Immunizations provide an excellent first line of defense against preventable illness. While Morocco requires no immunizations, it is wise to keep tetanus updated. Vaccines are also recommended for typhoid and hepatitis. When considering any vaccines, consult your physician for what is best for you and your circumstances.

The second line of defense has to do with those measures you take which will provide protection against illnesses transmitted through water, food, soil, insects, animals as well as through contact with an infected person. Treated water, clean food, frequent washing and bathing, and proper hygiene are specific means of staying healthy.

The third threat to health and well being is emergency situations arising from automobile accidents. Defensive driving should be in the forefront of every driver’s mind. It is recommended that everyone carry a First Aid Kit (pharmacie d’urgence) in their car. A list of suggested emergency supplies is given at the end of this chapter.

One helpful book might be Safety and Health Abroad by John A. Giordano and Mary Shaughnessy.

Infectious hepatitis is a viral disease of the liver. Some people who become infected, particularly children, get a mild undiagnosed form of the disease, recover and obtain a long lasting immunity to that type without ever knowing about it. Prevention is possible by observing the rules of water and food. Immunization with gamma globulin is useful in the prevention of hepatitis A and, if one chooses to do so, should be given to everyone over 12 years old. Many people choose to be vaccinated against Hepatitis B as well. The vaccine is marketed here as Engerix B.

HiB immunization is routinely given in the U.S. to prevent Haemophilus Influenza B, which can cause meningitis in very young children. The HiB vaccine is available in Morocco; consult a pediatrician as to the appropriateness of this vaccine for your family.

A pre-exposure series vaccine for rabies is available for people who will be in areas which have a high incidence of rabies.

Some health problems in Morocco result from contamination of food, water and soil, which can cause diarrhea, dysenteries, certain worms, typhoid, cholera and hepatitis. Your protection against these diseases is greatly enhanced if everyone in the house follows simple guidelines for food preparation, safe drinking water, and personal cleanliness. It’s very important to demand the same standard of all househelp.

Most attacks of diarrhea are not one of the above-mentioned diseases and can usually be treated with Imodium or Pepto Bismol and a bland diet. If diarrhea persists with cramping or vomiting, insist on a stool culture to identify the problem. Over time many people find they are less and less prone to stomach problems.

While Morocco’s municipal water supply is considered safe, some people prefer either to boil and filter their water or to buy bottled water. If you are traveling outside of the major cities, it is wise to carry bottled water. Ice is only as safe as the water used to prepare it. Water you are uncertain about should be boiled for a minimum of 20 minutes or treated with water purification tablets available at a pharmacy. Some areas of Casablanca have very old pipes and as a result the water has added impurities. Check with a LYDEC representative from the main office to ask about your area. LYDEC is in the process of replacing old systems.

"Long Life" or UHT Milk is safe for consumption. It is the refrigerated pouches of milk that are not safe to consume immediately after purchase. While this type of milk is pasteurized, the refrigeration during transportation is not reliable; therefore, you should boil it before consumption. Also, commercially prepared cheeses are safe; however, homemade cheeses, unless made by you with boiled milk, are not.

Fruits and vegetables may be contaminated during the growing or marketing process. Items that you plan to cook usually require only a good cleansing with water and detergent. Fruits and vegetables should be washed well and it is advisable to soak anything that will be eaten raw, in bleach or in Permanganate de Potassium which can be bought in pharmacies. Use 2 TBS bleach for a large dishpan of water (1 tsp/liter) and soak for 20 minutes. Be sure to separate all lettuce leaves and clean thoroughly before soaking.

The National Institute of Health and Poison Control of Rabat warns that the new Ace 12% Javel contains chemicals not intended for human ingestion. This should not be used for water purification or to clean fruits and vegetables as poisonings have been reported. Ask for Javel sans parfum usually sold in 5 liter containers.

These should be thoroughly cooked or frozen before preparation. Cutting boards and all surfaces where raw meat is handled should be cleaned with bleach to disinfect them before using those surfaces for any other purpose. For example, do not put cooked food back on a cutting board or plate where there was raw or uncleaned food. It is best to have a separate cutting board to use for raw food and nothing else.

Make sure that everyone in the household keeps food items properly stored, covered, and refrigerated.

These are frequently used indiscriminately throughout the world. Antibiotics are to be used specifically for bacterial diseases. They are useless and may be harmful for viral diseases, colds, viral diarrhea, flu, or viral sore throats. DO NOT take them on your own initiative. If you are ill enough to be taking them, you are ill enough to be under professional care. Once prescribed an antibiotic, be sure to take the entire dose. Stopping early when symptoms disappear can lead to the bacteria developing an immunity to the antibiotic, which is harmful to everyone in the future.

AIDS is a problem in Morocco as it is world-wide. AIDS is not casually transmitted; it is not thought necessary to test household workers. One should take precautions if at possible risk and carry a supply of disposal syringes when traveling. Make sure doctors use unopened disposal syringes. The local blood supply is screened for HIV and Hepatitis.

Warm humid weather makes the skin an ideal medium for all types of fungi. Keep an antifungal medicine on hand. People who spend a lot of time in chlorinated pools are particularly prone to swimmer’s ear, a bacterial infection of the outer ear canal. The key to prevention is to keep the ear canals dry and if recurrences are a problem, rinse the ear canal with rubbing alcohol immediately after a swim or shower.

During the summer months, be careful of the sun. Radiant heat can cause headaches and sunburns are common and painful. Remember to wear sunblock. Sun exposure hastens wrinkling of the skin and causes skin cancers. Be sure to drink plenty of water or juice. If serious dehydration occurs due to overheating or diarrhea drink plenty of fruit juice or ask for an oral dehydration salt package (from the Pharmacy) to be mixed with one liter of water. This is especially important for children suffering the effects of the heat or fluid loss.

There is a popular belief that an injection is better than oral medication. This is not so. In fact, injections give a higher rate of adverse reactions. Injections should only be used when oral medications cannot be taken, i.e. due to vomiting, unconsciousness, etc.; or when the person is very ill and needs high blood levels quickly. AVOID injections of iron, calcium, vitamins, and tetracycline (absorbed better by mouth). Penicillin shots should only be given in a clinic equipped to handle a possible adverse reaction.

Lead is used in glazing compounds by potters to impart a smooth surface and enhance colors to ceramic products. If not properly formulated and applied or fired to a sufficiently high temperature, the lead in the glaze will be leached or released by acidic foods or liquids. Repeated use of such lead-glazed pottery to store/serve fruit juices and wine can result in lead poisoning.

Rabies can be fatal. The Institut Pasteur (Tel: 27.52.06 or 27.57.78) has the antirabies treatment and vaccines. Rabies is transmitted in the saliva of rabid animals through a bite or a lick on a scratch or abrasion. It does not penetrate intact skin. If a rabid animal bites you, you will probably be started on a series of injections which are given in the arm. It is the same vaccine as the pre-exposure series and is not painful.

FIRST AID for suspected rabies contact:

• Wash the wound immediately with soap and water for 10 to 15 minutes. If possible, flush the wound thoroughly under a faucet. This should be done for any animal bite to reduce the risk of infection.
• Seek medical attention for any bite that penetrates the skin. Do not panic if you are bitten and the Institut Pasteur is closed or you are away from Casablanca. Rabies will not set in immediately and, according to the Institut Pasteur, waiting a couple of days will not matter.
• If you are bitten by a wild animal call immediately for help. If the animal is captured alive or dead, avoid all contact with it.
• If the bite was from a domestic animal and there is any possibility of rabies, the pet should be carefully watched for any signs of sickness and isolated from contact with humans for 10 days.

Educate your children not to play with puppies and kittens unless you know that they come from a vaccinated mother with a current rabies certificate. Keep your tetanus immunization up-to-date. Have all pets vaccinated yearly and keep their vaccination certificate on hand.

The "fluoroscopie" x-ray used at various medical facilities and clinics is an "instant" x-ray which can be read while the patient is being x-rayed. It may be quick and easy but the patient is exposed to a significantly higher dose of x-rays than with the film type. It’s advisable to avoid fluoroscopy except in case of dire emergency. Be sure to ask the radiologist for a x-ray shield apron.

Occasionally an accident will necessitate a medical evacuation to another country. This can be very costly if insurance has not been purchased. Also, it may take some time for an ambulance to arrive at the scene of an accident and it is not always well equipped once it arrives. Although there are clinics and hospitals throughout Morocco where emergency care is given, they may not always have disposable syringes and needles in stock. They will use those supplied by you.

The following two companies offer world-wide coverage and provide 24-hour emergency air transportation. You must have pre-paid coverage to benefit from these services.

International SOS Assistance From outside US call collect: 1-215-245-4707

From inside US call:  1-800-523-6586

MEDEX has offices in the U.S, Great Britain, Mexico, Japan, Spain, France, Australia and Germany. For those numbers contact

United States: 1-410-453-6330

This number can be used toll free from anywhere in the world for emergencies or information.

From the United Kingdom: 08-00-89-15-36

08-00-25-20-74

The items suggested below may be purchased at local pharmacies (prices may vary.) You can purchase 1 meter of muslin or plain cotton fabric at any fabric store. Cut it diagonally to make 2 triangular bandages.

1 each Roll tape (Sparadrap 5 cm x 2 cm)

2 boxes Compresses Steriles (40 cm)

1 box Compresses Stériles (20 cm)

1 each Betadine Solution (125 ml)

6 each Syringe & Needle

2 packages Skin Closures ("Steril Strip" 1/8 in x 2 in)

2 each Elastic Bandage (Band Crepe Velpo 1-cm)

1 box Diarit Rehydration Salts

2 each Intravenous Tubing (Tubulure Intra Veineuse/Perfusion)

1 each Scissors, bandage (Ciseaux, pansement)

2 each Triangular Bandage (Pasement Triangulaire)

1 each Suitable Container

Also consider carrying: Papain (meat tenderizing powder for bee and sea nettle stings); insect repellent; sunscreen; antibiotic ointment; hydrocortisone cream; antihistamines; acetaminophen; adrenalin if family member has a severe bee-sting allergy.

If you seek medical attention for an illness, beware of the following drug:

It is an antibiotic which should be used only for certain serious diseases. It should not be given for colds, sore throats, gonorrhea, or mild to moderate diarrhea. It is a dangerous drug because it can cause alterations in the bone marrow which could hinder your body’s ability to make red blood cells. Chloramphenicol is a popular drug in most emerging countries because it is an excellent and inexpensive antibiotic with a broad range of activity.

Its use in the United States is restricted to PROVEN cases of typhoid fever and some life-threatening infections. It is marketed under the trade names Cholratres, Syntomycin, Enterocin, and many others.

Here is a list of drugs which are similar to U.S. products and may be purchased on the local market. The = indicates drugs which are the same. Be sure you understand the correct dosage. Remember, all medications have side effects, so use them with caution.

Anti-Diarrheal Eyedrops

Imodium Boroclarine (sod. Borate, boric acid …

Novismuth Similar to Pepto-Bismol antiseptic & decongestant

Stalkosal Hermobleu-antiseptic

Trisbam Minhavez Collyre

Diarsid = Lomotil

Ercéfuryl 200 Hemorrhoids

Anusol suppositoires or cream

Laxative Antacid

Senokot-stimulan Gelusil comprimés (pills)

Cristal-stool softener (Glycerine) Gelusil lacte (liquid)

Maalox comprimés (pill)

Diaper rash Maalox suspension (liquid)

Deflamol

Mitosyl Tylenol

Doliprane

Wart removal Prantal

Sanitos

Asprin Methylan = Bengay

Aspro comprimés

Cough Syrup

APC Rhinathiol

Parasphan Synalar Neomycine

Sirop "roche"

Antibiotic ointment Trophires sirop-expectorant

Banedif (Bacitracin, neomycine, zinc Oxide) Netux sirop + tabs (with codeine)

Bexol = cough syrup with codeine

Cortisone cream Pulmo-fluide (bronchial condition)

Hydrocortimycine

Anti-inflammatory Antiseptic liquid

Brufen = Ibuprofen or Motrin, Advil Dermachrome

Antihistamine/Decongestant Cough drops (Pastilles)

Denoral comprimés or sirop Halls

Rinurel (sudafed, tylenol…) Clarix

Rhinathiol sirop Solutricine Pastilles

Bexol enfants sirop – anti-cough &

decongestant for children Medicated shampoo

Claritin = Clarityne Selsum

Lysothricine B6 Dramamine

Stomyteol Primperan

Zovirax Volgalene

Baralgyne Polydexa neomycine, polycmixin

Visceralgine Antibio-synalar

Otinette

Vaseline Asmotol

Vaseline

Other gastrointestinal

Toothache Antagon = Tagamet (Cimetidine)

Dentitette Asprine with codeine = Veganine

Nosedrops Antifungal

Otrivine Canestene (Solution)

Pernazene Daktarin

Dry skin Pevaryl – spray

Tonique peaux sèches Griseo – Ointment – for ring worm