Transcript Staying efficient and useful - Engineers Without Borders UK

The Essentials of
Travel Health
and…staying
effective on your trip
Dr Jane Wilson-Howarth
MSc (Oxon), BM, FRSTM&H, DCH, DCCH, DFFP
www.wilson-howarth.com
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
Who Are you?
Missionary / do-gooder
Mercenary /
gimme a job
Misfit / lonely
heart
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?
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
•
Play safe. Expect to be robbed.
Be properly insured. What cash & credit card
back up? Organise a grab-bag?
•
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)
Previously… any health worries?
What treatment have you received?
• Are you truly
allergic to
anything?
• Know dose &
generic
names of
medicines
• Pack spares
of any pills /
medicines
(luggage gets
lost; trips get
extended)
• You don’t
need vitamin
pills
PLANNING: What can’t you do without? TV? Music? Radio?
Books? Marmite? Crispy apples?
Will the local diet suit you?
Will these
be your
local
shops?
• Also find out
what’s going
to be available
• and what’s
legal locally.
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…..
HERD IMMUNITY
• In many resourcepoor 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)
Get hepatitis B cover if you are going to be away
long enough to have a haircut
Rabies
jabs?
• The jab reassures & gives time
• No need for Rabies Immune Globulin
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
The local
drugstore
Medicines are often readily available overseas
• If you are going
to be a do-ityourself doctor,
double check and
take a book
• Over-the-counter
meds in the UK
may require a
prescription
elsewhere,
e.g. in the US
beware..
• Withdrawn drugs
are dumped in the
Third World
• Counterfeit meds
are a problem
especially in SE
Asia and Africa
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
On arrival…
what’s the
most likely
illness that
will get you?
•
•
•
•
Strikes unexpectedly
(unfamiliar modes of
transport)
Hyoscine/scopolamine
(e.g. Kwells)
Antihistamines (e.g.
Stugeron/cinnarazine)
Patches (last 72h; these
are also hyoscine)
Motion sickness
Most likely
illness
• Stomach troubles,
diarrhoea & / or
vomiting, abdo
pain, queaziness,
dysentery, etc.
• And / or low mood
- maybe
• So…can you /
should you drink
the water?
• Or anything
else?
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.
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.
• Eat where the
locals eat
• Eat what the
locals eat
• Avoid locally
‘exotic’ foods
• Choose cook
to order (a la
carte)
• Beware of
buffets.
If you…
Peel it
Boil it
Cook it
or
Forget it…
you avoid these
earthworm sized
Ascaris roundworms too
• 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?
Eat or
Starve ?
•
•
•
•
•
The best foods?
Milk?
High calorie?
Vitamins?
Any abdominal
pain?
• Danger signs
Avoid dehydration
• 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 lifesaving
Vehicle (and other) accidents are common.
Could you save a life? Know your ABC?
Skin infections
Drying antiseptics
are best in hot
humid climates:
• Iodine
• Potassium
permanganate
• Gentian violet
• Caution with
creams,
especially
antibiotic
creams
• Think about the
risks
• Dress for your
environment (will
temps be >50ºC?)
• 100% cotton (or
silk) is best
• What is culturally
acceptable?
• Snakes?
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)
Skin protection
Permethrin
(a contact
insecticide)
can be used
on clothes
as well as
nets to keep
biters away.
The new
Lifesystems
EX4 is also
excellent &
persistent.