Spit the blood and venom out after you have sucked it into your mouth. Immediately go to the nearest village or town to find a doctor.

There are also scorpions in the dryer regions, mostly under rocks, though some buildings in Yerevan are infected. The stings are not poisonous, unless you are allergic (if you are allergic to wasp or bee stings, you most likely are allergic to scorpion stings). Normal treatment is to pick out the stinger (if it is still imbedded in the skin), clean with soap and water, then an antiseptic.

Sanitation Related Diseases
Diarrhea (loutz)
Change in water, food and climate, even jet lag can bring on the runs. A few dashes to the squatter with no other symptoms is nothing to worry about. More serious is diarrhea due to contaminated food or water.

Dehydration is the main danger, particularly for children, so fluid replenishment is essential. Weak black tea with a little sugar or soft drinks allowed to go flat and diluted with purified water are good. In severe cases a rehydrating solution is necessary to replace minerals and slats. If you didn’t bring a commercial brand with you, you can fake it by adding a few pinches of salt and a teaspoon of sugar to a liter of purified water; sip it slowly all day. Stick to a bland diet as you recover--Armenians stick to boiled potatoes, boiled rice (without oil or butter), as a staple for diarrhea. A natural medicine for diarrhea in Armenia is to boil the skin of pomegranates, and to drink the juice. The pomegranate (nour) is something like the Aloe Vera plant for its properties as a treatment. Another natural cure common in villages is pokhindz (poh-KHEENDZ"), made from wheat kernels that are fried without oil until brown, then ground into a flour. It is mixed with a little sugar and water, and can be made like a porridge, or into dough balls about the size and shape of an egg. It is an excellent home cure for diarrhea, (and a popular food). If you are offered it by a villager, do not be afraid. It is both tasty and will plug you up.

Imodium or Lomotil will also plug you but will not cure you. Use it only when necessary--when you have to travel. Don’t use either if you have a fever or are severely dehydrated. Antibiotics can be used to treat diarrhea that is accompanied by nausea, vomiting, stomach cramps or mild fever.

Giardia
Giardia lamblia is a parasite found in contaminated water. Symptoms of infection include stomach cramps, nausea, bloated stomach, watery, foul-smelling diarrhea and frequent gas. They may not appear until weeks after infection, and can come and go for weeks or months. The infection sometimes disappears of its accord. There is no preventative drug. Metronidazole (brand name Flagyl) is the recommended treatment but should only be taken under medical supervision. Antibiotics are of no use.

The water in Armenia generally is not infected, and marked spring water is considered safe. Occasionally there are outbreaks of giardia in the regions where people share drinking utensils and a single source. The parasite can be killed by boiling or iodine treatment. If you aren’t sure, or want to be safe, stay away from tap water, salads (which may have been washed with it), and ice.

Dysentery
Extremely rare in Armenia, the main symptoms of this serious illness, caused by contaminated water and food, is severe diarrhea, often with traces of blood or mucus. There are two forms. Bacillary (or bacterial) dysentery shows rapid onset, a high fever, headache, vomiting and stomach pains. It generally doesn’t last more than a week, but it’s highly contagious. Amebic dysentery develops more gradually, causes no fever or vomiting, but it more serious. It’s not self-limiting but will persist until treated and can recur and cause long-term damage. Only a stool test can reliably distinguish between the two, and they must be treated differently. Tetracycline can be used for Bacillary dysentery, Metronidazole for amebic.

Viral Gastroenteritis
This intestinal infection caused by a virus is characterized by cramps, diarrhea, sometimes vomiting, sometimes a slight fever. All you can do is rest and drink lots of fluids until it goes away.

Hepatitis
Hepatitis A or infectious hepatitis, the most common form of this disease, is spread by contaminated food, water or utensils. Minimal symptoms are general malaise, fatigue, aches and pains, loss of appetite; you may also have a fever, chills, headache, and in later stages nausea, vomiting, abdominal pain, dark urine, light colored feces and jaundiced skin. The whites of your eyes may turn yellow.

You should seek medical advice, though there isn’t much you can do but rest, drink lots of fluids, eat lightly and avoid fatty foods. People who’ve had hepatitis A must forego alcohol for 6 months afterwards, since the disease attacks the liver.

Hepatitis B or serum hepatitis is spread through sexual contact and skin penetration. It can be transmitted via dirty needles and blood transfusions, for instance. Avoid injections (or carry your own disposable syringes), having your ears pierced or tattoos done where you have doubts about sanitation. Symptoms and treatment are much the same as for type A.

Gamma globulin is only effective against type A. Some doctors feel that common sense eating habits far outweigh the effects of gamma globulin.

Typhoid
The risk of catching this very serious disease in Armenia is almost nil, but it requires medical help if symptoms appear. Typhoid fever comes from contaminated food or water. At first you may feel like you have a bad cold or flu, with a headache, sore throat and a fever that rises a little each day to 105°F (40°C) or more. The pulse may be abnormally slow and gets slower as the fever rises (in a typical fever the pulse speeds up). There may be vomiting, diarrhea or constipation.

By the second week pink spots may appear on the body, along with trembling, delirium, weakness, weight loss and dehydration. If there are no complications, the fever and symptoms can disappear in the third week but medical help is essential before this, as common applications are pneumonia or burst appendix, and the disease is very infectious.

The victim should be kept cool and made to drink a lot of fluids. Chloramphenicol is the recommended antibiotic but there are fewer side effects with ampicillin.

Malaria
This serious disease is spread by mosquito bites. There is a limited risk of malaria along the southern border of Armenia. Symptoms include headaches, fever, chills and sweating which may subside and recur. Without treatment malaria is potentially fatal.

Antimalarial drugs don’t prevent the disease but suppress the symptoms. In Armenia Chloroquine is the drug to use, as a tablet taken once a week, from 2 weeks prior to arrival in the area until 6 weeks after you leave. It’s safe for general use, side effects are minimal and it can be taken by pregnant women. Fansidar, once a Chloroquine alternative, is not recommended because of dangerous side effects, though it’s used as a treatment for known cases, as is Chloroquine in high doses.

Mosquitoes appear after dusk; wearing long clothes and using repellent will further reduce the risk. The chance of infection is lower in urban areas.

Sexually Transmitted Diseases
Abstinence is the only sure preventative for diseases spread by sexual contact, but use of a condom can be effective. Gonorrhea and syphilis are the most common diseases; symptoms include sores, blisters and rash around the genitals and discharge or pain when urinating. Symptoms may be less marked or absent in women. Syphilis symptoms eventually disappear, but the disease continues and can cause severe problems in later years. Treatment of gonorrhea or syphilis is by antibiotics.

There are numerous other sexually transmitted diseases, for most of which effective treatment is available. Infection by herpes virus is unpleasant but not dangerous to health. Symptoms include tiny blisters around the genitals or mouth and sometimes fever, aches, fatigue or swollen lymph nodes. Herpes is spread by sexually activity when genital sore are present.

There’s no cure, though symptoms may be milder after the first appearance. There is no cure for Acquired Immune Deficiency Syndrome (AIDS). Condoms and abstention are the most effective protection. AIDS can also be spread through blood transfusions or by dirty needles; vaccinations, acupuncture, tattooing, even dental work are potentially as dangerous as intravenous drug use if the equipment is not clean.

Women’s Health
Gynecological Problems
Poor diet, lowered resistance form the use of antibiotics, even contraceptive pills can pave the way for vaginal infections in hot climates. Keeping the genital area clean, wearing cotton underwear and skirts or loose-fitting trousers will minimize the risk.

Yeast infections, characterized by a rash, itch and discharge, can be treated with a vinegar or lemon-juice douche or with yogurt. Nystatin suppositories are the usual medical prescription.

Trichomonas is a more serious infection, with a discharge and a burning sensation when urinating. Male sexual partners must also be treated and is a vinegar water douche is not effective medical attention should be sought. Metronidazole (brand name Flagyl) is the prescribed drug.

Pregnancy
Most miscarriages occur during the first 3 months so this is the riskiest time to travel. The last 3 months should be spent within reach of good medical care. Pregnant women should avoid unnecessary medication, but the risk of illness must be weighted along with the potential for effects on the baby. Some malarial prophylactics are not recommended immediately during or immediately before pregnancy; consult your doctor. Good diet and rest are doubly important during pregnancy.