Backpackers Guide to Travel Health
This guide covers the basic issues that you should know about before you travel. I have been involved with travel health projects all over the World, and am now a GP in London.
It is important to keep in mind that this article is no substitute for a visit to your own doctor.
A good seven months before your trip you should:
- Visit your GP for a general health check-up in preparation for going overseas, especially if you are considering a long trip (now is the time to find anything dodgy that you need to know about)
- While you're there make sure you ask any questions relating to your trip, e.g. what contraception you should use while travelling, where your appendix is located and how to buy any medications that you are on overseas (they may have different brand names) etc.
- Visit your travel clinic well in advance to get the right immunisations. Some GPs charge for these, others don't.
Visiting your GP before you travel
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.
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 have to save up for them.
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, e.g. in most capital cities.
Travel health kit
Travel light is my advice. I advise taking a sterile needle kit if you're going to countries where the risk of HIV or Hepatitis B is high (most Asian and African countries). The kit contains sterile needles and syringes which can be handed to medical staff who will use this for your treatment when needed. It's not a DIY kit! If any of the items need to be used, replace them at the soonest opportunity.
A pair of tweezers will be handy to remove splinters or needles from sea urchins. Some alcohol wipes are a good way to disinfect certain small wounds and cuts. In terms of medicine: take some motion sickness tablets, Dioralyte sachets and Imodium (for diarrhea).
Some people insist on taking antibiotics. This may or may not be a good thing to do. Most gappers are not medically trained and you may end up taking the wrong antibiotic for the wrong ailment. This may increase anti-biotic resistance in general and delay you seeking proper medical attention.
Recommended: First Aid Kit
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 sterile set, is perfect for developing countries, where first aid is harder to come by and there is a genuine risk from unsterilised equipment.
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
- 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.
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.
Staying healthy in the sun
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 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.
Slow down your pace... relax... 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.
The main cause of diarrhea amongst travelers 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 diarrhea.
Most mosquitoes bite around sunrise and sunset (and some time thereafter). It's best to avoid getting bitten as this is unpleasant and may give you a tropical infection.
Mosquito nets and long sleeves are the two things you need to remember.
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.
Wear long sleeves and light cotton socks... even if it's hot!
Stay indoors during the worst time. Turn your lights off at night as they attract mossies. Consider taking mosquito repellent or coils to burn. Or you could travel with very smelly cheese (that's another story).
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.
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.
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.
Allow your body 24 hours to adjust for ONE time zone. If you’ve flown from London to Sydney, don’t expect your sleep patterns to be completely regular for a least a week.
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.
The dreaded 'Delhi belly'
Diarrhea is unformed stools more than twice per day. It may be accompanied with feeling nauseous and vomiting, fever, abdominal cramps and blood and mucous.
If you're suffering from diarrhea you can get dehydrated quickly, particularly in hot countries. Make sure you drink enough and some extra to replace the water you are losing.
Maintain good hygiene: wash your hands all the time to avoid re-infecting yourself.
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.
Diagnosis is important. Delhi Belly is a generic nickname for diarrhea. 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 diarrhea 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 diarrhea). Local doctors have the most knowledge about local diseases.
Imodium is not a treatment or cure for diarrhea, it merely masks the symptoms, and may be useful if you develop diarrhea while on a long bus journey.