| health and
insurance selecting a first aid kit, staying healthy, and choosing travel insurance |
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I first began writing about travel health in the
small Pakistani town of Khairpur after meeting a young engineer. He
was feeling so very ill and scared that he was about to flee to
England for treatment. He had a fever, a stonking headache and he
imagined various awful tropical infections. His malaise turned out
to be sinusitis which settled 24 hours after starting antibiotics
bought in the local bazaar. I’d been a medic on several expeditions, but it wasn’t until the incident in Khairpur that I realised just how scary illness can be when it strikes in a foreign land where you don’t speak the language, don’t know how to find a doctor or may not know how to judge his or her competence. Later I got to know several Pakistani colleagues and I discovered that my friend could have safely consulted the nearest doctors, all of whom spoke perfect English. When taken ill, most adventurers will not have had the luxury of researching the local medical services in advance, so it is essential to do a little reading and preparation before you go. This leaflet will give you some pointers. Dr Jane Wilson-Howarth Dr Jane Wilson-Howarth is a GP and author of the authoritative, award-winning ‘Bugs Bites & Bowels’, and also of the appropriately-titled ‘Shitting Pretty’. Both are available from Cotswold. |
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insurance & emergencies |
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Many travellers wonder about tropical diseases,
but the most likely source of ill health on your trip will be
accidents. It is sensible to bring any safety equipment from home,
and to avoid travel after dark (or by motorbike at any time) in
remote regions. If you try a hazardous sport while you’re away,
check that the instructors are qualified and the equipment in good
condition. Proper travel health insurance is crucial and it needs to cover getting you to proper medical aid and to an air ambulance if appropriate. Cover should be for at least £2 million, if you end up in intensive care somewhere and are then repatriated, the costs can be very high indeed, especially if there is any chance of being evacuated to a hospital in the United States. Always declare any on-going medical problems, regular treatments, or past medical problems since concealing information could invalidate your insurance and leave you stranded. It is also important to ensure that you are covered for any hazardous activities, and if you are going somewhere really remote, will the policy include helicopter rescue? The Blood Care Foundation (http://www.bloodcare.org.uk/) is a service that delivers safe blood for transfusion to a hospitalised client anywhere in the world. The African Medical & Research Foundation arranges air ambulances in East Africa: see http://www.amref.org/. |
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Wherever you are going it is wise to research the
risks. A travel clinic will give good information about what medical
precautions are required but it is also worth checking out other
sources. Increasingly, country guidebooks contain a chapter on local health considerations written by a doctor, which should put local health hazards into perspective. For immunisation advice look at http://www.fitfortravel.scot.nhs.uk/ or there is a good American site at http://www.tripprep.com/ The free brochure Health Advice For Travellers is available from Post Offices, doctors’ surgeries, or on www.doh.gov.uk/traveladvice. Not only does it contain excellent guidance on staying healthy while travelling, but it also tells you how to get treatment overseas and explains where it is subsidised or free. You might want to consider attending a first aid course. Simple techniques of cleaning and dressing wounds can be learned on a St John’s course or similar and will prove useful wherever you are bound. Those going to remote and dangerous locations are likely to want to attend a more specialised medical course. The Expedition Advisory Centre at the Royal Geographical Society (with IBG) can steer you in the right direction. To contact them, email: eac@rgs.org or telephone 020 7591 3030. Alternatively, visit www.rgs.org/eac. Might you get caught up in a coup, riots, national strike or curfew? For security information on every country in the world check with the Foreign and Commonwealth Office website at www.fco.gov.uk/travel, or telephone 0870 6060290. Country information is also provided on BBC2 Ceefax p470 onwards.
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your medical kit |
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Most travellers will get no end of knocks and
grazes, which will readily become infected in hot or unhygienic
environments. So it is a good idea to travel with some kind of first
aid kit. The type you buy or put together will depend upon your
style of journey and the distance you plan to be from towns and
cities. Personally, I’d choose a small one that contains wound
closure strips. I am very sold on these items because you can tape
large, deep cuts closed and thus stop the bleeding. By doing so you
might be able to avoid the inconvenience, discomfort and possible
risk of attending a local clinic where needles may not be
sterile. Crepe bandages are useful in a variety of scenarios; for example, mountaineers and hill walkers use them for knee support, whilst after snake bite, firmly bandaging the bitten limb with a crepe bandage is the safe first aid procedure. In developing countries it can be hard to find adhesive dressings that stay on sweaty skin so I always bring some from home. Are you intending to walk barefoot along coral shores or venture into environments where the plants are spiny? Then pack tweezers or choose a first aid kit containing something to extract thorns and pieces of coral or sea urchin spine. Or avoid these problems by wearing shoes or sandals. |
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what else to pack |
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You’ll need to consider what kind of medical
items you have required in the past. Find out what treatments have
worked for you when you’ve been ill before, and travel with a note
of the generic names of any prescribable medicines that have aided
your recovery. Also record names and doses of any regular medication
that you need. Take spares of essentials like asthma
inhalers. People with light skins – and especially those with red or blonde hair or freckles – must protect themselves from the sun with a good sunscreen and sun-protective clothes. For more information on sun protection, pick up a copy of The Knowledge: Gear For Hot Weather. If you are going anywhere hot, pack a couple of leak-proof water bottles so that you don’t keel over from dehydration during the first couple of days. I would also recommend taking a few oral rehydration sachets (ORS) for the almost inevitable bout of traveller’s diarrhoea. Check how many sachets need to be put into your bottle. ORS is also great for forcing fluids into your body when the temperature is very high, after exercise or after a heavy night out. Other bits and pieces: a soothing bottom cream like Sudocrem or Anusol can bring welcome relief; and anyone travelling to a remote destination, and especially travellers over 40, should consider buying a dental first aid kit. |
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Malaria scares the pants off me. There is no real
prospect of a vaccine against malaria and so it is important to find
out whether you will be travelling into a malarious region. If your
travel clinic tells you that antimalarial tablets are required,
don’t just buy some over the counter since those kinds are becoming
less and less effective, and they often cause quite a burden of
side-effects. Newer tablets are often better tolerated. If you
decide to take Lariam on your travels, try it for two or three weeks
before departure in case it makes you feel weird. |
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montezuma’s revenge |
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Most intrepid travellers will suffer from
diarrhoea or at least some gastro-intestinal unease from time to
time, but most bouts will settle in 36-48 hours.When the symptoms
are mild, the only treatment required is to drink lots of clear
fluids. I always travel with a one-litre Sigg drinks bottle and
iodine. I use the iodine to purify my drinking water so that I can
have plenty of safe drinks of water wherever I am. Stomach problems – of many varieties – are commonly acquired through contaminants getting into your mouth by way of food prepared for you by someone who hasn’t washed their hands properly after using the toilet. And the risk of such filth-to-mouth diseases is greatest where there are big centres of population, where soap and facilities for hand washing are poor and/or where people don’t know about microbes; tropical Latin America, India and Nepal have the highest hit rates. In regions where there are no spare resources for anything beyond survival, visitors risk not only simple, short-lived travellers’ diarrhoea but also many other filth-to-mouth infections including dysentery, hepatitis A and E, typhoid and worms. Travellers will stay healthier if they avoid raw food and untreated water, and consume only freshly cooked, piping hot dishes and bottled drinks. A la carte is safer than dining from the buffet. |
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going high |
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women & children |
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The risks to health in the mountains depend upon
conditions as much as altitude. I’ve certainly been colder and felt
more at risk in bad weather in Britain than I have at over 4000m in
the Himalaya and Andes. It is important to be properly clothed and
make sure you know where you are going with proper maps, compasses
and/or local guides. Getting lost and cold, or falling off a narrow
path, are significant risks and are more likely to befall the
ill-prepared adventurer than a bout of Acute Mountain Sickness
(AMS). Even so, if you plan to venture above 3000m (10,000ft) it would be wise to read about how to recognise altitude sickness. The British Mountaineering Council’s The Mountain Traveller’s Handbookcontains an authoritative chapter. Bugs Bites & Bowels, the Lonely Planet guides to the Nepal and Indian Himalaya, and the Bradt guides for Andean countries all cover the subject. In essence, plan any trek so that you take several days to reach 3000m and then sleep no higher than 300m (1,000ft) above the previous night’s camp. Try to sleep low in a valley rather than high on a ridge. Although bottled oxygen and pressure bags can assist a person with AMS, the only cure is descent. Study the map; a drop of just 500m can be enough to effect a recovery. If someone is suffering from AMS don’t wait until morning to evacuate them. |
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The only issues for women travelling to remote or
unfamiliar destinations are clothing and menstruation. Showing too
much flesh may attract unwanted attention which can spiral into
unpleasantness. It is best to affect modesty and wear long loose
clothes. In hot regions a long drawstring skirt permits squatting in
order to pee in public while retaining dignity. Women setting out on
long trips into regions where plumbing is basic or absent might want
to explore the use of progestogen Depo contraceptive injections, or
an implant, or a Mirena Intra-Uterine System (IUS): if administered
some months before departure any of these should dramatically reduce
or even stop menstruation. If you want to travel with unmolested
hormones, ensure your tampons are packed in waterproof containers in
several places in your luggage. Travel is challenging if your child is independently mobile (which starts at about eight months) but not yet amenable to bribery (from around three years). Under threes are also unable to communicate well enough to allow parents to distinguish boredom from cerebral malaria, so think twice about venturing into malarious regions or destinations with poor infrastructure unless you were already an experienced, cool and resourceful traveller before having kids. Your Child’s Health Abroad is the medical manual you’ll need if you find yourself far from a reliable paediatric clinic. |
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