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Wednesday, August 27, 2014
Health Guide

Health Tips, Cautions and Contacts (including insurance and english speaking medical contacts)
TourArmenia -

Updated 2014

Inside

Health Guides
Insurance
Insurance in Armenia
Medical Evacuations
Medical Kit
Immunizations
Cautions
Food & Drink
Water
Nutrition
Jet Lag
Symptoms
Medication
Help
Medical Centers
Gynecology
Maternity
Dental
Min of Health

Links

French Consulate
US Consulate
CDC Advisory
WHO Advisory
Open Directory: Health Search

The best prevention of health problems is to be in good health before you travel. It I also necessary to take simple precautions, and monitor yourself as you go. The most common complaint by visitors to Armenia are upset stomachs from drinking unfiltered water and eating a local diet rich in fat and spices; and fatigue from trying to see too much too quickly. More than anything else, loss of sleep combined with the changing biorhythms can cause a breakdown of the body’s natural defenses to common health problems. Get plenty of sleep, eat well, take vitamin supplements, watch for possible dangers or risks, don’t overdo it, and you can consider the risks here no more than traveling in the West.

If emergencies arise in larger towns, foreigners are shuttled to special wards or hospitals and polyclinics better prepared to treat them. In the regions there are nurses or doctors at all administrative centers. Prescription drugs are not easy to find, and the state of the medical profession is filled with skilled staff, but a dearth of specialized medicine, and sometimes disinfectant to clean rooms.

Health Guides
Staying Healthy in Asia, Africa and Latin America (Volunteers in Asia Press, Stanford, USA: address: VIA, PO Box 4543, Stanford, CA 95305) is a good portable guide. Home-treatment guides are also helpful, as they give simple advice for ailments, and sometimes offer alternative treatments which may be more readily available in Armenia. You can also get advice and printed material from the International Red Cross Red Crescent, which has facilities in Armenia. Check with a local chapter near you first to find the nearest International office.

Overprotective and cautious, but still a source of health advice, is the

Consulate of the US Embassy
(374-1) 52-16-11.
Can also be reached via Embassy switchboard (374-1) 15-15-51,
155-144
Tel/fax: (374-1) 151-138, 15-15-50 , 52-46-61, 52-16-11
18 Baghramian Ave., Yerevan

They're not big on protecting you if you are not a part of the "group", but they do offer some medical and insurance advice and other services.

Online

CDC Advisory
Excellent information, conservative, but reliable advice. Travel advisories tend to focus on the few mishaps, better safe then sorry. . .

Consulate Travel Advisory
Web site is woefully under-maintained (they still use old tlephopne codes and quote 1991 information that is 10 years out of date) and overly alarmist, but hey, they are the government.

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Insurance Outside Armenia
Insurance for traveling in Armenia is not that expensive, and there are many companies that include the CIS in their policies. In fact, most International insurers have a primary limitation the territory of the United States (where medical costs have skyrocketed). Certain clinics and hospitals in Armenia cater to foreigners, and accept insurance. Get a policy covering theft, loss and flight cancellations and medical problems overseas. Be sure it covers the member states of the CIS, and check the fine print: it may limit certain activities (like mountain climbing or hiking). If they don’t include the activities you have in your plans, get another, or ask about an amendment to your policy. Your travel agent should be able to find travel insurance for you which includes Armenia.

A good idea is to add or find medical evacuation coverage (also called MEDEVAC). If they have to take you out of the country for treatment, the cost can be high. Several companies sell medical evacuation insurance, and any reputable travel agent should know how to get it.

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Insurance In Armenia
"DIAGNOSTIKA" JSC
(374-1) 34-32-47, 28-74-11,
fax: (374-1) 151-639, (374-1) 28-74-11
E-mail: haik@diagnost.arminco.com),
6/1 Markarian St., Achapniak, Yerevan-73, Armenia,

sells medical insurance to foreigners in Armenia. Check with them first, and get a complete policy description and exact terms before buying. Mr. Haik Nikoghosian is the President and CEO.

The Consulate at the US Embassy strongly recommends American citizens traveling abroad take out insurance. They can provide some information about companies that service Armenia

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Medical Evacuations
The following companies offer medical air ambulance services:

(MEDEVAC)
+ (374-1) 52-46-61, +(374-1) 52-16-11
AT&T: +(374-1) 155-144;
AT&T Tel/fax: +(374-1) 151-138,
18 Baghramian Ave., Yerevan.

SOS International
+( 22-36-333 or 22-47-6161)
US Toll free +1 (800) 523-8930,
telex: 427 172-SOS SACH),
15 rue Lombard, 1205 Geneva, Switzerland

is the largest and best known medical evacuation insurance company for the CIS. Contact them for advance insurance before you come. Others include

Jetflight Finnish Air Ambulance Service
(358-0) 822-766, 684-07978,
telex: 122-520 JETFL SF;
fax: (358-0) 829-2203);

Delta Consulting (not a part of Delta Airlines)
Moscow: +7 (095) 240-9999;
Dr. Rita Ariane Komissarenko +7 (095) 339-4307; 488-4406

Lufthansa Airlines
(can configure an aircraft to accommodate a stretcher on 24 hours notice)
+7 (095) 975-2501,
Penta Hotel, Moscow,
Eduard Pfahler, Assistant Manager.

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Medical Kit
Get a good ( emphasis on "good") camping first aid kit, and you’ll have the basics for what you need, then add some of the following: (for hiking and climbing) snake bite kit, plaster or instant setting compound (for cracks or breaks), instant ice packs, and (for everyone) extra aspirin or Ibuprofen (or aspirin substitute if you are allergic to aspirin) water purification tablets or drops, gauze pads and adhesive tape, antiseptic, blister or mole pads, Alka-seltzer type antacid relievers, diarrhea medicine (Pepto-Bismol, Kaopectate, Imodium or Lomotil--for severe diarrhea bring some rehydration mixture), extra bandages, Ace bandages (for sprains or limb fatigue). If you plan to walk or move more than normally (not hard to do in Armenia), consider dome muscle pain relievers. Some people carry Momentum, which is good for muscular backaches.

Your thermometer should not be mercury, since it can explode in pressurized cabins on the trip over. Pepto-Bismol, Band-Aids, alcohol and aspirin can be found in Armenia, but are more expensive than in the West. Antiseptic or alcohol swipes are convenient and pack easily into day packs for outings. Alcohol or Hydrogen Peroxide and sterile pads can be used clean small cuts. Mercurochrome is a common antiseptic in the CIS, so if you have an allergy, be sure to have a substitute handy.

In summertime, bring insect repellent (it is not available in Armenia). Some come in towelettes, which is convenient for carrying around with you. For stings and bites, you can bring Calamine "pink lotion" or a sunburn and itch lotion/spray. Some say antihistamines relieve itches and motion sickness. Sunscreen lotion is available, but the variety isn’t above 12 or 15 UVA protection. If you are sensitive, or want to protect the nose, etc., bring your own total sun block lotion. There are a lot of skin lotions, including the most popular Western brands, on the market in Yerevan. You may also want talcum powder or athlete’s foot spray.

In Winter, sniffles and coughs are the most common complaint, and Western cold medicines are not always available. Bring some cold and flue medicine with you. Tablet versions are most convenient, as are the "tea" versions (and the hot fluid can be comfort itself).

Bringing your own antibiotic (tetracycline or penicillin) can be useful if you are in the woods, but be sure you are not allergic to it first. For these and all prescription drugs, bring a generic prescription in case you need to have it filled in Armenia. Some prescription drugs can be filled at apothecaries or at the polyclinics for foreigners, but be aware they may use a Russian type which may use different mixtures, or not be as strong as those in the West. Plan on bringing extra with you. Check with your doctor. Also, bring a doctor’s note for all prescription and/or narcotic drugs with you. You’ll need it when you pass customs.

Condoms are available at most city pharmacies, but it is a good precaution to bring your own. Women should bring their own contraceptives, as they are not normally found here. Sterile disposable syringes are available at all pharmacies (sealed with expiration mark), at the foreigner clinics and hospitals, but some travelers routinely bring a sterile pack of disposable syringes with them in case they are caught in an emergency off the beaten path, or as a double security measure. They are available at medical supply shops. You do need a note from your doctor to carry them, as customs forbids the import of "mind-altering drug" paraphernalia, and syringes are included and often confiscated.

If you have any allergic reactions to drugs, are diabetic, or have another specific conditions which doctors should know before they treat you, bringing a medical I.D. plastic packet that you can have on you at all time. It should specifically list the condition(s), allergies and the alternate treatment or drug required, or the specific drug you have an allergy to. It will help you in an emergency, or if (heavens forbid) you are unconscious. Write in Russian

(ATTENTION! Medical Information (in English)". If in another language use the Russian word for that language. All doctors read Russian, and they can find someone to read English, in the larger towns French and German. It’s not a bad idea to list primary problems in Russian as well:

Diabetic is


"dee-ah-BEH-teek"

Epilectic is


"eh-peh-lehp-seek"

Medical Allergies (reactions) is


"ah-lehr-jee-CHEH-skai-ah reh-AHK-stee-ah nah
meh-dee-TSEE-skeh preh-pah-RAHT-ee"

If you wear prescription glasses or contacts, bring spares. Prescription lenses for glasses are sold in State stores, but they do not carry every size, and it can take while to have specialized lens ground.

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Immunizations
None are required, but you should get booster shots (if it has been a while), and the routine protection you would want against tetanus and hepatitis. Measles and polio are normal childhood immunizations, but your doctor may suggest booster shots. You may be asked for proof of vaccination against smallpox and cholera (there have been no reported cases, but they also want to keep them out).

Be sure vaccination is recorded in an International Health Certificate, available from your doctor. Some countries provide immunizations from government health centers--travel agents can tell you where to get them. Plan ahead on vaccinations, since some can not be given at the same time.

Cholera Protection is good for 6 months only. Not recommended if you’re pregnant

Tetanus & Diphtheria Highly recommended as general protection. Boosters needed every 10 years.

Infectious Hepatitis The protection is to inject gamma globulin as a prepared antibody that can reduce the chances of infection. It cannot be taken simultaneously with other vaccinations, since it can interfere with the development of immunity. Lasts about 6 months, later doses can be less effective.

Typhoid Not a current problem in Armenia, but not a bad idea if you plan to travel to Central Asia before or after your visit. Vaccinations last 3 years and can cause side effects such as pain at the injection point, fever, headaches and a general unwell feeling.

See also
CDC Advisory

World Health Organization

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Common Sense Cautions
Many problems can be prevented by doing what makes sense: get out of the sun, wear enough clothes to keep yourself warm, wash you hands--the most common infection comes from bacteria entering the body from contaminated food handled by dirty hands. Armenians are fastidiously clean people, and they will insist you wash your hands before you eat (as much to protect themselves as you).

Food and Drink
The grumbling tummy is the most common complaint here (as it is in all exotic locations, and even in Western Europe and the States). It doesn’t normally last long, and loose bowels (or even diarrhea) can be caused by change in time and geography and the stress on your body as it is on the food or drink.

Water is generally safe to drink. There have been very few outbreaks of giardia in the regions in the last few years and they were quickly contained. Because Yerevan and other cities are under a water ration system (water flows at set hours each day), some foreigners (especially the diplomatic corps) swear to even look at water will cause their intestinal tracts to melt. This is not true. In fact, the problem to your tummy may be from the chlorine they add in cities like Giumri to purify the water (harmless, but it can remind one of lapping at a pool). But to be safe, and especially if you are not sure how clean the glass you are drinking from is, either boil the water first, or drink only bottled mineral water (from the bottle), which is available everywhere.

Restaurants are safe, as long as the food is well cooked. Avoid undercooked or raw fish, but do not miss the chance to eat the excellent iskra which is caught in some the cleanest waters in the world at Lake Sevan. Ice Cream is OK. Wash fruit and vegetables before you eat them. Eating off the street is OK as long as the food is well cooked. If the place looks clean, the servers and cook neat, it is usually safe to eat there. Doesn’t this sound like Mom talking? And wasn’t she always right?

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Water Purification
Boil it for 10 minutes to be sure (this is only sure way to kill hepatitis virus). Alternately, chemically purify it with iodine treatment (kills giardia, bacteria and amoebae), which is safe for short-term use. Avoid iodine treatment if you are pregnant or have a thyroid condition.

Either get it in a kit, or a 2% tincture of iodine can be used. Add two drops per liter or quart of water and let stand for 30 minutes. It tastes rotten, and some people add flavored powder to hide the taste (yeah, right). Keep it sealed between use.

Chlorine tablets do not kill amoebae or giardia. Simple filtration does not remove all pathogens.

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Nutrition
You can eat well enough not to have to take supplements, but when you are on the go, you may not always eat as well as you should, or on a regular basis. It is too easy to skip meals in the thrill of visiting new places.

Always be sure you eat well, and try to eat three to five times a day. Alternate snacks of fruits and nuts (very easy to get here, peeled fruit is safe and full of vitamins) with larger meals in the morning, midday and in the evening. Protein sources popular in Armenia are eggs, lentils, beans and nuts. Armenian food is rich in meat and fats, and though tasty, you may get a bloated stomach unless you are active. Getting grains and bread is not difficult. Armenians eat enormous amounts of bread, and it is a staple at all tables. Though cooked food is safer, overcooked (i.e. at state restaurants) loses its nutritional value.

Drink plenty of fluids. Not being thirsty doesn’t always mean you are OK. Very dark urine or not urinating on a regular basis can mean you need more fluids. If you sweat a lot, you need to drink a lot of juice and water: you can easily lose body salt and get muscle cramps. Packaged 100% juices are very popular in Armenia now, quite safe and tasty.

Vitamin supplements are a good idea for those on the go. In reasonable doses, multivitamin supplements cannot hurt you. The excess vitamins flush themselves out of the system. Combining B-50 complex with vitamin C adds an extra boost.

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Jet Lag
Some people now swear by Melatonin, which is a hormone supplement used by travelers who frequently cross time zones and have difficulty sleeping. Taking a small dosage can encourage sleep, and staying awake after a small dosage can speed the process of balancing biorhythms and adjusting you to the new time change more quickly. So they say. As with all supplements and medicine, you should consult your doctor before taking Melatonin. Some people complain of having groggy heads or difficulty waking up after using it.

Symptoms
Normal body temperature is 98.6°F (37°C). 102°F (39°C) or higher is a serious fever. Normal adult pulse rate is 60 to 80 per minute (children 80 to 100, babies 100 to 140). Learn how to take pulse and temperature. As a rule, pulse increases 20 beats per minute for each 1.8°F (1°C) rise in fever.

Breathing rate is another sign of illness. Normally adults and older children take about 12-20 times a minute (up to 30 times for young children, 40 for babies). With a high fever or respiratory illness, people tend to breathe faster. More than 40 times a minute is a symptom of pneumonia.

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Medication
Ideally take medication under medical supervision, and never take indiscriminately. Overuse of antibiotics can weaken your body’s natural immunities and reduce the jobs effectiveness in the future. Take the recommended dosage as it is written on the prescription or label. Continue for the prescribed period, even if you feel better sooner. Antibiotics attack specific infections; stop immediately if you have serious reactions and don’t use it at all if you are not sure it is for the infection you have.

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Help
Whenever possible, use medical assistance. You may know the diagnosis and treatment, but you also may not. Guides and tourist hotels can call a doctor in case you need one, though sometimes the response is slow. Armenian standards in hospitals is not like that in the West; surgeons and specialist doctors are quite skilled, but they are often lacking some of the supplies and medications we take for granted.

As a response to this need, the consulate at the US Embassy provides information to US citizens about doctors, hospitals and clinics which specialize in treating foreigners. They also provide insurance to foreigners, but call first for details. Though the embassies cannot provide medical aid, they should be notified if your condition is serious, and can provide information about evacuation.

Basic consultations and non hospital first aid is not free to foreigners, unless it is a part of your tour package. Consultations and routine examinations are $5-20. Basic hospital accommodations for foreigners varies from free to $50 per day in smaller towns (or drams in the regions) to the official foreigner hospital charge of $120-$250 a day. Be aware that if you stay in a non-foreigner hospital or clinic, the custom is that everything is free, but nothing is provided. Locals bring sheets, pillows, food and medicine, plus pay nurses and doctors for the supposed "free medical treatment".

Pharmacies have recently improved their stocks, but it still may be a "pill chase" to get the medicine you need. The foreigner hospitals have good stocks of medicine (at premium prices).

Before you gripe that foreigners are getting gouged, think of this: the ways the Health Ministry can raise funds for its needs nationwide is limited. Charging to Foreigners who normally have insurance to pay the costs is one of the ways to insure better treatment, and to pay its bills.

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Medical Centers
Note: inclusion does not constitute recommendation of services.

In Yerevan, two medical centers allocated for foreigners are the

Hospital of the 4th Main Administration of the Ministry of Health
((374-1) 53-66-41),
Proshian Street, Yerevan, Armenia;
Contact Person is Mr. Karen Gulian, MD. (speaks English).

4th Yerevan City Polyclinic
(374-1) 58-03-95,
13 Moskovian Street, Yerevan, Armenia.
Contact Person is Chief Doctor Ruben Vardanian.

See also:
Erebuni Hospital
Sevan Polyclinic
Nork Marash Heart Hospital
NOY
Website for doctors who have have completed training abroad. Hard to tell how strict admittance is, but there is a list by specialty.

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Gynecology

For gynecological aid, we’ve heard very good comments about

Dr. Rufino Mirimanovo at Polyclinic #4
(374-1) 58-03-95,
13 Moskovian St.

Dr. Mirimanovo treats patients on Tues-Thurs between 3-5 p.m. Another gynecological clinic is at Erebuni Hospital (374-1) 47-11-90, 14 Khaghagh Don Street. Erebuni is also considered a good general treatment hospital.

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Maternity

Maternity care is provided at the clinic on 22 Mashtots Ave. (374-1) 53-01-92.

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Dental

Dental work can be made at the Central Dental Institute on Tumanian Street, but we’ve it’s better at

ArgoDent
Next to Knigi store on Mashtots Ave
Ask for Maro

Dental Express
Lower floor office on Pushkin St
Tel: 53-71-21
Ask for Aghassi
Dental Express has the latest computer imaging, x-rays done on computer with high resolution, and a nifty micro camera that shows your teeth in real time on the computer screen in front of you.

Standard prices are 5000 AMD teeth cleaning, $25 complete tooth reconstruction, $200 bridges, $320 implants. It’s cheaper to fly here and have your teeth done than to have them done alone in the states.

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Optical

Also cheaper than and just as good as in the West, there are many many opticas in Armenia.  Standard rpices are 3000 AMD for an eye exam and prescription, with normaly a discount if you buy glasses at same place. Glasses 40-60% cheaper than in Europe or USA.

Achkid Luis (Eye Light)
20 Mashtots Ave.
Tel:  53-85-16

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For more information on these and other hospitals, private doctors, and pharmacies contact

International Relations Administration, Ministry of Health of Armenia
(374-1) 52-69-87,
fax: (374-1) 56-29-23 or AT&T (374-1)151-097,
8 Toumanian Street, Yerevan, 375001, Armenia

Min. of Health of Armenia Web Site
unsure if this site works, listed on several search engines, but unable to get in. Try and see.

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