health and insurance
selecting a first aid kit, staying healthy, and choosing travel insurance
I first began writing about travel health in the small Pakistani town of Khairpur after meeting a young engineer. He was feeling so very ill and scared that he was about to flee to England for treatment. He had a fever, a stonking headache and he imagined various awful tropical infections. His malaise turned out to be sinusitis which settled 24 hours after starting antibiotics bought in the local bazaar.

I’d been a medic on several expeditions, but it wasn’t until the incident in Khairpur that I realised just how scary illness can be when it strikes in a foreign land where you don’t speak the language, don’t know how to find a doctor or may not know how to judge his or her competence. Later I got to know several Pakistani colleagues and I discovered that my friend could have safely consulted the nearest doctors, all of whom spoke perfect English.

When taken ill, most adventurers will not have had the luxury of researching the local medical services in advance, so it is essential to do a little reading and preparation before you go. This leaflet will give you some pointers.

Dr Jane Wilson-Howarth

Dr Jane Wilson-Howarth is a GP and author of the authoritative, award-winning ‘Bugs Bites & Bowels’, and also of the appropriately-titled ‘Shitting Pretty’. Both are available from Cotswold.
insurance & emergencies
sources of information
Many travellers wonder about tropical diseases, but the most likely source of ill health on your trip will be accidents. It is sensible to bring any safety equipment from home, and to avoid travel after dark (or by motorbike at any time) in remote regions. If you try a hazardous sport while you’re away, check that the instructors are qualified and the equipment in good condition.

Proper travel health insurance is crucial and it needs to cover getting you to proper medical aid and to an air ambulance if appropriate. Cover should be for at least £2 million, if you end up in intensive care somewhere and are then repatriated, the costs can be very high indeed, especially if there is any chance of being evacuated to a hospital in the United States. Always declare any on-going medical problems, regular treatments, or past medical problems since concealing information could invalidate your insurance and leave you stranded. It is also important to ensure that you are covered for any hazardous activities, and if you are going somewhere really remote, will the policy include helicopter rescue?

The Blood Care Foundation (http://www.bloodcare.org.uk/) is a service that delivers safe blood for transfusion to a hospitalised client anywhere in the world. The African Medical & Research Foundation arranges air ambulances in East Africa: see http://www.amref.org/.

Wherever you are going it is wise to research the risks. A travel clinic will give good information about what medical precautions are required but it is also worth checking out other sources.

Increasingly, country guidebooks contain a chapter on local health considerations written by a doctor, which should put local health hazards into perspective.

For immunisation advice look at http://www.fitfortravel.scot.nhs.uk/ or there is a good American site at http://www.tripprep.com/

The free brochure Health Advice For Travellers is available from Post Offices, doctors’ surgeries, or on www.doh.gov.uk/traveladvice. Not only does it contain excellent guidance on staying healthy while travelling, but it also tells you how to get treatment overseas and explains where it is subsidised or free.

You might want to consider attending a first aid course. Simple techniques of cleaning and dressing wounds can be learned on a St John’s course or similar and will prove useful wherever you are bound.

Those going to remote and dangerous locations are likely to want to attend a more specialised medical course. The Expedition Advisory Centre at the Royal Geographical Society (with IBG) can steer you in the right direction. To contact them, email: eac@rgs.org or telephone 020 7591 3030. Alternatively, visit www.rgs.org/eac.

Might you get caught up in a coup, riots, national strike or curfew? For security information on every country in the world check with the Foreign and Commonwealth Office website at www.fco.gov.uk/travel, or telephone 0870 6060290. Country information is also provided on BBC2 Ceefax p470 onwards.



your medical kit
Most travellers will get no end of knocks and grazes, which will readily become infected in hot or unhygienic environments. So it is a good idea to travel with some kind of first aid kit. The type you buy or put together will depend upon your style of journey and the distance you plan to be from towns and cities. Personally, I’d choose a small one that contains wound closure strips. I am very sold on these items because you can tape large, deep cuts closed and thus stop the bleeding. By doing so you might be able to avoid the inconvenience, discomfort and possible risk of attending a local clinic where needles may not be sterile.

Crepe bandages are useful in a variety of scenarios; for example, mountaineers and hill walkers use them for knee support, whilst after snake bite, firmly bandaging the bitten limb with a crepe bandage is the safe first aid procedure. In developing countries it can be hard to find adhesive dressings that stay on sweaty skin so I always bring some from home.

Are you intending to walk barefoot along coral shores or venture into environments where the plants are spiny? Then pack tweezers or choose a first aid kit containing something to extract thorns and pieces of coral or sea urchin spine. Or avoid these problems by wearing shoes or sandals.

what else to pack
malaria & insect bites
You’ll need to consider what kind of medical items you have required in the past. Find out what treatments have worked for you when you’ve been ill before, and travel with a note of the generic names of any prescribable medicines that have aided your recovery. Also record names and doses of any regular medication that you need. Take spares of essentials like asthma inhalers.

People with light skins – and especially those with red or blonde hair or freckles – must protect themselves from the sun with a good sunscreen and sun-protective clothes. For more information on sun protection, pick up a copy of The Knowledge: Gear For Hot Weather.

If you are going anywhere hot, pack a couple of leak-proof water bottles so that you don’t keel over from dehydration during the first couple of days. I would also recommend taking a few oral rehydration sachets (ORS) for the almost inevitable bout of traveller’s diarrhoea. Check how many sachets need to be put into your bottle. ORS is also great for forcing fluids into your body when the temperature is very high, after exercise or after a heavy night out.

Other bits and pieces: a soothing bottom cream like Sudocrem or Anusol can bring welcome relief; and anyone travelling to a remote destination, and especially travellers over 40, should consider buying a dental first aid kit.

Malaria scares the pants off me. There is no real prospect of a vaccine against malaria and so it is important to find out whether you will be travelling into a malarious region. If your travel clinic tells you that antimalarial tablets are required, don’t just buy some over the counter since those kinds are becoming less and less effective, and they often cause quite a burden of side-effects. Newer tablets are often better tolerated. If you decide to take Lariam on your travels, try it for two or three weeks before departure in case it makes you feel weird.

If you are venturing into malarious or ‘buggy’ environments, pack long loose clothes and a good insect repellent that you’ve tried on your skin before departure. DEET-based products (such as those made by Lifesystems) repel best but can upset some people with eczema or sensitive skins, who might prefer to use Mijex Extra or Jungle formula (which contain Merck 3535), or a natural preparation such as Mosiguard. DEET is also effective at detering the mosquitoes that spread dengue and yellow fever as well as leaches and ticks.

Permethrin sprayed onto clothes provides a good level of extra repellency with less direct exposure to chemicals. Sleeping under a permethrin-treated bed net allows safe uninterrupted slumber, since insects won’t bite through the net if you roll against it in the night. Otherwise, a plug-in mosquito-killer or lighted coils will help to keep biters at bay.

Those not travelling with their own net might like to carry a permethrin or DEET spray to proof hotel nets since these chemicals render even holed nets protective. Bear in mind that repellents (and suncreams) can be hard to find in less developed destinations.

Do you react enthusiastically to insect bites? If so, add 1% hydrocortisone and/or a tried and trusted antihistamine tablet to your personal kit. If bites have caused swelling and other severe symptoms in the past, discuss this with your GP since a prescribed antihistamine might be appropriate. You may even decide to carry a prescription-only adrenaline Epipen.

montezuma’s revenge
Most intrepid travellers will suffer from diarrhoea or at least some gastro-intestinal unease from time to time, but most bouts will settle in 36-48 hours.When the symptoms are mild, the only treatment required is to drink lots of clear fluids. I always travel with a one-litre Sigg drinks bottle and iodine. I use the iodine to purify my drinking water so that I can have plenty of safe drinks of water wherever I am.

Stomach problems – of many varieties – are commonly acquired through contaminants getting into your mouth by way of food prepared for you by someone who hasn’t washed their hands properly after using the toilet. And the risk of such filth-to-mouth diseases is greatest where there are big centres of population, where soap and facilities for hand washing are poor and/or where people don’t know about microbes; tropical Latin America, India and Nepal have the highest hit rates.

In regions where there are no spare resources for anything beyond survival, visitors risk not only simple, short-lived travellers’ diarrhoea but also many other filth-to-mouth infections including dysentery, hepatitis A and E, typhoid and worms. Travellers will stay healthier if they avoid raw food and untreated water, and consume only freshly cooked, piping hot dishes and bottled drinks. A la carte is safer than dining from the buffet.

going high
women & children
The risks to health in the mountains depend upon conditions as much as altitude. I’ve certainly been colder and felt more at risk in bad weather in Britain than I have at over 4000m in the Himalaya and Andes. It is important to be properly clothed and make sure you know where you are going with proper maps, compasses and/or local guides. Getting lost and cold, or falling off a narrow path, are significant risks and are more likely to befall the ill-prepared adventurer than a bout of Acute Mountain Sickness (AMS).

Even so, if you plan to venture above 3000m (10,000ft) it would be wise to read about how to recognise altitude sickness. The British Mountaineering Council’s The Mountain Traveller’s Handbookcontains an authoritative chapter. Bugs Bites & Bowels, the Lonely Planet guides to the Nepal and Indian Himalaya, and the Bradt guides for Andean countries all cover the subject.

In essence, plan any trek so that you take several days to reach 3000m and then sleep no higher than 300m (1,000ft) above the previous night’s camp. Try to sleep low in a valley rather than high on a ridge. Although bottled oxygen and pressure bags can assist a person with AMS, the only cure is descent. Study the map; a drop of just 500m can be enough to effect a recovery. If someone is suffering from AMS don’t wait until morning to evacuate them.

The only issues for women travelling to remote or unfamiliar destinations are clothing and menstruation. Showing too much flesh may attract unwanted attention which can spiral into unpleasantness. It is best to affect modesty and wear long loose clothes. In hot regions a long drawstring skirt permits squatting in order to pee in public while retaining dignity. Women setting out on long trips into regions where plumbing is basic or absent might want to explore the use of progestogen Depo contraceptive injections, or an implant, or a Mirena Intra-Uterine System (IUS): if administered some months before departure any of these should dramatically reduce or even stop menstruation. If you want to travel with unmolested hormones, ensure your tampons are packed in waterproof containers in several places in your luggage.

Travel is challenging if your child is independently mobile (which starts at about eight months) but not yet amenable to bribery (from around three years). Under threes are also unable to communicate well enough to allow parents to distinguish boredom from cerebral malaria, so think twice about venturing into malarious regions or destinations with poor infrastructure unless you were already an experienced, cool and resourceful traveller before having kids. Your Child’s Health Abroad is the medical manual you’ll need if you find yourself far from a reliable paediatric clinic.

All outdoor activities are potentially hazardous. The information provided on this site offers guidelines only, and is no substitute for personal instruction from a qualified person. Whilst every effort has been made to ensure the accuracy of the information, no responsibility can be accepted by the author or Cotswold Outdoor Ltd. for any errors or omissions. By choosing to follow any of the advice contained in this leaflet, the reader accepts personal responsibility for a) learning any techniques required, b) any risks involved, and c) any damages or injuries of any kind - including death - howsoever caused. Cover shot: Checking the way ahead on the Trekker's Haute Route, between Chamonix and Zermatt.
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