Long-haul health questions answered

Dr Jane Wilson-Howarth looks at the ten key heath questions to consider before heading off an your exciting round the world adventure

1. What are my chances of getting sick?

Studies show that travellers are most likely to suffer from diarrhoea during their first week in a resource-poor destination. Also, it is estimated that half of all travellers spending a month in a resource-poor destination will experience a significant illness – sufficient to require a change of schedule.

Longer trips can make for lonelier trips, and travellers may feel tempted to indulge in unsafe casual sex.

2. How do I avoid taking a bag full of medical supplies?

Doctors exist all over the world. Should you need medicines or antibiotics it is best to find a clinic; know which medicines have historically worked well for you and which have upset you (and exactly how they have upset you) to inform any new doctor prescribing for you.

If you take any regular medication it is important you know what it is – don’t expect the clinician to know which ‘little red tablets’ you mean. Ensure you know the generic name and dose of any medication. Find out what will happen if something prevents you taking it or absorbing it. Stopping an antiepileptic or heart treatment, say, could be disastrous whereas a month without your statin is unlikely to harm you. Pack plenty for your trip or check availability at destinations halfway round.

The names of medicines vary even between English-speaking countries (contraceptive pills, for example, look very different in the US and Australia), and there may be no direct equivalent if you need to acquire a supply locally. Long-established medicines are often easier to source than the very latest treatments.

3. What problems can I deal with myself?

Travellers’ diarrhoea or a queasy stomach is highly likely on a long trip. Skin problems are also very common. Especially when in resource-poor destinations, you may get scraped by a bit of taxi, fence or market stall; wherever the weather is warm, cuts and grazes fester if you don’t clean and cover them. Prepare to deal with mosquitoes.

4. If I’m hopping in and out of malarious zones, should I take prophylactics continuously?

Malarone can be started 24 hours before entering a malarious region and is continued for only a week after leaving the risk area so this can be a good option if going in and out of malarial zones. However, this is an expensive prophylactic and sometimes it is best to take antimalarials continuously as part of your travel routine. Don’t let any travel advisor give you different antimalarials for different parts of your journey. Go for simplicity.

5. Do medicines go off?

Try to travel with tablets – generally medicines last well if they are in dry, pill form. Most capsules and tablets, and even melt-in-the-mouth preparations, are fine for a year after their expiry date. Liquids, syrups, some injections and sprays have surprisingly short shelf-lives; the GTN angina spray, for example, only lasts a month. Some liquids should not be frozen; manufacturers can advise if their medicines can be placed in the baggage hold of an aircraft.

Blister packs are bulky but are easier to keep dry. Consider how waterproof your tablets are in the packaging they’ve come in. Zip-lock plastic bags are useful for extra protection. Avoid leaving medicines out in direct sunshine.

6. What if an immunisation course needs completing or boosting while I’m away?

Don’t wait until the standard two months prior to departure before starting your immunisations – get going on them as soon as you can. However, if you do leave pre-trip immunisations too late and don’t have time to complete your schedule of injections before departure, there is – increasingly – an excellent range of travel clinics all over the world. Check the well-respected International Society of Travel Medicine website (www.istm.org) where you can search by country or city for a clinic offering immunisations and sometimes curative services.

7. Are any medicines illegal in certain countries?

Yes – plenty. Medicines with addictive properties, including sleeping pills and painkillers containing codeine, are viewed with suspicion in many destinations and special care needs to be exercised when passing through or entering many Middle Eastern states, Thailand and Latin America. Check the excellent US State Department country-specific information at http://travel.state.gov/travel.

Travel with a medical summary in case any border officials think you are a drug dealer.

8. What about health insurance?

Sort out travel insurance as soon as you’ve booked your trip – and don’t just pick the cheapest. Ensure that your policy covers local medical expenses and medical repatriation, and find out how the foreign hospital is paid. Also make sure the policy is suited to you. Do you need cover for any extreme activities: hiking at altitude, scuba diving, offroading? Have you declared any pre-existing conditions? Are you medically stable? Would you be travelling against your doctor’s advice (if you asked them)? Does the policy have a 24-hour doctor-supervised support centre?

9. What key medical items will see me all the way around the world?

Travel with a health guide. Read up on common illnesses and plan how you will cope. Know, for example, how to make homemade rehydration solutions so that you don’t need to carry sachets.

Take a small digital thermometer if travelling in the tropics. Pack soluble paracetamol; this is great for all aches and pains, for sore throats, and for reducing fever. Good-quality sticking plasters aren’t so easy to find at certain destinations. Carry a good drying antiseptic such as iodine (Savlon Dry). Pointed tweezers are great for extracting glass, coral, thorns etc.

My essentials are Oxo cubes(to make a nice savoury rehydration drink), Eumovate steroid ointment (for itchy bites or stings), blackcurrant throat lozenges (sore throats are common everywhere) and earplugs (I’m grouchy if I can’t sleep).

10. I want to pack light – what can I leave behind?

Aim to eat (washed) fresh fruit and vegetables every day so you won’t need vitamins or supplements. Regular de-worming is not necessary. Don’t bother with the snakebite kit or intravenous fluids.

It’s worth carrying one crepe bandage – they are more adaptable than specific joint supports, and are useful for sprains, after snakebite and for compression to stop severe bleeding.

I don’t think the gizmos for exercising on flights are worth their luggage space; you don’t need equipment to flex your calf-muscles. Heavy waterproofs are seldom needed in warm climates and predispose you to heat/sweat rashes; buy a cheap local umbrella if there’s a downpour.

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