‘He who drinks dies; he who does not drink dies as well’. Mongolian Proverb
General Travel Health Information
Travellers to developing countries should start with long term basic health protection. This means vaccinations against Polio, Tetanus, Typhoid and Hepatitis A.
Other vaccinations will depend on where you are going, local conditions at that time and your anticipated environment. Visitors to Yellow Fever areas such as West Africa should definitely be vaccinated against it.
Consult a health specialist. A series of jabs may take up to six weeks to complete, so get on with it!
Check links for the latest news and don’t forget your travel insurance, it’s really worth the money. .
Travel health: Food and Drink
Travel health: Water
• In developing countries avoid drinking or even brushing your teeth with tap water. Drink bottled water and check that the cap is securely sealed when you buy it. Turning it upside down and watching for drips is one method of checking.
• If you can’t buy it, sterilize it by boiling or dropping in purification tablets or iodine.
• Do not take ice in your drinks, unless it is clearly frozen mineral water.
• Tea, coffee, soft drinks and booze are fine from a bacterial point of view, though not so fine from a dehydration standpoint.
• Don’t share water bottles with other travellers unless you want to share their bugs too.
• Water filters are ok in theory but can break easily and usually don’t filter some serious viruses, such as Hepatitis A and E.
• Force yourself to drink clean water, lots of it, if you want to avoid headaches and lethargy from dehydration. And no, beer will have the opposite effect by dehydrating you even more.
• Water requirements at home are 6 glasses per day, so multiply that figure by at least 3 in tropical environment.
Travel health: Food
• Avoid ice cream from unreiable sources, raw or under-cooked fish, shellfish or meat, food kept warm, and salads – unless you can peel it or shell it yourself. Most cases of diarrhoea come from unhygienic food, not unclean water.
Eating in local restaurants in developing countries:
• Start acclimatising your intestines slowly. e. g. First day, don’t eat street. Second day, try a small well cooked snack. etc.
• Eat where it’s busy. This means that turnover is fast so fresh food has less chance to go off in a hot climate (where there may be little or no refrigeration). It also means that the food is good or cheap or both!
The Inca Two-step? Delhi Belly? aka diarrhoea. If there is time, do the natural cure:
Drink a lot of water.
For maximum absorption of water generally, add 1/2 a teaspoon of salt and 3 teaspoons of sugar to a litre (2 quarts) of water, and in the case of Ramases Revenge, double the salt and sugar levels. (Don’t take salt tablets, they can cause stomach irritation and vomiting).
Don’t eat for half a day at least, and then restart solids slowly, with plain, easily digested foods such as boiled, watery rice or plain bread. This will encourage your body to develop a stronger health defence system and Ramases will have more difficulty next time.
If you’re in a hurry Lomotil/Imodium or similar works well – but doesn’t kill the bug; it just stops your insides turning to water every thirty minutes.
Hepatitis A virus
This debilitating virus can be contracted from contaminated food, drink, ice or by person-to-person contact, basically from the feces of infected people via their handling of produce or from sewage pollution. Hepatitis A is common in developing countries where infections are frequently acquired during early childhood and usually mild, resulting in a high proportion of adults in the population that are immune to HAV
Most travel health related cases are associated with visits to Mexico, Central America, South America and North Africa but Hepatitis A is actually most prevalent in Central Africa, southern Africa, India and Pakistan. The risk of HAV infection for those traveling abroad varies with living conditions, length of stay, and the incidence of HAV infection in the area visited.
Health risk is highest for those who live in or visit rural areas, travel in backcountry areas or frequently eat or drink in settings of poor sanitation.
The incubation period for hepatitis is usually 15 – 50 days and averages 28 days. The infection may cause a mild illness lasting 1-2 weeks or a severe and disabling disease lasting several months. Symptoms of hepatitis A include fever, anorexia, nausea, and abdominal discomfort, followed within a few days by jaundice, so yellowing eyes is an indicator.
If illness does occur, its duration is usually less than 2 months. Ten percent of infected people have prolonged or recurring symptoms over a 6- to 9-month period. The fatality ratio is generally low at 0. 3%, but 1. 8% among adults aged over 50 years.
• Eating only well cooked foods or peeling fruit by yourself, drinking bottled or purified water and washing your hands a lot with good soap is quite an effective preventative.
• the best measure is a vaccine that may be semi-permanent, but usually requires two doses months apart so if you are planning to travel to the developing world talk to your doctor as soon as possible
Travel health: Altitude Sickness
Otherwise known as AMS (Acute Mountain Sickness) this is due to the air/oxygen thinning out as you go higher and is especially relevant to smokers and those with heart problems. At around 5, 000m there is about half the oxygen you would breathe at sea level.
With time the human body adapts to higher altitude by increasing red blood cells; even a few days en route to somewhere a lot higher will help dramatically. e. g. a couple of days in Arequipa, Peru (about 2, 300m) before heading for Cusco and the Inca Trail at 4, 000m+ will greatly assist your hiking ability and enjoyment.
Here are some popular destinations where you might get AMS without climbing mountains: Peru, Bolivia, Mexico, Tibet.
Stage 1, OK: light headedness, nausea, dizziness, severe headaches, insomnia, breathlessness, loss of appetite.
Cure: rest, eat well, drink lots of water and take a rest. You’ll be fine in a couple of days. But if your symptoms move to. . .
Stage 2, dangerous: dry cough, vomiting, confusion, loss of balance and co-ordination. Pulmonary oedema.
Cure: AMS comes on slowly – over a day or two days, so rehydrate and descend as soon as possible, or see a doctor for medication.
And don’t go above the tree line if you have a fever, nose bleed, cold or influenza, sore throat or any breathing difficulties.
• ascend slowly. This is the primary rule.
• get fit beforehand, preferably exercising at a modest altitude. e. g. hike Colca Canyon in Peru before doing the Inca Trail.
• don’t overdo it on the first day, AMS can take time to kick in, so relax a lot, eat small and avoid unusual foods. If you feel light-headed, beware.
• drink as little alcohol as possible, none if possible. Alcohol will further reduce the amount of oxygen reaching your brain.
• we’ve always thought that drinking a lot of water is always a good thing but a recent traveler from Bolivia tells us that the most successful guide at high altitude there, with far fewer AMS tourists than his competitors, discourages his charges from over-drinking water. Not only drinking just enough, but in small sips, not gulps.
• get a prescription for acetazolamide(diamox) and start taking it before the trip.
• chew coca or drink coca tea (in Peru/Bolivia).
• homoeopathic health advisors suggest taking aconite 6c to treat initial symptoms and arsenicum album 6c for further help. Both together is fine, x 4 per day, Amax 4 doses.
• An iron supplement, Floridax, and/or ginkgo biloba, taken daily for 2 weeks before travel are also supposed to help.
Travel health: Lyme Disease
Typical bulls-eye rash pattern indicating Lyme Disease seen on up to 70% of patients, not all!
Lyme Disease is a problem for an increasing number of walkers in wooded areas, especially in northern parts of the northern hemisphere in summertime. This is caused by infected ticks that look like very small spiders. Ticks mainly feed on animals such as deer (UK) and chipmunks/squirrels (US) but will take humans if nothing four-legged is around.
This should be treated immediately with antibiotics if a rash (that often looks like a circular bruise) is noticed as it can cause life-changing neurological damage and chronic fatigue if untreated. In rare cases it can be fatal.
Lyme disease patients who are diagnosed early, and receive proper antibiotic treatment, usually recover rapidly and completely. A key component of early diagnosis is recognition of the characteristic Lyme disease rash that often manifests itself in a bull’s-eye appearance, and is observed in about 80% of Lyme disease patients.
Some British sufferers were not diagnosed by the NHS and their condition only discovered by private health checks in other countries such as USA and Norway. Others are still out there suffering tiredness, muscle aches, pain in the joints, paralysis of facial muscles, mental confusion and heart problems.
The most common symptom – but only on 70% of sufferers – is a slowly expanding rash/bruise which spreads out from a tick bite, usually in 5 to 14 days.
Other symptoms include fever, headaches and fatigue and without a visible marking are frequently mis-diagnosed leading to years of grief.
However it is not necessary to avoid the countryside to avoid ticks, just cover up exposed skin (no bare legs or arms! ) when walking in long grass, dense shrubs or undergrowth.
More on Lyme from Wikipedia
Tick bites are usually harmless tho’ you may be allergic to tick bites and experience pain or swelling, a rash or burning sensation in the bite zone.
However, some ticks carry diseases that develop within several days to a few weeks after a bite. Symptoms may include:
- a red spot or rash near the bite site
- a full body rash
- muscle or joint pain
- a fever
Tick bites easy to identify as the tick may remain attached for up to ten days and are isolated.
Don’t forget that you may have a tick still hidden on your body tho’ they usually fatten up and fall off within 10 days. If not they could be lurking in damp, protected areas such as your armpit, or pubic hair.
A very enlarged adult deer tick, in reality looking more like a small spider on your arm or leg or your dog.
One bite protection expert visited 75 per cent of the parks in London, England (including Richmond Park and Bushy Park) in 2015 and found ticks in every one.
Walkers in cool, green, lush/woody areas should:
• wear long sleeves and long trousers, light-coloured clothing and proper footwear (not flip-flops!).
• walk in the centre of trails.
• apply tick repellant that’s minimum 20 percent DEET.
• apply permethrin repellent to clothing.
• take a shower or bath within a few hours of ending the walk and check skin especially under arms, behind ears, between legs, behind knees, and in hair.
It usually takes a disease-carrying tick (not all of them do) at least 24 hrs to infect a victim so find and remove asap.
If you find a tick on you remove it as soon as possible with a set of tweezers or dedicated tick-remover device. Don’t squash it or try to pull it off with fingers, unless you have latex gloves available. With tweezers grab it near to your skin and pull steadily straight up, away from the skin. Do not to bend or twist the tick to prevent leaving body parts behind. Check for any tick remnants and remove those too. Then clean the bite site with soap and water.
Kill the tick – with alcohol? – and take it to a doctor to see if treatment is necessary.
Sunbathing and Melanoma
Moderate sunbathing boosts vitamin D production which may help protect the body against some cancers. New York’s Brookhaven National Laboratory completed a study in 2007 indicating that UVB stimulates vitamin D production, helping to fight cancers of the breast, lung, colon and prostate as well as acting against osteoporosis, depression and premature ageing.
However, moderate sunbathing does not include using sunbeds (that tend to produce UVA radiation), nor overexposing oneself to strong sunlight such as midsummer, midday rays in southern countries. So small, regular doses of sunshine are essential to your mental and physical health!.
There is no point in lying around in the sun at midday in the tropics, subtropics, southern Europe or even the south of England on a good summer’s day. This will not only earn you a good chance in the melanoma lottery and add an unpleasant red highlight to your tan, but it will probably burn the tan off altogether after a few days.
You will brown up more smoothly and lastingly by sunbathing before 11am and after 3pm. And you may live longer too.
International researchers concluded in 2009 that the people most at risk from skin cancer are those with many existing moles, red hair or very pale skin.
Tim Spector, professor of genetic epidemiology at King’s College London, said: “The number of moles you have is one of the strongest risk factors for melanoma – stronger than sunshine. This paper shows that we found two important genes that control the number of moles you have. Those genes also give you an extra risk of melanoma. ”
Women are statistically more likely to get skin cancer than men, but men are more likely to die of it. Rates have quadrupled over the last 30 years. It is the most common form of cancer diagnosed in Britain.
However, another King’s College researcher, Veronique Bataille said: ‘As a dermatologist working in the melanoma field for nearly 20 years, I feel quite strongly that there is always an overemphasis on sunshine. You often read that nearly all melanomas are caused by sunshine – which is not supported by the evidence. The more research we do, the more we realise that sunshine is a small part of the puzzle.
In any population you study across the world, if you are ‘moley’ it is a very steady risk factor for melanoma, and it doesn’t make any difference whether you live in Glasgow or Sydney or LA. Let’s keep sunshine in the picture because it does make you age and causes you wrinkles – we have never denied that. But let’s move away from scaring people by saying they are going to die because they go in the sun. ‘
Basically, don’t go in the sun in the middle of the day and be especially careful when swimming, snorkelling (wear a T shirt), motor-biking and getting wrecked on the beach in a hot country. The basic rule, tan OK, but do not allow yourself to burn!
p. s. Recent research in the US suggests that skin care products containing AHAs (alpha hydroxy acids) increase the skin’s sensitivity to sunlight in some cases, so be particularly careful about applying sun protection if there are AHAs in your choice of skin creams.
Malignant Melanoma signs
• An existing mole is getting larger
• A mole has a ragged outline
• A mole has a mixture of brown/black colours
• a fast-growing irregular dark spot on previously clear skin.
Non-melanoma skin cancer signs
• A new growth or sore does not heal within 4 weeks
• A spot or scab continues to itch, hurt or bleed
• Skin ulcers persist without apparent reason
More: Cancer Research UK
DO NOT DELAY checking out possible melanoma signs. Mark Goodfield, president of the British Association of Dermatologists, said that although it might seem trivial people should see their GP immediately if they saw any sign of a mole changing shape, colour or texture.
‘Diagnosing a skin cancer early makes a real difference to the success of treatment. Making an extra effort to check changes in moles and going to the GP could save your life. ‘
If melanoma is diagnosed early, when thin and on the surface of the skin, it can be removed easily. If left, melanoma can spread through the lymph system or the blood stream, which can be serious and in some cases fatal.