16
Health
There’s no need to place your health under a microscope when you travel. The things you should concern yourself with are actually quite basic: get your pre-trip health details in order before you leave (including all the necessary immunizations); take some fundamental precautions while you’re on the road; keep an eye out for some specific symptoms; and get yourself to a doctor if you encounter any of them. Despite the tales you may have heard, many of the common illnesses are avoidable or easily curable with some of the basic information you’ll find in this chapter.
Where medications are listed in this section, you’ll only find the generic medical name. These are known by various commercial names in different countries. Simply check the label or consult your pharmacist or doctor.
IF YOU DO GET SICK
Here’s the basic approach: with high fever, loose stools or vomiting – anything very painful or unusual – get to a doctor and have blood and/or stool tests conducted. It’s generally quick and cheap and far better than trying to wait it out. With a quick diagnosis and the right medicine, you may be feeling fine within a day or so.
This is also a great time to check into a decent hotel with a private toilet and phone. You owe it to yourself and your fellow travellers. Hostel dormitories are not meant as recovering wards (beyond temporary alcohol-related afflictions). When you check in, tell the desk clerk that you’re not feeling well and see if they have a doctor who can pay you a visit. You can always ring for an ambulance or taxi if things take a turn for the worse.
If things seem serious, don’t take chances. Get yourself to a hospital and contact your family and travel insurance company. If you’re in a remote area, get to a major city immediately.
Fixing your pre-departure medical details
Far too many travellers neglect basic pre-trip medical arrangements and suffer needlessly as a consequence. It’s not a bad idea to get a check-up before leaving, especially if something has been troubling you a bit. Don’t make the common mistake of putting this off till the last minute. A month or two before departure is a more sensible time to schedule an appointment. If the doctor finds something during the check-up and wants you to come back for a second consultation, your next-day flight is buggered. Besides, you’ll want to get your check-up before you start the vaccinations. Some vaccinations should not be given if you have so much as a cold, or if you’re taking other medications. Make sure to ask for a copy of your clean bill of health to take along (this may require an additional fee if an official certificate is required), so you don’t have to pay for one again if you end up working on a kibbutz or volunteering for an organization that requires one.
Schedule a visit to the dentist as well. It would be a serious setback to get a nagging tooth problem while you’re in a country not known for dentistry.
Make sure you have enough contacts and fluid to keep you going (you can always send some lenses ahead as well). Glasses are important backups even if you never wear them at home: you may find yourself in dusty environments where contacts don’t function well. If you’re trying to decide between two frames for your glasses, take the most durable, even if they’re not the most flattering. Make sure you bring along a copy of your prescription and your optician’s telephone number in case you need emergency replacements on the road or ordered from home.
You should carry the following items:
- Your name, address and phone number
- Emergency contact’s name, address and phone number
- List of immunizations
- List of allergies
- List of any chronic health problems
- Family doctor’s contact information
- Name of health-insurance and travel-insurance provider with phone number and policy number
- List of current medications, plus copies of prescriptions with pharmacy name and phone number
- Prescription for glasses or contact lenses
- Vaccination record card
- EHIC (for Europeans travelling within EEA countries and Switzerland –
see
gov.uk/european-health-insurance-card)
Which vaccinations do you need?
This part is surprisingly easy. Simply visit the Centers for Disease Control and Prevention’s (CDC’s) website ( cdc.gov) and select the places you’re
visiting. The website has the latest information and will tell you exactly which
immunizations to get. Then call around to make sure you get a good price. A full
course of shots might set you back £200/$305. If your country has a national
health plan, a number of the shots (eg hepatitis A and polio) may fall under
that policy and can be received free from your GP. In the UK, check the NHS Choices website ( nhs.UK) for information on what the NHS will cover.
Confirm the information you get from the CDC or NHS with the doctor or clinic administering the shots, and be sure to inform them of any medical conditions (including allergies) and medications (including the Pill) you’re taking. Also, explain where you’ll be staying and how long you’ll be there. Even in a malarial region, for example, if you’re staying in the main cities where mosquitoes are rare, there’s often little risk. These relatively risk-free cases are not usually mentioned on the CDC website, so be sure to ask.
Some vaccinations require several shots over months to take effect, so don’t leave it until the last minute, or even the last month. If you’re getting several jabs, bear in mind that you may not be able to get them all on the same day. They may conflict with one another, require more than one course or take time to become effective. However, if you’re not entirely sure where you’re headed, you don’t need to get every needle in the cabinet. Vaccinations are all available on the road. Just make sure the clinic looks clean and professionally run and only uses sterile needles. If you have the option, try to get this taken care of in more developed countries. And it’s not necessarily a good idea to get “the works” just in case – lots of drugs can take their toll on your body and you increase the chances that you’ll experience some side effects.
Get a vaccination record card and keep it with your passport while travelling. You may need to demonstrate that you’ve received certain immunizations to enter a country or obtain a visa. And, let’s face it, with all these mega-syllabic names, it’s hard to remember what you got, what you didn’t want to get but got anyway, and what you were going to get but decided not to get at the last moment.
For information on the vaccinations required in each region, see the “Where to go” section.
Cholera
How you get it: This serious diarrhoeal disease is caused by consumption of contaminated water or shellfish. When there’s an outbreak (it seems to follow natural disasters and wars), avoid the area if possible and be very careful what you eat (no ice, only bottled water, no raw food unless peeled).
Symptoms: Profuse vomiting of clear fluid and diarrhoea (10–20 litres per day!), which may help convey the risk of fatal dehydration.
Vaccination: Until recently, there was no good vaccination for cholera. The old injectable vaccine was ineffective since it didn’t provide resistance against the majority of cholera strains. Two new oral vaccines (Dukoral and Mutacol) have proven more effective (85–90 percent immunity within six months of taking the vaccination, decreasing to 62 percent immunity after three years) and should be considered if you’re heading to areas where the disease is prevalent. Because the vaccine is new, it may not be available everywhere. Avoid antibiotics and malaria prophylaxis with Proguanil one week before and one week after cholera vaccine.
Full course: Two oral doses.
Booster: One week apart (killed vaccine) or one single oral dose (live vaccine).
Time before effective immunity: One week after the last dose.
Hepatitis A
How you get it: Contaminated food, water and people pass this bowel blaster along.
Symptoms: Flu-like with diarrhoea, possibly itchy skin and jaundice.
Vaccination: There are two basic types: one (Havrix) lasts a year, but takes a month to become effective, while the other (gamma globulin) lasts two to six months, but is effective immediately. In the UK there is a combination Hep A and Hep B vaccination that will also give you ten years of immunity and is available free from GPs. But you’ll need half a year to get all three shots taken care of. Or ask your doctor about Hepatyrix, fifteen-year protection against Hep A and typhoid in one stab.
Time before effective immunity: One minute to one month depending on which type.
GETTING HEP A
On one of my trips to Ho Chi Minh City for a Hong Kong art magazine job I landed, a large group of Vietnamese artists organized a large dinner in honour of my visit. They asked me if I liked seafood…which of course I do. They ordered, among other things, an enormous platter of oysters. I had never seen oysters so big – they were larger than my hand – and this purplish colour I didn’t even know existed on the colour spectrum. And they were delicious. However, the next day when I travelled to Hanoi, I felt like I was going to die. I mean I literally thought I was going to die in Hanoi. I was freezing cold, running a fever, puking and expulsing out the other end as well. I tried a few local concoctions, but they didn’t do much. Then two Swedish expats recommended a doctor at their embassy. I managed to get over to the Swedish Embassy in a haze, shivering on my cycle. Once I took the prescribed antibiotics, I was fine in half a day.
Hepatitis B
How you get it: It’s transmitted like AIDS (most commonly via unprotected sex, tattooing or any invasive medical treatment you receive in a developing – or not-quite developing – nation’s hospital or clinic) but it’s about a hundred times more infectious.
Symptoms: Often a “silent disease” that doesn’t necessarily make you feel sick, but symptoms can be flu-like, with loss of appetite, fatigue, cramps and vomiting. In extreme cases skin and eyes may be jaundiced.
Vaccination: Three jabs over six months. For those who have put it off to the last second, it’s possible to get three jabs in three weeks with an additional booster, but it’s slightly less effective. As previously noted, in the UK there’s a combination Hep A and Hep B jab that will also give you ten years of immunity, available free from GPs.
Time before effective immunity: One month after third dose.
Japanese encephalitis
How you get it: Mosquitoes carry this brain-attacking virus around rural parts of Asia.
Symptoms: A stiff neck and intolerance to light. It’s both life-threatening and neurologically damaging.
Vaccination: You’ll need three shots over a month and the jabs should last you three years, but you may need an additional booster before then.
Time before effective immunity: Ten days after last dose.
Meningococcal meningitis
How you get it: Coughing and sneezing spread this much-feared disease in central Africa.
Symptoms: Most recognizable by a rash that starts as pinprick blood spots on ankles and armpits, buttocks or groin, and matures into purplish bruises that do not fade or disappear when pressed.
Vaccination: One dose with booster every three years.
Time before effective immunity: Two weeks.
Polio
How you get it: From contaminated food or water or (if you have a weak immune system) contact with those who are taking the vaccine.
Symptoms: Of those who do contract polio, 95 percent will show no symptoms and, despite its reputation, paralysis occurs in only 0.1 percent of cases. In five percent of cases, people experience flu-like symptoms.
Vaccination: If your parents were against the vaccination or your government was, now is the time to get your shots: a full three-dose course administered at monthly intervals. Otherwise, make sure you’ve had your lifetime booster.
Time before effective immunity: Two weeks after the second injection.
Rabies
How you get it: It’s transmitted by animal bites, scratches and licks (mainly dogs).
Symptoms: Begins with loss of appetite, fatigue, headache and fever; then nervous-system damage appears with hyperactivity, hypersensitivity, hallucinations, seizures and paralysis.
Vaccination: Three doses over one month with a booster after two to three years.
Time before effective immunity: Two weeks after completed course.
Tetanus/Diphtheria
How you get it: Diphtheria is passed person to person quicker than an email chain letter. Tetanus spores enter the body through open wounds as small as a pinprick, and can be picked up through contact with dirt, manure and – the classic – rusty nails.
Symptoms: Typical diphtheria unpleasantness includes fever, chills and a sore throat. Eventually it can cause heart failure and paralysis. With tetanus, you won’t get the symptoms for five to twenty days, but the one that should get your attention (and any doctor’s attention) are spasms of the jaw muscle. Those will spread across your face and into your torso, and that’s when things get really nasty. It is potentially fatal. And those who have it are highly infectious for ten days. Seek medical help if you suspect it: a quick throat swab can determine if you’ve been exposed.
Vaccination: Check your booster records, because you definitely want to make sure you’re vaccinated against this bacterial illness. You need one after ten years.
Time before effective immunity: A few days.
Tuberculosis
How you get it: By breathing the same air as those who are infected by it. Sneezing, coughing, speaking, etc.
Symptoms: Cough that is worse in the morning, chest pain, blood in spit, night sweats, breathlessness.
Vaccination: One dose, no booster required. Not routinely recommended for travellers; to be considered for infants and health workers, as infection usually requires prolonged exposure to infected individuals in a closed environment.
Time before effective immunity: Unknown.
Typhoid
How you get it: Areas with poor sanitation and poor health standards attract the most typhoid. This bacterial illness is picked up by ingesting contaminated food and water or by coming in contact with the faeces of an infected person.
Symptoms: High fever, increasing daily for the first week and accompanied by weakness, stomach ache, coughing and deafness. It’s cured by antibiotics.
Vaccination: One dose (with booster every two years or oral every five years). Recommended, but not overwhelmingly effective (eighty percent).
Time before effective immunity: Two weeks.
Yellow fever
How you get it: Ticks, flies and mosquitoes carry this fatal viral infection primarily just north and south of the equator in Africa and South America.
Symptoms: High fever, vomiting and abdominal pain, which will abate on its own after a week. For fifteen percent of those infected, there will be a lull of a day or two after this first wave before it kicks in again with more severity, with symptoms including jaundice.
Vaccination: Full course one dose, should be avoided if you have severe egg allergy or compromised immunity; requires special consideration if you also wish to take Hep A immunoglobin.
Booster: After ten years.
Time before effective immunity: Ten days.
What you can’t get vaccinated against
These are the ones you’ll have to watch out for, and may just get anyway. Some maladies are more common than others and some more severe, so read through the descriptions to get acquainted with the symptoms and dangers you may face.
TRAVELLING WITH IMMUNE ISSUES
This applies not just to those with AIDS/HIV, but post-chemo patients and
many prescription-drug users. If you have special health considerations that
render you immuno-compromised, keep in mind that
the bacteria and bugs that affect all travellers may have a more profound
effect on you. Developing countries in particular pose significant risks for
exposure to opportunistic pathogens. Your consulate or the International
Association for Medical Assistance to Travellers ( iamat.org) can provide
English-speaking physicians trained in Europe or North America.
VACCINATIONS
The CDC currently recommends that live-virus vaccines (except the
measles vaccine) be avoided by people with immunodeficiency. “Killed
vaccines” such as tetanus/diphtheria, hepatitis A, rabies and Japanese
encephalitis are okay, and recommended for “healthy” HIV-infected
travellers. However, the immune response to these vaccines might be
reduced and is largely dependent on the degree of immunodeficiency. For
more information, visit cdc.gov.
MEDICATIONS
Discussing an emergency plan with your doctor prior to departure is an excellent idea. The CDC advises all HIV-infected travellers heading to developing countries to bring an antimicrobial such as ciprofloxacin (500mg twice a day for 3–7 days) for empirical therapy for diarrhoea, although alternatives (such as TMP-SMX) should be discussed with a doctor. If the diarrhoea does not respond to this treatment, there is blood in the stools, fever and shaking chills, or dehydration, get to a doctor.
GOING THROUGH CUSTOMS
If you are carrying a full array of HIV drugs, or just the virus, be
aware that some countries have vague restrictions preventing those with
“communicable diseases” from entering. So, faced with an inquisitive
customs officer holding your medications, you might offer other
half-truths about the things you’re suffering from first (such as
liver/heart/kidney problems), and delay mentioning HIV. If you’re
staying for an extended period to work or study, you may face a
serological screen in many countries. Check out the unofficial list
compiled by the US State Department on travel.state.gov.
Allergies
If you experience allergies at home, you’ll probably encounter them on the road. Watery eyes, runny nose, sneezing… you know how it goes. Pack an antihistamine (chlorpheniramine or cetirizine) to relieve the symptoms. If these don’t help, or if you experience more serious symptoms such as hives, difficulty breathing or swelling of the throat, visit a doctor ASAP.
Altitude sickness
This is more dangerous than most people believe, especially when others who don’t have it are egging you on to keep going up. If your head feels like it’s about to implode or you’re dizzier than a wino trapped on a Ferris wheel, that’s your cue to head down the mountain. Continuing up (or even staying where you are) can be fatal. It doesn’t mean making a beeline for the base camp (unless it has reached a critical stage). Usually, the symptoms will abate after just a little descent, and you may even be able to continue once your body has adjusted at its own pace.
Fitness is only one factor: you could be a competitive triathlete and still get altitude sickness. Other factors are your rate of ascent, elevation, and how well your body happens to cope with it. At higher elevations, do what climbers do: don’t go up more than 300m per day once over 3000m and hike up past the camping spot to acclimatize, then return and sleep. Follow a careful acclimatization plan and, most important, listen to your body. If you want to try a short cut, the drugs Acetazolamide and Nifedipine have been known to help combat the sickness. As have coca leaves (chewed or in tea), which are readily available in parts of South America.
Bed bugs
These are not merely bedtime-story myths. They’re out there, typically in the cheapest hotels, and they do bite. The bites aren’t serious, but they seriously itch. And you’d have a better chance of spotting Elvis than some of these critters. Your best defence is a good sleep-sheet: make sure it’s big enough to cover the pillow as well. A tight weave should keep most of them out. The bites look like two or three little red dots in a row. Treat with hydrocortisone or antihistamine cream and refrain from scratching.
Bilharzia
Truly exceptional spellers may know it as schistosomiasis. These micro-worms live in freshwater lakes, canals and still sections of rivers: the larvae penetrate your skin, head to your liver and lay eggs. You could get the disease by drinking the affected water, eating food washed in it and by swimming in it. Showers are fine, though. Without going into the full graphic detail of what these critters do in your body for one to ten weeks before you notice the symptoms (such as blood in the urine), you should know it is also called the disease of the “menstruating males”. It mainly affects the urinary tract and gut and can be treated quickly once diagnosed. It’s best prevented by avoiding stagnant water, especially in Africa (perhaps most commonly in the Nile, Lake Malawi and Madagascar). It can also be found in Southeast Asia, South America and the Middle East. If you suddenly realize you may have exposed yourself, hop out of the water and rub yourself thoroughly and abrasively with your towel in case your skin hasn’t been fully penetrated yet.
Check out our list of basic medical supplies you don’t want to leave home without.
Cold sores
Don’t kiss people with lip sores or blisters. Don’t share water bottles with them either. There’s really nothing cold about these sores, which are actually herpes picked up by oral contact (fellatio and cunnilingus included) with someone exhibiting symptoms, even early-stage ones. They are most likely triggered by too much direct sunlight and stress or tiredness. Once you’ve got the virus, you’ve got it for life, and most adults carry it. To keep the sores at bay, keep your lips well glossed while exposed to the sun and apply aciclovir cream as soon as you feel the tingling sensation coming on (apply five times a day for five days; it may require prescription). Once the sore breaks open, the medicine won’t help.
Constipation
Because people are so worried about travellers’ diarrhoea, they usually forget about this one, which can be nearly as uncomfortable and troublesome. Travellers who are new to the trail are especially susceptible. They take one look at a squat toilet (or one of its unsanitary hybrid cousins) and suddenly they don’t have to go any more. A few days later the mental block has become an intestinal block. This can be solved by simply carrying some laxatives (senna) and not waiting too long to use them. Better yet, force yourself to go when you have the urge, no matter what the loo looks like. And a little diet altering won’t hurt: more fruit, bran and fluids.
Dehydration
The trick here is to drink before you get thirsty. For a full day of walking in a hot climate, you should be drinking about four litres of water. In dry or high-altitude terrain, you’ll need even more, and wind masks the amount you’re sweating away. Once you’re dehydrated, you’ll experience a dry mouth, dark urine, headache and, in extreme cases, fainting. Find some shade, take it easy and mix your water with a rehydration mix so you get your salt balance back, and if fluid can’t be taken orally, get to a hospital for an IV.
Dengue fever
Here’s another great reason to use mosquito repellent. This viral infection is not typically fatal, but it hurts like hell for about a week and there’s little you can do to treat it. It’s most commonly found in subtropical Asia, the Caribbean, Central America, South America, Australia and the Pacific islands. These white and black mozzies tend to bite during mornings and late afternoons in shaded areas of the body. Once bitten, the incubation period is about a week. Then you’re looking at high fever, joint pain and backache. As if that’s not enough, you’ll probably see an itchy rash develop on your torso and experience bleeding from your nose, mouth and rectum. You want to be in a hospital for this one, preferably in your own country, as weeks of depression may set in after the severe symptoms are gone.
Diarrhoea
It has plenty of colourful monikers, from Delhi Belly to Montezuma’s Revenge. Whatever you call it, you’ll probably get diarrhoea at some point, no matter what precautions you take. The good news is that it’s most often extremely treatable and the troublesome symptoms can be cured in less than a day. This may be the single most valuable thing you get out of this guide, and if it saves you a week of traumatic toilet dashes, the book will have paid for itself a few times over. You’ll meet numerous travellers suffering from dysentery for days or weeks. The typical reason is that they’re trying to ride it out. You want to do exactly the opposite.
The moment you start to “go liquid”, drink a bottle of water mixed with a packet of rehydration mix that you should be carrying in your first-aid kit. And keep drinking. The biggest danger with dysentery is dehydration. Then, the next time you have to go, bring a little plastic container with you and put a stool sample in it. Either take the sample to a nearby clinic yourself or have a trusted fellow traveller do it for you. With a quick look under the microscope, a doctor will most often be able to identify the cause. If so, they’ll write a prescription on the spot, which will likely include the pharmaceutical equivalent of a cork. Less than a day after you start taking the medicine, you may feel back to normal, or at least better. While recovering, stick to simple, unspiced foods like rice for a day or two just in case. Little tip: carry an anti-diarrhoea pill (loperamide) in your passport pouch. If you’re on a long bus ride or walking around town, it will come in handy more than you can imagine. Travellers taking the pill should be aware that diarrhoea can reduce this contraceptive’s effectiveness.
WILL EATING THE “WRONG” FOOD GIVE YOU THE SHITS?
There’s a travel-health mantra that if you can’t peel it, boil it or cook it – forget it. Only one problem with this approach: in practice, over the long haul, it’s basically worthless. You can’t travel around the world in a hermetically sealed suit, and you’re going to be taking some culinary chances at some point whether you want to or not. Some rules of thumb are wise, like avoiding shellfish in developing countries especially when you are not right on the coast (it’s very temperature-sensitive while shipping and storing). But other things can be deceiving, such as “fine dining” being safer – depends what you get… a four-star buffet can actually be more risky than a small, cheap restaurant because so many people handle the food for a buffet and all it takes is one non-hand-washing offender contaminating one dish.
There’s simply too much interesting food out there to painstakingly investigate its biological properties three to five times a day. Rely instead on your own good judgment. Are the locals drinking the water? Are there bugs visibly swimming in it? Does the meat look like it has been cooked long enough? Is it dead? Are flies laying eggs in the fruit? Is the street vendor jamming his hand down his pants between servings? On a long trip, you’re almost certain to entertain an occasional spell of travellers’ diarrhoea. Accept it and don’t worry about it. The cure is usually quick and painless (see Diarrhoea) and your stomach will most likely get stronger as you travel.
Ebola
For all the media attention Ebola has been getting, you’d think stepping off your plane in West Africa (in particular Guinea, Liberia and Sierra Leone) would be enough to contract it. The fact is, you’d need to have unprotected contact with infected blood or body fluids, reuse hypodermic needles or eat bushmeat to contract Ebola. You’re most at risk if you’re caring for an infected person, as it’s only infectious once symptoms manifest, and you should be leaving that to a medical professional anyway. Early symptoms (which can take about a week to appear) include fever, fatigue, muscle pain and weakness, headache and sore throat, leading to vomiting, diarrhoea and stomach pain. If you suspect you may have it, it’s vital that you get yourself tested immediately. At the time of writing Ebola vaccines were going through clinical trials, with the hope of being licensed for use by the end of 2015.
Hepatitis C
Less common than Hep A and Hep B (but with no vaccination) this one requires contact with contaminated blood – so stay alert where any needles are concerned. Always make sure they’re opened from new sterile packages while you watch. If you get taken to a hospital in an emergency, ask for screened blood.
Hiking blisters
Nepal’s Annapurna circuit is not the ideal place to try out a new pair of hiking boots. If you buy or rent some, give yourself at least a day or two for your feet to adjust (especially with new boots). For serious treks, make sure you bring a skin-like blister cover (such as Compeed), sport tape, petroleum jelly or a silicon spray, and scissors (with antiseptic to sterilize) to cut the dead skin from blisters. Puncturing used to be the way to go; now professionals recommend cutting away all the dead skin so the tender skin underneath gets exposed to the air and hardens and heals quicker. Tape should be applied in advance to trouble spots, then sprayed with silicon. Two pairs of socks are advisable, neither of them cotton. Polypropylene or silk (next to the skin) and wool make an excellent combination.
HIV/AIDS
You’ve probably heard an earful about this already. What you may not know is that in some areas of the world it affects over seventy percent of the sexually active population, and it’s continuing to spread at a staggering rate. Among prostitutes and drug users, you may find even higher proportions with HIV. It’s a pandemic poised to wipe out enormous portions of Asia and Africa, and you as well if you don’t take precautions. Consider this before you have unprotected sex or share a needle.
Hookworm
This one doesn’t sound like much fun. And it’s not. These tiny worms live in the soil, so avoiding them is simply a matter of wearing shoes. Otherwise, they enter the foot, make their way to the lungs and lymph glands, and eventually end up in your gut, where they will probably cause you to feel nauseated and generate loose stools, and you’ll experience general abdominal discomfort while they go about laying eggs. A simple stool sample can identify the worms. Once identified, it’s easily treatable and there are a number of drugs suitable for the task, including mebendazole. Iron tablets should also be used if anaemia is detected.
Hypothermia
A lot of people say they’re freezing, but hypothermia is the real thing. The medical definition of loss of core body temperature starts at 35ºC (a normal body temperature is about 37ºC). The condition begins with uncontrolled shivering and is followed by slurred speech and mental confusion and, eventually, stiff muscles, abnormal heart rhythms, coma and death. Sufferers should be gradually warmed (not rubbed, as that can cause the skin to come off) and given sugary drinks (not a St Bernard-style shot of whisky). Alcohol, exhaustion and illness all weaken the body’s ability to keep warm.
Infected cuts and scrapes
In tropical environments, cuts don’t tend to heal like they do back home. They’re easily infected and can actually grow in size. Use antiseptic ointment or powder and try to expose the cut to direct sunlight so it has a chance to dry out. Visit a doctor if you’re unable to stop the growth of the wound on your own.
Jet lag
An alarming number of travellers don’t take simple steps to combat jet lag, and are then plagued by fatigue for days, starting off their trip on the wrong foot. If you can sleep well your first night in the new time zone, you’re not going to experience much jet lag, if any. Sleeping on the plane may also help, if it’ll start to match your body clock to the new time zone. If you’re not naturally gifted at the art of sleeping on planes, it can be achieved with an over-the-counter or prescribed sleeping pill.
According to all studies, drinking alcohol is exactly the wrong approach. The next worst thing you can do is stay up late watching a movie and eating, when you should be sleeping in the new time zone. There’s no reason to eat dinner at 11pm, then watch a movie at midnight simply because you’re at 30,000 feet. Drink lots of water to stay hydrated, refrain from naps until bedtime and take a sleeping pill if you wake up during that first night or pop a Melatonin tablet (only available over the counter in the US) before bed to ensure you sleep a little longer. If you can’t resist the meal on the plane, order a special meal (doesn’t cost extra, and chances are it will be as good as or better than the standard food) and you’ll get served first so you can get to sleep sooner.
Malaria
The reason this mosquito-carried disease gets so much press is that there’s no simple fire-and-forget jab in your arm that will prevent it.
You have to take pills regularly. And which pills you take (or don’t) depends on where you’re headed, how long you’ll be there and how your body reacts to them. Lariam (mefloquine) is the most common, and gets the most complaints for side effects (typically panic attacks and nightmares), though your chances of getting these are minimal. Chloroquine, once the all-purpose prophylaxis, is now only used in places where mosquitoes haven’t become resistant to it. And doxycycline is typically used just in places where chloroquine and mefloquine no longer work. Therefore, it’s vital that your information is up to the minute. For long-term care, the chloroquine/proguanil combo can be used for up to five years provided you get frequent eye checks. Otherwise, Lariam is prescribed for up to a year. None of the prophylaxes is one hundred percent effective. And because of the side effects, some travellers (especially those living or travelling in a malaria region for a long time) opt not to take them.
Symptoms typically take one or two weeks to develop and involve three stages: cold shivering and shaking; high fever with rapid heartbeat; then sweating and a drop in temperature. You can also expect coughs, joint pains, vomiting and general unpleasantness. If you suspect it after one day (even if you’re feeling okay the next day) get to a clinic, even if you’re already back in your home country. You can come down with malaria up to two years after your trip. A simple blood test will reveal if you have the disease, and the treatment is best administered under medical supervision. In an emergency, if you’re unable to get to a doctor for days, you strongly suspect malaria and you have mefloquine, take 20–25mg per kilo of bodyweight as a single dose.
Anti-malarials aren’t enough when the bugs are out in force. Use mosquito spray or lotion containing DEET at all times. At night or when you’re relaxing in your room, burn mosquito coils (easy to find anywhere there’s a risk of malaria). And use mosquito nets when provided, or buy your own if you arrive and find they are not regularly provided in that area.
In the end, how you prevent malaria is up to you. What’s important is that you make an informed decision. If you do decide to take prophylaxes, make sure you also use mosquito repellent and take other precautions. And remember, the drugs take time to become effective (one week for choloroquine/proguanil, two weeks for mefloquine, two days for doxycycline), so you will need to start taking them before you arrive in an at-risk area.
GETTING MALARIA
I was a ball of twine and the malaria was a great big frisky cat. It started batting me around about a month after I got home from a protracted stay in the swamps of Indonesia. One hot summer day, I started shivering intensely, shaking so badly that my teeth rattled. Later, I found that the convulsive first stage of an attack usually lasted about two hours. It was exhausting. After shaking myself asleep, or at least half conscious, I’d doze while a fever soared. White-hot dreams bloomed and detonated somewhere in the back of my mind. The final two-hour segment of my typical malarial attack involved sweating. I could go through two or more thick terry-cloth robes and leave them sopping. At first the disease hit me every week. Gradually, it subsided to once a month, then once a year. I haven’t had an attack in over three years, and while it is very exotic to be treated for malaria in Montana, where I live, the price of celebrity, in this case, is intolerable. And I don’t miss it, not even a little bit.
Motion sickness
It’s not serious, but it’s bad enough to ruin a day or two of your trip. On a winding bus ride, try to sit near the front (although not at the front, where you’d be the first one through the windscreen) and next to a window or air vent. Make sure you get out to stretch your legs whenever the bus stops. On a boat, stay above deck and try looking at the horizon. Take deep, relaxing breaths or simply try to stay busy. And, in any event, have a motion sickness pill or a skin patch (hyoscine or scopolamin) ready just in case. It takes at least an hour before the effects of these pills are noticeable, so you may need to take them in advance of boarding.
Rashes
You’ll be encountering plants, fruits and bugs that your skin has never been exposed to before. It’s common for travellers to experience a host of new body art. Try applying topical antihistamine, calamine lotion or steroid creams (hydrocortisone) to the area. If it persists, visit a local doctor.
Snake, spider and scorpion bites and stings
If you’re not a professional snake handler, don’t approach snakes. Followthis essential strategy and they’ll almost certainly leave you alone: if you are walking in tall grass in a known snake area, wear high, protective boots and carry a leafy branch to keep any you meet at bay. If the snake that bites you is dead, bring it along for identification so the proper antivenin can be administered if necessary. Otherwise, try to get a good description without getting bitten again. Do not suck on the bite, apply ice or make an incision. Place a firm bandage (not tight) on the torso side of the bite, just a few inches above the wound. Wash and apply cold compresses if possible. Otherwise, just keep the limb immobilized while you get to a medical facility. Antivenin is the only direct treatment, and it should be administered only by a medical professional.
Spiders are less likely to be dangerous, but apply the same guidelines for bites from unknown and poisonous ones (black widow, redback and brown recluse). Scorpions are found in arid regions; the treatment is the same as with spider and snake bites. To help with the severe pain, administer painkillers and antihistamines liberally while en route to a medical facility. And get in the habit of shaking out shoes and sleeping bags before using.
STDs
Just because you’re choosy about who you have sex with doesn’t mean they were. Once is all it takes to wake up with syphilis, gonorrhea, chlamydia, chancroid, trichomoniasis or herpes. Symptoms include: unusual vaginal or penile discharge, pain when passing urine, itching, abnormal vaginal bleeding and genital ulceration. There’s only one thing to do if you get any of these: go to a doctor. With chlamydia (and often gonorrhea) it’s a little trickier. Most women don’t notice they have it. Some never find out. Some only learn of it at a fertility clinic while trying to find out why they can’t get pregnant.
The best way to avoid getting an STD is to use a barrier method of protection for any sexual contact (condom, femedom, dental dam, etc), and if you’re sexually active while you travel make sure you get checked regularly, even if you don’t have any symptoms.
Sunburn
Sunscreen keeps you from burning, but it also keeps people out in the sun longer with more UV exposure, and the long-term effects of this are yet to be determined. Still, burning is bad. So get in the habit of using SPF 25+ sunblock and reapplying it frequently. Note that some medications reduce your skin’s ability to fend off the sun’s powerful rays: ciprofloxacin, tetracycline-group antibiotics, sulphonylurea (for diabetes) and thiazide (for high blood pressure).
Vaginal thrush
Warm climates, tight nylon underwear and increased sexual activity are among the factors that lead to higher incidence of thrush on the travel circuit. Soreness, discomfort during sex, pain while urinating and passing a white or yellowish discharge are among the symptoms. It’s easily treated by an antifungal preparation that should be easy to find in most countries, but you may want to carry one just in case. In a jam, try applying regular plain yoghurt (at night with a pad for three to seven days) and altering your diet briefly: no sugars, bread, beer, wine, mushrooms, Marmite, Vegemite or other yeast-containing or yeast-encouraging foods.