MEDICAL ADVICE

- Before you go
- Immunisation
- Food and drink
- On your way
- Specialist Medical Sites

Before you go Consult your Doctor

Travel Insurance // Blood group // Embassy/High Commission/Consulate // Emergency services // Medication // Medical history // General

Consult your doctor
It may seem an obvious one but recent reports in the press suggest not enough of us do this before going off on our adventures. As well as checking out your general level of fitness before undertaking a strenuous adventure it is vital you get advice and arrange the necessary immunisations. Some can take months to become effective for example while in some countries it is necessary to have a yellow fever immunisation before you can enter. Similarly if you are on regular medication you will need to seek advice on their availability abroad for example.
If you are still not sure even when it comes to the time of departure it may be worth investing in an emergency medical kit to keep with you.

Travel Insurance
Get some travel insurance that will also cover you in a medical emergency. Even countries with a reciprocal health link with the UK may require money for some treatment. Generally though, travellers who are resident in the EU are entitled to emergency medical care when travelling in other countries in the EU. All you need to obtain free treatment is a form E111 from the Post Office to show that you are applicable. An E111 form is however no substitute for comprehensive travel insurance.
Things you should know before you go

Blood group
Quite simply if you know your blood group it will allow quicker emergency treatment. In an emergency your Embassy may be able to find an expatriate donor. In some parts of the world this will substantially reduce your risk of being given contaminated blood.

Embassy/High Commission/Consulate
Before you go, find out the address and telephone number of the Embassy, High Commission or Consulate in the country or countries that you are visiting.

What a UK consul can do:
Issue emergency passports.
Contact relatives and friends.
Advise on how to transfer funds.
At most posts (in an emergency) advance money against a sterling cheque for £50 supported by a bankers card.
As a last resort, provided certain strict criteria are met, make a repayable loan for repatriation to the UK.
Provide a list of local lawyers, interpreters and doctors.
Arrange for next of kin to be informed of an accident or a death and advise on procedures.
Contact British nationals who are arrested or in prison and, in certain circumstances, arrange for
messages to be given to relatives or friends.
Give guidance on organisations experienced in tracing missing persons.

Emergency services
Before you travel or on arrival take the time to find out how you would contact the police, the fire services and the ambulance services in an emergency and make a note of the relevant telephone numbers.

Medication
If you are taking regular medication you should make sure that you take an adequate supply for your journey or make sure that the medication is available at your destination. Make a note of any pills or medicines you are taking (with both generic and trade names), the dose that you take and the time of day you take the medicines in case you need emergency treatment.
It might also be worth investing in a small emergency medical kit. Even basic kits contain comprehensive but importantly sterile medical equipment. At least always take a small first aid kit of bandages, insect repellent, antiseptic and water sterilisation tablets.

Medical history
If you have had any serious medical problems it is worth briefly noting down the relevant details including the treatment you were given with dates and the drugs you are taking. Again, this may be of great help in an emergency. You should also note down any pills or medicines that you are allergic to.

General
Take a photograph of all your kit
Make a list of the following...
- Serial number of tickets, passport number and date issued
- Credit card numbers and emergency number to report theft.
- Drivers license number.
- Serial numbers of travellers cheques.
- Serial numbers on valuables e.g. cameras.
- Take copies of prescriptions for spectacles/contact lenses.
- Serial number of travel insurance policy and a note of any emergency contact number.

N.B. It might also be worthwhile making 2 copies of this info (leave one copy with someone you can reach in an emergency and take the other copy with you keeping it separate from your luggage and valuables).

Immunisation

The following immunisations are generally recommended to travellers.
Malaria // Polio // Tetanus // Typhoid // Hepatitis // Yellow Fever // Cholera // Rabies // TB // Hepatitis B // Japanese Encephalitis // Tick Borne Encephalitis // Diphtheria // Meningococcal meningitis

Malaria
It is vital that you undertake a course of immunisation against malaria. It is also important to realise that the tablets you should take may vary according to the country in which you are travelling. This is because in some parts of the world, the malaria parasite is resistant to certain drugs.
Remember though that antimalarial tablets do not provide complete protection and you should always try to avoid mosquito bites.
If at any point during your trip you get a measured fever of 38°C (use a thermometer) or higher, 7 days or more after arriving in a malarial area it is possible that you could have malaria and immediate medical help should be sought. If you cannot reach help that day and your condition deteriorates you should take emergency self-treatment.

Self-treatment should be considered to be a first-aid measure only and you should still endeavour to get to medical attention. Suitable standby kit (adult) For malarious areas with no chloroquine resistance. Treat with 3 tablets of Fansidar as a single dose and seek medical attention. For malarious areas with chloroquine resistance. Treat with 600mg of quinine sulphate taken three times daily for three days followed by a single dose of 3 tablets of Fansidar after the course of quinine is finished.

Polio
This vaccine is given orally, often on a lump of sugar, and is a simple and safe protection against poliomyelitis which is still prevalent in tropical and developing countries. A booster is needed every 10 years.

Tetanus
All travellers should be in date for tetanus immunisation as the disease is spread throughout the world and is potentially fatal. A booster dose is given as a single injection and lasts for 10 years.

Typhoid
Contracted from contaminated food and water which leads to high fever and septicaemia. Immunisation can be either by a new injected single-dose vaccine or a live oral vaccine. Immunisation is usually advised for those going to areas where the standards of food and water hygiene are lower than the UK.

Hepatitis
A Short term protection against this water-borne viral disease is offered by a single injection. A vaccine is now available which provides protection for ten years and is suitable for the frequent traveller. Immunisation is usually advised for those going to areas where the standards of food and water hygiene are lower than the UK.

Yellow Fever
A single injection provides protection against yellow fever for ten years. An International Certificate of Vaccination against Yellow Fever is valid ten days after the injection or immediately upon re-vaccination, and is a mandatory requirement for entry into certain countries.

Cholera
Cholera is an uncommon disease in travellers Immunisation against cholera is not appropriate for most travelers, although, it has been known that border officials may demand a cholera certificate,so it might be best to have one prior to departure.

The following vaccines are occasionally suggested to travelers at particular risk or those who may be staying for long periods of time..

Rabies
Pre-immunisation against rabies should be considered by travelers going to areas where rabies is endemic, who are staying for considerable periods of time or are at particular risk.

TB
The majority of travellers from the UK will have had a BCG vaccination in childhood and do not need to be boosted. Unimmunised adults and children going to endemic areas for prolonged periods should consider immunisation. The vaccine is given as a single injection.

Hepatitis B
Hepatitis B is a viral disease of the liver that is endemic in many tropical countries. It is transmitted by sexual activity and through contaminated needles and syringes. Travelers at particular risk should consider being in date for this immunisation. The course comprises two injections separated by one month and a further injection at six months. An accelerated schedule is available for those who do not have time to complete the recommended course.

Japanese Encephalitis
Japanese encephalitis is a serious viral disease transmitted by mosquitoes in certain rural parts of India, Asia and south east Asia. A vaccine is available which should be reserved for those going to risk areas for periods of a month or more.

Tick Borne Encephalitis
Tick borne encephalitis is a viral disease transmitted by ticks. It is prevalent in certain European countries where the ticks are found in the long grass at the edge of forests. The vaccine is recommended for those who will be staying in such areas for prolonged periods of time.

Diphtheria
Most travellers from the UK will have been immunised against diphtheria in childhood. A booster of low-dose vaccine would be advised every 10 years for those intending to make long-stay trips to developing countries. Travelers requiring a booster for tetanus should be given the new combined diphtheria/tetanus vaccine.

Meningococcal meningitis
A single dose vaccine is available which protects against the A and C strains of the disease. The vaccine would be advised for travellers to areas where there are outbreaks of these strains of meningococcal meningitis. Long-stay travelers to areas where the disease is endemic (e.g. the "meningitis belt" in northern sub-Saharan Africa in the dry season) should also be offered the vaccine. A booster is required every 3-5 years.

Food and Drink

Avoiding Contaminated Food // Avoiding Contaminated Water

Avoiding Contaminated Food
Contaminated food is a frequent source of common infections. In general you should have a high level of suspicion of any food presented to you unless you know it is made from fresh ingredients and has been thoroughly cooked. The following guidelines will help reduce the risk of contracting diseases from contaminated food:

Always wash your hands before eating and dry them thoroughly on a clean cloth Thoroughly wash all fruit and vegetables before eating, salads are best avoided but if eaten should be washed well and left to soak in water containing chlorine based sterilising tablets or household bleach (4 drops per litre) similarly washing in water at 60°C will reduce the risk. If fruit is to be eaten raw peel it first.

Protect food being left for any period of time with a fly net and don't eat food left un-refrigerated for more than 2 - 4 hours. Above all don't eat undercooked or raw meat, fish or shell fish even if they are the all part of the local culture.

Don't drink unpasteurised cow, sheep or goats' milk. If in doubt you can pasteurise by bringing almost to the boil and then cooling, likewise dairy products such as ice cream, butter and cheese, if from an uncertain source, should be avoided.

Avoiding Contaminated Water
Water is a frequent source of infection.
While most cities and large towns have large piped water systems but the water is only safe to drink if it has been fully treated and chlorinated. Even in areas where the tap water is safe to drink the level of chemical treatment may be sufficient to render it unpalatable to the UK traveler. To be entirely safe the following alternative means of sterilisation are available.

The simplest form of sterilisation is to bring water to the boil and then let to cool off before drinking.
Alternatively chemical disinfectants can be used however these are often ineffective if the water is visibly cloudy. Examples of such chemical disinfectants include:

Iodine
4 drops of 2% tincture of iodine should be added to each litre of water and left for 15 minutes. Prolonged use of iodine should be avoided (longer than 6 weeks).

Sterotabs and Puritabs.
These are chlorine based tablets that can be purchased in most outdoor shops.
In an emergency use household bleach (2 to 4 drops per litre of clear water) and leave for 15 minutes, this is safe and effective but will taste of chlorine.

Iodine resin water purifiers.
These light modern systems both filter and purify fresh water from any source.

Remember ice may be made from contaminated water and is therefore not necessarily safe, bottled water and drinks are normally safe, especially fizzy drinks. Always use safe water for brushing teeth and for washing vegetables or salad which are to be eaten raw (the water from the hot tap in your hotel is likely to be safer than the water from the cold tap but let it run for at least a minute first). Above all don't drink the water from open wells and rivers unless using an iodine resin water purifier.

On your way

Travel Sickness // On the Water // Jet lag // Combating jet lag // Safe Sun Exposure // Accidents // Sports and Special Pursuits

Travel Sickness
If you suffer from motion sickness you will be well aware of how unpleasant it can be. There are a number of techniques you can use to reduce the effects of travel sickness.

On the Water
When on a ship try to move to a position where the motion is least. This will usually be near the middle of the ship on a low deck. Stabilise head movement, and sit with your head braced against a chair or wall. If you are in an enclosed space (e.g. your cabin) lie down and close your eyes. If you can see out then fix your gaze on the horizon or a similar fixed point.

Jet lag
If your flight crosses more than 3 time zones, then you might experience "jet-lag".

Symptoms of jet-lag include:
Fatigue, loss of appetite, difficulty concentrating and generally feeling off form.
The symptoms arise because your body clock is slow to adjust to the new time zone. Jet-lag tends to be more of a problem if you are older, if you are flying east or if you are flying long distances.

If your stay in the new time zone will be brief (1 or 2 days) then you are unlikely to be able to adjust to the new time zone.

Combating jet lag
This can be achieved with a few simple remedies. During the flight The air you breathe on the plane is very dry and so reduce the risk of dehydration by drinking plenty of fluids (although the free booze may be tempting it's best to stick to water or fruit juices to stay hydrated!) Avoid cramp by taking brief strolls but if this isn't possible then stay in your seat and perform neck and breathing exercises, toe wriggling and tensing and relaxing the muscles of your arms and legs. Then adjust your watch to your destination time and, in accordance with this, plan when to stay awake and when to sleep and when to take a snack or main meal.

In your new time zone adjust your habits as fully as possible to the new local time. Physical activities (walking, sightseeing) that take you outdoors are particularly important as light and activity help your body clock readjust. After a flight to the east you should take them during the time corresponding to 5am - 11am on old time. After a flight to the west times corresponding to 9pm - 3am on old time are best. Naps however can mislead the body as to when it is night and so try and push through the tiredness.

Research has demonstrated that exposure to bright light at appropriate times can reduce the symptoms of jet-lag. The times of exposure to light and dark are important and the light source must be sunlight or from special light bulbs. There are companies that can supply "light hats".

As a rough guide, the symptoms of jet-lag will last up to TZ/2 days after a flight to the west, and TZ/1.5 days after one to the east, where TZ is the number of time zones crossed.

Safe Sun Exposure
Overexposure to the sun can be very damaging. Overexposure to the suns UV rays can cause sunburn, leading to premature skin ageing and an increased chance of skin cancer. Take care not to burn in the sun and remember the following:

Avoid sun exposure between 12 and 2pm when the sun's rays are at their strongest and where possible stay in the shade (the sun is also stronger the closer you are to the equator). Remember though to be careful in and around water as UV rays are reflected by water.

Wear loose-fitting, closely woven cotton fabrics that you cannot see through, a broad-rimmed hat to protect head, face and the back of neck and use a broad spectrum (blocks UVA and UVB rays), high protection factor sunscreen (SPF 15) applied frequently especially after being in water. Also wear sunglasses that filter out UVA and UVB rays to protect your eyes from sun damage.

Another risk of overexposure to the sun is becoming dehydrated. Avoiding strenuous exercise during the hottest hours is an obvious start and drink plenty of non-alcoholic fluids to replace lost fluid.

Accidents
More travellers die from accidents than any other cause as the consequences of having an accident abroad are often far more serious than if they occur at home. Emergency treatment may be limited and of an uncertain standard and there may be communication difficulties if you cannot speak the local language. You should know how to deal with an emergency and how to summon help locally but above all try to avoid exposing yourself to unnecessary danger.

Sports and Special Pursuits
These often involve a certain degree of risk which adds to their enjoyment and attraction. When accidents do occur, the cause can usually be traced back to avoidable factors such as poorly maintained equipment, lack of training or an inadequate level of fitness. Ensure equipment is maintained to a high standard, that you have adequate training with appropriately qualified personnel and that if the activity to be undertaken involves strenuous exercise that you build up your fitness gradually. Also check your travel insurance policy covers you for all the pursuits that you will be undertaking.

Specialist medical needs:
http://www.lonelyplanet.com/weblinks/wlheal.htm