travel bugs

by Matt Brooker

In 2005 a quarter of a million British backpackers will jet off around the globe on voyages of discovery to see what the world has to offer them.

© iStockphoto / Lise Gagne

Without some basic preparation, however, those with romantic notions of 'finding themselves' are more likely to be concerned with locating the nearest toilet. Even those with the most iron constitution could find their visits to dream destinations from Angkor Wat to the Zambezi reduced to nightmares they'd happily trade for nothing more than the use of a 'western loo'. It's not just the intestinal issues either; these gastric concerns can pale into insignificance if bitten by the wrong insect…

A serious bout of food poisoning, though memorable, is unlikely to be the sort of experience you long to relive, and whilst fungal infections could still leave you with itchy feet (and more), malaria may put paid to any further 'broadening' of horizons.

So just what steps can be taken to minimise the mossie-bites and Delhi-belly, short of staying home altogether?

pre-emptive measures – before you go

1. Make use of all the check-ups we take for granted at home. Trips to your GP, dentist and optician could be the best-value preparations you make: an untreated tooth cavity could become a major problem later in your trip.
2. Iodine (solution or tablets) is the most effective water-purification method but is not advised for long periods. Chlorine is more suitable for longer-term use but will not kill some pathogens. Flavoured tablets are available to mask the taste.
3. Get all vaccinations recommended for the regions you're visiting and that they're up to date (see Holiday Health article). Plan well in advance of your trip as some vaccinations, such as rabies, require a course of injections.
4. Medical kit – recommended items include: antiseptic, rehydration salts, antihistamine, relief for diarrhoea (e.g. loperamide) and for vomiting (e.g. metaclopramide), painkillers – which can also help reduce fever, prescribed antibiotics.
5. Sterile supply kits are advisable for when you're off the beaten track. It's a good idea to include a couple of syringes if you have concerns about medical hygiene in the area you're visiting.
6. Comprehensive travel and health insurance. Check the details of the policy to ensure you'll be covered for all countries you're visiting and that any 'dangerous activities' you have planned are not excluded.
7. Check that you've got the right anti-malarials for the areas that you're planning to visit (see Malaria article) and when you should start – and stop – taking them.
8. Insect repellent – DEET based is recommended (50% solution for use on the skin or 100% for clothes). Permethrin (a powerful insecticide) can be used to treat clothing and lasts for 2 weeks, killing ticks and mosquitoes on contact.
9. Mosquito net – essential for visits to exotic climes, malarial or not. Permethrin impregnated nets are preferable.

precautionary measures – when you're there

1. Food is perhaps the infamous cause of infections when travelling yet remains a chief culprit – ensure any meat is fresh and thoroughly cooked. Vegetables and pulses that are boiled and fruits that can be peeled are safest.
2. Ice creams, if re-frozen, and rice, if re-heated, can give rise to serious food poisoning. Even these simple foodstuffs need to be 'fresh'.
3. Drinking water – check the seal on all bottled water. If you have ice cubes in drinks, be sure they are made with water you'd be happy to drink.
4. Take care when sterilising water – be sure to use correct quantities of iodine/chlorine and allow enough time for agents to act. At high altitude water boils at lower temperatures and so this method of sterilising becomes less effective.
5. Take care where you bathe – check with any available resources whether it's safe – local knowledge can be invaluable (but err on the side of caution as your immune levels may be somewhat lower than those of your guide).
6. Finish any courses of medication – e.g. antibiotics – don't just stop because the symptoms of an infection have cleared up: it may then reoccur and resistance to treatment can increase.
7. Keep taking malaria pills as prescribed – the onset of the disease may occur even after leaving an affected region.
8. Walking barefoot, contact with animals and wearing man-made fibres all increase chances of contracting fungal diseases including ringworm.
9. Insect bites – it's easier said than done but try to avoid scratching them! You could well create a greater risk of infection from breaking the skin than from the bites themselves.

getting out of trouble

1. To remove leeches use salt or a burning cigarette – simply pulling them may result in part of the leech being left in the skin, making infection more likely.
2. For ticks, push down on the skin surrounding the tick and pull carefully away by the head. Avoid holding ticks by their bodies as this can burst them and force contaminants into the skin, increasing the risk of infection.
3. Wash cuts and scratches thoroughly and use antiseptic. In tropical areas, even small wounds can easily become infected if not kept clean and dry. Change any dressings regularly.
4. If you run out of mossie-repellent keep skin covered, especially at dawn and dusk, and wear light-coloured clothing (you will be more attractive in darker shades, even if only to mosquitoes).
5. In the event that you do fall foul of insect bites, treat them with antihistamine, hydrocortisone or camomile lotion to prevent irritation.
6. Diarrhoea causes dehydration, especially in hot climates. As well as drinking plenty of sterile water, rehydration mixture can be used to replace essential body salts.
7. Once fungal infections have been treated keep the area dry and expose to air and sunlight as much as is (tastefully) possible. Loose-fitting clothes made of natural fibres are a must.
8. Make your travelling partners aware if you feel ill and if concerned, seek medical advice – keeping quiet for fear of holding up your companions might only cause more serious problems, not to mention delays, at a later stage.
9. If malaria is suspected, seek medical help immediately. If none is available malaria tablets can be used for treatment (see Malaria article).

help and info

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organisations

Hospital for Tropical Diseases – Department of Travel Medicine
Mortimer Market
Capper Street
London WC1E 6AU
Tel: 020 7387 9300
Travellers Healthline Advisory Service: 0906 1 33 77 33 (50p per minute. Calls should last on average 7 to 8 minutes)
Fax-back Information Service: 0906 1 991 992 (150p per minute. Calls should last no longer than 2 minutes)
E-mail: administrator@thehtd.org.uk
Website: www.uclh.org/services/htd/index.shtml
Provides pre-travel advice, including up-to-date information on anti-malarials and prophylatic drugs, consultant led clinics and post-tropical screening.

HPA Malaria Reference Laboratory (formerly PHLS)
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
Malaria Prevention Advice Line: 09065 508 908 (24 hours, 100p per minute at all times)
Website: www.lshtm.ac.uk/pmbu/PHLS/index.html
Provides in-depth information and advice to travellers on malaria prevention.

MASTA (Medical Advisory Services for Travellers Abroad)
Moorfield Road
Yeadon
Leeds LS19 7BN
Tel: 0113 238 7575 (note: MASTA do not accept personal travel enquiries by phone)
Travellers' Health Line (for MASTA Health Brief): 0906 550 1402 (calls are charged at £1 per min, calls to mobiles may be higher)
E-mail: enquiries@masta.org
Website: www.masta.org
Aims to raise the awareness of health issues associated with travel. Services include up-to-date information about immunisations and anti-malarials, an online search facility to find your nearest MASTA associated travel clinic, a health library with travel advice, factsheets and news, and a chat room. Also produce a Health Brief, which gives personalised immunisation and anti-malaria advice for a specific journey. The website includes advice on staying well when you're away from home, including info on immunisation and antimalarials.

websites

Health Advice For Travellers
www.dh.gov.uk/PolicyAndGuidance/HealthAdviceForTravellers/fs/en
Find all the health advice you need if you are thinking of travelling to an exotic or tropical location here.

Health Guide For Travellers to Thailand
www.on-samui.com/info-thailand/healthguide.html
This site has a range of health information for those thinking of travelling to Thailand, including information on Malaria, Japanese encephalitis, Dengue fever, Rabies, Diarrhoea, Typhoid fever, HIV-Aids and Viral Hepatitis.

World Health Organisation
www.who.int/ith
Find details of all the areas you plan to visit and the potential health problems you may encounter there.

World Wise Directory
www.brookes.ac.uk/worldwise
Provides information on each country to help you prepare and plan for safe travelling. Gives an overview of security conditions and tells you about basic health, safety, visa and currency requirements as well as things you should know about local codes of dress and behaviour.

reading

	The Backpacker's Handbook by Hugh McManners (Dorling Kindersley Publishing, 1995) This little handbook advises how to plan and prepare, how to get physically fit before the trip, and what food and equipment you will need. Information on travelling in various conditions follows, from the best way of walking to avoid injury, to using maps and compasses and moving over difficult terrain. Get this book
	Travelling Woman: Great Tips for Safe & Healthy Trips by Catherine Comer and Lavon Swaim (Impact Publications, 2001) Two seasoned female travellers focus on the special health and safety needs of women travellers. They offer a wealth of tips on everything from using public transportation and credit cards to preventing jet lag and handling sexual harassment. Get this book
	Where There Is No Doctor: Village Health Care Handbook for Africa by David Werner (Macmillan Education, 1993) Provides information about recognising, treating and preventing common illnesses and injuries and covers a wide range of subjects that affect the health of the villager. Get this book
	Health Advice for Travellers by Department of Health For those planning to travel abroad, this gives detailed information on health precautions, reciprocal health agreements, and vaccinations. It contains Form E111, which entitles you to free or reduced cost emergency medical treatment in many EC countries. The booklet is available over the counter at main post offices or by phoning the Health Literature Line (free of charge) on 0800 555 777. It's available to read online at: http://www.dh.gov.uk/PolicyAndGuidance/ HealthAdviceToTravellers/fs/en

(March 2004, resources updated January 2005)