Travel Health Issue - May 2005

Travel health is something that is often overlooked when planning a holiday.  Getting ill while away or when you return from overseas can often ruin the entire holiday.  With around half of all Australian’s who go overseas reporting some kind of illness while away, it makes good sense to seek specialist travel health advice before travelling.

Dr Tony Gherardin, is the National Medical Advisor of Australia’s largest travel health group, the Travel Doctor – TMVC.  Here are a few of the travel health issues he is frequently asked about.

Travellers Diarrhoea

Bali Belly, Tourista, Montezuma’s Revenge, call it what you will. Travellers diarrhoea is an illness that affects about 50% of travellers to places such as Egypt, India, Nepal and Bangkok during a 2 week stay.  Yes, as common as that! It becomes more common the longer you stay in a developing country.

Travellers diarrhoea [TD] is defined as two or more loose bowel motions in a twenty-four hour period accompanied by stomach cramps nausea and/ vomiting.

Dysentery is a term used to describe a more severe illness, usually prolonged and with fever and blood in the stool.

Travellers diarrhoea tends to strike on the 3rd or 4th day of your trip and lasts 36-48 hours if untreated. The cause is usually bacteria and spread by contaminated food or water. The main problem with TD, apart from the general inconvenience and discomfort, is dehydration. This can occur quite quickly in tropical countries and especially in children.

More severe diarrhoea, particularly when there is blood in the stool and fever, requires medical advice.  There are oral Rehydration products such as Gastrolyte, on the market but simple Rehydration with mineral water is usually adequate for adults.

Prevention is, of course, better than cure and meticulous handwashing helps much more than most travelers realize. There are medications, which act by slowing the gut thus reducing the cramps and frequency of bowel action. They do however tend to keep the toxins in the gut so can actually prolong the illness.

Follow the rules of eating and drinking safely - "boil it, cook it, peel it--or forget it" - to help minimize the chances of contracting Travellers Diarrhoea.

The older traveller

Early retirement has prompted many older, even much older, people to pack a bag and head ‘off to see the world’ or to visit relatives overseas.

It is often said that age brings wisdom and it is true that sometimes age and style of travel can help you to avoid health risks but vaccinations are important at any age. Even if you have had vaccines previously, boosters may now be advisable. Influenza vaccine is a consideration for all older travellers who might have a more severe illness. Remember that the ‘flu’ season in the northern hemisphere is November to March.

Here are a few points to consider when planning your dream trip:

• Lack of exercise in airports and on planes can result in venous thrombosis and possibly pulmonary embolism. This is what is sometimes called DVT or Deep Vein Thrombosis. Swollen ankles often result from long periods sitting in the cramped aircraft seating. Walk around as much as possible and keep exercising the feet and legs whilst seated. Plan stopovers in long haul trips.

• Adequate supplies of all regular medication should be carried with you. Familiar brands may not be available overseas. Allow enough for unexpected delays and always have a doctors letter detailing your current medical problems and reason for medications.

• Angina and breathlessness can be worse at high altitudes and sometimes in airplanes. Airlines can usually arranges additional oxygen if advance notice is given.

• Diabetes, urinary incontinence, chronic airway disease and many other ongoing medical conditions are not deterrents to travel but do. make advance planning essential.

• Advancing age is often accompanied by a reduced capacity for exercise. Poor balance and reduced stability make falls more likely and there is a greater risk of accidents in strange surroundings. For these reasons, good walking shoes are a must.

• Hearing and sight impairment can cause confusion in unfamiliar situations – particularly busy airports with continual loudspeaker announcements.

• Hot climates can aggravate low blood pressure particularly in those on anti-hypertensive or anti-Parkinson Medications. In addition, sunburn is a greater risk when the skin is aging or thin and a SPF 30+ sunscreen should be used regularly.

• Older people frequently have reduced stomach acidity, which can increase the risk of Travellers Diarrhoea and gut infections. It is important to have a medical kit with appropriate medications for this and other commonly occurring health problems. Travel health specialists, such as the Travel Doctor can provide a range of medical kits and can help you select the on most suitable for you and your destination.

Finally, whatever your destination it is essential to have adequate travel health insurance – existing medical conditions including recent surgery must be disclosed in advance. For those with ongoing health problems it is important to remember that even with insurance, emergency care is only as good as the available medical facilities.

If I get sick, will I be able to get the medicines I need overseas?

Many familiar medicines are not available overseas.  A prescription from your doctor here cannot be filled overseas, if you are unable to carry sufficient for your entire trip it is advisable to have the names of doctors capable of helping you in the places you will be visiting.  Additionally, individuals are usually familiar with the pharmaceutical name of drugs, such as Panadol, rather than the generic name – paracetamol.  When travelling it is wise to know the generic name for any medications you may be taking, as these may be available under a different pharmaceutical name in other countries.

It is also important to recognise that the sale of bogus drugs is a common problem in developing countries.  Medicines widely sold in developing countries are not always what they purport to be and are frequently not subject to the same stringent standards that apply in Australia and New Zealand.  They are often not stored correctly and many have passed the expiry date. In addition, the World Health Organisation estimates around 30% of all medicine sold worldwide has undergone some degree of falsification or adulteration.

For example, a recent study showed that in South East Asia it was found that a commonly sold antimalarial drug, artesunate, was lacking the active ingredient in more than a third of samples bought in Myanmar, Cambodia, Vietnam, Laos and western Thailand.  In a second report, which examined the quality of medications supplied by pharmacies in Lagos and Abuja in Nigeria, it was discovered that almost half the tested samples were substandard or fake.

The Travel Doctor strongly recommends that travellers take with them the medications required to treat common travel ailments together with an adequate supply of any medicines taken on a regular basis. All such medications should be accompanied by a signed medical authorisation in order to avoid problems with custom officials.  Specially designed Traveller’s Medical Kits can be obtained from Travel Doctor-TMVC clinics.

About The Travel Doctor, TMVC

The Travel Doctor (TMVC) is Australia’s largest individual supplier of travel health services, with dedicated travel health clinics in 26 major centres of Australia and New Zealand and relationships with clinics in South East Asia and Africa.

Find out about some of the travel health issues at places that you’ve always wanted to visit at the Travel Doctor website:  www.traveldoctor.com.au.

For your closest Travel Doctor call 1300 658 844