Time Zone: +5 hours. No daylight saving time in 2008.
Tel. Country Code: 993
USADirect Tel.: 0
Electrical Standards: Electrical current is 220/50 (volts/hz). North American Style Adaptor Plug and European Style Adaptor Plug. Grounding Adaptor Plugs A, D.
TRAVEL ADVISORY - TURKMENISTAN
Europe, Russia and former the Soviet Union countries vary widely in travel risks and adequacy of health care delivery. Water- and food-borne illnesses such as travelers' diarrhea, typhoid and Giardia are threats outside of Western Europe. Insect-transmitted diseases, such as Lyme disease and tick-borne encephalitis are common in wooded, rural areas in most countries, including Western Europe.
• Canada’s embassy in Ankara, Turkey provides diplomatic and consular services to Azerbaijan, Georgia & Turkmenistan.
The Canadian Embassy
Tel:  (312) 409 27 00
Fax:  (312) 409 27 12
Canadian citizens may access the Watch Office in Ottawa at no charge by calling the Embassy and following instructions or by calling collect:  (613) 996-8885.
• British Embassy
3rd Floor Office Building
Four Points Ak Altyn Hotel
Tel:  (12) 36 34 62
Fax:  (12) 36 34 65
Out of office emergency mobile:
(99 366) 30 20 65
ENTRY/EXIT REQUIREMENTS: American citizens must have a valid passport and visa and/or letter of invitation from the Government of Turkmenistan to enter and exit Turkmenistan. To apply for a visa, all U.S. citizens must complete an application and have a letter of invitation approved by the State Service for the Registration of Foreigners (SSRF) in Ashgabat.
Visitors holding tourist visas organized by a travel agency must stay in hotels; other visitors may stay in private accommodations whose owner must register the visitor’s presence. Visit the Embassy of Turkmenistan web site at www.turkmenistanembassy.orgfor the most current visa information.
More information here: http://www.sitara.com/turkmenistan/general.html
HIV Test: Required for foreign visitors staying more then 3 months.
Required Vaccinations: None required.
Turkmenistan is a Central Asian nation roughly the size of California. It shares borders with Kazakhstan, Uzbekistan, Afghanistan, and Iran. Turkmenistan gained its independence in 1991 during the dissolution of the Soviet Union. Primarily a desert country, it has a population of around six million people. Tourist facilities, especially outside of the capital city of Ashgabat, are not highly developed. Many of the goods and services taken for granted in North American and Western European countries are not yet available. Travel within the country can be difficult due to limited infrastructure and government-imposed internal travel restrictions.
VACCINATIONS: RECOMMENDED AND ROUTINE
HOSPITALS / DOCTORS
All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers diarrhea or other infections; they should bring drugs for malaria prophylaxis, if needed according to their itinerary. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country - the equivalent drugs may not be available or may be of unreliable quality.
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage. Policies should cover: ground and air ambulance transport, including evacuation to home country; payment of hospital bills; 24-hour telephone assistance. Serious illness or injury may require medical evacuation to Europe.
Medical care is limited and substandard throughout the country including in Ashgabat. There is a shortage of basic supplies, including disposable needles, anaesthetics and antibiotics. Doctors and hospitals expect immediate cash payment for health services.
Important telephone numbers in Ashgabat:
• City Ambulance: 03
• VIP Hospital
Tel:  12 39 87 77
• Turkish Central Hospital
Tel:  12 45 03 03
DESTINATION HEALTH INFO FOR TRAVELERS
AIDS/HIV: Central Asia contains Kazakhstan, Uzbekistan, Turkmenistan, Kyrgyzstan and Kazakhstan. Throughout this region HIV epidemics are growing rapidly. In 1995 there were almost no reported cases in the region. However, from 2003 to 2005 UNAIDS estimates the number of people living with HIV infection has more than doubled. Central Asia contains major drug trafficking routes connecting to Europe, resulting in large amounts of injecting drug use. Indeed, in some parts of the region, heroin is now said to be cheaper than alcohol, driving its use as a recreational drug.
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with the body fluids of another person or their blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.
Note: There is a risk of exposure to unsafe blood and blood products in Turkmenistan. Travelers may need to specifically request the use of sterilized equipment. Additional charges may be incurred for the use of new syringes in hospitals or clinics.
Accidents & Medical Insurance: Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.
Arboviral Diseases: Tahjna virus fever (mosquito-borne; virus circulates through much of the former USSR).
• Sandfly fever (sandfly-borne; limited to regions of southern central Asia, April–October).
• Dengue fever (mosquito-borne; no recent cases reported).
• West Nile fever (mosquito-borne; cases have occurred in the Tadzikstan).
• North Asian tick fever (occurs wherever tick vectors are found).
Cholera: This disease may occur, but no recent cases have been reported. The threat to tourists is very low. Cholera vaccine is recommended only for relief workers or health care personnel who are working in a high-risk endemic area under less than adequate sanitary conditions, or travelers who work or live in remote, endemic or epidemic areas and who do not have ready access to medical care. Canada, Australia, and countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States.
• The main symptom of more severe cholera is copious watery diarrhea.
• Antibiotic therapy is a useful adjunct to fluid replacement in the treatment of cholera by substantially reducing the duration and volume of diarrhea and thereby lessening fluid requirements and shortening the duration of hospitalization.
• A single 1-gm oral dose of azithromycin is effective treatment for severe cholera in adults. This drug is also effective for treating cholera in children. (NEJM:http://content.nejm.org/cgi/content/short/354/23/2452)
Crimean-Congo Hemorrhagic Fever: A tick-borne viral illness, also known as Central Asian hemorrhagic fever, is endemic. Risk areas are rural steppe, savannah, semi-desert, and foothill/low mountain habitats below 2,000 meters elevation. Outbreaks occurred in southcentral Kazakhstan during 1989. Tourists are at low risk.
Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Travelers who are non-immune to hepatitis A (i.e. have never had the disease and have not been vaccinated) should take particular care to avoid potentially contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation.
• Hepatitis E is endemic but levels are unclear. Sporadic cases may be underdiagnosed or underreported. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals, such as swine, and also deer and wild boar, may serve as a viral reservoirs. (HEV is one of the few viruses which has been shown to be transmitted directly from animals through food.) In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• Hepatitis B is hyperendemic. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at >8%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic but the prevalence is unclear. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C - an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.
Insects: All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include a DEET-containing repellent applied to exposed skin, insecticide (permethrin) spray applied to clothing and gear, and use of a permthrin-treated bednet at night while sleeping.
Leishmaniasis: There is low risk for cutaneous and visceral leishmaniasis. Travelers should take measures to prevent sandfly bites.
Lyme Disease: Occurs focally in rural forested areas below 1,500 meters elevation. Lyme disease is transmitted by Ixodes ticks that are found in wooded, brushy areas, although transmission can also occur in backyards of homes in endemic areas.
All travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions of endemic areas should take measures to prevent tick bites. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.http://content.nejm.org/cgi/content/abstract/345/2/79).
Malaria: Malaria is present in in the south-east, mainly in the Mary district and in the flood plains between the Murgab and Tedzhen Rivers, from June-October. Chloroquine prophylaxis is recommnended for travel to this region during the transmission season.
A malaria map is located on the Fit for Travel website (www.fitfortravel.nhs.uk), which is compiled and maintained by experts from the Travel Health division at Health Protection Scotland (HPS). Go to www.fitfortravel.nhs.uk and select Malaria Map from the Turkmenistan page on the Destinations menu or A-Z Index.
Malaria is transmitted via the bite of an infected female Anopheles mosquito. Anopheles mosquitoes feed predominantly during the hours from dusk to dawn. All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents have been the gold standard of protection under circumstances in which it is crucial to be protected against insect bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
NOTE: Picaridin repellents (20% formulation, such as Sawyer Picaridin or Natrapel 8-hour) are now recommended by the CDC and the World Health Organization as acceptable non-DEET alternatives to protect against malaria-transmitting mosquito bites. Picaridin is also effective and ticks and biting flies.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.
• Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours.
Other Diseases/Hazards: Brucellosis (travelers should avoid unpasteurized dairy products, especially goat cheese)
• Bchinococcosis (dog and shheep feces may be infective)
• Tick-borne relapsing fever (reported from Kirghizstan, Turkmenistan, and Uzbekistan)
Rabies: Sporadic cases of human rabies are reported. Pre-exposure rabies vaccine is recommended for travel longer than 3 months, for shorter stays in rural when travelers plan to venture off the usual tourist routes and where they may be more exposed to the stray dog population; when travelers desire extra protection; or when they will not be able to get immediate medical care.
• All animal bite wounds, especially from a dog, should be thoroughly cleansed with soap and water and then medically evaluated for possible post-exposure treatment, regardless of your vaccination status. Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Even if rabies vaccine was administered before travel, you will need a 2-dose booster series of vaccine after the bite of a rabid animal.
Tick-Borne Encephalitis (TBE): Peak transmission period is April through June. Risk is present primarily in rural brushy and forested areas below 1,500 meters elevation. TBE is usually known as “Central European tick-borne encephalitis” or “Russian spring-summer encephalitis” west of the Urals. The TBE vaccine (available in Canada and Europe), is recommended only for people at significant risk of exposure to tick-bites, for example, campers and hikers on extended trips, or forestry workers.
• Travelers, especially those engaging in outdoor activities in rural areas, are advised to take measures to prevent tick bites from March to November. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A map showing the distribution of TBE is here:http://www.nathnac.org/includes/contents/documents/TBEmap.gif
More information on TBE at:http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/TBE.htm
Travelers' Diarrhea: All water supplies are suspect, including municipal tap water, which may be untreated and grossly contaminated. Outside of hotels and resorts, we recommend that you boil, filter or purify all drinking water or drink only bottled water or other bottled beverages and do not use ice cubes. Avoid unpasteurized dairy products. Do not eat raw or undercooked food, especially meat, fish, raw vegetables. Peel all fruits.
• Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%.
• A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.
• Seek qualified medical care if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.
Tuberculosis: Tuberculosis is highly endemic in Turkmenistan with an annual occurrence was greater than or equal to 40 cases per 100,000 population. Tuberculosis (TB) is transmitted following inhalation of infectious respiratory droplets. Most travelers are at low risk. Travelers at higher risk include those who are visiting friends and relatives (particularly young children), long-term travelers, and those who have close contact, prolonged contact with the local population. There is no prophylactic drug to prevent TB. Travelers with significant exposure should have PPD skin testing done to evaluate their risk of infection.
• Multidrug-resistant tuberculosis (MDR-TB) has emerged as a major threat to TB control, particularly in the former Soviet Union. About 11% of patients in Turkmenistan are infected with multidrug-resistant strains of TB.
MDR-TB is defined as resistance to three or more second line antibiotics for TB. The condition remains treatable with other types of medications, but those are less effective, costlier and toxic. MDR-TB is often fatal if not treated within a month.
Typhoid Fever: Typhoid fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended by the CDC for all people (with the possible exception of short-term visitors who restrict their meals to hotels) traveling to or working in Central Asia, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi, the cause of paratyphoid fever. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should continue to practice strict food, water and personal hygiene precautions, even if vaccinated.