Guide to Travel Health

by Sebastiaan Kalwij

stay healthy on the road

Guide to Travel Health

Warning: travelling without reading this guide can seriously damage your health!

Healthy travel is all about being prepared. Unfortunately, this tends to involve being poked repeatedly with needles, but hey, it's preferable to the alternatives (Tick-Borne Encephalitis, anyone?). Then there are all those things to consider when you're on the road, like dodging mosquitos, avoiding Delhi belly and the perils of sex on the beach...

Sounds like a bit of a minefield? Don't worry, we've asked travel health expert Doctor Seb to share his wisdom...

In this guide, we cover the basic health issues you need to think about before you travel. However, this guide is not a substitute for a personal consulation with your GP. You should seek personal, professional advice about these issues, and if you experience health problems whilst travelling.

About the Author

Author Dr Sebastiaan Kalwij has practiced medicine in El Salvador, Zambia, India, Peru and Australia, and on a cruise ship. He now works in London as a GP, where he doles out travel vaccinations and advice on malaria tablets. Occasionally he sees travellers with interesting tropical diseases that need to be investigated and treated. Hopefully for all of you reading this guide, this won't be necessary in the future...

Before you leave - visit your GP

It's important to plan your travels in advance. Some people decide on the spur of the moment to travel or join friends. This may leave you unprotected against some illnesses (mainly Hepatitis A and B). Vaccinations and anti-malarial tablets can be expensive and you may need to save up.

A minimum of one month before you set off, you should visit your GP for advice about vaccinations etc. However, if you want to be completely immunised against Hepatitis A and B, it's best to be seen seven months before travelling as you'll need boosters one month and six months after the initial jab - on the page opposite we've given you a chart of the main backpacker destinations, and the vaccinations required for each one. Again - treat this as a guideline - always consult your GP over health issues.

Before you visit your doc, get as precise an idea as possible of where you are going to. For example, Phuket has a different risk for many illnesses than the remote jungle in the North of Thailand, and beach holidays are completely different from jungle safaris. Time of the year is important too - you may need different protection in the dry season from in the wet season.

The more information you've got the better advice you'll get. Obviously plans may vary along the way (you may want to stay longer in a place you like, or travel to a more remote place when you feel more confident). If this is the case it may be possible to stock up on more medication or get vaccinated en route, which should be possible in most capital cities.

Malaria Hep A Hep B Rabies Jap Enceph Polio Typhoid Diphtheria Tetanus

Fiji No Yes Yes No No No Yes Yes Yes

Cook Islands No Yes Yes No No No Yes Yes Yes

New Zealand No Yes Yes Depends No No No No Yes

Australia No Yes Yes Depends Yes No No No Yes

Indonesia Yes Yes Yes Depends Yes Yes Yes Yes Yes

Singapore No Yes Yes No No No No No Yes

Malaysia Yes Yes Yes Depends Yes Yes Yes Yes Yes

Thailand Yes Yes Yes Depends Yes Yes Yes Yes Yes

USA No Yes Yes No No No No No Yes

As far as vaccinations go, a lot depends on the activity, length of stay and location. For example, a stopover in Bangkok for one night en route to New Zealand carries a very low malaria risk; backpacking in the remote areas near the Burma border for three weeks and working as a volunteer in a refugee camp is a different matter. However, if a group of lads en route to a mango-picking job in Australia have a one-night stopover in Bangkok, visit some local strip joints and fall for the charms of a pretty girl (or man - you never know!) then a Hep B vaccination would be highly recommended!

We recommend a Hep B immunisation for all destinations as nobody knows what can happen. The same for malaria for all countries that have it. Dengue Fever (from mosquito bites) and Hepatitis C (usually from unprotected sex, infected blood etc.) have no vaccine yet, so take other precautions like using mossie nets and repellents and always have sex using a condom... which can also prevent Chlamydia (which can cause infertility).

Injections, blood transfusions: ensure a sterile needle set is used and you are in the best quality hospital you can get to. Rabies is in general low risk but vaccination is recommended for those travelling to remote areas and those who are planning to work with animals, e.g. a stint as a volunteer in an animal sanctuary or game park.

Check our travel health kits on page 9 for more information on sterile needle kits you can take with you.

HOW much?

The main problem I find amongst backpackers is that they get a cheap ticket to Thailand, and then have to pay half of that amount again in travel jabs! Many often take the risk and leave them out. Please please don't take this risk. The value of your life and health far outweighs the cost of a few injections and a box of pills. Accept that it is all part of the package and get them done. On the opposite page, we've laid out roughly what it all costs. The difference you're going to find is whether you go through your local GP or whether you go to a private travel health clinic.

As far as your local GP goes, you'll find that some run travel health clinics, and some don't. Some nurses are very enthusiastic and good, some are less so and are pressed for time (a few may also envy your travel plans - escaping the cold and the rat-race!). Some GPs can prescribe malaria tablets and Hep A & B on the NHS, so this can be a massive saving. However, the issue of waiting times, the quality of advice you might get (and so on) does result in many people considering specialist, private travel health clinics. The private firm will be slightly more expensive, but the advice will be up to date, the waiting times less, the premises smarter and they'll probably be open on a Saturday. The choice is one of price and practicality, and it's ultimately your decision.

Please note - these prices indicate a rough guide and are not meant to recommend any specific brand – always consult your GP if you're in any doubt at all.

- Malaria: tablets, 1 month, probably Doxycycline @ £50-£65

- Hepatitis A: Dose 1 @ £40+, dose 2 (1 year later) @ £40+ = £80+

- Hepatitis B: £25+

- Rabies: 3 doses @ £35+ = £100+

- Japanese Encephalitis: 3 doses @ £35+ = £100+

- Typhoid: £20+

- Diphtheria, Tetanus, Polio: £25+

- Polio: solo £20+

- Yellow fever: £35+

For a standard RTW trip you're likely to need defence against: Malaria, Hepatitis A and B, Japanese Encephalitis, Typhoid, Diphtheria, Tetanus and Polio. Rough cost = £175 - £240

How are they given to you?

All are injections into the arm, apart from the malaria tablets which you will need to take daily before, during and after your trip.

Important point:

Loads of people get back from their trip, think they don't have Malaria and so stop taking the tablets. These are the people who tend to become seriously ill from it or even die from it. Vital that you obey the rules...

Does it hurt?

It's similar to a bee sting and your arm may feel a bit numb for a bit afterwards as well. If you don't like needles / jabs / a bit of discomfort then there's nothing wrong with taking someone with you to hold your hand. Make sure you have plenty to eat and drink before you arrive.

Common Health Issues: The Sun

We all know the phrase: 'Only mad dogs and English men stay

out in the midday sun'.

When you first arrive, a high temperature can seem oppressive and you'll probably sweat more than you're used to - this can lead to dehydration and lethargy. It can take up to three weeks to adapt, so don't exert yourself too much for a while.

Welcome as the sun is to those living in grey climates, it can be your worst enemy. Avoid being out in the sun full stop between 11am and 4pm. You can use this time to have lunch, a siesta or visit an indoor sight such as a temple or museum.

Be overly-generous with sun tan lotion. Re-apply after each swim and every two to three hours. Wear a sun hat, sunglasses and if possible, long linen shirts and trousers. You don't see many locals dressed in shorts and T-shirts: it may seem a paradox but long sleeves and long trousers are in fact more comfortable to wear in the heat than beachwear. Go figure.

Slow down your pace. Relax - you look nicer. Don't rush about. Stay longer in one place and get a feel for it properly - there's no point in exhausting yourself with long, hot bus or train journeys trying to see a whole continent in a few weeks.

Check out gapyearshop.com for products to help you avoid the sun. Don't take risks - just take a hat!

Common Health Issues: Drinking water

The main cause of diarrhoea amongst travellers is drinking unclean water. Water can be contaminated with bacteria in many ways. A nice-looking stream or lake may be a sewage drain for a small settlement. Water from wells may be stagnant or untreated. Cutlery and dishes may have been washed in dirty water.

In many places you can buy bottled water, but at a pound or two a day it can seem costly when you're on a backpacker budget. If you do, make sure the bottle is sealed properly. Vast profits are being made by people selling ordinary tap water in mineral water bottles. Also think of the plastic waste trail you will be leaving behind.

The best way to treat water is to filter it (through a cloth) and boil the water for at least 10 minutes. This may be time-consuming but depending on where you stay and how long for you can prepare larger quantities at a time. It may be impractical and expensive, however, if you have to use your own gas-stove.

Iodine tablets are a good, cheap way to treat local water. The taste isn't very nice, but it will save you from a night on the toilet with cramps and diarrhoea. They're also available through gapyearshop.com, so be sure to check them out.

Common Health Issues: Mosquitos

Most mosquitos bite around sunrise and sunset (and some time thereafter). It's best to avoid getting bitten as this is unpleasant at best, and at worst, may give you a tropical infection.

Mosquito nets and long sleeves are the two things you need to remember. This is vital if you're going to a country where malaria is found.

Mosquito nets come in all sizes. Go for the one with the smallest holes and with some hooks attached. If your hostel or guesthouse provides bednets, check for holes. Permethrin nets are the best type, as they are impregnated with insecticide - you can also find wrist/ankle bands that use the same trick.

Wear long sleeves and light cotton socks, even if it's hot! There's nothing more aggravating than a swollen bite on your ankle, especially if you're a keen hiker.

Stay indoors during the worst time. Turn your lights off at night as they attract mozzies. Consider taking mosquito repellent, insecticide plug-ins or coils to burn. Or you could travel with very smelly cheese (although that's another story).

Common Health Issues: Depression

Depression is not a tropical illness, but some people find that travelling isn't the positive experience they have hoped for. Friends may argue, a holiday romance may have turned sour; there may be periods of loneliness or homesickness. Being confronted with poverty on a daily

basis can be depressing. You may feel useless coming from a consumer society and not being able to help local people. Long bus and train journeys may give you too much time to think about life. There are many reasons why one can get depressed whilst abroad. It is important to recognise this and discuss it in openness with friends, family and healthcare professionals.

To avoid getting depressed whilst travelling, make a plan or add a structure to your journey. You can think of this before you travel. Try to get something long-lasting out of your travels, such as learning Spanish in Latin America, or Balinese dancing. Spend a bit longer at a certain place to settle in and meet local people.

Common Health Issues: The Dreaded Delhi Belly

Nobody likes diarrhoea (well, they might, but if they do, we think they need help). It can be inconvenient, uncomfortable, painful and, in the wrong situation, very dangerous indeed.

Technically, diarrhoea is unformed stools more than twice per day. It may be accompanied with feeling nauseous and vomiting, fever, abdominal cramps and blood and mucous.

Diagnosis is important. Delhi Belly is a generic nickname for diarrhoea. The cause could be

food-poisoning, a virus, Salmonella, an amoeba etc etc. Depending on the cause you may recover quickly without much treatment or you may go downhill rapidly. If diarrhoea lasts more than two days you must seek medical attention. A stool sample will be needed and depending on the cause you may need some antibiotics (not effective in food poisoning or viral diarrhoea). Local doctors have the most knowledge about local diseases.

When you have diarrhoea, your body rapidly becomes dehydrated and low on essential salts - this is even more likely in a hot country. Make sure you drink enough and some extra to replace the water you are losing. Sachets of rehydration solutions are always a good idea, but if these aren't available, dissolve 8 level teaspoons of sugar and a single level teaspoon of salt in a litre of

safe drinking water. At least one glass after every fresh bout of diarrhoea should prevent any severe dehydration from occurring.

Remember, although useful, Immodium is not a treatment or cure for diarrhea. It merely masks the symptoms, and may be useful if you develop diarrhoea while on a long bus journey. However, regular use can make the problem worse in the long run, so ensure you only use them

when you really need to, like when you're on a packed train with one toilet shared between two carriages.

Maintain good hygiene - we don't want to sound your your mother but wash your hands all the time to avoid re-infecting yourself. There's nothing worse than thinking you've shaken a stomach bug only for it to come back ten times worse.

Avoid long bus and train journeys. Try to stay somewhere comfortable and cool. Inform others (friends, hostel staff) so you are not suffering by yourself in an anonymous hostel room in the back streets of a big city.

Diarrhoea will often pass in a few days. However, if it becomes prolonged, or you spot blood, mucous or you develop a fever, seek medical attention as soon as you can.

Common Health Issues: Motion sickness

Motion sickness can affect everybody, although some people may find themselves more susceptible than others. It occurs when the endolymph - the fluid found in your ear canals - becomes agitated, causing your brain to become confused between the movement it perceives and the actual movement your body is going through.

A quick fix to travel sickness is simply to sit in the front of the car, towards the front of the plane, or sitting in the middle of a ship - these are the places that the motion of travel is least apparent.

Another way to relieve the nausea slightly is to fix your eyes on a stationary object far away, like the horizon. It'll help your brain to reassert its sense of balance.

There are plenty of travel sickness tablets available, and your GP or pharmacist should be able to recommend the tablets best suited to you. Ginger tablets and capsules tend to work across the board, and there are plenty of travellers who swear by wrist-bands that place pressure on acupuncture points.

One final note - never read when you're feeling travelsick. Because you're focusing on something small and detailed, it can aggravate the sense of nausea acutely, and can make you feel much worse.

Common Health Issues: Altitude sickness

Although comparatively few backpackers run the risk of developing altitude sickness, the increasing ease of travel to mountainous areas means the number of cases in recent years has risen dramatically.

If you intend to travel to over 3,000m, your ascent must be taken slowly so your body can acclimatise to the extreme conditions. If this doesn't happen, you'll find yourself getting breathless after very little exertion, and this may be accompanied by headaches and nausea. Paracetamol should relieve the headache (as altitude headaches are caused by swelling of the brain), but if it's severe and accompanied by nausea then medical attention should be sought at the first opportunity.

Realistically, you should allow three days to acclimatise to 3,000m. However, this isn't always possible, and a drug called acetazolamide can help in some circumstances. It's prescription-only, so consult your GP about it before leaving.

If you want to limit the effects of altitude sickness, avoid alcohol and get plenty of rest as you acclimatise. Altitude sickness can develop rapidly and is extremely dangerous, so take every precaution you can think of, and then some.

Common Health Issues: Jet-lag

If you're flying long-haul, we can almost guarantee you'll suffer from some form of jet-lag. Your body's natural clock will take longer to adjust to the new time zone, and as a result you can feel tired in the middle of day, wake up in the middle of the night and have hunger cravings at unusual times.

There are many tales around about how to prevent jet-lag, but very few have any proof attached to them. There is much talk of melatonin (a hormone released by the brain just before sleep) but it is currently unavailable in the UK.

There are a few tips that may make the transition to a new time zone easier:

- It is always best to avoid alcohol on flights and maintain a good fluid intake of water and fruit juices

- Change your watch to the time at your destination as soon as you board the plane

- Get some sun (sensibly) as soon as you get to your destination, this will suppress natural melatonin production and encourage your body to believe that it is in fact daytime

- Adopt local time as soon as you arrive, even if you are not tired go through the motions of going to bed to get a new rhythm as soon as possible.

Common Health Issues: Safe sex

We really are starting to sound like your mum, aren't we? Fortunately, safe sex is almost all common sense, and we trust you've got that by the bucketload. For those whose buckets may have sprung a leak, here are the basics:

Practice safe sex - take contraceptives with you and always use a condom. It's a joint responsibility so take control. Always look for the British kite-mark and make sure the condoms are in date. AIDS is a real danger all over the World.

Before travel, it is likely that anyone would say that there is no chance of them having sex whilst travelling - it's too risky. However, it is a fact that in a relaxed atmosphere after a few drinks the unexpected will often occur, and it is always better to be prepared than to run the risk of pregnancy and sexually transmitted diseases, not least of all HIV.

You may think that the partner you have chosen seems like a nice bloke/girl, but the last person that they slept with may not have been! Condoms will not be available in many countries throughout the World and those that are available may be of poor quality due to bad storage or old age.

Unprotected, unsafe sex might not ruin your holiday, but it could easily ruin the rest of your life. Stay safe.

Recommended Kit: First Aid

It is very important that you take a sterile set (which has sterilised needles in case you need to hand them to a medical team, vital for developing countries) and a small medical kit (not a First Aid kit that deals with paper cuts back home).

The two items on offer through the gapyearshop.com are the Lifesystems Trekker Kit (right) and the Lifesystems Sterile Set (below). The trekker kit is small and cheap at

£9.99, and has everything you need for basic first aid - plenty of backpackers head to popular destinations with excellent healthcare, yet they still buy huge first aid kits that never get used.

The sterile set (left), at £16.99, is perfect for developing countries, where first aid is harder to come by and there is a genuine risk from unsterilised equipment.

If you need something larger, we also offer the Lifesystems Travel medical Kit (below) at £29.99, a superb pack that will last you for years.

Kits don't come with everything you need - they'd be rucksacks in their own right if they did. We've listed some extra stuff that's easy to get hold of - it should all be at your local supermarket.

Just check your first-aid kit and see what's included and what's not before heading out. Common extra purchases to make will include:

• Sachets of rehydrating solution
• Wound closure strips
• Extra Paracetemol/Ibuprofen
• Antibiotic cream
• Anti-diarrhoea medicine
• Anti-fungal foot powder
• Anti-itching/bite/sting cream
• Motion sickness pills
• Throat lozenges
• Vitamins
• Sharp-ended tweezers
• Pointed scissors
• A thermometer

   

Also, take Medic Alert ID - these are used by people with, for example, diabetes, or an allergy to penicillin. They're very important for foreign doctors so they can diagnose you correctly.

Water purification tablets, if you haven't got them already, are also a good idea.

Travel Insurance

The highest cost of medical bills for a traveller that we've heard of is £900,000. Not got that in your back pocket? It might make sense to book yourself some insurance.

If you're planning on any extreme sports, your premium will be higher - there's no way to avoid that. If your planned activities have a higher risk of resulting in injury, the insurance company are justifiably asking for suitable compensation if you decide to break your arm while white-water rafting.

The insurance for skiing is notoriously expensive (it can even double your premium completely), but the increased risk associated with the sport make the additional cover much better value for money than it seems.

On the opposite page, we've got an account from Lara Hallam, who found her travel insurance invaluable when exploring Kuala Lumpur, Malaysia. Listen and learn.

"After a few days of feeling rough, gritting my teeth and saying 'I'll be fine' I decided I had to go to the local hospital. On arriving I had to fill in endless forms and be informed about the hospital costs - all of which really went over my head. Luckily I was not alone when entering the hospital, my travel partner was with me which made the experience more bearable.

After seeing numerous doctors and giving blood, I was told I needed to be admitted. I was quite worried but I must emphasise how all the staff I met understood my circumstances and did all they could to make me feel welcome and to return me to full fitness as quick as possible.

Unfortunately the hospital did try to con me out of money. They informed me the only bed available was the 'VIP deluxe suite' i.e. an expensive room. My friend luckily was in a more stable mind than I was, and said that in order for me to claim the cost via my insurance company, I would need written clarification that this was the one and only bed left in the hospital. I told them I would not sign for anything until I received this letter. After a long wait and more discussions, they gave up and told me a bed had been miraculously found on a ward.

Once in the ward the nurses fussed over me and once a few communication problems were resolved, I was hooked to a drip and lay in bed for three days. I was visited daily by a doctor and had loads of nurses around to keep an eye on me too. Once I was settled, I told my friend to let my parents know what was happening, firstly to relieve the pressure on him, and also in case anything bad happened - particularly in terms of health or money.

Even though being in hospital overseas was a scary experience, I did meet some lovely people who really helped my experience become less daunting. In particular, on my second day a lady appeared from the administration department with an email from home. She even allowed me to write a response that she would email back to my parents for me. My parents were also allowed to ring daily to speak to me. On my third day in hospital, I was discharged finally. However, I made sure I received a medical note from the doctor and all receipts for the medical costs, for my insurance company."

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