With the summer exodus underway, we present an alphabet of travel health and safety.
Summer survival guide: an A to Z of travel health
While it’s one thing to be ill while at home, it’s quite another to be sick on holiday. Who wants to pass up a once-in-a-lifetime sightseeing opportunity because you’re searching for a chemist or waiting at a clinic?
Thankfully, there are effective vaccinations for some of the most common and serious risks, and great strides have been made against a variety of debilitating tropical diseases. Ignorance will be no comfort when you’re lying in a foreign hospital bed, but with sensible planning and packing, you can ensure that you’re ready for almost anything. Get organised ahead of time by thinking about your destination and the weather and other conditions in that country. If you’re taking part in risky activities, including driving, think about worst-case scenarios.
Avoid certain destinations if you’re pregnant or have a complicated medical condition that necessitates easy access to advanced facilities. If you’re going on a long trek, train beforehand rather than aiming to “get fit” en route. Make sure you have renewed your travel insurance and that the coverage is comprehensive. Some policies exclude pre-existing medical conditions or certain destinations.
Wherever I go, I always pack a medical bag containing painkillers, sleeping tablets (or Panadol Night for a two-in-one), antihistamine gel for insect bites, rehydration salts, antiseptic cream, plasters and decongestant. Motion-sickness tablets and antibiotic ear drops are also a good idea, but beware that some medications lose their effectiveness after being open for a long time. If I’m taking any medication, such as antibiotics, I will take adequate supplies with me, along with a copy of the prescription. Those needing vaccinations or with long-standing medical conditions should visit their doctor at least two months before departure to obtain advice and prescriptions.
It’s also important not to forget the importance of rest. Too often, the lead-up to a trip can be so hectic that people are exhausted on arrival. While this may be less problematic if you’re on a two-week beach holiday, it’s not what you want before a four-day climb of Mount Kenya. If you can’t rest much before a long outbound flight on departure, treating yourself to an upgrade is a great way to arrive feeling fresher. And if you do get ill, remember that, in all likelihood, what doesn’t kill you will make you stronger for your next trip. In the meantime, here’s a list of the commonest issues that you might have to deal with.
Altitude. This can surprise people, but the ease of international travel can bring even seemingly fit people dangerously close to peril. If you have a heart condition and fly into Cusco, Peru, for example, which is at an altitude of 3,400 metres (1,000 metres higher than Machu Picchu), your doctor may suggest not staying in the city but somewhere lower down, to give you time to acclimatise. They may even advise against travel there completely. Hiking trips usually build acclimatisation days into their programmes, but check beforehand. Altitude sickness affects people in different ways, but results from a lack of oxygen in the air. Nausea, vomiting and headaches can result if you experience a change in altitude too quickly, and it can quickly become a medical emergency.
Bedbugs. While not dangerous, bites from bedbugs can provoke an extreme allergic reaction, mostly in the form of swelling and itching. Demand to move rooms, or even hotels, if you find them in your accommodation, and pack a silk sleeping-bag liner if backpacking.
Children. While many families travel successfully with children on relatively adventurous trips, consider what you are comfortable with as a parent in regards to safety and medical facilities, and what you are prepared for. If you’re visiting Sri Lanka, for example, are you happy for your children to be seated in a tuk-tuk without any seat belts? Do sanitation standards mean that every mealtime will be a massive chore? Plan your destination around that rather than shoehorning your family into doing something that you would really rather do alone.
Dehydration. The combination of outdoor activity, sweating and not drinking enough water can quickly lead to mild to moderate dehydration. Severe dehydration, which can also result from sickness, is a medical emergency. Always make sure you have access to quality drinking water, bottled or treated if necessary, and pack rehydration salts. In Asia, drink fresh and cheap coconut water (take your own straws if you are concerned about those provided).
Ear infections. Long days at the beach and in swimming pools can result in bacteria entering the ear and causing infections, which can become excruciatingly painful and serious. While it’s always best to visit a doctor if possible, some antibacterial ear drops can abate the symptoms if you’re miles from anywhere.
Food. In countries where water-quality and hygiene standards are poor, it’s safest to eat only freshly cooked food, because cooking kills most germs. Pre-prepared salads and fruit can be a bad idea in places such as India, but risks are present in all countries. Flies can land on buffets, kitchen staff may not have washed their hands properly, and salmonella and E-coli can be present in meat and eggs. Even five-star hotels are not a guarantee of safety; it’s best to eat at places that are popular and clean. When out and about, use hand sanitiser or wipes before you eat and choose fruit that you can peel yourself.
Gastroenteritis. Commonly referred to as a stomach bug, this is what you are likely to end up with if you don’t follow the above advice, though it can also be caused by contact with someone who has the virus. Treat with soluble rehydration salts and, if necessary, antibiotics with instructions from your doctor. If you have diarrhoea and have to endure a long bus, train or plane journey, consider Imodium tablets to see you through.
Hepatitis. This is a liver disease with five different types: A, B, C, D and E. A and E are mainly spread by contaminated food and water, while B is sexually transmitted. B and C are spread also through infected blood, and D only affects those who already have B. Vaccines are available for A and B, and the main preventions are good hygiene, being aware of the water that you come into contact with, and protection from the bodily fluids of other people.
Insurance. Never travel without proper travel insurance, and if you travel regularly, take out annual coverage. In the UAE, Axa Gulf provides a comprehensive annual policy for Dh850. Print it out and take it with you, and also carry an electronic copy in your webmail.
Jet lag. Rather than just fatigue, jet lag is the result of an imbalance in the body’s “biological clock” as it tries to recover from travelling through several different time zones quickly. Fully getting over this process can take as long as two weeks, but the worst symptoms usually dissipate within a few days. You can lessen the impact by adjusting your watch to the time zone of your destination ahead of time, breaking your trip with a stopover, drinking plenty of water and walking around in the sunshine once you reach your destination to try to reset your circadian rhythm. Strategically drinking caffeine and taking melatonin tablets can also help.
Katayama fever. This condition can develop if the body becomes infected with parasitic flatworms that are present in contaminated freshwater. The tiny worms, called schistosomes, are released from infected snails and can enter the body while swimming in lakes in developing countries. The umbrella disease is called schistosomiasis, also known as bilharzia, and it is mostly present in Africa, Asia and South America. Symptoms can include abdominal pain and diarrhoea, but the long-term effects can range from kidney failure to infertility. Infections can be diagnosed by a tropical-diseases specialist and treated with praziquantel, but there are often no symptoms, so the best preventive measure is to research the prevalence of the parasites where you're visiting, and if in doubt, refrain from unnecessary contact with water.
Leeches. Don’t underestimate the horror of hiking in tropical forests, only to look down and find your ankles covered in blood. Leeches lie in wait on vegetation around pathways, ready to attach themselves to you as you brush past. They can bite painlessly through socks and fill up on your blood. They usually don’t spread disease, but you can avoid them completely by investing in tightly woven “leech socks” which you wear inside your hiking boots. If you need to improvise, you can spray Deet mosquito repellent onto ordinary socks.
Malaria. The effects of mosquito-borne diseases such as malaria, dengue fever and Japanese encephalitis can be deadly, and though treatment is available if applied promptly enough, it can be hard to spot the symptoms early on. Antimalarial tablets may be worth taking, depending on your destination and the length of time you will be away; always consult your doctor before travelling and, as much as possible, try not to get bitten. A combination of long clothing, Deet-based repellent, mosquito nets and staying inside with doors closed at dawn and dusk all help.
Nausea. Even those not normally susceptible to motion sickness (kinetosis) may find things change on a long bumpy road or rough sea. Sitting in the front seat, opening the window, keeping your eyes on the horizon and not reading can all help, as can music (for distraction) and, if needed, medication.
Optical. If you wear glasses and/or prescription sunglasses, consider taking spare pairs of both with you in case of loss, plus a supply of daily disposable contact lenses.
Prescriptions. If you use prescriptions at home, take them, and your medication, with you when you travel.
Questions. Never be afraid to ask what may be considered rude or inconvenient questions of tour providers, restaurant owners or hotel staff. Information from local people about current hazards could also save your life.
Rabies. A deadly disease spread by the saliva of infected animals, usually via a lick or a bite. Talk to your doctor about your travel plans, and if your trip will bring you into regular contact with certain animals, a vaccine may be recommended. If you are bitten by a stray dog, it is important to visit a hospital straight away because immediate vaccinations may be needed.
Safety. Don’t put yourself at unnecessary risk. By researching your destination ahead of time and familiarising yourself with the geography of where you are staying, you can avoid many potential problems. This is particularly important if you are travelling alone. If you don’t feel confident, don’t book a flight, train or other form of transport arriving late at night. It’s important to act confident and look like you know where you are going, even if you don’t. Don’t stand on street corners with your guidebook open, looking desperate. If you need to get back to your hotel and it’s late, try to have other travellers drop you off, or get another hotel or guesthouse to book you a taxi. If you are followed or approached, head towards a busier area as quickly as possible. It should go without saying, but don’t dangle around valuables, such as handbags, flashy mobile phones or cameras, in public places; hide them in a backpack or leave them in a safe at your accommodation.
Ticks. Another parasitic menace, these small insects are present in forests and other hiking areas, and can transmit Lyme disease in Europe and the United States, tick-borne encephalitis (TBE) in central and eastern Europe and parts of Asia, and in Africa, tick-bite fever. Wear long, impregnable trousers if hiking through grasslands, use insect repellent and inspect your skin; if you plan to go on a long hiking holiday in an area where TBE exists, get a vaccine.
UV rays. The best way to avoid serious damage to your skin from the sun’s rays is not slapping sunscreen all over your body, but covering up. If you’re going to be spending a lot of time on or in the water, on boats, in kayaks or snorkelling, buy a long-sleeved swimming top and shorts with a SPF of 50, and wear them at all times. Sunscreen can be applied elsewhere, but it’s the back, shoulders and neck thatare most vulnerable. A hat with a peak and flaps at the side is also worth investing in.
Vaccinations. Several common vaccines offer powerful long-term protection against potentially fatal conditions such as typhoid, tetanus and hepatitis. Have them and make sure you keep them up to date.
Water. In countries where sanitation is poor, don’t drink tap water or use it to brush your teeth, unless it has been treated; filtered, bottled, treated or boiled water should be used instead. If you’re hiking or staying in remote areas where the water is unsafe or unreliable, take chlorine tablets with you; these can be added to suspect water to make it safer. Unless you see them prepared in front of you, in developing countries, don’t risk juices that may have been watered down and be wary of ice.
Xenophobia. While travel is usually a trouble-free way of getting to know different cultures and customs, beware of hostility connected to you being from a different country, culture or religion. Don’t bother to argue or engage when you start seeing or hearing the signs – simply remove yourself from the situation as soon as possible and seek safety among others. Tips for deflecting attention include wearing a hat and sunglasses; another way of blending in and looking like a local is to buy an inexpensive item from a local supermarket and then carry that carrier bag with you wherever you go (this can also stop you being ripped off).
Yellow fever. An often-fatal tropical virus spread by mosquitoes that affects the liver and kidneys, causing fever and jaundice. Yellow fever can be prevented by a vaccine, which used to be valid for 10 years, but is now effective for life. Last year, the World Health Organization (www.who.int) announced that the certificates issued by doctors that are required at entry points in some countries in Africa and Central and South America are now also valid for life.
Zika virus. Spread by mosquitoes, this disease has been linked to microcephaly and Guillain-Barré syndrome in unborn children. Pregnant women or those trying to conceive are particularly advised to avoid areas where the virus is present, as are their partners, who could pass it on to them. A list of affected countries is available on the World Health Organization's website; they include many in Central and South America and the Caribbean.