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Advice for Australia, New Zealand, Canada, USA & most parts of Europe >
General health protection advice for Australia, New Zealand, Canada, USA and most parts of Europe >
Diarrhoea & intestinal upset >
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Mosquito repellents Remember that DEET (Di-ethyltoluamide)
is the gold standard. Apply the repellent every 4-6 hours but more often if
you are sweating heavily. If a non-DEET product is used check who tested it.
Validated products (tested at the London School of Hygiene and Tropical Medicine)
include, Non-DEET Jungle formula and non-DEET Autan. If you want to use citronella
remember that it must be applied very frequently (ie hourly) to be effective.
If you are popular target for insect bites or develop lumps quite soon after
being bitten, carry an Aspivenin kit. This syringe suction device is available
from many chemists and draws out some of the allergic materials and provides
quick relief. Sun Block The Australians have a great campaign, which has reduced
skin cancer. It is called Slip, Slap, Slop. Slip on a shirt, Slap on a hat,
Slop on sun screen.
Pain killers Paracetomol or a suitable painkiller can have multiple uses for
symptoms but remember that more than eight paractemol a day can lead to liver
failure.
Ciproxin (Ciprofloxacin) A useful antibiotic for some forms of travellers
diarrhoea (see below).
NB It is risky to buy medicinal tablets abroad because the
doses may differ and there may be a trade in false drugs.
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Immodium A great standby for those diarrhoeas that occur at awkward times (ie before a long coach/train journey or on a trek). It helps stop the flow of diarrhoea and in my view is of more benefit than harm. (It was believed that letting the bacteria or viruses flow out had to be more beneficial. However, with Immodium they still come out, just in a more solid form.)
Pepto-Bismol Used a lot by Americans for diarrhoea. It certainly relieves symptoms but like Immodium it is not a cure for underlying disease. Be aware that it turns the stool black as well as making it more solid.
MedicAlert These simple bracelets, or an equivalent, should be carried or worn by anyone with a significant medical condition.
For longer trips involving jungle treks taking a clean needle pack, clean dental pack and water filtration devices are common-sense measures.
As with all medical care, first impressions count. If a facility is grubby and staff wear grey coats instead of white ones, then be wary of the general standard of medicine and hygiene. Its worth contacting your embassy or consulate on arrival and asking where the recommended (ie those used by diplomats) clinics are. Providing embassies with information of your whereabouts can be also useful if a friend/relative gets ill at home and there is a desperate search for you around the globe. You can also ask them about locally recommended medical do's and don'ts. If you do get ill, and you have the opportunity, you should also ask your medical insurer whether they are satisfied that the medical centre or hospital that you have been referred to is of a suitable standard. Try to avoid road accidents. You can reduce the likelihood of accidents by not drinking and driving, wearing a seatbelt in cars and a helmet on motorbikes, but you should be aware that others on the road may think that they are in the remake of Death Race 2000.
Unfortunately there is no vaccine against this and the mosquitoes that carry it bite during the day. You will feel like a mule has kicked you for 2-3 days, you will then get better for a few days and then feel that the mule has kicked you again. It should all be over in 7-10 days. Heed all the anti-mosquito measures that you can.
Symptoms Hepatitis means inflammation of the liver. Viral causes of the disease can be acquired anywhere. The most obvious symptom is a yellowing of your skin or the whites of your eyes. However, prior to this all that you may notice is itching and tiredness.
Cures Early on, depending on the type of hepatitis, a vaccine or immunoglobulin may reduce the duration of the illness.
Prevention Pre-travel hepatitis A vaccine is the best bet. Hepatitis B (for which there is a vaccine) is spread through blood and unprotected sexual intercourse, both of these can be avoided. Unfortunately there is no vaccine for hepatitis C, E or the increasing alphabetical list of other Hepatitis viruses.
Symptoms White Britons are notorious for becoming red in hot countries because they like to stay out longer than everyone else and do not use adequate sun protection. This can lead to sunburn, which is painful and followed by flaking of skin. Aloe vera gel is a good pain reliever for sunburn. Long-term sun damage leads to a loss of elasticity of skin and the development of pre-cancerous lesions. Many years later a mild or a very malignant form of cancer may develop. The milder basal cell carcinoma, if detected early, can be treated by cutting it out or freezing it. The much nastier malignant melanoma may have already spread to bone and brain at the time that it is first noticed.
Prevention Sun screen. SPF stands for Sun Protection Factor. It is measured by determining how long a given person takes to "burn" with and without the sunscreen product on. So, if it takes 10 times longer to burn with the sunscreen product applied, then that product has an SPF of 10. If it only takes twice as long then the SPF is 2. The higher the SPF the greater the protection. However, do not just use higher factors just to stay out in the sun longer. 'Flash frying' (desperate bursts of excessive exposure), as it is called, is known to increase the risks of skin cancer. Follow the Australians' with their Slip, Slap, Slop campaign.
This is almost inevitable. One study showed that up to 70% of all travellers
may suffer during their trip.
Symptoms Diarrhoea can refer either to loose
stools or an increased frequency; both of these can be a nuisance. It should
be short lasting but persistence beyond two weeks, with blood or pain, require
specialist medical attention. Cures Ciproxin (Ciprofloxacin) is a useful antibiotic
for bacterial traveller's diarrhoea. It can be obtained by private prescription
in the UK which is expensive, or bought over the counter in Sri Lankan pharmacies.
You need to take one 500mg tablet when the diarrhoea starts and if you do
not feel better in 24 hours, the diarrhoea is likely to have a non-bacterial
cause and may be viral (in which case there is little you can do apart from
keep yourself rehydrated and wait for it to settle on its own). The key treatment
with all diarrhoeas is rehydration. Try to keep hydrated by taking the right
mixture of salt and water. This is available as Oral Rehydration Salts (ORS)
in ready-made sachets or can be made up by adding a teaspoon of sugar and
a half teaspoon of salt to a litre of clean water. Drink at least one large
cup of this drink for each loose stool. You can also use flat carbonated drinks
as an alternative. Immodium and Pepto- Bismol provide symptomatic relief.
Prevention The standard advice is to be careful with water and ice for drinking. Ask yourself where the water came from. If you have any doubts then boil it or filter and treat it. There are many filter/treatment devices now available on the market. Food can also transmit disease. Be wary of salads (what were they washed in, who handled them), re-heated foods or food that has been left out in the sun having been cooked earlier in the day. There is a simple adage that says wash it, peel it, boil it or forget it. Also be wary of unpasteurized dairy products, these can transmit a range of diseases from brucellosis (fevers and constipation), to listeria (meningitis) and tuberculosis of the gut (obstruction, constipation, fevers and weight loss).
Sex is part of travel and many see it as adding spice to a good trip but spices can be uncomfortable. Think about the sexual souvenirs any potential new partner may have picked up or live with. The range of visible and invisible diseases is awesome. Unprotected sex can spread HIV, Hepatitis B and C, Gonorrhea (green discharge), chlamydia (nothing to see but may cause painful urination and later female infertility), painful recurrent herpes, syphilis and warts, just to name a few. You can cut down the risk by using condoms, a femidom or avoiding sex altogether. If you do stray, consider getting a sexual health check on your return home, since these diseases are not the sort of gift people thank you for.
This can occur in sub-Saharan Africa, Asia, South America, Papua New Guinea and several other parts of the world (www.malariahotspots.co.uk). The simple ABCD of malaria may also help protect you against other mosquito-borne diseases (ie Dengue Fever).
To protect you against disease related to travel there are 4 key steps
1) Reducing bites from mosquitoes
2) Having the right vaccinations and keeping them up to date
3) In areas with malaria, follow the ABCD guidance
4) In cases of traveller's diarrhoea having the appropriate support medication
Reducing bites from mosquitoes >>
In areas with malaria, follow the ABCD guidance >>
Cover up as much skin as you can. In many countries mosquitoes that carry DENGUE virus bite in the day and the ones that carry MALARIA bite early evening and morning. So one way or another you could get bitten by an infected mosquito.
Use a good and effective mosquito repellent. DEET is the gold standard. If you do not like DEET there are other products that we can give you advice on.
You can spray your clothes before you travel with PERMETHRIN inside and out. Our product will last several weeks.
You can use a PERMETHRIN spray around you to kill mosquitoes and create a safe zone around you. Ask for the product details.
A. Awareness. We will discuss with you were there is a malaria risk and what type of malaria.
B. Bite avoidance. See above.
C. Compliance with anti-malaria medication. We offer a choice of 4 drug groups. Choloroquine and/or Paludrine are only suitable for certain parts of the world. Many other areas require Lariam (Mefloquine), Doxycycline or Malarone. For Details about these drugs click here.
D. Diagnosis. Despite all we do and what you do, you can still get malaria and it can make itself known up to 1 year after you return. Come to us and we will test you for malaria.
All drugs have side effects, some more than others do but these are not as bad as dying of malaria. Almost all drugs can cause some nausea and vomiting.
Choloroquine and/or Paludrine (£ cheap)
This is a very safe drug combination. You can get mouth ulcers, bad dreams, and a minor degree of hair loss. These drugs are usually taken 1 week before entering the malaria area, whilst there and for an additional 4 weeks after.
Lariam (Mefloquine) (£ moderate)
This drug causes anxiety and depression in some but especially those of you with a past history. It is only taken once a week but if you have never had it before we would only give it 3 weeks before travel to rule out any likely side-effects. If you do take it, it must be continued whilst in the malaria area and for an additional 4 weeks after.
Doxycycline (£ cheap)
This drug can cause thrush in women, about 5% of people develop a sun-activated rash and it must be taken with food. If it is not taken with food there is the risk of a gut ulcer and a hole in the gut. It is usually taken 1 day before entering the malaria area, daily whilst there and for an additional 4 weeks after.
Malarone (£ expensive)
This drug has an excellent safety profile to date. It may cause mild diarrhoea. It is usually taken 1 day before entering the malaria area, daily whilst there and for only 7 days after.
Make sure you have travel insurance, get a dental check (especially if you are going to be away for more than a month) (Goodge street dental), know your own blood group and if you suffer a long-term condition such as diabetes or epilepsy make sure someone knows or that you have a Medic Alert bracelet/necklace with this information on it.
As for all countries we recommend:
Hepatitis A and Typhoid - both of these diseases are transmitted from 'muck to mouth' , just one unhygienic person in the food preparation chain is required to give you viral jaundice (hepatitis with yellow skin, eyes and 6 months of tiredness or a bacterial infection, typhoid, that risks causing a hole in your gut)
Diphtheria and Tetanus - the former at its worst causes a choking grey scum at the back of the throat, the latter causes your jaw and back to go in to spasm (a simple cut on a rocky beach could cause it)
Polio (the risk of polio is decreasing and the World Health Organisation hope to have eradicated the disease within the next 5 years, which is a great relief since this is the disease that led to the development of the iron lung and still has many people in wheelchairs in the developing nations)
In addition to the routine vaccines
Yellow Fever for many parts of East, West and Central Africa
A course of 3 rabies jabs spread over 3 weeks
Sometimes Meningitis ACWY for specific areas and if we hear about an outbreak
You also need to be aware of
A course of 3 rabies jabs spread over 3 weeks IS STRONGLY RECCOMENDED India still sees more than 30,000 deaths a year from rabies.
Sometimes Meningitis ACWY
You also need to be aware of
Health care will mostly be as good if not better than in the UK. There will of course be cultural differences and regional variation.
Sleep, tiredness and Jet lag
International travel is tiring but the extra washed out feeling known as jet-lag comes from crossing time-lines and is worst as you travel East. If you travel West (i.e. from the UK to the USA) it is thought best to stay up and go to bed when the locals do. If you travel East do not plan to have a business meeting at the start of the next day, leave it to the afternoon at the earliest. Do not forget your flight socks (Forthcoming link)
Alcohol
The best strategy with alcohol is to pace yourself. Stretch the alcoholic drinks out and try to alternate with a non-alcoholic drinks.
Diet
Moderation is the key. New diets will come and go but make sure you have a good balance of fruit and vegetables. The UK government recommends at least five portions per day of either fruit or vegetables. You can buy vitamin supplements if your location prevents you eating healthily (Forthcoming link)
Vaccinations
We advise all travelers to be up to date with basic vaccinations such as Hepatitis A and Typhoid, Diphtheria, Tetanus and polio. The risks may be low but are never zero.
Certification Number EO10000521
