General...
Travelling in a foreign country does not necessarily increase your risk of
becoming sick or even of suffering from minor illnesses such as nausea or the dreaded
traveller's diarrhoea, provided you exercise a little care and common sense.
Nonetheless, some travellers may experience minor stomach upsets or changed bowel
actions while they are away from home. While these are usually nothing more than minor
inconveniences and are often the affect of an exotic diet rather than of a serious
illness, it is important to be able to recognise a serious problem if one should arise.
The risk of accidents or sunburn are often more dangerous to the traveller than food
related illnesses. The sensible traveller will never put aside the notion of common sense
where health and safety are concerned - a foreign country is not the place to find
yourself in need of emergency medical attention, especially through your own neglect or
misadventure. Always take care, and enjoy a safe, healthy holiday.
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- Consult a travel health specialist rather than a regular G.P. to be more certain of
getting up-to-date advice and treatments for your trip.
- The World Health Authority "Yellow Book" is considered the best source for
determining which vaccinations are required in particular geographical areas.
- Immunisation against potential diseases should be considered several weeks before you
leave home.
- Some vaccinations may not be taken at the same time as others, so discuss travel health
issues with a doctor several weeks before leaving home.
- Travellers should consider adequate insurance coverage for foreign travel. Emergency
medical evacuation coverage to a nearby country (such as Australia or Singapore for
example) should also be considered.
- Wear a hat and sunscreen for protection from sunburn.
- The subject of food and what is safe to eat will always generate discussion amongst
travellers. Each person can react differently to a changed diet, time-zone, living
conditions etc. so what is perfectly OK for one person may cause someone else to feel sick
for days. Use the information provided by others you meet by all means, but always apply
your own common sense when it comes to a decision about where and what to eat.
- Everyone you meet will have their own opinion about the risks of malaria and the drugs
commonly used to protect travellers from this incideous disease. Do not be swayed by those
that offer advice that opposes that provided by your doctor. The best time to discuss the
merits of and against malaria prophylaxis is before you leave home.
- If you intend to burn mosquito coils at night, be very careful that they cannot set your
room on fire. Always be aware of fire risks and plan an escape route from your
lodgings in case of an emergency - facilities such as sprinkler systems, hoses and
extinguishers are not always common, even in large hotels.
An accident, perhaps a fall, a traffic accident or even a cut or scratch pose the
biggest risk to any traveller embarking on an adventure holiday. Take care to avoid
accidents, but be prepared if they do happen. Always carry a first-aid kit, and consider traveller's insurance just in case.
People on holidays often exhibit a carefree, even careless attitude, which greatly
increases the possibility of accidental injury, and unfortunately for tens of unsuspecting
tourists each year--the result is death.
Cholera is a type of gastroenteritis, associated with infection by bacteria found in
contaminated water. It produces severe stomach cramps and profound watery diarrhoea, and
may lead to severe dehydration. The risk to travellers is usually low (if you stay clear
of cholera outbreak areas), however mortality is high if it is left untreated.
Immunisation is available but is not always 100% reliable, so seek medical advice if you
intend to travel in a high risk area or fear that you have been exposed to cholera.
Cholera areas are usually widely reported - discuss the your planned
destinations with your doctor or traveller's medical centre before leaving home for
the most up-to-date information.
Everyone is at some risk of receiving cuts, scratches and general abrasions etc. whilst
walking or travelling. Care must be taken to clean all wounds (even minor ones) using pure
water, and if possible, with a disinfectant or antiseptic solution or ointment. After
cleaning, cover cuts and scratches with a band-aid or bandage. The rate of infections is
high if cuts are not treated, and healing may be very slow. Avoid most risks by wearing
shoes whilst walking around, and by keeping an eye open for broken glass, damaged
footpaths, holes in the road etc.
Cuts and scratches from coral are notoriously slow healing, as the coral injects a
weak poison. Always wear some form of footwear to avoid coral cuts when walking
across reefs, and cleanse a coral cut with hydrogen-peroxide if it's available.
Violent crime must be considered a risk to travellers, and attacks, including robbery
and even rape are unfortunately becoming more common as time goes on. Report all attacks
to police, and seek medical attention and counselling, especially if travelling alone. Be
aware that nowhere is free of risk.
Dengue fever is an acute infectious tropical disease that is caused by a virus
transmitted from person to person by mosquitoes. The symptoms include severe headache,
fever, intense joint and muscle pain and a generalised skin rash.
Although seldom fatal and usually running its course in 6 or 7 days, convalescence is
long and slow, and no specific treatment is available.
Dengue is endemic in some parts of the tropics including much of Indonesia, and
epidemics periodically occur.
There are many treatments and tablets available for emergency relief of diarrhoea. It is wise to carry a small supply of
diarrhoea tablets, but they should only be used when really necessary. It is most
important to avoid alcohol and to maintain an adequate intake of clean water when
suffering from diarrhoea.
If treatments such as tablets are used, the instructions should be followed exactly,
and of the condition does not respond to treatment, you should consult a doctor. You must
always be aware of the possibility that diarrhoea is a symptom that is common to a number
of serious diseases, although for most who experience it, the diarrhoea will be caused by
a change of diet, too much alcohol, or exposure to some bugs that your body has not had to
deal with before.
This is a bacterial infection which causes a moderately sore throat. A greyish membrane
is visible over the infected area, and in severe cases the throat may become quite
swollen. In tropical countries the infection may also occur in sores and skin ulcers.
After a few weeks, the effects of the bacterial toxins may cause severe weakness, mainly
affecting the muscles of the neck, and if left unchecked, the inflammation may cause
asphyxiation or heart failure.
Transmission of diphtheria is usually via direct contact with an infected person, or by
sharing a drinking glass or bottle etc.
In hot climates, and whenever you are very active, ensure you drink plenty of fluids.
Always carry a bottle of drinking water with you when hiking, and even whilst on bus trips
or just strolling around town.
The most important rule is, "Don't drink the local water" unless you are
certain it's safe. Bottled drinking water and soft drinks (soda) are available almost
everywhere in the world, and are generally fine, although you must be sure to only use
water from containers with a factory seal (usually plastic shrink-wrap). Milk should be
treated with suspicion, although cartons of UHT treated milk will be pasteurised, and
typically have a long shelf-life even in hot climates. Tea and coffee will generally be
OK, as the water used to prepare the drink will have been boiled.
The simplest way to purify water is to boil it thoroughly for at least five minutes to
kill bacteria and parasites. Commonly available chlorine tablets will kill many pathogens,
but not cysts and the parasites that cause giardia which may be destroyed by adding a few
drops of Iodine.
Travelling to a foreign country to score cheap drugs is a false economy, especially if
you get caught. Save the airfare, a long stint in jail is too high a price to pay.
Lost body salts due to excessive sweating, vomiting or diarrhoea may be replaced by
proprietary electrolyte tablets or drinks as an aid to recovery.
Eating in small, often out of the way places may introduce possible risks that usually
don't exist in large and popular hotels: issues such as the freshness of ingredients, lack
of refrigeration, contamination and even the standards of cleanliness in the food
preparation areas must be considered. When on the road, keep an eye open for the busiest
eateries. If a place is packed with tourists, and generally looks clean and well run, then
its food is probably safe, while empty restaurants are often questionable.
As a general rule, food that has been thoroughly cooked is the safest (but not if it
has been left to cool or if it has been reheated). Undercooked meats should be avoided, as
should shellfish, including oysters, mussels and clams, which can carry dangerous bacteria
and parasites. Fruit and salads should be washed with clean (boiled or bottled) water, and
peeled wherever possible.
If the food available is limited or of poor quality, or if you are feeling sick and
missing meals, you can soon become run-down. Ensure your diet is well balanced. Staples
like rice, noodles, breads, eggs, tofu, cooked vegetables and fruits are unlikely to cause
illness or an upset stomach, and are a good source of protein and vitamins.
This severe intestinal disorder is caused by a parasite that is present in
contaminated water. The symptoms include stomach cramps, nausea, watery diarrhoea and
frequent gas. Giardia can appear several weeks after exposure to the parasite, and
symptoms may disappear for a few days and then return over a long period. Do not use
antibiotics to treat Giardia. A single dose of Flagyl is the recommended drugs for
treatment. See a doctor if symptoms persist.
Similar to heatstroke but less severe, the symptoms of heat exhaustion include fatigue,
dizziness and nausea due to prolonged exposure to hot conditions, although temperature is
about normal and sweating persists. Be aware of the risk of heat exhaustion when on long
bus trips and walks.
Treatment entails cooling the person and providing small sips of water, which may also
include glucose or electrolyte replacement
tablets, or even a small amount of salt.
The chance of heatstroke and heat exhaustion can be minimised by moderating activity
during the hottest part of the day, and by maintaining an adequate intake of fluids and
salt.
Heatstroke (or sunstroke) is an extreme body response to very hot conditions, generally
caused by excessive sweating depleting the body of vital salts. Symptoms include
dizziness, tingling sensations, general confusion, and fainting, and usually the skin is
dry, hot and red. The body temperature may rise to above 41 degrees Celsius and sweating
may have ceased.
If untreated, heatstroke may be fatal, or cause shock, brain damage, or kidney failure,
especially in persons with underlying disease.
Treatment must be immediate and and must be focused on bringing the temperature back
into normal range of 36.4° and 37.2° C (97.5° and 99° F). This is best accomplished by
cooling the victim's skin with a wet towel or gently showering with cold water.
This is a viral disease with several strains, known as hepatitis A, B, C etc. The
disease affects the liver, and symptoms include alternating fever and chills, generalised
weakness, loss of appetite, nausea and general abdominal discomfort. These symptoms are
generally accompanied by jaundice (a yellowing of the skin and eyes, and a darkening
of the urine). Often, and particularly in children, there are few specific symptoms,
while on some occasions the jaundice may be severe and prolonged.
If left untreated, the most severe result is complete liver failure.
The hepatitis A virus is transmitted person-to-person, or by the contact with
infected faecal material, and transmission is particularly prevalent in overcrowded areas
with poor sanitation. Contaminated drinking water and food (especially raw or undercooked
shellfish and raw vegetables) are also major causes of infection.
An injection of immune gammar globulin is used as a safe and effective short-term
prophylaxis against the highly infectious hepatitis A, which is probably the most serious
health risk to travellers. Recently, other drugs have been introduced to provide even more
effective protection over longer periods. Past infection with the hepatitis A virus gives
life-long immunity.
Hepatitis B is a more serious form of viral hepatitis, which is transmitted through
contaminated blood or body fluids and by unprotected sexual intercourse. Vaccination is
recommended for those who will be staying in high-risk areas for more than 6 months, for
those who may share unsterilised needles (for drug use or at tattooists for example) or
those have unprotected sexual contact with persons in high-risk groups.
Other hepatitis strains (Non-A/Non-B types) have been recently identified, and the
risks, the need for vaccination and methods of prevention against these should be
discussed with your doctor.
Most at risk, are those who share needles with, or have unprotected sexual contact with
persons in high-risk groups, such as drug users and prostitutes, however a good rule of
thumb is, all unknown people are high risk.
Hookworms are intestinal parasites that take their name from the hooklike appendages
surrounding their mouths. They cause symptoms including anaemia, abdominal pain, and
diarrhoea.
The eggs of hookworms are deposited on the ground in the faeces of animals and people
suffering from infestation, and develop into larvae that are able to penetrate the skin of
anyone who comes into contact with them by walking barefooted in the contaminated area.
After entering the body, the larvae travel through the bloodstream eventually maturing
into adults and attaching themselves to the walls of the small intestine. Anaemia is a
result of the loss of blood, which the worms drain from the intestinal wall for their
nourishment.
Hookworm disease is prevalent in many developing countries, and is best prevented by
wearing shoes at all times whilst walking in public areas. Seek medical treatment if you
suspect infestation.
Although it is an additional cost that must be budgeted for, travel insurance may be a
good investment for anyone contemplating a low cost back-packer style holiday. The risks
are increased simply because the traveller tends to be more adventurous and more mobile.
Always consider the need for insurance (including emergency evacuation cover), but be very
careful to read the "small-print".
Influenza is a common viral infection that is spread from casual person to person
contact. Discuss the need for Influenza vaccination with your doctor or travellers medical
centre prior to leaving home.
This is a viral disease which causes a severe influenza-like illness with headaches,
neck stiffness, confusion and ultimately if untreated, coma. Mortality may reach 30%
of those that contract the disease, and long-term effects on the nervous system are common
amongst survivors. The virus is spread by mosquito bites (generally from those that bite
at night, and especially in remote and rural areas). Protection against bites, such as
that offered by wearing appropriate clothing, using mosquito nets, citronella or DEET
sprays and burning coils is recommended. Anyone planning to stay within a known Japanese
Encephalitis area should be vaccinated.
A lot of discussion about the use of Malaria prophylaxis has been generated recently,
with the opinion of whether to use a prophylactic agent divided evenly between those who
would, and those who would not. The best advice is that you consult a traveller's medical
centre before leaving home, and discuss the relative merits of the argument.
Due to the emergence of chloroquine resistant strains, more powerful drugs with
reportedly unpleasant side-effects, including dizziness, nausea, and palpitations are
often prescribed. Ask your doctor about using these drugs as a treatment only, in the case
of infection (at the first sign of symptoms) rather than using them as a prophylactic
agent.
The principal symptoms of malaria are chills with sweating and fever, headache, and
malaise. Malaria has either malignant or benign strains. The incubation period
(before symptoms occur) is usually 12 days for the malignant strain but may be up to 30
days for the benign form. Malignant malaria may progress to severe shock, and
even life-threatening coma. Benign malaria may produce episodes of fever, which
sometimes recur over many years. Malaria is diagnosed while active by microscopic
examination of the blood or can be confirmed after recovery by an antibody test.
The best protection, is to use an insect repellent containing a 20% or greater
concentration of DEET, applied frequently to exposed skin, and to use mosquito nets for
protection whilst sleeping in areas where mosquitoes appear to be active. The breeze from
a ceiling fan may also assist whilst sleeping. Never assume that there is no chance that
you will catch malaria - always take appropriate precautions.
If you choose to burn mosquito coils in your room overnight, be very careful to
eliminate all risks of them starting a fire.
Eating in small, often out of the way places may introduce possible risks don't need to
be considered in large popular hotels: issues such as the freshness of ingredients, lack
of refrigeration, contamination and even the standards of cleanliness in the food
preparation areas must be considered.
Many of the more savvy travellers choose to eat only vegetarian meals whilst on the
road. Staples like rice, noodles, breads, cooked vegetables and fruits are far less likely
to cause illness or an upset stomach than meat based dishes. Remember that under-cooked
eggs (soft yolks) can harbour salmonella
Most developing countries have only basic medical facilities and hospitals. Larger
cities and some villages will have a clinic, but specialist and emergency facilities are
less likely to be available than at home. Many large hotels in the popular tourist areas
have resident doctors.
Even major hospitals in the developing world are far below the standard that would be
expected in the west, and in the most serious injury or illness cases, it may be best to
exercise emergency medical evacuation to a nearby country. Be sure when you purchase
traveller's insurance that it covers this
possibility.
Health care is not free in most countries, so it is wise to have traveller's insurance.
Cash payment for services is usually required so retain all receipts for insurance claims.
Meningitis is an infection of the membranes of the brain and spinal cord, which can be
caused by many different bacteria and viruses. Meningococcal meningitis can pose a serious
hazard to travellers, as it can occur in epidemics and is easily transmitted through
inhalation of bacteria in droplets coughed or sneezed into the air by infected carriers.
The main symptoms are fever with severe headache, stiffness of the neck and back,
photophobia and a blotchy rash. The onset is generally sudden, and progression to coma is
often rapid if treatment is not started immediately.
This disease is caused by a virus which spreads from person-to-person via inhalation of
mucous droplets coughed or sneezed into the air by infected carriers, or by contamination
of food and drink with infected faecal material.
The early symptoms include fever, headache, nausea and vomiting as the virus multiplies
inside the body, eventually invading the blood-stream and nervous system. Paralysis occurs
in less than 1 percent of infections, although the risk increases with age.
An oral vaccine is available to protect against polio, and 10 yearly boosters should be
taken to ensure maximum immunity.
Rabies is a viral infection that is acquired via a lick or a bite from an infected
animal, often a dog, cat, monkey or bat.
Symptoms include an itching or tingling at the site of the bite, but rapidly progress
to include headache, fever, confusion, aggression, hydrophobia and paralysis. It may take
many weeks or even months for symptoms to develop.
Never approach or handle animals you don't know, especially if they are acting
strangely. Thoroughly cleanse all animal bites with soap and water and seek immediate
medical attention if the skin is punctured by a bite.
Sunburn will probably affect every visitor to the tropics, although it is generally
avoidable if common sense is used. Use a maximum protection sunscreen at all times, wear a
hat and stay in the shade during the hottest part of the day. Avoid spending any excess
time in the sun, and drink plenty of fluids.
Travelling in any underdeveloped country and eating food that is kept and prepared in
less than ideal conditions can expose you to the risk of intestinal bacterial infection.
The offending bacteria can also be found in contaminated water.
Common symptoms include an abrupt onset of painful abdominal cramps, nausea, vomiting,
and diarrhoea which may contain blood. The symptoms can occur any time from several hours
to as much as a couple of days after the exposure to tainted food or water.
You can take precautions to lessen your risk to exposure whilst travelling, and to ease
the discomfort should you or one of your party be afflicted.
Agents used to control diarrhoea include antibiotics, which may be obtained with a
prescription from home and used if needed, according to the advice of your doctor
(generally, antibiotics should be be taken only if really necessary) Treatment may be
supplemented with Imodium to relieve the symptoms, and perhaps to help when travelling by
bus etc. If the condition is severe, or does not respond to treatment within 24 hours, a
doctor should be consulted.
A local remedy for those who would prefer not to use drugs, is to drink cooled water
that has been used to boil rice. It is likely that the affect is similar to that of taking
Imodium due to the starch contained within the water.
Never drink alcohol or soft-drinks (soda) while suffering from diarrhoea. Replace lost
body fluids by drinking plenty of pure water from sealed bottles to prevent dehydration,
and replace lost body salts with electrolyte
replacement products.
To minimise the chance of suffering a case of diarrhoea, drink water that has been
boiled (such as tea and coffee), or pure water from sealed bottles, canned and bottled
beverages etc. Avoid ice if you cannot be sure the water was boiled or purified before it
was frozen.
Eat only cooked foods. Salads and raw vegetables that have been washed in the local
water can yield harmful exposure.
Do not believe that eating expensive meals in large hotel restaurants will be safer
than eating in warungs and markets. The places that are used by the local population are
often likely to be among the safest to eat at.
Be aware, that changes in diet may cause changed bowel actions, generally without any
other symptoms such as cramping or nausea. Many still confuse the effects of a changed
diet (particularly one that includes ingredients such as indigestible palm oil, spices and
fruit) with the symptoms of more serious illnesses.
Please discuss recognition of the danger signs and ask for instructions on dealing with
illness with your doctor before leaving home.
Tattoo's applied to the skin via needles expose some risk of infection, which is
understood by almost everyone. Many visitors to Asian countries however are tempted by the
tribal appearance of temporary tattoo's, especially as the temporary tattoo's are not
applied by needles. Some of the paints or transfers are however, made with chemicals that
may cause skin irritation (including petrol / gasoline). Always ask to patch test
temporary tattoo's (on a very small area on the forearm), and note any reaction or
irritation over the next few days. Only buy and apply temporary tattoo's if you did not
encounter any problems.
Tetanus vaccinations should be boosted every few years, and should be considered for
travellers who will be in higher risk situations (including those who intend to take on
jungle walks or other active, outdoor activities). It is better to have the vaccination at
home where you are certain the needle will not be contaminated.
Tinea is a fungal infection of the skin, often affecting the feet and/or the groin.
Symptoms include a reddish eruption and cracks in the skin between the toes, accompanied
by itching. It is highly infectious and may be contracted by walking barefoot,
particularly on moist floors such as bathrooms, shower bases and swimming pools. Treatment
is via a locally applied anti-fungal ointment or powder.
TB is a bacterial disease that usually affects the lungs, causing a persistent
cough, often, accompanied by fever and sweating. The disease is slow to establish itself
and general weakness and weight loss are characteristic during the incubation period
(which may be up to 3 months). The spread of TB is usually through infected sputum
(hence many laws that forbid spitting in public). Another form of TB is spread
through milk from infected cows, so never drink unpasteurised milk.
Typhoid is a bacterial infection caused by micro-organism called Salmonella typhi. It
is usually acquired through the ingestion of contaminated food, milk, or water. Symptoms
include fever, progressing to diarrhoea (which is often bloody). A rash also may appear on
the torso. A tablet or an injectable form of vaccination is available.
This is a form of Gastroenteritis caused by a virus. Symptoms include often severe
stomach cramps, diarrhoea and vomiting. A slight fever is usually also detected. Treatment
is restricted to resting, and drinking plenty of fluids (not alcohol).
This viral disease is characterised by a severe influenza-like illness, jaundice, and a
tendency to bleed. Monkeys are the major carriers of yellow fever, so principally, this is
a disease of jungle areas. There are however, occasional outbreaks in villages and cities.
The disease is transmitted to humans by the bite of infected mosquitoes, although it is
not transmitted from person-to-person expect by mosquito. The incubation period is about 3
to 6 days.
All occurrences of this disease must be reported to the World Health Organisation. Some
countries require proof of immunisation against yellow fever as a condition of entry.
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