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Health  

There is a range of health advice on this page but you must ask a professional - the information here is mostly from two particularly good sites - www.masta.org and www.travelvax.net.

Below is help and advice for the period before you go and while you're there (it includes stomach problems, malaria risks, accidents, etc) - don't forget your vaccinations:

  Polio Recommended  
  Tetanus Recommended  
  Typhoid Recommended  
  Hepatitis A Recommended  
  Hepatitis B Sometimes Recommended  
  Yellow Fever Yellow fever certificate of vaccination required if entering from infected country.
  Diptheria Sometimes Recommended  
  Other vaccines Rabies (sometimes recommended).  Japanese encephalitis (sometimes recommended).  
  Malaria Malaria prophylaxis recommended for certain areas
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 38C (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.

 

 

 

 

 

 

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 60C 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.
    1. 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).
    2. Sterotabs and Puritabs. These are chlorine based and are less effective against amoebic cysts than iodine.
    3. 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.