Staying Healthy on the road.

Nothing spoils a trip more than getting sick. There are some things you can do before hand to prepare but, equally important is to know what to what for at to respond quickly with something minor that you may ignore at home. Your body may not be as resilient with the change of routine, diet and climate- so take that little bit of extra care. Take a basic supply of medicines with you (it is way easier than hunting out something in the middle of the night to “nip something in the bud”.

SOME THINGS TO DO BEFORE YOU GO

Get your travel Insurance: I have a whole blog on this because it’s so difficult. If cancellation cost worry you- get it from when you pay for the first large cost. The cheapest is seldom the best. It has to suit what you are planning to do. If you dive or ski- don’t pretend you don’t to save money! Simply a trip of under 6months can be well insured by a travel credit card where you purchase $500 on the card before you leave and have a return ticket (shop around the get these good perks). Over 6 months and you will have to look. People recommend World Nomads but the older you get the more expensive so there are better options for over 40’s and families. It is important to KNOW what your insurance covers and check out the MANY exclusions in the policy (they all have lots and mostly make their money by paying as little as possible- yes, I’m a bit cynical). Know the procedure for making a claim and have all details with your important documents.

Do a First Aide course: You could save your own life or the life of someone else. I believe we all have the responsibility to understand how to care for ourselves and others in a medical emergency. Train and prepare and hope you will never have to use it. Sadly, we were unable to save the life of a traveller who died in front of us on the floor of a bus station in Malaysia. But the collective efforts of his fellow travellers , who knew CPR and began working on him immediately while the locals called an ambulance, at least gave him a fighting chance.

Have a Medical Summary with your wallet: If you take any medication or have any medical conditions you should have details listed with you ICE (In Case of Emergency) in your wallet and with your phone and passport. Include blood type, allergies and vaccinations.

Take your medications: If you have regular medications get a supply for the time you are away and some spare. Travel with the prescription and keep them in the box in a sealed waterproof plastic bag. Check and temperature conditions that may damage them.

Get a medical and dental check-up: What harm can it do? Check out those niggling questions you may have had. Better than losing a filling in China.

Do your homework: Check out the latest warnings for the places you are visiting and do some research on any vaccinations you may need. Check out what the emergency contact details are and what facilities are in the country you are visiting.

Get your vaccinations and malaria pills: You will need to get onto this a few months before you go as some vaccinations need to be taken well in advance and you will want to spread them out. And not be getting the last one as you get on the plane. There are special Travel Health clinics where the doctors (usually travellers themselves) specialise in travel medicine. Some of these may be free but others will cost, so make sure you build this into your budget. Remember to ask the Dr to provide you with a Vaccination certificate (often held in a WHO booklet) to take with you as you may need a record (especially for Yellow Fever). So, what do you need? The million dollar and rather controversial question. It does depend on where you are going (city, country, rural), your age, your state of health, how long you are staying plus other factors, so a specialist will need to advise you. This list is just to give you an idea:

Hepatitis A- Injection:Single dose:Top up 6-12 months later = Immunity

Hepatitis A is a serious viral infection that can cause liver problems or even failure. This is a virus present in faeces and is usually caught by consuming contaminated food or water. It is common throughout Asia, Africa and Central and South America.

Hepatitis B- Injection:3 doses. Now+ 1 month +1 month: 5 Year booster

Hepatitis B is an often-symptomless viral infection that can cause serious long-term damage to the liver. It is transmitted through the exchange of bodily fluids (a tattoo or having sex).

Cholera-Oral- Two doses 1 to 6 weeks apart to protect for two years.

Cholera is a bacterial infection that is spread by contaminated food and water in areas with poor sanitation. It is rare in backpackers and is not often recommended as a vaccine but is recommended to volunteers .

Rabies- injections: 3 injections: 1+1 week+2 weeks

Rabies is a viral infection that is present worldwide and is spread through the saliva of an infected animal (especially if you have open wounds such as a cut or graze).There is no treatment or cure for rabies, and it is almost always fatal. The vaccine is recommended for any traveller who are travelling for extended periods or conducting activities that may expose them to the disease.

Typhoid- oral or injections:Single dose: Lasts 3 years

Typhoid is caused by bacteria called Salmonella and can contaminate food or drink in areas of poor sanitation. It can be very serious and even potentially fatal, and the vaccination is recommended for all travellers to affected regions, especially the Indian subcontinent, Asia, South America and Africa, and particularly if they will be spending extended periods exposed to poor sanitation or hygiene conditions.

Japanese Encephalitis- Injection:2 doses 28 days apart: Lasts for 1 year

Japanese encephalitis is a viral disease spread by mosquitoes throughout South East Asia. Chances are low but it can be fatal. Many patients experience very mild or no symptoms at all, but because it is a viral infection that affects the human brain there is a chance it can lead to inflammation and swelling of the brain.

Polio, tetanus and Diphtheria- injection:A part of teenage vaccinations:Single injection:Last 10 years. This is a combined vaccination used to combat the common viral and bacterial infections and diseases of polio, tetanus and diphtheria.

Meningitis- injection:Single dose: 5 years

There are several strains of meningococcal meningitis that can affect travellers, including A, C, W and Y, and is passed from person to person. These are all bacterial as opposed to viral and can be very dangerous, causing an inflammation of the meningeal tissue around the brain and spinal cord.

Yellow Fever- Injection: Specialist Centre: Takes 10 days to take effect:Immunity

This is a serious disease that is spread through the bite of infected mosquitoes that tend to feed during daylight hours. It is prevalent throughout tropical Africa and South America. Symptoms can range from flu like fever to vomiting, jaundice or bleeding which can be fatal. You must have proof of this vaccination in a Yellow Passport.

Malaria : If you decide to take them, you can have a tester which shows your reactions to the different treatments (called malaria prophylaxis).That is way better than buying the course and starting and finding out they don’t work for you.

Make up a first Aid kit: I admit to this being very light when we were younger and travelled without children. If you are a traveller at higher risk, then you will have more. We don’t buy the commercially made kits, we make our own up and carry it in a waterproof light weight zip bag (with some little bags inside). Remember to keep the boxes (or cut off the cover at least) in case customs ask. All the things below I have used and have been very pleased to have. I don’t take whole boxes but strips. I place all creams in those small travel pots and don’t carry anything in glass jars. I use sachets when I can and look for long use by dates. These are all shown on the Resource Page as a First Aide Kit checklist.

Plasters-lots of sizes and a few blister plasters

Gauze- in sealed packs, swab away from the wound

No stick dressing- to cover wounds- use tape

Surgical tape- to tape dressings,

Crepe Bandage

Triangle bandage with safety pin

Instant Cooling pack- sprains- mostly single use

Sterile gloves

Tweezers

Scissors

Tiger Balm

Saline- a small plastic vile to was eyes, clean wounds

Antiseptic- Iodine wipes

Paw Paw cream- a natural antiseptic

“Black Balls” Chinese pills called Po Chai-or Imodium for diarrhea

Anti- Bacterial cream-helps to heal cuts and scrapes

Cold and flu tablets

Sore throat spray and lozengers

Paracetamol

Antihistamine tablets and cream

Anti- inflammatory tablets and cream

Cold sores and strong lip balm

Anti-fungal cream

Something for Urine infections

Something for ulcers

Something for worms

Zimcam- Nasal swab for preventing colds

Glue- for cuts

SOME TRAVELLERS HEALTH ISSUES TO WATCH FOR:

Travelling will expose you to all sorts of bugs that your body may not have encountered before, so you may have little immunity. Your diet and lifestyle are also different. It means simply, you may get more “stuff” than you do at home. We also hear horror stories about the worst that can happen- remember distinguishing between the possible and the likely. Don’t stress about what “could” happen and don’t over stock with a whole backpack of medical supplies. Be realistic, be prepared and be sensible.

Vomiting and diarrhoea.  Minor diarrhea and an upset stomach happen to most people due to a change of diet. The bacteria that causes it isn’t bad in itself, it’s just that your body isn’t used to it. To be technical, diarrhoea is at least 3 watery bowel movements in a day with some nausea, vomiting, cramps or simply feeling generally unwell. A mild form of diarrhoea is very common, where there is one loose watery bowel movement and then you are fine.

More severe cases due to a poison (from contaminated poo in your food) is much less common. There are two types: The fast and the furious (over in a day and caused by bacteria- see a chemist) and the slow and the deadly (builds up). Stay put, wash your hands, drink (water with salt, sugar and a squirt of lemon or orange) and eat (dry biscuits, boiled potatoes or rice) if you can (hydrating supplements if needed), let it get out however you can. Mostly you need to relax and trust that your body knows what it is doing and is flushing out the toxins that are making you unwell. Taking strong medications (Imodium) that- stop the diarrhea may actually cause the toxins to be trapped inside and you need to think carefully before you do that. They do not cure you. We have some amazing “black balls” Chinese medicine we use only if we have to travel. Oral rehydration tablets are to help rehydrate you and replace lost salt, glucose and other minerals. They aren’t usually needed unless you’ve been unwell for a while – you can put in few powdered sachets if you are worried. Antibiotics DON’T help at all. Anti- nausea medications don’t work when you self-medicate as you usually just throw them up again. See a DR if it lasts more than 3 days or if you have some other gastro- intestinal issues.

Deep vein thrombosis (DVT). There is a lot of misinformation mostly by the companies trying to sell you DVT socks. DVT occurs when blood clot forms in the veins due to prolonged immobility. Most blood clots are reabsorbed into the body, but sometimes one breaks off and travels to the lungs causing a pulmonary embolus. However, unless you are at risk and have circulatory or heart problems, then it is highly unlikely you will have any problems. Do the socks work? The experts say not but they do seem to reduce the swelling that I get in my feet (now that I am older). The best thing to do on long flights is to simply get up and move around regularly, once an hour for example, just to stretch your legs and muscles. Drink plenty of fluids and stay hydrated and avoid alcohol.

Hepatitis- No tattoos please: The number of serious infections (including Hepatitis which is deadly) that are a result of tattoos from unlicensed and unsafe practitioners is alarming. Mum will pay when you get home!

STI’s and Hepatitis B- If it’s not on it’s not on: The risk of STI’s, HIV/Aids/ Hepatitis B from unprotected sex is ever present- from locals or other travellers. For Gods’ sake if you remember nothing else- NEVER, NEVER, NEVER have unprotected sex. Do you get my point. Repeat after me….. I will NEVER, NEVER, NEVER have unprotected sex (sorry written for my children again- but maybe it applies to you?)

Over Drinking: Ok I’m old now so I can say this. It makes no sense to make your-self ill with a hangover when you are travelling. Managing the after effects of a big night out in a dorm bed with no AC and a shared bathroom is beyond agony. Just don’t do it!

Headaches may be a warning sign: Meningitis whilst not common is very serious. Go to hospital immediately if you get a blinding headache.

Pain and Inflammation: We travel with some paracetamol (Panadol) and an anti- inflammatory (use VERY sparingly Ibuprofen). For a nagging headache, mild fever or as we are older pain in joints or muscles.

Colds, Flu and sore throats are common: The most common medication we use. Change in weather, AC, altitude, shared sleeping all circulates germs. Hit the flu preventers and vitamin C. Stay put and keep warm.

Exhaustion: I put this here as I have seen people running from place to place on a crazy schedule and simply wearing themselves out. We always have one day off a week. When we took malaria tablets that was the day (in case we felt sick). We did our washing, slept in and if we could afford it stayed in a nicer hotel. Don’t rush- have a minimum of 3 nights in a place when you can.

Watch your feet: Fungus infections are common (especially between the toes). Add an antiseptic powder and ‘air’ your feet by spreading your toes. Don’t walk in wet shoes, if possible, if you do at the end of the walk dry your feet, shoes and socks ready for the next day.

Constipation will happen: So, go with the flow (or lack of flow as the case may be). It’s all to do with diet changes. Try to eat some extra fibre or grab a supplement.

Altitude sickness can be fatal: Try not to fly in. Take your time. Watch for headaches. Drop down at night (walk high and sleep low).

Sunburn: You know the drill. Cover up, apply and reapply sunscreen and try to stay out of the hottest part of the day. Watch at high altitude especially as you can be cold and burn to a crisp. It seems the higher SPF is less important than frequently reapplying sunscreen. If you get burnt, drink plenty of water, use cool compresses and find a cream, with Aloe Vera (or the actual plant is even better, and they grow wild in tropical countries).

Watch for animal bites: While not common Rabies can happen after an animal bite. These are especially bad on the face and from a wild animal. Scrub for 5 mins, flood with antiseptic, get to a hospital.

Heat Exhaustion and Heat Stroke: Don’t underestimate how common this is for people who are not used to the combination of heat, dehydration and exercise to suffer from Heat Exhaustion. Blood pressure drops and this will lead to symptoms such as hot/flushed skin, tiredness a headache or dizziness, a rapid heartbeat and nausea. Heat exhaustion can be treated very easily. Get into the shade, rest and drink plenty of water. Put a towel or cloth soaked in cool (not cold) water the back of the neck. Symptoms should disappear after half an hour or so. Heatstroke on the other hand is a medical emergency and should be treated as soon as possible. Symptoms are more severe and include a temperature of over 40 degrees, heavy sweating that stops suddenly because your body doesn’t have the fluids to produce sweat, a fast heartbeat and breathing and muscle cramps and possibly dizziness, confusion and anxiety.

Tetanus is alive and well: Deep wounds can be serious even if you have a shot. So, watch for infection.

Poor Nutrition upsets your balance: Ulcers (double dose of vitamin C) are common in your mouth.

Insects bites- The majority of bites such as bedbugs, ticks and leeches are harmless. Bees and wasp are painful unless you are allergic. Mosquitos are the deadly little creatures that are one of your biggest worries when you travel. Different types carry Zika, Dengue Fever, Ross River Fever and Malaria, to mention a few. They can get you day or night (it’s a myth that they only get you at night) and vary from making you mildly sick with flu like symptoms to killing you (or your unborn baby). Malaria is the big concern for most travellers.Most anti-malaria drugs are expensive, and their side effects are potentially nasty. Unless you’re going to travel rough in a part of the world where a deadly strain of malaria is common, like rural areas of West Africa, we personally don’t bother with anti-malaria meds. We also never gave them to our children. You will have to see professional advice to make a call on this one.

Prevention is ALWAYS better than cure. There are a wide range of products on Amazon from wrist bands, to moisture creams, deodorants and hair bands! I’m especially prone (lucky me) so am still looking for the perfect protection. I’ve heard so many mixed reviews about DEET (an ingredient found in many repellents at levels of 35% or higher) so I only spray it on my clothes It may make no difference, but I feel happier when I’m not spraying it directly on my skin. At dusk I wear clothes that that covers me up and is secure at the wrists and ankles.

If you do get bitten don’t scratch the bites ( infection is a problem), put on some ice and use an antihistamine cream and if worse comes to worst, a tablet. We were very sick with Malaria in Africa when we were younger and then we travelled with children, so we tend to avoid travelling to high risk malarial areas. Zika and Dengue are now prevalent in so many places. Unlike malaria, there are no preventative medications.

Jet lag: Most Aussie backpackers become experts in self- management of jet lag. Some people suffer badly but we are lucky to be generally OK. They say it is worst going west to east, but Gary insists its psychological and its always bad when you go home-which ever direction! We put our watches on the new time zone as soon as we get on to start the adjustment and try and eat and sleep according to that. Don’t drink alcohol, keep hydrated and when you arrive try to push through to the night.

PREVENTION IS BETTER THAN CURE

Wash your hands and wash them again: Did you get that! This is a BIG one and it makes a BIG difference. The jury is still out on the hand sanitiser gels, but they are better than nothing. Good old soap works.

Follow some basic food rules:

· Boil it, cook it, Peel it!

· Avoid salads, home-made ice creams, juices (all have water added),

· Eat it piping hot. Watch for reheating-Watch buffets (the food sits too long)

· Eat  less meat and with caution (it’s no guarantee if you are in a restaurant)

· Eat in the popular place for the locals

· Eat local food. It often has fresh ingredients and is prepared by a cook who knows how to make the food taste great.

· Eat street food. It may sound crazy, but most have a fast turn over and doesn’t sit. Sure, you might get a diarrhea, but this is often more about the change is spices etc than poor food. If you watch the places you eat this should be minimal.

· Western food does not guarantee western standards- rather the opposite.

Basic hygiene rules to protect you from hepatitis, diarrhoea, cholera, dysentery and worms!

· Drink only drink bottled, boiled (5 mins) or filtered water – unless trekking and then use blue light or iodine tablets (hide the taste with powdered orange juice).

· Don’t reuse plastic bottle- have your own reusable one.

· Don’t put your hands in your mouth.

Brush your teeth with tap water: If you’re going to stay in one place for a while, your body will have to get used to the local bacteria at some point. A little tap water when you brush your teeth won’t kill you. In fact, it probably contains a tiny dose of bacteria that will help your insides adjust.

IF YOU GET SICK

Rest: The minute you feel unwell REST. If that means changing your travel plans than do. Listen to your body and give it time to heal. Take any preventative medicines you have. Drink bottled water. Find a nice hotel with room service, clean sheets, a private bathroom and AC.

If you get to the point you are worried-go to an expensive hotel. Get your credit card ready. They will have access to western Doctors and International hospitals, and you will recover much more quickly with all the mod cons.

So, be prepared, be sensible and get going!