Staying Healthy in Turkey

STAYING HEALTHY IN TURKEY

Turkey – some statistics

• Statistics• Total population 74,816,000• Gross national income per capita (PPP international $) 13,420• Life expectancy at birth m/f (years) 72/77• Probability of dying under five (per 1 000 live births) 20• Probability of dying between 15 and 60 years m/f (per 1 000

population) 134/73• Total expenditure on health per capita (Intl $, 2009) 965• Total expenditure on health as % of GDP (2009) 6.7• Figures are for 2009 unless indicated. Source: Global Health

Observatory

Health Issues for Turkey

• Rabies

• Water Safety

• Food Safety

• Tuberculosis

• Road Safety

• Earthquakes

• Malaria

• Other issues

RABIES

• Rabies is an acute viral infection that is nearly always fatal. Transmission is usually through saliva via the bite of an infected animal, with dogs being the main transmitter of rabies to humans. The World Health Organization has estimated the annual number of human rabies deaths to be in excess of 55,000. Most of these deaths take place in developing countries, particularly in South and South East Asia.

Rabies in Turkey

• According to the UK’s Public Health Agency, Turkey is a ‘high-risk’ country for rabies.

Human Deaths in Turkey from Rabies

• After a bite from a suspected rabies-infected animal, the development of the disease can be prevented with appropriate post-exposure prophylaxis. In Turkey, approximately 167,000 suspected rabies-infected animal bites are seen in health clinics each year, and an average of 1–3 rabies-related deaths occur annually. Appropriate post-exposure rabies prophylaxis is very important. Death rate after contracting rabies is 100%.

If you get bitten.......

• Turkish health services have an extremely organized and efficient system to make sure that with prompt and correct attention the fatal ‘worst case scenario’ can be avoided.

• Allocated state hospitals in every district carry the rabies vaccine and will immunize for free if a person has been bitten.

Ankara State Hospitals that provide rabies vaccine:

• Saglik Bakanligi Ankara Egitim ve ArastirmaHastanesi, Ulucanlar, Ankara

• Tel: (0312) 595 3000

• Ataturk Hastanesi, Bilkent, Ankara

• Tel: (0312) 291 2525

• For both hospitals, go to: ‘enfeksiyonpoliklinigi’

WATER

• Ankara’s water authority is known as “ASKI”

Ankara’s Water Supply

• 7 main reservoirs around Ankara and water also supplied from the Kizilirmak River (125km pipeline at a cost of $350 million) in order to supply the growing needs of the city.

Water TestingASKİ water testing Laboratory uses the following

guidelines and quality controls: TS-266, ASTM, Standard Methods, EPA and EEC standards. In addition, water is tested from 1238 different sources within the city and the results published on ASKI’s (water authority’s) website every week.

Ankara’s projected water demand

Water and Liquid Precautions

• Water should only be drunk when you are sure of its purity.

• Try to drink bottled water whenever possible.

• This applies to water used for making ice cubes and cleaning the teeth.

• Tap water is safe to use for cooking as long as you are boiling it.

Food

• Avoid leftovers or food that may have been exposed to the air for any length of time.

• Fish and shellfish can be hazardous at certain times of the year, even if well cooked. Take local advice about seafood but when in doubt it is best to avoid.

• Vegetables should ideally be eaten when thoroughly cooked.

Meat

• Meat should be freshly prepared, thoroughly cooked and eaten hot whenever possible

Cheese/Milk

• Cheese and ice cream are often made from unpasteurised milk and when in doubt, these should only be bought from larger, well established retailers where quality can usually be assured.

Salads

• Green salads should be avoided as these are easily contaminated by soil or flies and are difficult to clean.

• When buying lettuces/spinach etc. make sure that you pre-soak them and then wash each leaf thoroughly with clean water. According to the WHO, no bleach solution is required to clean the fruit and veg in Turkey.

Tuberculosis (Tb) IncidenceAccording to the WHO, a country with an incidence of 44+ per 100,000 is classed as a

‘high-risk’ country...

Country Year Incidence of Tb per 100,000 per year

Turkey 1990 58

Turkey 2010 24

United Kingdom 1990 12

United Kingdom 2010 13

How Tb is spread...

Avoidance...

• Avoid crowded areas such as public transport during rush-hour...

PPD Skin-testing for Tb

• In the US, annual PPD skin-testing is recommended for folk living overseas in areas with high incidence of Tb.

• For Turkey, have a PPD on arrival in the country and prior to leaving Turkey.

Road Safety http://www.youtube.com/watch?v=Xr

GIyWDUrX4

• Nearly 10,000 people lose their lives due to traffic accidents in Turkey each year.

• And it has a lot to do with mentality. “There really is no culture of road safety in Turkey. It's just not part of the mentality yet,” said Dr. Etienne Krug from the World Health Organization (WHO)

• The total socioeconomic cost of last year's traffic accidents could be as much as TL 16.5 billion

(source: Today’s Zaman, August 27, 2012)

• Only 22 per cent of drivers wear a seat belt in Ankara

• Not wearing a seat belt, together with excess speed, is one of the leading causes of deaths and injuries on the road in Turkey

• Turkey, with over 23 million drivers and more than 16 million registered vehicles on the road, aims to cut the number of road casualties in half in 10 years.

Turkey is making progress…

• In the last 10 years, deaths from accidents has decreased by 8 percent. Compared to 2010, the number of fatal crashes in Turkey decreased last year by 3.6 percent, while the number of people who lost their lives dropped by 5.2 percent.

So…

• Always expect the unexpected

• Always buckle up

EARTHQUAKESTurkey’s most seismically active areas......

• 1999 – Devastating earthquake in Istanbul area... 17,127 killed and 43,959 injured, but many sources suggest the actual figure may have been closer to 45,000 dead and a similar number injured

Earthquake Survival Kits

• Keep an earthquake survival kit in your homes. For more information, go to:

http://72hours.org/index.html .

What to do in an earthquake...http://www.earthquakecountry.info/d

ropcoverholdon/

Malaria

Malaria statistics…

• 9 cases of confirmed malaria in Turkey in 2010

• Prophylaxis is recommended for the southeastern part of the country. Peak transmission occurs from May to October

• Use insect repellent precautions

Other issues…

• An outbreak of Crimean-Congo hemorrhagic fever (CCHF) was reported in May 2012 from the Black Sea Region, causing five fatal cases: three in residents of Kastamonu province in northern Turkey, a shepherd from Tokat district in Tokatprovince, and a farmer from Corum province. As of June 2008, a total of 1315 confirmed cases and 63 deaths had been described. Five cases occurred in health care providers. In the first eight months of 2009, a total of 274 cases were identified, of which 61 were fatal (see Eurosurveillance and ProMED-mail).

• Crimean-Congo hemorrhagic fever is a life-threatening viral infection which is usually transmitted by ticks (less commonly by direct contact with infected animals or by exposure to an infected person). In Turkey, most cases occur between May and September and most are reported from the eastern provinces of Tokat, Yozgat, and Sivas (see Emerging Infectious Diseases). Initial symptoms may include fever, muscle aches, backache, joint pains, headaches, dizziness, and light sensitivity. Complications may result from hemorrhage into the skin, intestine, or other sites.

Use insect precautions…

Tick removal

Pharmacies/Eczanes

• Open 08.30 – 19.00 Mon-Friday

• Open 08.30 – 18.00 Saturday

• Sunday – check online for on-call pharmacy in your district: http://www.asm.gov.tr/eczane.htm

Ambulances and Hospitals

• Turkish State Ambulance 112

• MedLine Private Ambulance 4441212

• Guven Hospital 4572525 (English-speaking coordinator's direct line = 4572535)

• Tobb Etu Hospital 2929995

• For hospital/clinic in your area when travelling, go to: www.hastane.com.tr

Any questions?