Nicaragua - Back in the Third World

TRAVEL NOTES

NICARAGUA

January 2011

Part 1

Ken’s Personal Observations & Experiences:

BACK IN THE THIRD WORLD

Traveling Nicaragua with the Twenty-Something Backpackers

Part 2:

U.S. Government Information

(Centers for Disease Control & Communication, U.S. State Department)

Health

Medicine

Crime & Security

Roads

BACK IN THE THIRD WORLD

Traveling Nicaragua with the Twenty-Something Backpackers

Colorful streetscape, Granada

It had been many years since I’d been traveling in a Third World, poor country, staying in simple accommodations and relying on primitive public transportation. It was over a decade since David and I had been in South India, Laos, Brazil, Morocco. And now I was that much older, a Medicare baby, but with my young-at-heart spirit still wanting to hit the road and see the world.

Nicaragua gave us a taste of the good old days. We were usually staying at places and palling around with other budget-travelers, most of them European, in their twenties, a big backpack the sum of their luggage, and a minimum of 3 months, usually more, to travel around Central America. Our measly three-week trip was barely enough to get in the groove.

I found it very refreshing to spend time with these kids – from Holland more than from any other place, oddly enough, but also from Norway, Finland, Wales, Israel, Canada, France, Germany, Spain, Argentina, and many other places. The age difference between them and us rarely seemed to get in the way, which reinforced my “you're only as old as you feel” attitude. Many of these kids had professional jobs but had found a way to take time off, and so they tended to be quite mature and sophisticated (plus Europeans get far longer annual vacation leave than working Americans, who lag the rest of the planet). Compared to young American men and women, these travelers seemed to have a much better developed understanding of the world, current history, cultural differences – and they were stunningly intrepid.

There was a great deal I found refreshing about being in a country like Nicaragua. People were extraordinarily friendly and helpful. Life was straightforward and easygoing, without the formality of procedure that seems such a part of traveling in more developed parts of the world, particularly the U.S. In the places we visited, there were not the usual signs of our increasingly globalized world – we did not see any Starbucks, Wal-Marts, MacDonald’s. Hotels and restaurants were individually owned, family run operations. While there were pretty and upscale places, often we slept in a simple hotel with a cold shower, and ate at restaurants where you could see the woman of the family cooking up the food. The food was rarely sophisticated, but it was made from scratch (except for the occasional instant coffee) and tasty. Tropical fruit was intense with flavor, because it was local, ripe when picked, and served without fuss.

Transportation was basic. Intercity buses are recycled U.S. school buses that had seen countless miles of rough roads, but seemed to never call it quits. It was difficult to figure out schedules (assuming there were any), and travel times were long, because the buses stopped for anyone along the way who flagged them down. Ferries and launches on Lake Nicaragua generally only travel two or three days in a week. This meant several things for us. First, we realized we had to scale back our ambitious original plans to see a great deal of the country, and focus on a much more limited itinerary – in our case, pretty much the southwestern quadrant of the country – Granada, Masaya, San Juan del Sur, Ometepe Island in the middle of Lake Nicaragua, and several destinations along the southern shore of Lake Nicaragua, including the Rio San Juan, which flows from the lake all the way to the Atlantic Coast. We spent more time in fewer places, because you could eat up a good deal of your three weeks just getting from Point A to Point B. Towards the end we eased off a bit on our budget travel strictures and took taxis between cities or to some natural area, after carefully negotiating the fare. If you are good at bargaining, those taxi fares, in a country like Nicaragua, can be very reasonable, considering all the time you save.

Being in a hot country, where even the nights never got chilly, is part of the experience. Taking it easy when the midday sun is out, enjoying a beer in the late afternoon as the shadows lengthen, relaxing over dinner in an outdoor courtyard, were all part of the languidness that going to a place like Nicaragua introduces into the rhythm of one’s days.

Many of the young travelers we spent time with had also visited Costa Rica, and uniformly liked Nicaragua much better. We had been to Costa Rica 23 years before, and loved it then, but I have to assume it has changed. We heard stories of crime, greed, nastiness to tourists, a kind of complacency that comes with having been a popular destination for decades. Without exception, travelers told us how much more they enjoyed being in Nicaragua than neighboring Costa Rica.

Part of the fun of a trip such as this one is that the tourist infrastructure is still pretty basic. One doesn’t see tour buses, and I am not aware of the major (or even small-time) tour agencies offering trips to Nicaragua (e.g., Road Scholar, Overseas Adventure Travel, National Geographic). Yet Nicaragua has a wealth of natural beauty, national parks, wildlife reserves and the like. It has the volcanoes, beaches, cloud forests, bird life, flowers and trees, that Costa Rica is known for, but if you want to explore them, you have to find the local tour companies and guides to lead you up to volcano summits and introduce you to the resplendent bird and animal life. In addition to excellent local guide services, there are numerous opportunities (which we did not have time to avail ourselves of) for community-oriented stays that often include community development work projects, learning about sustainable agriculture, permaculture, coffee co-ops, and the like.

We began our trip in Granada, Nicaragua’s finest colonial city, and the first city founded by the Spanish in the Western Hemisphere (in 1524). In fact, we were never in Managua, the capital, as few recommend it for tourists, and one can take a shuttle service directly from the international airport to Granada, approximately one hour by car away. We also ended our trip in Granada, which is right on Lake Nicaragua, so that we could do several trips to natural areas (the hundreds of small islands in the lake known as Las Isletas, and the slopes of Mombacho Volcano, which forms a dramatic backdrop to the city). Granada, while not quite as spectacular on the colonial index as a number of Mexican cities, is nevertheless quite lovely, and an excellent place to relax. It is filled with outdoor cafes and restaurants that appeal to travelers (American breakfasts, health food, organic, carefully brewed coffee), has a lively main plaza (known in all Nicaraguan cities and towns as the Parque Central), some beautiful courtyards, and several historic churches and cloisters. For a return to the Third World, it was an excellent place to begin and to end.

Mombacho Volcano seen from the Convento de San Francisco Granada Street scene

Of all our nature experiences, perhaps our finest was our introduction to Los Guatuzos Wildlife Refuge. This is near the southern shore of Lake Nicaragua (2^nd largest lake in Latin America and the 10^th largest in the world). The refuge is situated along the Rio Papaturro, a short distance from the Costa Rican frontier and approximately 4 kilometers upstream of Lake Nicaragua. We had read that the bird, insect, animal, and plant life in Los Guatuzos was extraordinarily rich, and wanted to see it. Fortunately, we stopped in the offices of a very good small tour company in Granada, and the fellow behind the desk knew that the just-ended rainy season had resulted in flooding, and so the eco-lodge at Los Guatuzos was closed. But he knew the guide for the refuge, called, and notified him of our arrival. Our guide was also the lead businessman in the little village of Papaturro, in the middle of the refuge. He’d built accommodations – two cabanas joined under one roof right on the river -- he ran the very basic grocery store, and he was the wildlife guide.

Getting there was no easy matter. First we had to take the ferry from Granada to San Carlos, a ramshackle town at the southeastern corner of Lake Nicaragua. The ferry runs only twice a week, and was leaving that afternoon. The crossing took 15 hours, and we’d arrive at 5:00 a.m. the next morning. We were told that a launch was leaving San Carlos at 9:00 a.m. the morning of our arrival for Papaturro (it ran three times a week). Once we found where the boat left from, it was a 4-hour trip on a super-basic boat, with cross-boards for seats, little storage space, and a simple roof. No toilet of course!

Simple boat across Lake Nicaragua, between San Carlos and Papaturro

But it all worked out, and as we went up the jungle-fringed Rio Papaturro after cutting across Lake Nicaragua, Armando – our guide and host – pulled up in his small boat to meet us, and we transferred over. We truly were in the middle of nowhere, in a town with no electricity. But our guided trips up and down the river and a bird walk with Armando down the dirt road to the Costa Rican frontier were extraordinary experiences, as Armando had numerous bird books and knew all the scientific names. We saw all three species of monkeys native to Nicaragua, various lizards and iguanas, a baby boa constrictor, and a very active two-toed sloth! Armando’s obvious love for the natural wonders of where he lived was very palpable.

Women washing clothes in the river, Papaturro Man crossing jerry-built "bridge" on the Rio Papaturro

A housekeeper prepared delicious breakfasts and dinners for us in virtual darkness. As silence enveloped the town with nightfall, one evening we heard a group of men at a bar across the river playing guitar and singing local songs. By the time we had to take the next boat back (we had arrived on a Friday, and the next boat returning was not until Monday morning), we felt we had been in some magical, remote village (Macondo?) out of a Gabriel Garcia Marques novel. If I wanted to read at night (darkness came by 5:45 p.m.), it was by candle light, which tired me out quickly and made me think of what it must have been like in earlier eras when that was the only light there was. First light came around 5:45 a.m., and as we neared that time, not only were the roosters going, but most dramatically, the howler monkeys were letting loose with roars that easily put a lion to shame. Gradually waking up under the mosquito netting, to the bird sounds and the monkey roars, with no sound of automobiles, was perhaps the most memorable part of the whole stay in Papaturro.

Rare Green-and-Rufous Kingfisher, Rio Papaturro Iguana on the banks of the Rio Papaturro

A trip down the Rio San Juan from San Carlos, right after our return from Papaturro, was another fascinating experience. We only had time to go as far as El Castillo, about halfway to the Atlantic coast, stay overnight, and return the next morning, so we could catch our twice a week ferry from San Carlos to Ometepe Island in the middle of Lake Nicaragua. The boat down the Rio San Juan was a long, narrow launch, with rows of plastic seats, two across on one side, one across on the other, and low in the water. It was a real experience of traveling with the locals, who got on and off at tiny settlements all along the way. We arrived at El Castillo at sunset – very dramatic, and got a glimpse of the castle (“El Castillo”) on a tall hill overlooking the town, that was built by the Spanish in the mid-18^th century to stop the forays of pirates and then the British. This may become Nicaragua’s 2^nd UNESCO World Heritage Site. I got up early the next morning, before the launch’s return to San Carlos, and the night watchman let me onto the grounds – it was light at 6:00 a.m., and at least I got to take a brief tour of the castle, dominating the jungle river with a set of rapids spread across it.

Rio San Juan, at sunset, approaching El Castillo

On Ometepe Island, we eventually wound up at a dreamy “albergue” known as the Albergue Ecologico “El Porvenir” – it was built on the lower slopes of the Maderas Volcano, set in magnificent tropical gardens, with an orchard of various tropical fruits to one side (pineapples, oranges, bananas, mangoes). Everywhere there were rocking chairs and hammocks to relax in, often positioned to get wonderful views of distant Concepción Volcano, which is still active, and has the perfect conical form of Mt. Fuji.

Our room was simple but clean and attractive. It was only $20/night, but given the spectacular setting – with the gardens and volcano views – I had to ask myself if I ever needed anything more luxurious than this? And I realized that my quotient of happiness would be unlikely to be any greater in a $1000/night super-upscale luxury hotel in the Seychelles, Mauritius, or Africa than it was here in this simple, isolated, but exceedingly beautiful place. That’s a rather felicitous realization to arrive at! This kind of travel always seems to be filled with serendipitous experiences. At El Porvenir it was definitely all the interesting people we met. Amongst the most memorable were two older American men who had become friends in the Peace Corps 8 years earlier in El Salvador. They had discovered El Porvenir a year before, fell in love with it, and decided to come back. They were folk musicians, one playing guitar, the other fiddle. They’d brought sheet music of American folk songs, but also knew many other songs for which they had no music. So each night, they held a jam session, and here, in this sublimely delightful tropical paradise, I was transported back in memory to country folk festivals in America. I had any number of song requests (Wabash Cannonball, Ashokan’s Farewell, Weave Me the Sunshine), and the guys made a dedicated effort to work out the notes.

Concepción Volcano seen from an El Porvenir hammock Gardens at Albergue Ecologico "El Porvenir"

EL Porvenir was the jumping off place for two great outdoors trip. The trail up Volcan Maderas, the extinct volcano that dominants the lower loop of the figure-8 shaped Ometepe Island (active Volcan Concepción rises in the center of the upper loop), begins right at the Albergue. Nicaragua requires those hiking up and on its volcanoes to go with a guide, and we did hire one from the Union of Guides of Ometepe, a delightful young fellow named Walter. The trail was rough but beautiful, especially as we ascended to the top, where we entered a dripping cloud forest of mist and lush growth. We never made it all the way to the top, but got pretty far. The guide assured us that what we were seeing was quite similar to the forest at the summit, and we decided the journey was as important, if not more so, than the goal. We saw all kinds of bromeliads, hanging vines, leaf-cutter ants busily parading across the trail with the gigantic leaf pieces they were carrying back to their ant hill, and much more. The other trip out of El Porvenir was a kayaking journey into the lagoons of the isthmus that forms the “waist” of Ometepe Island, a rich area of bird and water plant life, backed up by jungle views of the two volcanoes.

Cloud forest view - slopes of Volcan Maderas, Ometepe Island Leaf-cutter ants traveling across trail, Volcan Maderas

Scenes while kayaking in the isthmus, Ometepe Island

Another memorable outdoor experience was a nighttime trip to La Flor National Park, south of San Juan del Sur, on the south coast, Pacific side. The park is famous for various species of endangered sea turtles that come on to shore to lay their eggs. We were present for that portion of the cycle when the baby turtles, newly hatched, dig their way up out of the nest of sand on the beach, and under the light of a full moon, find their way to the sea. The sight of these tiny 2-inch hatchlings (Olive Ridley was the turtle species) emerging onto the beach, and then, slowly, heading down into the waves, was an awesome reminder of the infinite variety of ways nature has come up with to sustain and perpetuate life. Our group watched in hushed wonder.

Olive Ridley turtle hatchlings emerging from the nest, beach, La Flor National Park

San Juan del Sur is undoubtedly the most popular town in Nicaragua for tourists, a lively mix of young and aging surfers, ex-pats, not too adventurous tourists who want just a taste, but not a whole mouthful, of Third World travel, and hedonists who simply want to enjoy a laid-back beach town. It’s got coffee houses and breakfast places with fresh-ground and carefully brewed coffee, beachfront restaurants with “typical folk dancing” and a few upscale restaurants filled with comfortably well-to-do Americans. This may make the town sound like a “must-avoid” but in fact, it is rather enjoyable, as all the different traveler types, plus real Nicaraguans, rub shoulders in a colorful mish-mash. Nearby beaches north and south of town are quite beautiful – attractive for both swimmers and surfers. In short, after weeks of rougher traveling, it is a comfortable place to slow down and enjoy the easy life.

Playa Maderas beach, north of San Juan del Sur

Another grand nature experience was exploring some trails high up on Volcan Mombacho, which frames the view from the old colonial city of Granada. Mombacho and Maderas are the only two volcanoes in Nicaragua whose slopes include the rare cloud forest eco-zone. Mombacho was as richly cloaked as Maderas and on its upper reaches we saw some of the most spectacular orchids we had ever had the good fortune to come across in the wild.

Orchid "Sobralia Macrantha", slopes of Mombacho Volcano Orchid "Spanish Flag," slopes of Mombacho Volcano

Nicaragua has more volcanoes and volcanic activity than any other Central American country. We spent the better part of a day at Volcan Masaya, the most popular national park in the country. This is a complex of several craters, one of which continues to smoke and has molten lava in a deep inner cone that can be seen on nighttime tours. Nearby is Laguna del Apoyo, a magnificently beautiful crater lake – same idea as Crater Lake in Oregon. We hiked a very steep trail from the crater rim down to the lake, and found a lovely little hotel which let us use all its facilities at no charge, if we would take a meal there, which we were delighted to do!

Smoking from Volcan Masaya Laguna del Apoyo, seen from above at Mirador de Catarina

Both Volcan Masaya and Laguna del Apoyo are close to the city of Masaya, which was our base for exploring these natural wonders. Masaya was the city that led the way in the downfall of the last of the Somoza family line of dictators (he ordered his Air Force to strafe the city), but is most famous for being considered the folkcraft capital of the country. This town was definitely not heavily touristed and gave us a genuine taste of the country, with its large Parque Central, artisanal market, hammock-making workshops, several handsome churches, a malecon (promenade) above Lago Masaya, and working class neighborhoods.

Hammocks, famous product of Masaya, at the Folk Craft Market (Mercado de Artesanias)

But back to the natural wonders of Central America. Costa Rica is famous for its parks and reserves, and as a result has developed a very sophisticated eco-tourism business. Interestingly, Nicaragua seems to have the same natural richness and beauty as Costa Rica, but far fewer non-Nicaraguans know what it has to offer. As I said earlier, we did not come across any foreign tour companies leading nature groups, but discovered there are very fine local tour companies that conduct various half-day, all-day, and multi-day trips to the numerous parks and refuges in the country. Also, if you know how to find them, there are superb free-lance guides, such as the memorable Armando in Papaturro, described above.

So, for me, Nicaragua offered the possibility of high-quality outdoors experiences without the international superstructure and the groups of overweight, pampered tourists. Costs are very reasonable, guides are knowledgeable, the places to explore are superb. There are some highly recommended reserves in the north of the country – in the coffee growing highlands (with considerably cooler temperatures) – that I would love to go to if we ever make a second trip: Selva Negra (“black jungle”) near Matagalpa, and Miraflor near Esteli. Both are renowned for their rich bird and plant life, but it is all very different from what we experienced in the southwestern quadrant of the country. (Also in the northwest is the other fine colonial city, León, which we would want to visit on any return).

In short, Nicaragua did not feel overrun by tourists, was extremely inexpensive, and felt very home-grown. The local populace is amazingly friendly (including to Americans, surprising considering our history of interference and supporting dictators there) and it all had a very low-key ambience. It gave us an opportunity to experience local life without entirely distorting it by our being there. The young European visitors we frequently talked to and traveled with consistently recommended Panama as another Central American country that they thoroughly enjoyed – rich local life and extraordinarily wild, natural places. It is definitely also on our list of places to see.

Our trip was all too short, but for the time we had, it was a refreshing return to many basics, and the experience made me feel like a young, footloose traveler once again. I think back fondly to my 10-month trip around Europe and the Middle East (1969-1970, when the dollar was strong and Europe was extraordinarily cheap), an 8-month trip around South America (1980-1981), 9 weeks crossing the Sahara from North Africa to the Gulf of Guinea and back, and two months in Nepal and India (1978-1979), and while three weeks in Nicaragua does not measure up very impressively against such long trips, it did bring back a sense of what the good old days of bumming around were like, and that they have not entirely died out yet – neither for me at this stage of my life, nor for travelers in general who still value this way of seeing the world.

Part 2: U.S. Government Information

Centers for Disease Control & Communication and U.S. Department of State

HEALTH ADVICE & GENERAL INFORMATION: NICARAGUA

Dengue Fever: Advice for Travelers

Travelers can reduce their risk of getting dengue fever by protecting themselves from mosquito bites. The mosquitoes that spread dengue usually bite at dusk and dawn but may bite at any time during the day, especially indoors, in shady areas, or when the weather is cloudy.

Travelers should follow the steps below to protect themselves from mosquito bites:

• Where possible, stay in hotels or resorts that are well screened or air conditioned and that take measures to reduce the mosquito population.

• When outdoors or in a building that is not well screened, use insect repellent on uncovered skin. If sunscreen is needed, apply before applying insect repellent.

◦ Look for a repellent that contains one of the following active ingredients: DEET, picaridin (KBR 3023), Oil of Lemon Eucalyptus/PMD, or IR3535. Always follow the instructions on the label when you use the repellent.

◦ In general, repellents protect longer against mosquito bites when they have a higher concentration (percentage) of any of these active ingredients. However, concentrations above 50% do not offer a marked increase in protection time. Products with less than 10% of an active ingredient may offer only limited protection, often no longer than 1-2 hours.

◦ The American Academy of Pediatrics approves the use of repellents with up to 30% DEET on children more than 2 months old.

◦ Protect babies less than 2 months old by using a carrier draped with mosquito netting with an elastic edge for a tight fit. For more information about the use of repellent on infants and children, please see the “Insect and Other Arthropod Protection” section in Traveling Safely with Infants and Children and the “Children” section of CDC’s Frequently Asked Questions about Repellent Use.

◦ For more information on the use of insect repellents, see the information on the Mosquito and Tick Protection webpage.

• Wear loose, long-sleeved shirts and long pants when outdoors.

◦ For greater protection, clothing may also be sprayed with repellent containing permethrin or another EPA-registered repellent. (Remember: don't use permethrin on skin.)

Symptoms and Treatment

Symptoms of dengue include:

• fever

• severe headache

• pain behind the eyes

• joint and muscle pain

• rash

• nausea/vomiting

• hemorrhagic (bleeding) manifestations

Usually dengue fever causes a mild illness, but it can be severe and lead to dengue hemorrhagic fever (DHF), which can be fatal if not treated. People who have previously been infected with dengue fever are more at risk of getting severe dengue.

No vaccine is available to prevent dengue, and there is no specific medicine to cure illness caused by dengue. Those who become ill with dengue fever can be given medicine to reduce fever, such as acetaminophen, and may need oral rehydration or intravenous fluids and, in severe cases, treatment to support their blood pressure. Aspirin (acetylsalicylic acid), aspirin-containing drugs, and other non-steroidal anti-inflammatory drugs (e.g., ibuprofen) should be avoided because of the possibility of bleeding. Early recognition and treatment of severe dengue (e.g., signs and symptoms consistent with impending blood pressure failure) can reduce the risk of death.

If you return from a trip abroad and get sick with a fever, you should seek medical care. Be sure to tell the doctor or other health-care provider about your recent travel.

Malaria: Advice for Travelers

Areas of Nicaragua with Malaria:

Present in districts of Chinandega, Leon, Managua, Matagalpa, Region Autonoma Atlantico Norte (RAAN), and Region Autonoma Atlantico Sur (RAAS). (more information)

If you will be visiting an area of Nicaragua with malaria, you will need to discuss with your doctor the best ways for you to avoid getting sick with malaria. Ways to prevent malaria include the following:

• Taking a prescription anti-malarial drug

• Using insect repellent and wearing long pants and sleeves to prevent mosquito bites

• Sleeping in air-conditioned or well-screened rooms or using bednets

Primaquine is the preferred anti-malarial drug (only after G6PD testing) in Nicaragua. Atovaquone/proguanil, chloroquine, doxycycline, and mefloquine are alternative choices. For detailed information about each of these drugs, see Table 2-23: Drugs used in the prophylaxis of malaria. For information that can help you and your doctor decide which of these drugs would be best for you, please see Choosing a Drug to Prevent Malaria.

More Information About Malaria

Malaria is always a serious disease and may be a deadly illness. Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health-care provider for a prescription anti-malarial drug and by protecting yourself against mosquito bites (see below).

Travelers to malaria risk-areas in Nicaragua, including infants, children, and former residents of Nicaragua, should take one of the antimalarial drugs listed in the box above.

Symptoms

Malaria symptoms may include

• fever

• chills

• sweats

• headache

• body aches

• nausea and vomiting

• fatigue

Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, you should see a doctor right away if you develop a fever during your trip.

Malaria may cause anemia and jaundice. Malaria infections with Plasmodium falciparum, if not promptly treated, may cause kidney failure, coma, and death. Despite using the protective measures outlined above, travelers may still develop malaria up to a year after returning from a malarious area. You should see a doctor immediately if you develop a fever anytime during the year following your return and tell the physician of your travel.

U.S. Embassy – Managua, Nicaragua

Km 5 ½ Carretera Sur, Managua – Nicaragua

Telephone: (505) 2252-7100

Emergency after-hours telephone: (505) 8882-3140

Facsimile: (505) 2252-7250

Items to Bring With You:

Medicines you may need:

• The prescription medicines you take every day. Make sure you have enough to last during your trip. Keep them in their original prescription bottles and always in your carry-on luggage. Be sure to follow security guidelines, if the medicines are liquids.

• Anti-malarial drugs, if traveling to a malaria-risk area in Nicaragua and prescribed by your doctor.

• Medicine for diarrhea, usually over-the-counter.

Note: Some drugs available by prescription in the US are illegal in other countries. Check the US Department of State Consular Information Sheets for the country(s) you intend to visit or the embassy or consulate for that country(s). If your medication is not allowed in the country you will be visiting, ask your health-care provider to write a letter on office stationery stating the medication has been prescribed for you.

Other items you may need:

• Iodine tablets and portable water filters to purify water if bottled water is not available. See A Guide to Water Filters, A Guide to Commercially-Bottled Water and Other Beverages, and Safe Food and Water for more detailed information.

• Sunblock and sunglasses for protection from harmful effects of UV sun rays. See Basic Information about Skin Cancer for more information.

• Antibacterial hand wipes or alcohol-based hand sanitizer containing at least 60% alcohol.

• To prevent insect/mosquito bites, bring:

◦ Lightweight long-sleeved shirts, long pants, and a hat to wear outside, whenever possible.

◦ Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.

◦ Bed nets treated with permethrin, if you will not be sleeping in an air-conditioned or well-screened room and will be in malaria-risk areas. For use and purchasing information, see Insecticide Treated Bed Nets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.

See other suggested over-the-counter medications and first aid items for a travelers' health kit.

Staying Healthy During Your Trip:

Prevent Insect Bites

Many diseases, like malaria and dengue, are spread through insect bites. One of the best protections is to prevent insect bites by:

• Using insect repellent (bug spray) with 30%-50% DEET. Picaridin, available in 7% and 15% concentrations, needs more frequent application. There is less information available on how effective picaridin is at protecting against all of the types of mosquitoes that transmit malaria.

• Wearing long-sleeved shirts, long pants, and a hat outdoors.

• Remaining indoors in a screened or air-conditioned area during the peak biting period for malaria (dusk and dawn).

• Sleeping in beds covered by nets treated with permethrin, if not sleeping in an air-conditioned or well-screened room.

• Spraying rooms with products effective against flying insects, such as those containing pyrethroid.

For detailed information about insect repellent use, see Insect and Arthropod Protection.

Prevent Animal Bites and Scratches

Direct contact with animals can spread diseases like rabies or cause serious injury or illness. It is important to prevent animal bites and scratches.

• Be sure you are up to date with tetanus vaccination.

• Do not touch or feed any animals, including dogs and cats. Even animals that look like healthy pets can have rabies or other diseases.

• Help children stay safe by supervising them carefully around all animals.

• If you are bitten or scratched, wash the wound well with soap and water and go to a doctor right away.

• After your trip, be sure to tell your doctor or state health department if you were bitten or scratched during travel.

For more information about rabies and travel, see the Rabies chapter of the Yellow Book or CDC's Rabies homepage. For more information about how to protect yourself from other risks related to animals, see Animal-Associated Hazards.

Be Careful about Food and Water

Diseases from food and water are the leading cause of illness in travelers. Follow these tips for safe eating and drinking:

• Wash your hands often with soap and water, especially before eating. If soap and water are not available, use an alcohol-based hand gel (with at least 60% alcohol).

• Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.

• Do not eat food purchased from street vendors.

• Make sure food is fully cooked.

• Avoid dairy products, unless you know they have been pasteurized.

Diseases from food and water often cause vomiting and diarrhea. Make sure to bring diarrhea medicine with you so that you can treat mild cases yourself.

Medical Facilities and Health Information:

Medical care is very limited, especially outside of Managua. Basic medical services are available in Managua and in many of the smaller towns and villages. However, treatment for many serious medical problems is either unavailable or available only in Managua. Emergency ambulance services, as well as certain types of medical equipment, medications and treatments, are not available in Nicaragua. Physicians and hospital personnel frequently do not speak English, and medical reports are written in Spanish.

In an emergency, individuals are taken to the nearest hospital that will accept a patient. This is usually a public hospital, where conditions are poor, unless the individual or someone acting on their behalf indicates that they can pay for a private hospital. Payment for medical services is typically done on a cash basis, although the few private hospitals will accept major credit cards for payment. Hospital Metropolitano in Managua does have a direct contract with BlueCross/BlueShield but U.S. health insurance plans are generally not accepted in Nicaragua.

Dengue fever is endemic to Nicaragua and outbreaks are common during rainy season, even in Managua. Currently, no vaccine or specific medication is available to prevent or treat dengue fever. Malaria is endemic to the Atlantic coast region and anti-malarial medication should be taken before and after travel to this region. Travelers are advised to take a prophylactic regimen best suited to their health profile. No prophylaxis anti-malarial medication is required for Managua and the Pacific coast region. For bothdengue fever and malaria, the best prevention is the use of insect repellant containing DEET, and wearing protective clothing and bed-nets to prevent mosquito bites.

Tap water is not considered safe in Nicaragua. All persons should drink only bottled water.

Individuals traveling to Nicaragua should ensure that all their routine vaccinations are up to date. Vaccinations against Hepatitis A, Hepatitis B, rabies and typhoid are strongly recommended. A yellow fever vaccination is not required to enter Nicaragua unless the traveler has recently visited a country where yellow fever is endemic. Travelers taking prescription medications should bring an adequate supply with them when coming to Nicaragua. Many newer combination medications are not available in local pharmacies.

Crime:

Violent crime in Managua is increasing and petty street crimes and taxi-kidnappings are common. Gang activity also is increasing, though not at levels found in neighboring Central American countries. Pick-pocketing and occasional armed robberies occur on crowded buses, at bus stops and in open markets like the Oriental and Huembes Markets. Gang violence, drive-by shootings, robbery, assault and stabbings are most frequently encountered in poorer neighborhoods, including the Rene Schick and Jorge Dimitrov neighborhoods in Managua and the Ticabus stop area, a major arrival and departure point for tourist buses.

U.S. citizens should exercise particular caution when approached by strangers offering assistance with finding a taxi cab. To ensure safer travel, radio-dispatched taxis are recommended and can be found at the International Airport and at the larger hotels. In any case, entering a taxi, make sure that it has a red-bordered license plate and that the number is legible. Pick taxis carefully and note the driver's name and license number. Instruct the driver not to pick up other passengers, agree on the fare before departing, and have small bills available for payment, as taxi drivers often do not make change. Also, check that the taxi is properly labeled with the cooperativa (company) name and logo. While riding in a vehicle, windows should be closed, car doors locked and valuables placed out of sight. Purse and jewelry snatchings sometimes occur at stoplights.

Dozens of U.S. citizens have reported being victimized by fellow travelers who befriended them then offered to assist them in locating and/or sharing a taxi. Upon entering the taxi, the U.S. citizens were held at knife-point or with a gun, threatened with bodily injury and/or rape, robbed of their valuables and driven around to ATM machines to withdraw funds from their accounts. After the assault, the U.S. citizen victims were left abandoned and destitute in remote areas. This crime is particularly common around the International Airport area and in the cities of Managua, Rivas, Granada and Masaya

Do not resist a robbery attempt. Many criminals have weapons, and most injuries and deaths have resulted when victims have resisted. Do not hitchhike or go home with strangers, particularly from nightclubs. Travel in groups of two or more persons whenever possible. Use the same common sense while traveling in Nicaragua that you would in any high-crime area of a large U.S. city. Do not wear excessive jewelry in downtown or rural areas. Do not carry large sums of money, ATM or credit cards that are not needed, or other valuables.

In the past, there have been instances of U.S. citizens targeted by criminals posing as Nicaraguan police officers who pull over their vehicles – including those operated by reputable hotels – for inspection. In each case, the incidents happened after dark and involved gun-wielding assailants who robbed passengers of all valuables and abandoned them in remote locations. Some assailants employed threats of physical violence. While the traditional scene of these attacks has been the Tipitapa-Masaya Highway, this activity has also spread to the Managua-Leon Highway. Though some of the criminal bands have been caught, exercise extreme caution when driving at night near Managua’s International Airport, on the Managua-Leon highway and the Tipitapa-Masaya Highway.

In the past few months, the Embassy has received several reports of U.S. citizens being victims of armed robbery when stopping at the Momotombo Mirador (look-out point) on the New Leon Highway. They have reported that they are approached by a group of five armed men, threatened and held at knife-point close to the lake while they are robbed of all their belongings

Though violent criminal activity has decreased in the tourist destination of San Juan del Sur, armed robberies and theft continue to be problematic. In September 2009, a U.S. citizen family was violently assaulted and robbed by several armed men. Other American citizens were the victims of armed robberies by assailants wielding machetes, knives and/or guns along the beaches in and around San Juan del Sur. U.S. citizens should continue to exercise caution when visiting the beaches of Maderas, Marsella, Yankee, Coco and Remanso.

Police coverage is extremely sparse outside of major urban areas, particularly in Nicaragua’s Atlantic coast autonomous regions. Lack of adequate police coverage has resulted in these areas being used by drug traffickers and other criminal elements. Two Nicaraguan navy personnel died during a December 2009 clash between traffickers and government forces in the remote coastal community of Walpasiksa. Street crime and petty theft are common problems in Puerto Cabezas, Bluefields and the Corn Islands along the Atlantic coast. For security reasons, the Embassy has limited travel by its staff to the North and South Atlantic Autonomous Regions (RAAN and RAAS), including the Corn Islands. Given the area’s geographical isolation, the Embassy’s ability to provide emergency services to U.S. citizens who choose to travel in the Caribbean coastal area is constrained. Police presence on Little Corn Island is intermittent and officers have little resources in case of an emergency. Police officials must travel from Big Corn Island if there is a disturbance or reported crime. U.S. citizens have previously been the victims of sexual assault on Little Corn Island and other beaches in the country. The Embassy recommends traveling in groups when in isolated areas. Single travelers should exercise special caution while traveling in the Corn Islands and other remote areas of the country.

Throughout the country, U.S. travelers should utilize hotels and guest houses which have strong security elements in place, including but not limited to rooms equipped with safes for securing valuables and travel documents and adequate access control precautions.

Do not leave valuables inside parked vehicles. Recently, several U.S citizens have reported vehicle break-ins outside of gasoline stations and restaurants. The U.S. Embassy has also noted a gradual increase in the use of armed violence and hostage taking following residential break-ins. U.S. citizens are urged to review residential security procedures, including with their domestic employees, and strengthen security measures to help safeguard their houses.

In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products may be illegal under local law. In addition, bringing them back to the United States may result in forfeitures and/or fines. The Computer Crime and Intellectual Property Division in the U.S. Department of Justice has more information on this serious problem.

Traffic Safety and Road Conditions:

While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. Driving in Nicaragua poses many difficulties and risks, including mandatory arrest for drivers involved in accidents that result in death or serious injury until police are able to determine who is at fault. If involved in an accident do not move your vehicle or any vehicle involved in the accident, even to clear traffic. A person who moves a vehicle before the police arrive will often be held legally liable for the accident regardless of what actually occurred.

Driving is on the right side of the road in Nicaragua. Motorists driving to Nicaragua should use the principal highways and official border crossings at Guasaule, El Espino and Las Manos between Nicaragua and Honduras and Penas Blancas between Nicaragua and Costa Rica. Although some of the principal highways connecting the major cities are in generally good condition, drivers should be aware that seasonal, torrential rains take a heavy toll on road beds. With few exceptions, secondary roads are in poor repair, potholed, poorly lit, frequently narrow, and lack shoulders. Road travel after dark is especially hazardous in all areas of the country. Motorists are encouraged to prepare accordingly and to carry a cellular phone in case of an emergency.

Some of the major highways and roads are undergoing major repairs, repaving and upgrading. Be on the lookout for detours and slow traffic on these roads. In general, road signs are poor or non-existent. Bicycles, oxcarts, dogs, horses and vehicles without lights are encountered even on main thoroughfares in Nicaragua. The lack of sidewalks, medians and crosswalks force pedestrians to walk dangerously close to traffic. Motorcycles, often carrying passengers, dart in and out of traffic with little or no warning. Many vehicles are in poor condition, travel very slowly and break down without warning. Drivers should be especially careful on curves and hills, as many drivers will pass on blind spots. Speed limits vary depending on the type of road and, because the government lacks the resources, traffic rules are rarely enforced.

Due to the age and disrepair of many vehicles, many drivers will not signal their intentions using turn indicators. Rather, it is common for a vehicle operator to stick his hand out the window to signal a turn. If you do drive in Nicaragua, you need to exercise the utmost caution, drive defensively and make sure you have insurance.

Nicaraguan law requires that a driver be taken into custody for driving under the influence or being involved in an accident that causes serious injury or death, even if the driver is insured and appears not to have been at fault. The minimum detention period is 48 hours However, detentions frequently last until a judicial decision is reached, often weeks or months, or until a waiver is signed by the injured party, usually as the result of a cash settlement.

Visitors to Nicaragua might want to consider hiring a professional driver during their stay. Licensed drivers who are familiar with local roads can be hired through local car rental agencies. In case of accident, only the driver will be taken into custody.

The Embassy regularly receives complaints from U.S. citizens who have been stopped by transit police authorities demanding bribes in order to avoid payment of fines. Motorists in rental cars and those whose cars have foreign license plates are more likely to be stopped by transit police. Transit police have seized driver licenses and car registration documents from motorists who refuse or are unable to pay. Subsequently, these drivers have reported difficulties in recovering the seized documents. U.S. citizens are urged to ensure that their vehicles comply fully with Nicaraguan transit regulations, including being in possession of an emergency triangle and fire extinguisher, and that the vehicle is properly registered. If transit police authorities demand an on-the-spot payment, drivers should ask for the officer's name and badge number, as well as a receipt, and inform the Embassy of when/where the event took place. Reports should be sent via email. Rental car agencies should also be advised if their vehicles have been deemed negligent in meeting Nicaraguan transit regulations.

Avoid taking local buses. They are overcrowded, unsafe and often are used by pickpockets. Because of the conditions discussed above, traffic accidents often result in serious injury or death. This is most often true when heavy vehicles, such as buses or trucks, are involved. By law, vehicles involved in accidents in Nicaragua may not be moved - even to clear traffic- until authorized by a police officer. Drivers who violate this norm may be held legally liable for the accident.

Regulations governing transit are administered by the National Police. For specific information concerning Nicaraguan driver’s permits, vehicle inspection, road tax, and mandatory insurance, you may wish to refer to the National Police web site. You may also contact the Embassy of Nicaragua or a Consulate for further information.