Travel and Health

Sadly many people’s dream holiday is ruined by sickness which in many cases could have been avoided. Also for most people who have a ‘bucket list’ , travel to a nice overseas destination is high on the list. Again being prepared and taking a few precautions can make this a much more enjoyable experience. There is some wise advice on where. when and how to travel on this website.
Other tips – take a reusable empty water bottle on the plane with you and fill up from the water fountain. You will always have water without relying on the flight attendants. Take a basic first aid kit, hand sanitizer, a small umbrella. Make a photocopy of your passport, credit cards and important documents,

Pre travel – check with your doctor and also travel advisor on the need for immunisation and malaria precautions which will depend on your destinations.
Organise all the tablets and drugs you may need and take them if possible on the plane with you. Have an emergency supply also in your luggage.

Air travel –

Barotrauma – planes are not pressurised to sea level (usually about 8,000 feet or 2,400 metres which is equivalent to the top of a fairly significant mountain). This can affect people with some heart and lung diseases, also people with sickle cell anaemia and other anaemias, who may need supplemental oxygen, which is provided in all commercial jetliners.

Reduced humidity – the plane scoops air from the outside for us to breathe, and at 30,000 feet this contains very little water, so the humidity in the plane air is low. (This is one of the few advantages of flying economy class, with all those people together breathing, it increases the humidity in that area). Better is to regularly put drops of water into the nose and eyes or breathe through a damp flannel every now and again.
Venous thrombosis – Prolonged immobilisation can cause clots to form in the legs – deep vein thrombosis (DVT). This can happen in fit healthy people but in many people with disease it is more likely. This has been labelled the ‘economy class syndrome’ because of limited leg room and inability to move around so easily. This can be avoided by – moving around the cabin every one to two hours (choosing an aisle seat makes this much easier), regularly flexing and stretching the ankle and knee joints and muscle. It is best to avoid drugs which can cause immobilisation and dehydration such as sedatives and alcohol, and drink plenty of fluids.
Drugs – surprisingly, despite the millions of air travellers who could make for excellent research, there is almost no data on the use of drugs to reduce DVT. Injected low molecular weight heparin has a mild effect, but in the few trials done, aspirin has shown no benefit.
Blocked eustachian tubes (from the back of the nose to the ear) and sinuses, can cause considerable discomfort. Usually this can be cleared by swallowing or blowing the nose. In children crying achieves this, also sucking a dummy or some drink during take off and landings. If you have problems with these tubes, the best treatment is to carry a nasal decongestant (otrivine, drixine etc) and use this when symptoms develop.
Scuba divers should wait 12 – 48 hours after a dive to avoid developing the ‘bends’.
Wheelchair assistance – in many modern airports there is often a long walk to and from the gates. For those with heart, lung or other conditions this is a real problem, and airlines and airports appreciate this and provide wheelchair access. USE THESE – they are made for you. Not only does it enable you to get to and from the plane in comfort, but it also speeds your way through customs and immigration – you become a VIP. Enjoy this – you deserve it. Ask your travel agent to organise this when she/he books your flights.
Jet lag – this is discussed below.

Cruise ships –

These do their utmost to stay clean, but cooping thousands of people together can occasionally lead to outbreaks of diseases, especially diarrhoea and norovirus. Nearly all of these are caught from faecal/oral spread, and careful hand washing before touching any food, avoid touching hand rails (when the ship is stable) and other communal areas (open the toilet doors with paper – one can not assume everyone has washed their hands).
Seasickness is very common, and usually due to conflicting information reaching the brain from the ear semicircular canals and the eyes. It can be reduced by looking at a distant earth fixed object such as the horizon, so the eyes and the ear information is less conflicting. Look straight ahead rather than down, and reading, watching a video etc is not a good idea. Symptoms usually subside after a day or two of misery, it is important to keep fluids up by sipping water regularly. Chewing ice can both hydrate amd also help the sicknesss, if your teeth will allow. Antihistamines (dramamine, meclazine) can help also anticolinergice (scopolomine patch) is also very effective, but needs to used with caution in people with glaucoma. Ginger also helps, and flat ginger ale also helps with hydration. Caffeine has been shown to reduce symptoms especially when given with antihistamine drugs. Acupressure over the P6 pressure point (over the front of the wrist 3 finger breadths above the wrist fold) has been shown to work in some but not all studies. Magnets have been suggested but there is no evidence for their benefit. Smokers improve considerably if they stop when they develop motion sickness.

Diarrhoea

-travelors diarrhoea is the most common illness afflicting travellers almost everywhere. For people with significant illness this can be serious and they must be careful not to become dehydrated bu regularly sippling er when they can Much diarrhoeal illness are caught by faecal/oral spread, so meticulous hand washing before eating is essential. Food eaten is also a major source of bacteria (and viruses) which cause this illness. Drink only bottled water, do not have ice in drinks as freezing does not kill the bugs- nor does alcohol. Avoid salads and fruit salad, as the contents have almost certainly been washed in potentially contaminated water.
There is good evidence that regularly taking probiotics can help, and we strongly suggest this simple and safe alternative advice to travelers. Drugs for diarrhoea include ciprofloxasin and rifamamin seem to be the best. Once diarrhoea has developed, unless severe it is often self-limiting, and keeping up fluids is all that is needed. Antibiotics can reduce the severity and duration of the illness (ciprofloxacin 500 mg twice daily for 4 days, azithromycin 1gram single dose or rifaxamin 200 mg three times a day for 3 days). It is best not to use antimotility agents unless given with antibiotics as they do not address the underlying cause. If the diarrhoea persists, seek medical advice and have the stools checked for parasites.

Emergency medical kit

In many places medical help may not be available, and it is wise to take a good first aid kit to come with minor injuries and illnesses.
First aid – adhesive bandages (multiple sizes) and adhesive tape, Alcohol-based hand sanitizer, Antiseptic wound cleanser (for example, alcohol or iodine pads), Blister pads, Disposable latex or vinyl gloves, Gauze, Packets of oral rehydration solutions, Safety pins and scissors, crepe bandages for sprains, Thermometer, tweezers to remove splinters and ticks.
Drugs – Any prescription or over-the-counter medication you normally use, 1% hydrocortisone cream to treat minor skin irritation, such as itching caused by bug bites or poison ivy, allergy medication, such as an antihistamine, anti-diarrheal medication, anti-motion sickness medication, antifungal and antibacterial ointments or creams to apply to wounds to prevent infection, cold and flu medications, such as decongestants, cough suppressants or throat lozenges, pain and fever medication, such as Aspirin and paracetamol, ibuprofen, stomach and intestinal medication, such as antacids and laxatives. If recommended, destination-specific medication, like those for malaria or high-altitude sickness, aloe gel for sunburns adequate supply of condoms extra pair of glasses or contacts (or a copy of your prescription) insect repellant, mosquito net, saline eye drops, sunscreen, water purifying tablets or filter. Hand wipes, disinfectant sprays, tissues.
If you need to use needles or syringes, take more than enough to last for your entire trip and carry a medical certificate from your health care provider explaining that the needles or syringes are for medical use.
Documentation – carry papers with your Name, address, and phone number, details of a family member, Name and phone number of your health care provider at home, Address and phone number of your accommodations at your destination(s) Emergency contact number of your health insurance, and medical information and letters from doctors. Carry your insurance card in your wallet.

Jelly fish stings

In many countries jellyfish are found, and it is wise before swimming to speak to a local to check whether they are present or in season. Some sting by close contact, but many have very long tentacles metres long, so can sting even when they cannot be seen, and some jellyfish are so tiny they cannot be seen, especially the tiny box jellyfish causing Irukandji syndrome, which can be lethal, in northern Australia. Stinger suits can protect against most jellyfish but not the tiny ones including the Irukandji ones.
The effects depend on the type of jellyfish, the amount of the sting and the age and medical condition of the swimmer. Most cause immediate pain (except the Irukandji which initially can be very mild like a mosquito sting, and then gradually over some hours becomes excruciatingly painful).
First aid –

If box jellyfish or dangerous species is suspected – get to hospital as fast as possible. Although there are a few antidotes, good supportive treatment will save lives.
Remove the tentacles by brushing off with a piece of plastic like a credit card, and a substance like shaving cream. Salt water can be used to wash it off but NOT fresh water as it makes the tentacles fire more stings. Similarly do not rub the area vigorously.
Immerse the area in hot water 40 – 45oC – as hot as is just comfortable, for about 20 minutes. Household vinegar (acetic acid) in a 1 in 4 solution of warm water can also ease the pain. Baking soda 3 teaspoons in 1 teaspoon of sea water can help with some stings but not all.
Do NOT use methylated spirits, alcohol or urine – these may be easily available but they do not help the symptoms and can make the tentacles fire more stings.

Jet lag

– sleeplessness, impaired performance and fatigue when one crosses time zones. It is worse moving to the east rather than westward. It is best to try to get into the new time zone as quickly as possible, by exposure to daylight when you are there. Melatonin, the sleep hormone is probably the best therapy, taken before bedtime at the destination, and use a night mask if there is still some light. Sedatives like zopiclone can also be used at night, but are better not used with melatonin. Caffeine during the day to stay awake is a time tested solution which works. restrict the amount of alcohol. Short naps of less than 30 minutes, at least 8 hours before bedtime can also help. ‘Earthing’ sounds weird to most people, but science has quite a lot of evidence that separation from the vast supply of electrons on the earth’s surface can affect our physiology. Walking barefoot outside (preferably on a beach) can reconnect us and may well help with jet lag.

Swimming and beaches

it is best not to swim in fresh water where schistosomiasis is present (Africa, the Caribbean, south America, south-east Asia and the Middle East). This also applies to rafting and other water activities. Chlorinated water and sea water are safe.
Also be careful; walking barefoot or in loose footwear in sand or soil that could be contaminated with human or animal waste. All sorts of diseases can be caught from the eggs of hookworm, larva migrans and other nasties.

Water to drink

It is best to use either bottled water or soft drinks. Boiling for 3 minutes followed by cooling to room temperature (do not add ice) to kill bacteria, parasites, and viruses. Adding two drops of 5 percent sodium hypochlorite (bleach) to a quart of water will kill most bacteria in 30 minutes. Adding five drops of tincture of iodine to a quart of water will kill bacteria within 30 minutes.
Compact water filters in which the filters are impregnated with iodine remove parasitic pathogens and kill viral and bacterial pathogens; they provide a reasonable alternative for those who expect to be travelling under rustic circumstances. These are available commercially at camping or wilderness supply stores.

City Mapper –

If you travel overseas, this is a fantastic tool to help you get around many of the major cities. Not only does it have maps to tell you where to go, including many shops, restaurants etc ( I know google maps has this too), but it also tells you which bus, tram , ferry or train to take and their numbers, from your current location. It also has ferry, light rail, train and tram maps as well. Take a look at it – Citymapper