Chapter 4Select Destinations

Ava W. Navin, Emily S. Jentes

DESTINATION OVERVIEW

Guatemala, known as the Land of Eternal Spring for the temperate climate and lush foliage of its highlands, is located in Central America, with Mexico to the north, Belize to the east, and Honduras and El Salvador to the south and east. In an area the size of Tennessee, Guatemala offers a wide variety of topography: from active volcanoes to the black sand beach and mangrove swamp of Monterrico and the cloud forest reserve of the Biotopo del Quetzal. The visitor to the bustling market town of Chichicastenango in the highlands (7,125 ft; 2,171 m) will need preparation different from that for the visitor to the Mayan temples of Tikal in the hot lowlands of the Petén (636 ft; 193 m). Belize, an equally beautiful tropical paradise, is roughly the size of the state of Massachusetts. Northern Belize is characterized by coastal plains with pockets of dense forest, whereas the west and south are predominantly coastal plains/ savannas and low mountains, respectively. To the east, Belize’s coastline with the Caribbean Sea boasts sandy white beaches, numerous islands, and the second-longest barrier reef in the world.

Tourists interested in the Ruta Maya often visit sites in both Guatemala and Belize. Temples and ball courts, the remnants of the Mayan civilization that flourished in the Yucatán 1,000 years ago, have been reclaimed from the jungle. In Belize, the Mayan ruins of Xunantunich (Cayo District), Caracol (Cayo District), and Lamanai (Orange Walk District), among others, provide impressive excavated examples of the cities and leave the visitors wondering what else might be hidden underneath the trees and hills.

The colonial capital of Antigua, Guatemala (5,193 ft; 1,582 m), a UNESCO World Heritage site, was founded in 1543 by Spanish conquistadors and destroyed by an earthquake in 1773. The ruins of the cathedral, government buildings, and monasteries provide a hint of colonial grandeur. Holy Week, when the images from the churches are carried through the streets in colorful processions, is an especially popular time to visit Antigua.

Travelers visiting Belize’s inland regions will enjoy a variety of adventure activities, including climbing the ruins, zip-lining through jungle canopies, cave tubing, hiking, and canoeing. However, most visitors to Belize are drawn to the sandy white beaches and to the barrier reefs off the coast, which boast some of the best scuba diving in the Caribbean. Near Ambergris Caye, The Hol Chan Marine Reserve and the Great Blue Hole (a UNESCO World Heritage site) are popular sites for both scuba divers and snorkelers, who will be delighted by the variety of fish, eels, and coral living in the clear blue-green water.

Guatemala’s tremendous geographic variety extends to its linguistic richness: in addition to Spanish, 21 distinct Mayan languages and many more dialects are spoken. In rural areas, Spanish is more often a second language, and Mayan customs and rituals are still observed. Guatemala, especially Antigua, is noted for immersion language schools; students can live with a family while they attend classes. Belize is similarly linguistically diverse. Although the official language of Belize is English, Belizean Creole, Spanish, Mayan languages, and Plautdietsch (a variety of German spoken by Mennonite settlers) are also spoken.

HEALTH ISSUES

Immunizations

All travelers should always be up to date on routine vaccinations. Hepatitis A and B vaccines are recommended for visitors to both countries. Typhoid vaccination is also recommended for all travelers. Countries in Central America have been the source of many cases of typhoid fever that continue to be imported into the United States.

Rabies vaccination should be considered for travelers who will be involved in outdoor activities or have occupational exposure to animals. It is particularly recommended for long-term travelers such as missionaries and their children. Although yellow fever is not a disease risk in Guatemala or Belize, the governments of both countries require travelers arriving from countries where yellow fever is endemic to present proof of yellow fever vaccination.

Malaria

Malaria is found throughout Belize, except for Belize City. In Guatemala, malaria is found only in rural areas at altitudes <4,921 ft (1,500 m); therefore, the specific destination is important to know. Travelers who plan to visit only the capital and highlands do not need prophylaxis. Travelers who mention plans to scuba dive or visit Mayan ruins, though, will be at risk for malaria. Some clinicians feel that primaquine is the preferred antimalarial drug (only after G6PD testing) due to the amount of Plasmodium vivax, although atovaquone-proguanil, chloroquine, doxycycline, and mefloquine are alternative choices.

Other Vectorborne Diseases

Mosquito and insect precautions are important. Dengue infections have been on the rise in most areas of Central America. GeoSentinel data show that the most common cause of febrile illness in travelers returning from this area is dengue. Cutaneous leishmaniasis has been reported in travelers to these countries as well. Although transmission can occur to any part of the body, frequently it occurs while walking on contaminated beaches, so shoes may be protective. Filariasis, onchocerciasis (river blindness), and American trypanosomiasis (Chagas disease) are other diseases carried by insects that also occur in this region, mostly in rural areas and mostly in the indigenous populations.

Travelers’ Diarrhea

Diarrhea in travelers is common throughout both Guatemala and Belize and is the most common complaint in returning travelers who seek medical attention at GeoSentinel clinics. Travelers should be reminded of precautions for safe food and water and carry an antibiotic for self-treatment.

Other Health and Safety Risks

Safety and Security

For much of the last 30 years, Guatemala’s geologic instability was paralleled by its political unrest. Since the peace accord was signed in 1996, safety concerns are more likely to stem from economic conditions and drug-related violence. Although petty crime such as burglary and pickpocketing can be a serious problem in Belize as well, safety concerns in Guatemala’s neighbor more often involve road, boating, and diving accidents. Visitors to both countries are advised to travel in groups and stay on the main roads.

International Adoptions

Guatemala at one time was second only to China as a source country for international adoptions; 4,728 children were adopted by US families in 2007. In early 2008, after allegations of fraud and exploitation, adoptions were suspended until the country’s procedures could be made compliant with the Hague Convention on Intercountry Adoption. The National Council for Adoptions (CNA), established to oversee adoptions of Guatemalan children, published new procedures in July 2010 to implement the December 2007 adoption law. Concerns about child trafficking have led to suspicion and occasional hostility toward foreigners seen with Guatemalan children. The Department of State advises visitors to avoid close contact with children, especially in rural areas.

Medical Tourism

Travel to obtain medical care has increased in popularity in recent years, and Guatemala, which boasts specialists trained in the United States, has benefited from this trend. Popular procedures sought by medical tourists to this region include cosmetic and bariatric surgery, fertility treatments, and dental procedures. The Internet abounds with sites that promote medical tourism and offer help with transportation, accommodations, and language issues. A government initiative called “International Health City” (Ciudad Salud Internacional) has been established under the Tourism and Health Commission to promote medical tourism at a number of health facilities in Guatemala City, including private hospitals, diagnostic centers, clinics, spas, and laboratories. For guidelines for travelers seeking care abroad, see Chapter 2, Medical Tourism.

BIBLIOGRAPHY

1. Central Intelligence Agency. World Factbook: Guatemala. Washington, DC: Central Intelligence Agency; 2010 [updated Sep 22; cited 2010 Aug 6]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/gt.html.
2. Lynch MF, Blanton EM, Bulens S, Polyak C, Vojdani J, Stevenson J, et al. Typhoid fever in the United States, 1999–2006. JAMA. 2009 Aug 26;302(8):859–65.
3. Miller L, Chan W, Comfort K, Tirella L. Health of children adopted from Guatemala: comparison of orphanage and foster care. Pediatrics. 2005 Jun;115(6):e710–7.
4. Pan American Health Organization. Guatemala, Country Health Profile. Washington, DC: Pan American Health Organization; 2001 [cited 2010 Oct 22]. Available from: http://www.paho.org/English/SHA/prflgut.htm.
5. UNICEF. At a glance: Guatemala. Geneva: UNICEF; 2010 [updated Aug 5; cited 2010 Oct 22]. Available from: http://www.unicef.org/infobycountry/guatemala.html.
6. US Department of State. Guatemala. Washington, DC: US Department of State. Available from: http://www.state.gov/p/wha/ci/gt/.