| Before
you go
Immunisations
offer protection against
some of the diseases which may affect travellers.
You should ensure that
you are up to date with the immunisations recommended for your journey
and, ideally, allow 6 - 8 weeks to undergo a full course of
immunisation. To find out which immunisations are recommended
for your journey you should contact your doctor or attend a travel
clinic.
Please note that yellow
fever immunisation is mandatory for entering some countries. You will
not be allowed entry without a certificate. Cholera immunisation used
to be a mandatory requirement for entry into many countries. This is
no longer the case but some border officials are unaware of the fact
and may insist that you are immunised (under no circumstances allow a
border unit to inject you with an unsterilised needle).
All travellers are
advised to be "in date" for tetanus and polio. Other
immunisations will depend on your particular itinerary.
Malaria is
a possibility in Indonesia - if you are travelling to an area where
malaria is a risk you should do everything you can to avoid getting
bitten and the medical advice is that you take the right drugs (2,364
travellers returned to the UK with malaria in 1997; twelve of them
died.)
It is important to
realise that the tablets you should take may vary according to the
country in which you are travelling. This is because in some
parts of the world, the malaria parasite is resistant to certain
drugs.
You should be aware
that antimalarial tablets do not provide 100% protection and so not
getting bitten is your best defence.
You should start taking
your tablets one week (2 to 3 weeks if taking Mefloquine) before you
enter a malaria area and you should continue taking them for one month
after you leave the last malarial area of your journey.
If a measured fever of
38°C (use a thermometer) or greater develops, 7 days or more after
arriving in a malarial area it is possible that you could have malaria
and immediate medical help should be sought.
Insurance is
vital - If you get ill it could cost you an absolute fortune - get
medical insurance; you can even get this without getting baggage
insurance if necessary.
Medication - if
you are taking regular medication you should make sure that you take
an adequate supply for your journey. Make a note of any pills or
medicines you are taking (with both generic and trade names), the dose
that you take and the time of day you take the medicines. In an
emergency this information may be valuable to a doctor. If
you have had any serious medical problems it is worth briefly noting
down the relevant details including the treatment you were given with
dates and the drugs you are taking. Again, this may be of great help
in an emergency. You
should note down any pills or medicines that you are allergic to.
Medical kit -
definitely worth having, even if it is just some plasters, some
iodine, paracetomol, rehydration salts and a bandage.
Embassies - before
you go, find out the address and telephone number of the your Embassy,
High Commission or Consulate in the country or countries that you are
visiting. Consulates exist to help their Citizens abroad to help
themselves but their resources are limited.
General
Make a list of the
following:
- Serial number of
tickets.
- Passport number and
date issued.
- Credit card numbers
and emergency number to report theft.
- Drivers licence
number.
- Serial numbers of
travellers cheques.
- Serial numbers on
valuables e.g. cameras.
- Take copies of
prescriptions for spectacles/contact lenses.
- Serial number of
travel insurance policy and a note of any emergency contact
number.
Make two copies of a
list containing the information above. Leave one copy with someone you
can reach in an emergency and take the other copy with you keeping it
separate from your luggage and valuables.
It is a little tedious
making such a list but if the worst comes to the worst it will be
invaluable.
Check all this advice
with a professional.
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While
you are there
Stomach problems and
dehydration are tow popular complaints. If the worst happens
make sure that you drink loads of water (freely available in sealed
plastic bottles). It is also worth using this water for cleaning
your teeth - avoid tap water whenever possible.
Contaminated food
is a common problem and in
general you should have a high level of suspicion of any food
presented to you unless you know it is made from fresh ingredients and
has been thoroughly cooked.
The following
guidelines will help reduce the risk of contracting diseases from
contaminated food:
- Always wash your
hands before eating and dry them thoroughly on a clean cloth
- Thoroughly wash all
fruit and vegetables before eating. Salads are best avoided but if
eaten should be washed well and left to soak in water containing
chlorine based sterilising tablets or household bleach (4 drops
per litre). Washing in water at 60°C will reduce the risk.
- Peel all fruit and
vegetables to be eaten raw.
- Protect food being
left for any period of time with a fly net.
- Residents abroad
should make certain that house staff follow strict kitchen hygiene
rules
- Don't eat raw
vegetables or salads in public restaurants
- Don't eat
under-cooked or raw meat, fish or shell fish even if they are the
local delicacy. Inadequately cooked shell fish are a potential
major source of infection.
- Don't drink
unpasteurised cow, sheep or goats' milk. If in doubt you can
pasteurise by bringing almost to the boil and then cooling. Dairy
products such as ice cream, butter and cheese, if from an
uncertain source, should be avoided.
- Don't eat food left
un-refrigerated for more than 2 - 4 hours.
Do not make the mistake
of assuming that because a meal looks and smells delicious it will be
safe.
Contaminated water is
a frequent source of infection. Most cities and large towns have large
piped water systems but the water is only safe to drink if it has been
fully treated and chlorinated. Even in areas where the tap water is
safe to drink the level of chemical treatment may be sufficient to
render it unpalatable to the United Kingdom traveller.
To be entirely safe the
following alternative means of sterilisation are available.
- Bring it up to a
rolling boil and allow it to cool, prolonged boiling is
unnecessary.
- Disinfectants. These
are often ineffective if the water is visibly cloudy.
- Iodine is very
effective. 4 drops of 2% tincture of iodine should be added to
each litre of water and left for 15 minutes. Prolonged use of
iodine should be avoided (longer than 6 weeks).
- Sterotabs and
Puritabs. These are chlorine based and are less effective
against amoebic cysts than iodine.
- In an emergency
use household bleach (2 to 4 drops per litre of clear water)
and leave for 15 minutes, this is safe and effective but will
taste of chlorine.
- Iodine resin water
purifiers: These light modern systems both filter and purify fresh
water from any source. They are convenient and effective (for
example MASTA Travel Well Trekker).
The following
guidelines may help in avoiding contaminated water:
- Remember ice may be
made from contaminated water and is therefore not safe.
- Bottled water and
drinks are normally safe, especially fizzy drinks.
- Use safe water for
brushing teeth and for washing vegetables or salad which are to be
eaten raw.
- The water from the
hot tap in your hotel is likely to be safer than the water from
the cold tap. Run it for a minute or so first. It can be used for
brushing teeth in an emergency.
- Don't drink the
water from open wells and rivers unless using an iodine resin
water purifier.
The Sun is
ridiculously hot and overexposure can cause sunburn, leading to
premature skin ageing and an increased risk of skin cancer. Take care
not to burn in the sun and remember the following:
- Avoid sun exposure
between 12 and 2pm when the sun's rays are at their strongest.
Where possible stay in the shade.
- Be careful in and
around water. Ultra-violet rays are reflected by water.
- Wear loose-fitting,
closely woven cotton fabrics that you cannot see through.
- Wear a broad-rimmed
hat to protect head, face and the back of neck.
- Use a broad spectrum
(blocks UVA and UVB rays), high protection factor sunscreen (SPF
15) and apply frequently especially after being in water.
- Wear sunglasses that
filter out UVA and UVB rays to protect your eyes from sun damage.
Keep babies under six months of age out of direct sunlight. Their
skin is easily damaged.
- Children should wear
hats and sunglasses and be covered up when out in the sun. A broad
spectrum, high protection factor sunscreen should be applied
frequently especially after bathing.
Another risk of
overexposure to the sun is dehydration:
- Avoid strenuous
exercise during the hottest hours.
- Drink plenty of
non-alcoholic fluids to replace the fluid lost through
perspiration.
- Ensure you are
wearing clothing appropriate to the weather conditions.
Medical attention
is sparse. Any problems, go to the pharmacy (apotik), which can
provide many medicines without prescription. Condoms (kondom)
are also available from pharmacists. Only in the main tourist areas
will assistants speak English; in the village health posts, staff are
generally ill-equipped to cope with serious illness. If you need
an English-speaking doctor (doktor) or dentist (doktor gigi) seek
advice at your hotel or at the local tourist office. You'll find
a public hospital (rumah sakit) in major cities and towns, and in some
places these are supplemented by private hospitals, many of which
operate an accident and emergency department. If you have a
serious accident or illness, you will need to be evacuated home or to
Singapore, which has the best medical provision in Asia. It is,
therefore, vital to arrange health insurance before you leave home.
Mosquitoes can
transmit several diseases including dengue fever, Japanese
encephalitis, malaria and yellow fever. Most (but not all) bite
after dusk and at night. To reduce the chance of being bitten:
- Wear long sleeved
shirts and long trousers after dusk.
- Spray your room or
tent before going to bed with a knockdown spray (flyspray).
- Sleep in a screened
room if possible, otherwise use a bed net. The new wide mesh nets
impregnated with residual insecticide (permethrin) are
particularly effective.
- Use mosquito nets to
cover cots. This is essential to protect babies.
- Use a plug-in
electric insecticide vapouriser. Smoke coils are an alternative.
- Use air conditioning
as this eliminates mosquitoes in sleeping areas.
- The new, natural,
eucalyptus based insect repellents have been shown to provide many
hours protection when applied to skin. DEET impregnated into
cotton is effective for many hours. Ankle and wrist bands are very
useful for local protection.
- Spraying of walls by
the local authorities with residual insecticides is practiced in
many towns and cities and greatly reduces the risk of being
bitten.
- Remember mosquitoes
breed in stagnant water wherever this collects (e.g. drains, old
tins, open sewers, marshes etc.). Long term residents should
therefore ensure that breeding areas within 500 yards of
accommodation are regularly sprayed or eliminated.
- Try to return from
country trips before dark as there is much less risk in towns and
cities than in the country.
Certain mosquitoes are
active mainly during the day (day time biters). To reduce the chance
of being bitten by them:
- Avoid shady
conditions outside in the late afternoon.
- Do not take late
afternoon siestas indoors unless protected by a net ideally in a
screened and air conditioned room.
Ticks feed
mainly on animals and then drop into the grass or scrub land
vegetation. When they are hungry for blood they crawl up the leaves of
plants and attach to passing people or animals. When biting they stay
strongly attached to the skin for many hours and are difficult to
detach.
- Avoid likely
tick-infected areas such as scrub land, pastures and forests.
- If this is
unavoidable search body every 3-4 hours for ticks.
- If they are found,
they should be removed by gentle steady traction using tweezers or
fingers protected by tissues.
- Apply antiseptic to
the bite site and if a tick has been touched with bare hands wash
thoroughly with soap and water.
- Always wear long
trousers in these areas and tuck in the bottoms. (Consider
treating with insect repellent i.e. DEET).
- The new, natural,
eucalyptus based insect repellents have been shown to provide many
hours protection when applied to skin. DEET impregnated into
cotton is effective for many hours. Ankle and wrist bands are very
useful for local protection.
- Hands should be
protected when you remove ticks from man or animals.
- De-tick dogs
regularly using insecticide powder.
- Sleep on camp beds
raised from the floor if in nature huts, camps or ruins.
Accidents
- more travellers die from
accidents than any other cause and most of these accidents could have
been avoided. The consequences of having an accident abroad are often
far more serious than if they occur at home. Emergency treatment may
be limited and of an uncertain standard and there may be communication
difficulties if you cannot speak the local language. You should know
how to deal with an emergency and how to summon help locally but above
all, try to avoid exposing yourself to unnecessary danger.
Take Care on the Roads
- Always check on
local traffic regulations and stick to the speed limit.
- Wear a seatbelt when
travelling by car and ensure children are strapped into a car seat
or child restraint.
- If you must travel
on motorcycles or mopeds always wear a helmet and protective
clothing.
- Check the condition
of cars and bikes for hire and the insurance cover provided.
- Never drink alcohol
and drive.
Take Care in Water
- Children should
always be supervised by an adult who can swim well when playing in
or near water. Even a shallow paddling pool is a potential danger
for young children.
- Ensure when diving
into water that it is deep enough for you to do so safely. Each
year, many people are left permanently paralysed as a result of
injuries sustained from diving into shallow water. A useful slogan
to remember is "Feet first, first time".
Sports and Special
Pursuits
- These often involve
a certain degree of risk which adds to their enjoyment and
attraction. When accidents do occur, the cause can usually be
traced back to avoidable factors such as poorly maintained
equipment, lack of training or an inadequate level of fitness.
Ensure equipment is maintained to a high standard, that you have
adequate training with appropriately qualified personnel and that
if the activity to be undertaken involves strenuous exercise that
you build up your fitness gradually and not "over-do
things". Also check your travel insurance policy covers you
for all the pursuits that you will be undertaking. Not all
policies will cover activities such as mountaineering, scuba
diving or motorcycle riding.
Safe sex -
travellers have been shown to be at increased risk of acquiring
sexually transmitted diseases as people often behave differently when
they are abroad. There are many factors influencing behaviour such as
being away from the usual constraints of home, seeking adventure and
new experiences and wanting to make new friends.
Diseases such as HIV
and hepatitis B are more prevalent in some parts of the world than in
the UK and the risk of infection may be much higher (for example HIV
is principally a disease of high risk groups in the UK but is spread
mainly through heterosexual intercourse in much of sub-saharan
Africa).
It is best to avoid
casual sexual intercourse and, in particular, activities where the
skin may be damaged or there may be contact with bodily fluids. The
risk of transmission of HIV, hepatitis B and other sexually
transmitted diseases is reduced but not eliminated by the use of a
condom which should be used throughout sexual contact. Condoms
purchased abroad may not be as reliable as they may not be of the same
high standard as those purchased in the UK. Take a supply with you.
Check all of this
advice with a professional.
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