Frequently Asked Questions: Should I buy travel insurance? We encourage every passenger to buy travel insurance before leaving home. You can find further information on the following web page: http://www.travel-insurance-online.com/ How will I be met at the airport? If your itinerary includes airport pickup, an ACTUAR representative will be waiting for you with a sign with your name(s) on it. You will find him as you leave customs with your luggage, as you exit the airport building. Is there a number I can call in case I am delayed? ACTUAR's office is open from 8-5 Monday through Friday. Their phone number is 248-9470. The emergency cell phone for ACTUAR is 360-7475. If you are dialing it from outside Costa Rica, it will be 011 506 360-7475 . Can I use my cell phone in Costa Rica? The best way to make calls home while in Costa Rica is to buy a 197 or 199 calling card (tarjeta telefónica), which you can purchase at local stores, pharmacies, etc. The more expensive 199 cards have more minutes, but are not always available. You can use these cards with any pay phone or land line. If your cell phone company has a roaming agreement with Costa Rica, you can use your cell phone, but the minutes will be expensive. for instance, AT&T charges $2.29 per minute to make or receive calls in Costa Rica. You can check messages on your cell phone by calling your number from a land line and punching in your password. Find out more about this from your cell phone company. Because of Costa Rica's mountainous terrain, there is not always reliable cell phone reception. Changing money: ATMs (cajeros automáticos) are available at banks throughout Costa Rica. They will automatically give you the correct equivalent of the dollar amount you ask for in colones, the Costa Rican currency. Travelers checks can only be changed banks. The kiosks in the customs area of the airport do not give the correct exchange rate. It is better to go to an ATM. Bring US dollars with you to use at the beginning of your trip. You can often change some money at your first hotel. What to bring? - Two of the most important things to bring to Costa Rica are a pair of binoculars and a field guide (we recommend Birds of Costa Rica). Binoculars are a must for getting a closer look at wildlife and are not available for rent in Costa Rica. - Your valid passport for at least 6 months and copies of all passports in your group. - A valid driver's license (if you have a rented car). - Travel alarm clock. - Sunscreen and insect repellent. - Shirts: cotton or lightweight synthetic, long- and short-sleeved. - Trousers: cotton or lightweight synthetic pants. Bring at least 2 sets of clothes that dry quickly. (Jeans not recommended; too slow to dry.) - Hiking shorts. - Footwear: waterproof, light-weight hiking boots, river sandals (Teva-type sandals), tennis shoes/running shoes. If you do not bring hiking boots, make sure you bring TWO pairs of tennis shoes. As soon as one pair gets wet, use that pair whenever you're likely to get your feet wet. Go to any length to keep the other pair dry! - Socks: bring extra pairs in case feet get wet. - Rain gear: poncho, lightweight raincoat or umbrella. - Hat(s) with visor for rain and sun protection. - Plastic water bottle: especially for hikes. - Flashlight with spare batteries and bulb. - Camera and plenty of film. Also, extra batteries/battery charger and plenty of memory for a digital. - Ziplock plastic bags for spillable toiletries, and to store your camera and binoculars in if it rains or you are traveling by boat. Plastic bags for wet items. - Extra prescription glasses and medication (if applicable). - Small day pack or fanny pack for hikes. - Sweatshirt and lightweight windbreaker - Underwear. - Sleepwear. - Sunglasses. - Swimwear. - Beach towel - Bandanas. - Collapsible luggage to store extra items in San José Nature Guide/Driver policies: If you have chosen to have a bilingual naturalist guide/driver for all or part of your trip, all meals and accommodations for the guide are covered by ACTUAR. Guides are usually tipped at the end of your trip--$3 to $5 per adult traveler per day. Vaccinations: Costa Rica is relatively free from the famous tropical diseases. This is largely due to a good health care system and an extensive public-awareness campaign that has promoted good hygiene and sanitation. Currently, an international vaccination card is not required, but there are a few precautionary vaccinations you may want to consider before travelling to Costa Rica. All travelers should be up-to-date on routine immunizations, including: • Tetanus-diphtheria vaccine (recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.) Tetanus can be contracted through punctures, dirty cuts and scratches. This is a serious infection of the nervous system. Diphtheria is also spread by droplet infection through close personal contact. • Measles vaccine (recommended for any traveler born after 1956 who does not have either a history of two documented measles immunizations or a blood test showing immunity. Many adults who had only one vaccination show immunity when tested and do not need the second vaccination. Measles vaccine should not be given to pregnant or severely immunocompromised individuals.) • Varicella (chickenpox) vaccine is recommended for any international traveller over one year of age who does not have either a history of documented chickenpox or a blood test showing immunity. Many people who believe they never had chickenpox show immunity when tested and do not need the vaccine. Varicella vaccine should not be given to pregnant or immunocompromised individuals. • Cholera vaccine is not recommended. Cholera is not being reported from Costa Rica at this time. • Polio vaccine is not recommended for any adult traveller who completed the recommended childhood immunizations. Polio has been eradicated from the Americas, except for a small outbreak of vaccine-related poliomyelitis in the Dominican Republic and Haiti in late 2000. • Tuberculosis is not at all common in Costa Rica. It is most commonly transmitted via droplet infection. Check with your doctor or nurse. Commonly Recommended Vaccinations: • Booster Shots: - As needed, booster doses for tetanus-diphtheria and measles • Hepatitis A: - Hepatitis A or immune globulin (IG). Hepatitis A vaccine is recommended for all travellers. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Travellers who are less than two years old, are pregnant, or have less than two weeks before departure should receive a single intramuscular dose of gammaglobulin instead of vaccine. • Hepatitis B: Hepatitis B, if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months, or be exposed through medical treatment. Hepatitis B vaccine is recommended for travellers who will have intimate contact with local residents or potentially need blood transfusions or injections while abroad, especially if visiting for more than six months; for all health care personnel and for all infants and children. Hepatitis B is spread through infected blood, contaminated needles and sexual intercourse. It affects the liver, causes jaundice and occasionally liver failure. Those visiting high-risk areas for long periods or at social or occupational risk should be immunised. • Typhoid: Typhoid vaccine is recommended for all travellers. The oral vaccine is approved for travellers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine is probably preferable to the oral vaccine in pregnant and immunocompromised travellers. Typhoid and Hepatitis A are spread through contaminated food and water. Typhoid causes septicaemia and Hepatitis A causes liver inflammation and jaundice. Vaccination is particularly recommended for those who will be travelling in smaller cities, villages, and rural areas off the usual tourist itineraries. Travellers should be cautioned that typhoid vaccination is not 100% effective and is not a substitute for careful selection of food and drink. In these areas you should be immunised if good hygiene is impossible. • Yellow Fever: - Yellow fever vaccination is suggested for travellers to Panama who will be going outside urban areas. Insect-borne diseases Mosquitoes and flies can transmit a variety of diseases in this country, including malaria, dengue fever, and leishmaniasis. Personal protective measures are extremely important since insects cannot be avoided. Mosquito repellent is suggested, and long sleeve shirts and pants recommended to minimize potential exposure. Of these: • Malaria: Risk (almost exclusively P. vivax, the least dangerous of the malaria species) exists in rural lowland areas (generally below 1,600 feet (500 meters)) in Alajuela, Guanacaste, Heredia, and Limon provinces. There is no risk in the following tourist areas: San Jose and surrounding towns, Monteverde, Arenal volcano, Manuel Antonio National Park, San Ramon Forest Reserve, Rincon de la Vieja National Park, Braulio Carrillo National Park, Chirripo National Park, and La Amistad International Park. The medicine chloroquine protects against malaria in this area. The best drug for you depends on your itinerary and on a number of personal factors that should be discussed between you and your health care provider. Because no malaria drug is 100% effective, if you have travelled in an area of malaria risk, seek immediate medical attention for any fever or flu-like illness occurring within 3 months of your return home. Be sure to tell your health care provider your travel history. The risk of contracting malaria in Costa Rica is extremely low. Judicious use of insect repellent is probably sufficient prevention; in fact the Ministry of Health here does not recommend the use of malaria prevention medication, which can have unpleasant side effects. However, many physicians outside the tropics continue to recommend prophylactic treatment. Each visitor should weigh the pros and cons and make his/her personal decision on the matter. But, remember, the best way to avoid mosquito-borne diseases is to avoid being bitten by using protective clothing and insect repellent. Few volunteers or tourists, and none of our staff, take medication for the prevention of malaria. There are very few known cases of malaria in Costa Rica. For the most part, malaria has been eradicated, but immigrants re-introduce it occasionally, causing a small outbreak that the Health Ministry quickly controls. There have been cases of malaria in Talamanca, but neither staff nor visitors have ever contracted malaria. However, you should check with your doctor for his/her recommendation. • Dengue fever: Dengue, like malaria, is spread by a mosquito called Aedes aegypti, which thrives around dwellings in urban areas but rarely occurs in the forest. Producing severe flu-like symptoms (high fever, severe muscle and joint pain) the first time it is contracted, dengue is extremely uncomfortable but seldom fatal. However, should a person contract dengue a second time it often manifests as hemorrhagic dengue which is much more dangerous and can result in fatal shock, if not treated promptly. Incubation time for dengue is about 3 – 6 days and it can be asymptomatic. After being absent from Costa Rica for more than 50 years, dengue fever broke out here again, in 1993 - reintroduced from neighbouring countries. Since that time, there were two years with significant outbreaks of dengue. Since then it has been decreasing. Of all the dengue cases in Costa Rica, a minimal percentage has been proven as hemorrhagic dengue and only one death has resulted. It should be noted that the incidence of dengue greatly diminishes in the dry season, for obvious reasons. Nevertheless, each rainy season finds Costa Rican health officials fumigating to eradicate mosquitoes. All outbreaks to date have been brought swiftly under control. Even more important are the campaigns to educate the public on the elimination of standing water around their homes, the spraying inside closets and other dark areas, where the mosquitoes congregate during the day and the use of insect repellent and protective clothing. Leishmaniasis or papalomoyo: • Leishmaniasis is a tropical ulcer caused by a flagellate protozoan and transmitted by forest dweling sand flies, but not the ones from the beach. It occurs from time to time, especially at the onset of the rainy season. Their parasitic life cycle includes the sandfly and an appropriate host. Humans are one of those hosts. Leishmania infection can cause skin disease (called cutaneous leishmaniasis). • There are several species of leishmania; Costa Rica only has the least serious species. These protozoan parasites cause a nodular sore on the surface of the skin that may or may not be a long-term condition. The nodule is formed by the parasites, which live in human cells called macrophages. The macrophages containing the parasite are then encircled by other cells called lymphocytes. These cells prevent the spread of the parasite to other regions of the body. The transmission of infection to humans occurs through the bite of an infected sandfly. Sandflies become infected through feeding on infected animals. Once a sandfly is infected it can transmit the parasite to both humans and animals for the rest of its lifespan. The infection produces a single slow healing ulcer. It may cause skin lesions that resemble those of other diseases including cutaneous tuberculosis, syphilis, leprosy, skin cancer (basal cell carcinoma), and fungus infections. Leishmania can also cause systemic disease (visceral leishmaniasis) with fatal complications. When introduced into the body by the bite of a sandfly, the parasite migrates to the bone marrow, spleen, and lymph nodes. Systemic infection in adults cause fever for 2 weeks to 2 months, accompanied by non-specific symptoms, such as fatigue, weakness, and loss of appetite. Weakness increases as the disease progresses. The skin may become greyish, dark, dry, and flaky. The parasites damage the immune system by decreasing the numbers of disease-fighting cells. Preventing sandfly bites is the most immediate form of protection. Insect repellent, appropriate clothing, screening of windows, and fine mesh netting around the bed (in endemic areas) will reduce exposure. To stay healthy, do... Wash hands often with soap and water. The water in most urban areas in Costa Rica is safe. But if you want to be 100% sure, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles, and avoid tap water, fountain drinks, and ice cubes. Likewise, thoroughly washed fruits and vegetables are generally safe to eat. However, health workers often recommend to eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Protect yourself from insects by remaining in well-screened areas, using repellents (applied sparingly at 4-hour intervals) and permethrin-impregnated mosquito nets, and wearing long-sleeved shirts and long pants from dusk through dawn. To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot. Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases. If you have any further questions, do not hesitate to contact us!