Going Travelling?

Posted: 03/02/2020 Author: Dr John Cahill

Just a few helpful medical tips for those going further than the Costa Brava...

Plan ahead
It’s worth it and might even be enjoyable! Don’t rely totally on your travel agent particularly for the tropics or unusual destinations. There are some excellent websites which will give you health advice specific to the country of visit [ as well as visa requirement/security/safety issues]. They are very useful in guiding whether you will need specific vaccinations and assessing malaria and yellow fever risk

More informal but potentially more streetwise advice can be accessed through travel website forums

  • Lonely Planet
  • Thorn tree
  • Trip advisor

It’s still acceptable to do the retro thing and bring a Travel Book with you.
Don’t be too ambitious with your itinerary- jet lag and stomach upsets can take their toll. If you are travelling to altitude greater than 2500 metres you will need a few days to acclimatise; if you’re off to Everest base camp you may need to discuss remedies against acute mountain sickness [AMS] e.g. Diamox. Bear in mind AMS is no respecter of age, sex or fitness level.

Check your immunisation status
It’s really useful if you can bring evidence of previous immunisations; your NHS GP surgery should be able to provide this free of charge . If you’ve had a look at the travel websites above you will have a good idea of what may be necessary. Comprehensive and specific advice can be given at a consultation but there are a few useful facts for your information

  • Yellow fever vaccine; a single vaccination is now valid for life [WHO guideline]. We are a registered yellow fever clinic and administer these vaccinations and all those below regularly.
  • If you’ve had a full course of Tetanus as a child/young adult you don’t need boosters every 10 yrs
  • Hepatitis A vaccine does need boosters every 10 yrs
  • Hepatitis B course is worth having if you working [ or playing the field] in high risk situations .
  • Rabies vaccine is recommended in any at risk area especially for prolonged stays and activities such as cycling and running.
  • There are currently no available vaccinations against Malaria Zika and Dengue fever although trials are taking place.
  • Cholera vaccine isn’t very effective but would be given for travel to zones where outbreaks have occurred

Avoid…
This is not a comprehensive list !

  • Contact with wild animals - dogs are not the only animals to transmit rabies [monkeys too] nor will a dog with rabies always appear rabid. If you get bitten or even scratched wash the wound thoroughly with antiseptic and seek medical advice. Having had Rabies vaccine doesn’t eliminate the need for treatment as soon as possible after a skin break; if you haven’t had any vaccine you really need to act urgently. Also animal bites are very likely to become infected and again prompt medical treatment is advised
  • Tap water outside of Western Europe. Be very suspicious of any water supplied even if the management say its been filtered. Sadly for the environment bottled water is safest. Ditto avoiding ice cubes.
  • Restaurants or plastic chair eateries that have no locals eating therein. People aren’t stupid!
  • Having sex with strangers paid or unpaid. If you must, use a condom. Hepatitis B and C and HIV are not rare conditions.
  • Mosquito bites. Daytime bites may transmit Dengue and Zika and nighttime bites Malaria ! Use at least 50% DEET [care with children and sensitive skins], cover up with light coloured clothes especially at dawn and dusk when the blighters are particularly active. Mosquito nets and air conditioning will ease your nocturnal worries.
  • Snakes; serious bites are mercifully rare but don’t go walking through tropical undergrowth in your flip-flops. If you do get bitten don’t attempt the Wild West method of sucking out the poison. Keep still [it's unlikely you will keep calm] and immobilise the affected part [it’s usually lower limb]; a light tourniquet or compression can prevent venom going in to the main circulation. Get help urgently even if you feel well. It’s useful to identify the species of snake that bit you so that specific antivenim can be given [although I think you can be forgiven if your Herpetology skills temporarily aren’t up to scratch].
  • Unsafe transport. Road fatalities are generally much higher in Asia, Africa and South America. If your minibus driver is a bit slurred or the vehicle is hopelessly overcrowded go with your instinct and make alternative plans. Avoid nighttime road travel - fly or take a train if you can [see the excellent website www.seat61.com ]
  • Too Much Sun, Not Enough Water- it had to be said!

Do…

  • Get Health Insurance [and keep the phone number somewhere safe]. There are very few countries where you will get good medical care gratis in a medical emergency. The cost of getting you home may dwarf the price of a Business Class ticket. For most people an annual policy is the best value. If you have any new medical episodes or treatment changes or investigations you MUST let the insurance company know before you travel or it might just be the most expensive trip you’ve ever had!
  • Get an EHIC card if you’re from the EU and travelling in the EU. Brexit or not it’s still available for free [watch out for sneaky internet sites who will charge you for procuring these cards- use the www.gov.uk portal]. The acceptance of it seems to be variable and not all charges may be covered e.g. medication.
  • Get a dental check before you go , particularly on a long trip. An unscheduled and forceful extraction doesn’t make for holiday fun.
  • Take an iPad/Tablet with you . Download all the languages of the countries you are visiting before you go. So without the need for wi-fi you can type in your symptoms and show a translation to your local health care professional without speaking a word of the language [we are British!]. Be prepared for mirth and confusion - the translations aren’t foolproof . While you’re waiting you can always learn a few words.
  • Get a doctor’s letter [and always get the biggest most official looking stamp] to confirm why you are carrying any prescription drugs especially Codeine/Tramadol and any form of morphine, particularly if you have large amounts. Don’t take more than you need. The same applies to needles/syringes for diabetics; it might be worth pre loading some explanatory sentences [checked by a native speaker] on your iPad ; it might save you a lot of grief at Customs.
  • Make an appointment to discuss your specific health needs; we can also advise or prescribe medication to take with you for emergencies. Don’t forget many things can be bought over the counter at Chemist - First Aid kit, Ibuprofen, anti-histamines, Paracetamol and Imodium should be part of your medical armamentarium.


Bon Voyage!

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