Presentation Transcript

1. The Essentials of Travel Health and…stayingeffective on your trip

   Dr Jane Wilson-Howarth MSc (Oxon), BM, FRSTM&H, DCH, DCCH, DFFP www.wilson-howarth.com
2. I told him I intended going to West Africa and he said, ‘When you have made up your mind to go to West Africa the very best thing you can do is get it unmade again and go to Scotland instead; but if your intelligence is not strong enough to do so… get some introductions to the Wesleyans: they are the only people on the coast who have got a hearse with feathers.’ Mary Kingsley Travels in Africa 1897
3. Who Are you? Missionary / do-gooder Mercenary / gimme a job Misfit / lonely heart
4. The person you are determines….. What risks you take? with snakes motorbikes unsafe sex swimming drunk wandering into unsafe parts of the city? What safety equipment will you pack?
5. Death threats? Accidents Car smashes Violent crime Alcohol/drugs Drowning Electrocution Falls, etc Communicable disease takes less than 4%. Diseases that are vaccine-preventable account for a fraction of even this small number
6. Play safe. Expect to be robbed.Be properly insured. What cash & credit card back up? Organise a grab-bag?
7. Of 100,000 people visiting a developing country for one month: Half will develop some kind of illness 8000 will visit a doctor 5000 will be confined to bed 500 will require repatriation by air 300 will be admitted to hospital during their trip or on return 1 will die From The Textbook of Travel Medicine and Health by Prof Robert Steffen & Dr Herb DuPont Expats twice as likely to die as stay-at-homes (Dutch data)
8. Previously… any health worries?What treatment have you received? Are you truly allergic to anything? Know dose & genericnames of medicines Pack spares of any pills / medicines (luggage gets lost; trips get extended) You don’t need vitamin pills
9. PLANNING: What can’t you do without? TV? Music? Radio? Books? Marmite? Crispy apples? Will the local diet suit you?
10. Will these be your local shops? Also find out what’s going to be available and what’s legal locally.
11. Preparing is more than going to a travel clinic for jabs. Research before seeing the immunisation nurse but… Avoid commercial websites (selling things). Check several sources: www.fitfortravel.scot.nhs.uk www.nathnac.org Centers for Disease Control US site is unbalanced & scary www.fco.gov.uk www.state.gov/travel There are also books, chapters in country guides & dedicated travel health references e.g…..
12. HERD IMMUNITY In many resource-poor nations ordinary childhood infections are rife. Ensure that childhood jabs (MMR, DPT etc) were done and are up to date. Ask your GP practice nurse. Free jabs are : typhoid, hepatitis A & usually DPT (dip/tetanus)
13. Get hepatitis B cover if you are going to be away long enough to have a haircut
14. Rabies jabs? The jab reassures & gives time No need for Rabies Immune Globulin
15. Expect to get ill Where will you find a doctor? How will you pay for care? Carry an EHIC: the European Health Insurance card Check your insurance covers everything
16. The local drugstore Medicines are often readily available overseas
17. If you are going to be a do-it-yourself doctor, double check and take a book Over-the-counter meds in the UK may require a prescription elsewhere, e.g. in the US
18. beware.. Withdrawn drugs are dumped in the Third World Counterfeit meds are a problem especially in SE Asia and Africa
19. My minimal first aid kit Drying antiseptic (?iodine; potassium permanganate) Water bottle with a good seal Purification tabs Repellents + sunscreen Antimalarials if necessary Knowledge of oral rehydration Bum cream e.g. Sudocrem or Anusol Paracetamol (soluble) ?thermometer (esp for malarious regions) Antihistamine tablets or steroid ointment Steristrips + wound dressings Crepe bandage Dental first aid kit if over 40 Torch Condoms ?health guide or means of remote health advice
20. On arrival… what’s the most likely illness that will get you?
21. Motion sickness Strikes unexpectedly (unfamiliar modes of transport) Hyoscine/scopolamine (e.g. Kwells) Antihistamines (e.g. Stugeron/cinnarazine) Patches (last 72h; these are also hyoscine)
22. Most likely illness Stomach troubles, diarrhoea & / or vomiting, abdo pain, queaziness, dysentery, etc. And / or low mood - maybe
23. So…can you / should you drink the water? Or anything else?
24. Best sterilising method is (1st) boiling, then: (2nd) iodine, (3rd) chlorine (Puritabs) and lastly (4th) silver.Filter devices are expensive & can get blocked, lost or stolen.
25. Most likely source of grief is…. Dangerous foods: Ice cream Strawberries Lettuce Cold cooked food / pies Messed about with drinks / cocktails So…Peel it, boil it, cook it or chuck it.
26. Eat where the locals eat Eat what the locals eat Avoid locally ‘exotic’ foods Choose cook to order (a la carte) Beware of buffets.
27. If you… Peel it Boil it Cook it or Forget it… you avoid these earthworm sized Ascaris round-worms too
28. How will you manage if/when you get severe diarrhoea? How to calculate the amount of fluid you are losing? How do you replace it?
29. Eat or Starve ? The best foods? Milk? High calorie? Vitamins? Any abdominal pain? Danger signs
30. Avoid dehydration
31. Rehydration is vital Mixtures of sugar and salt get fluids into the body better than water alone Starch / complex carbohydrates also aid fluid absorption Rehydration is life-saving
32. Vehicle (and other) accidents are common. Could you save a life? Know your ABC?
33. Skin infections Drying antiseptics are best in hot humid climates: Iodine Potassium permanganate Gentian violet Caution with creams, especially antibiotic creams
34. Think about the risks Dress for your environment (will temps be >50ºC?) 100% cotton (or silk) is best What is culturally acceptable? Snakes?
35. Avoid bites/sunburn and protect your skin Use: The right clothes A hat An umbrella? the right products (sun screen and DEET-based insect repellent)
36. Skin protection Permethrin (a contact insecticide) can be used on clothes as well as nets to keep biters away. The new LifesystemsEX4 is also excellent & persistent.