We are not health professionals or experts in any way, so please read what follows with that in mind. If you need professional advice, turn to others. But we have learned a lot through living here and we hope and believe that our experience, and that of our many friends and guests, may be helpful to other travellers.
Obviously, check with your doctor. We cannot advise. But Sri Lanka is malaria-free and the only major risk in terms of disease is from dengue fever. Dengue is found all across the tropics and there is no preventive vaccination. However it is rare provided you stay clear of places with poor standards of environmental hygiene (such as stagnant water where the mosquito can breed). Also, the type of mosquito that carries dengue only flies by day so if you have been bitten at night while asleep you will not get dengue. But do bring plenty of high-deet insect repellent as you cannot buy it easily here. You should also make sure your tetanus vaccinations are up to date – but that is a risk anywhere, not especially in Sri Lanka.
If you are staying in mid-range and upwards places you can be sure any drinking water you are provided with will be either bottled or purified (as it is at Jungle Tide). Similarly in such places you won‘t need to worry about the ice in your lime soda or gin and tonic; it will be made from frozen potable water. If you’re backpacking then it is wise to check that any water is potable and/or carry your own bottled water with you.
Most tropical fruit comes sealed in an inedible skin so no need to worry about that, though it makes sense to rinse apples, grapes or tomatoes, for example, before eating them raw. There are pesticide regulations but they may not be as strict as some of those in the west. Incidentally, the juice of the local drinking coconut (thambili) is so pure it can be – and in emergencies has been – used as a saline drip for severely dehydrated people far from any medical facilities!
Do try the street food, which is delicious, but take sensible precautions – seafood sold on street stalls, even on the coast, might be a bit of a risk. Generally it’s best to stick with vegetarian street food unless you feel confident about the seller – for example recommended by someone you trust or a well known reputable store such as Devon Bakery.
When it comes to eating out in restaurants or the hotel or guest house you’re staying at, it’s best to take a look at reviews. If people have suffered digestive problems they are pretty sure to want to tell the world to avoid that place, or at least that type of food.
If you have a food allergy, or if you avoid certain foods on principle, just make sure you tell the hotel, guest house or restaurant and make sure you have been understood! Sri Lankans often smile and say “Yes, no problem” when in reality they haven’t the faintest idea what you are talking about. That said, being a vegetarian or even a vegan in Sri Lanka is probably as easy as anywhere in the world, while eating either gluten- or dairy-free is also easy provided you check. Most flour, for instance, is rice flour but not all; some is mixed with wheat. Coconut milk is widely used where in the west we would use cow’s milk – but again by no means always. You can buy non-dairy milks (goat, almond etc. as well as – obviously – coconut) in most supermarkets.
There are plenty of biting and stinging insects around, but mostly at night. Don’t leave windows open and lights on in your room after dark if you want to avoid potential invasions, especially if you’re not in the room. AC and fans deter most insect pests. You will perhaps see a few cockroaches even in the best hotels; they are just a fact of life in the tropics and if they disturb you the staff will deal with them. Most places either have mosquito nets as standard or provide them free on request, as we do. Being up in the mountains we get few mosquitos at Jungle Tide, but we can’t pretend they don’t exist. They’re just far more common on the coast.
But our advantage in the mosquito stakes is offset by the problems we (and all other hill country locations) have with leeches in the gardens and while you’re out walking. In wet weather they cling to vegetation and can move remarkably fast to latch onto your skin and suck your blood. They are in fact completely harmless and their bite is painless, but most of us think they’re horrible. If one has got hold of you, the best way to get it off is to sprinkle it with salt – so ask your hotel or guest house to give you a small pack of salt if you’re heading off on a walk in the hill country unless the weather has been completely dry for a couple of days. These kinds of leech don’t live in water, unlike the European ones, so swimming and paddling in mountain pools and streams is OK.
Sri Lanka has many snakes and some of them (a minority) are venomous. Surprisingly, you very rarely actually see one! We have never been bitten and we don’t personally know anyone who has – and over the years that includes many hundreds of guests. So no need to be afraid, but if you’re out walking it’s good to take a strong stick or borrow a walking pole if you haven’t brought your own. Use it to swish around in front of you so that any snake lying ahead of you will disappear quickly – you almost certainly won’t even know it was ever there. And don’t pick up or sit on piles of vegetation without giving it a thorough prod first – you don’t know whose home you may be invading. Just remember that all wildlife is more scared of you than you are of it, and there is nothing in Sri Lanka that will choose to attack you unless it has been made to feel threatened.
But what about domestic and feral dogs? The street dog problem in Sri Lanka is significant, though not as bad as it was several years back, thanks to the activities of various animal charities. Rabies exists in Sri Lanka but its incidence is around 20 cases per year, one fifth what it was at the turn of the 21st century (according to Sri Lankan government data). Given that the population numbers around 22 million that is literally a one in a million chance. And monkeys are more likely to carry rabies than even feral dogs. Provided you don’t try to befriend either wild monkeys or dogs you don’t know, there is no real likelihood of you getting rabies. Just a very remote possibility and certainly not enough to let worrying about it spoil your holiday.
Sri Lanka has quite a high incidence of road accident deaths. Around three thousand per year, making it 150 times more likely to die in a road accident than from rabies, incidentally! (WHO and Sri Lankan Government data). That the death rate is not higher, given the much larger number of accidents, is due to the slow traffic speeds. The highest proportion of deaths occur on bicycles/motorbikes. Three wheelers come next and cars, vans and buses are relatively safe ways to travel. Trains, not surprisingly, are the safest of all.
Road accidents aside, the most common risk of injury to the general public and tourists is probably from falls due to uneven pavements and pot-holes. You do need to keep your eyes open while walking in cities such as Kandy and not look at your phone all the time!
This can be summed up quickly: the standards of clinical care are very high indeed, but the quality of the “health environment” (cleanliness of floors, toilets etc.) can be poor, and the public hospitals are often extremely overcrowded. Generally, the private hospitals are better maintained than the government ones though this is not always the case. Except in an emergency you will probably be using private medical facilities if you need any treatment. The costs are very low compared to those in the west and we have had a few guests who have needed medical treatment – in one case it was very complex – and did not claim the costs against their health insurance as it was hardly more than the excess amount, so not worth the trouble! We also have had two separate cases of guests with complex medical problems whose doctors, when they arrived home, were astonished at how well and accurately the Sri Lankan doctors diagnosed and treated them.
Recently the government has introduced a universally available emergency ambulance service. By dialing 1990 they guarantee to get an ambulance to you within thirty minutes. From our limited experience it does work.
If you or a loved one has to stay in a private hospital for a couple of nights or more there is a sometimes a system where you will be given an adjoining room and you will be expected to shop and cook for the “patient”. Private healthcare costs do not include feeding. But one former guest who had to look after her husband in this way said it was the best value for money she’d ever had from a hotel!
Prescribing practices are not what westerners are used to. Doctors and dentists will often prescribe drugs which are readily available over the counter such as basic painkillers; on the other hand pharmacists will usually sell medicines we would normally expect to require a prescription (such as sleeping tablets) over the counter! Doesn’t make a lot of sense. There are good pharmacies in the larger supermarkets as well as stand-alone ones, often near to hospitals.
Finally there is the traditional ayurvedic medicine. This is not something we have used – through ignorance rather than any considered opposition to it – so we will not comment on it here. There are plenty of ayurvedic pharmacies in Kandy and around the whole island, if this is your preference.
We wish you a healthy holiday, and above all we hope you won’t allow your fun to be spoiled by undue worries.