Sweet Home Floripa, Florianópolis, Brazil

Dr. Rolf, a tall man with piercing blue eyes and sandy hair, is a familiar figure around Florianópolis.  Of English and Dutch descent Dr. Rolf speaks English, Spanish, and German as well as Portuguese.  He told me that 20% of his patients are foreign and so he is an obvious choice for those moving to the island or for tourists just visiting for a brief time.  Dr. Rolf trained as a doctor in Porto Alegre and also studied medicine in Germany.

I asked Dr. Rolf about what health issues visitors face in Florianópolis that they don’t usually encounter at home.  “For the most part the environment in Florianópolis is a healthy one,” Dr. Rolf told me, “There is no malaria, no cholera, no rabies, for instance.  Still there are a few tamer ailments that visitors should know about and be able to identify.”

Here are Dr. Rolf’s top five health risks on the island:

Mycosis–or ringworm, as it is commonly known–thrives on the island, especially during the warm, humid months of summer.  Unfortunately, just like all of us, mycosis loves the warm beach.  So before you stretch out on that beautiful white sand, spread out a kanga or a beach towel and help avoid inviting ringworm to make a home in your skin.  While mycosis is not particularly dangerous it is itchy, pesky and ugly to look at.  Remember that mycosis is especially fond of children—or perhaps children are especially fond of playing in the sand and so are particularly vulnerable to ringworm.  So if you see round itchy red splotches on you or your child’s body, treat it immediately to avoid a larger invasion.  You can pick up an anti-fungal medicine like Cetoconazol 2% at the pharmacy.  Be sure to spread it on three times a day to stop this pest in its tracks.

Many visitors think that the mycosis is an allergic reaction and treat it incorrectly.  If you have persistent red splotches on your skin you may want to check with a qualified health professional.

Borrachudos. During the hot, summer months borrachudos, or gnats, come out in the twilight hours to feed on juicy humans.  Known to residents of the hotter regions of the United States as no-see-ems, these pesky insects can leave a patch of nasty bites, especially if you go out walking on the dunes at night.  Even worse, some people are allergic to the bites and the result is a nasty red welt.  The solution?  “Prevention,” said Dr. Rolf, “Using insect repellent is a must to preserve your health on the island.”  (My personal favorite is OFF!) Citronela is another solution and the local pharmacies sell a spray called Citronim by Welleda.  If you find OFF! too strong you may want to try Citronela.  Some local pharmacies sell a citronella based repelant called Citronim by Welleda.  Off! Kids also works for sensitive skin or constitutions.

Bicho-de-pé. A problem familiar to year-round residents of the island, but not to visitors, is bicho-de-pé—or translated literally, foot animal or pest.  Bicho-de-pé appears as a round, black circle that resembles a fish eye, usually on the bottom of the foot.  This circle has alarmed more than a few visitors to the island who, not recognizing the bicho-de-pé, thought it was some sort of malignant growth.  In fact, bicho-de-pé is a female sand flea that burrows into the bottom of your foot in order to nest and have it’s sand flea babies.  The black circle is the pregnant flea.  Treatment is simple—you must dig the flea out of your skin.   Dr. Rolf suggested that a trip to the local posto de saude would solve the problem quickly.

Tetanus. Though bicho-de-pé is not anything to worry about, it does sometimes lead to a much more dangerous condition—tetanus.  Caused by the bacteria Clostridium tetani, tetanus strikes victims with painful muscle spasms, including lock jaw and can, if not treated properly, cause death.  “Tetanus is a serious illness,” Dr. Rolf said. “All visitors to Florianópolis should get a tetanus vaccine before leaving home.”

Hepatitis. “All three types of Hepatitis are present in Florianópolis,” Dr. Rolf said,  “and it is important to protect yourself accordingly.”

Hepatitis A is associated with contaminated water. To avoid Hepatitis A drink bottled water and watch where you swim.

“While the waters on the Atlantic side of Florianópolis are pristine,” said Dr. Rolf, “effluents do flow into the bays on the western side of the island.  Florianópolis is growing quickly and its water sanitation system has not yet caught up to the rapid rise in population.”  Because of this, some of the lakes on the island may be less than ideal for swimming as they can harbor hepatitis A as well as other parasites.  While the waters of Lagoa de Conceicao bordering Avenida Rendeiras and the dunes are safe and clean, swimming in the southern lobe of Lagoa de Conceicao is not a good idea.  Some people have recently begun to avoid swimming Lagoinha Pequena, in Campeche, as well because of health concerns.  If you are unsure whether the water is safe  look for signs posted by the city.  The signs identify the water as “proprio” (appropriate) or “improprio” (inappropriate) for swimming.

Hepatitis B is sexually transmitted. Remember folks—use that camisinha (condom.)  Each year the Brazilian government distributes hundreds of millions of free condoms.  There’s a reason for that!

Hepatitis C is passed through blood. First thought to be sexually transmitted, Hepatitis C is now known to be associated with blood-to-blood contact.  Some 300 million people worldwide carry this disease, many without even knowing they have been infected.  The main cause of infection, scientists now know, is recreational, intravenous drug use, specifically the sharing of dirty needles.  A large percentage of injection drug users in the US are infected.  Unsafe sex practices that cause cuts, scrapes, lesions and therefore allow for blood-to-blood contact have also been implicated.  Symptoms include liver scaring, cirrhosis, and liver scarring.  Hepatitis C can be deadly.

Dengué. Dr. Rolf told me that Dengué fever—or bone-break fever, as it is sometimes known—is NOT endemic to Florianópolis, but people who travel here from more northerly places in Brazil do sometimes bring it to the island with them.  Dengué is transmitted by mosquitos so you should take proper precautions if you are traveling further north than Sao Paulo.  Wear that repellant!  While your first dose of dengué won’t kill you, it will cause you considerable pain for two weeks.  The second time you get the illness, it can be deadly.

In all, however, there are few very serious health risks in Florianópolis and with a little education, a little prevention, and a little common sense you should have a very healthy time here on the island. But should you need medical attention Dr. Rolf will be there to help you.

If you don’t speak ANY Portuguese, but need to contact Dr. Rolf urgently call the clinic and say “Por favor, preciso falar com Dr. Rolf de urgencia.” If that doesn’t work just say “Dr. ROLF, help me!!!!”

Dr. Rolf Hillman can be found at Clinica Prontomed in Lagoa, Rua Orlando Carioni, 64—that’s the street running beside the HSBC automatic teller and across from the gas station at the center of town.  For an appointment, call 55 (48) 3232-1704 or 55 (48) 3232-0470.