5. If a swimming pool smells of chlorine, the risk of SWADLINCOTE SURGERY infection is probably slight. GUIDE TO HEALTHY TRAVEL 6. Travellers to the tropics beware of water associated diseases eg. Schistosomiasis. Seek local advice on the presence of these diseases and water snakes.

Accident Prevention Jet Lag Road and swimming accidents are the most common cause of death and injury to travellers.

Usually only appreciable if crossing more than 5 time zones (five hours’ time difference). Worse if the flight is eastwards Road Safety (ie. When the day of travel is shortened). 1. Do not drink alcohol and drive. 1. Do not book heavy commitments for the first 24 hours 2. Wear seat belts in cars. after travel. 3. Wear crash helmets when riding motor bikes and mopeds. 2. Sleep on the plane. Ensure your clothes help protect your arms and legs. 3. Avoid or limit your alcohol intake. Drink plenty of soft drinks. 4. Keep regular medications on home time and meals during the flight, when practicable, and adjust on arrival. Diabetics need more detailed advice. 4. Check that rented vehicles are in good condition and are insured. Sun and Hot Climates 5. Find out about local traffic systems, regulations and road conditions. Swimming Safety and Leisure Activities 1. Do not drink alcohol and swim. Wait at least an hour after eating before swimming. 1. Prevent damage to the skin in the first place by careful 2. Think before you jump. Make sure you know the depth of preparation. Initially limit exposure to the sun and increase the water before diving. gradually. Fair skins are 3. Find out about local safe beaches and sea conditions. most at risk. Beware of water currents and inflatable airbeds or 2. Use high factor sunscreens with frequent top ups dinghies. especially after swimming. 4. Children need close supervision by water. 3. Wear hats and T-shirts and other loosely fitting clothing. 7. If you do need a blood transfusion ensure it is absolutely Encourage children and snorkellers to wear T-shirts over necessary. Ask if alternatives such as plasma expanders swim suits. can be used or the availability of screened blood. 4. Increased sweating means increased fluid loss, therefore 8. The charity the Blood Care Foundation will provide increase fluid intake and add extra table salt to meals. screened blood for Emergencies worldwide. For Drink enough to keep your urine light coloured. information write to the Blood Care Foundation, PO Box 5. If you get sunburnt: avoid the sun, have cool showers, 7, Sevenoaks, Kent TN13 2 SZ. Tel. 01732 742427. drink plenty of fluids, and use calamine lotion. Painkillers Sexually Transmitted Diseases and AIDS such as paracetamol and anti-histamines may help. Do not 1. Beware of casual sex. Do not take risks. burst any blisters as it encourages local infection. 2. Always use a condom. Take adequate supplies of condoms, which have the British Standard Kitemark. Blood Borne Diseases, Sexually Transmitted 3. Alcohol encourages sexual risk taking. Diseases and AIDS 4. If in doubt visit the local STD or genitourinary clinic on your return. Sterile Needles and Syringes 1. Medical kits are available containing sterile needles and syringes for emergency use. Carry it at all times and keep it in its original case so that Blood Borne Diseases it’s purpose is obvious. Many countries do not have the standard of healthcare that you are used to in the UK. Medical and dental equipment may not be properly sterilised. Blood is not always screened for Travellers Diarrhoea infections. 1. Make sure you are fit to travel. 2. If you have a medical problem, try to find out where you will receive a good standard of medical care at your 1. Use only bottled water (preferably carbonated) or boiled destination. If you become ill abroad seek advice from the water and ensure the seal is intact. This includes water British Embassy or High Commission. used for brushing teeth, washing fruit and salads, and in 3. Any dental treatment should be completed before travel. ice cubes. Beware of locally produced drinks; ice cubes 4. Ensure holiday insurance includes medical repatriation. and ice cream. Water can also be purified by boiling for at 5. Reduce the risk of accidents abroad and attend a first aid least 10 minutes, or using water sterilising tablets, or using course. a water filter/purifier. 6. Know your blood group and find out if any fellow 2. Peel fruit, including tomatoes and avoid those that cannot travellers have a compatible blood group. be peeled. Eat only cooked vegetables and avoid salads. 3. Cook meat, seafood and fish thoroughly. Ensure food is Animal Bites, Scratches and Licks served piping hot and avoid left overs and reheated food. 4. Boil unpasteurised milk. 5. Be wary of soft cheeses and other dairy products particularly if made with unpasteurised milk and when there is no refrigeration. If you are going to a country where rabies is present, then all 6. Wash your hands thoroughly with soap and clean water bites, scratches and even licks should be considered as suspect. before eating and always after going to the toilet. Use Rabies is a virus infection carried by infected dogs, cats, foxes, paper towels or hot air for drying hands and whenever bats and other animals. possible avoid touching food with your hands. 1. Always consider the possibility of rabies if you are bitten, What to do when diarrhoea strikes scratched or licked by an animal. Most episodes of diarrhoea will pass in three to four days 2. Clean the wound immediately and thoroughly with soap without treatment. and running water for at least 5 minutes. Apply tincture of 1. Assess the diarrhoea. Is it watery? Is there any blood or iodine or alcohol. mucous present? 3. If the owner of the animal is present, find out if it has been 2. Check your fluid balance. Make a rough guess about vaccinated against rabies and ask to see the last certificate. whether you are losing more fluid through diarrhoea than Exchange each other’s details. you are drinking. 4. Make sure you seek local medical advice about rabies 3. Drink plenty of fluids – enough to keep your tongue moist vaccination as soon as possible, even if the animal has and your urine a pale yellow colour. Small amounts of been vaccinated or you have had the rabies vaccine. dark urine suggest you are at risk of dehydration. (See 5. Inform the local police in the country and then your GP on “Travellers First Aid Kit” for oral rehydration mixture). returning home. 4. Seek medical attention if you develop a temperature above 38C, find blood in your stools, become dehydrated, or if Prevention of Malaria the diarrhoea persists for one week. 5. Introduce food gradually. Avoid solid food for the first day or two. 6. Antidiarrhoeal tablets are recommended when the diarrhoea will be an inconvenience. They are not Malaria is the most serious disease that a traveller faces in recommended for children. tropical climates and it can be fatal. It is transmitted by the bite 7. Antibiotics are not routinely recommended. of a mosquito; these are most active between dusk and dawn. Personal Protection Remember: boil it, cook it, peel it. When in doubt, miss it 1. Avoid exposing areas of skin after sunset. Wear long out! sleeved tops and trousers. Light colours are less attractive to mosquitoes. 2. Use insect repellents. Skin preparations should contain year. Always inform your doctor that you have visited a DEET. Eucalyptus preparations are an alternative and malaria zone. more user friendly. Apply to all exposed areas, especially Taking Children to Malarial Areas the wrists, ankles and feet. Wrist and ankle bands soaked The advice for babies and children is the same as for adults. in DEET are available and last for several weeks. 1. Antimalarials should be started in babies from birth. Breast-feeding does not provide protection. Some antimalarials are available in syrup. Physical Protection 2. Insect repellents containing DEET should be used 1. Always use a mosquito net treated with permethrin in sparingly avoiding the mouth and eyes. malarial areas in rooms that do not have air-conditioning. 3. The onset of malaria can be very rapid in babies and Check the net for holes and tuck it firmly under the children, therefore seek medical attention promptly if the mattress. signs or symptoms of malaria appear. 2. Use accommodation that has screens on windows and doors and air conditioning that runs all night. Keep doors and windows tightly shut. The Travellers First Aid Kit 3. Mosquitoes that have entered a room can be killed with insecticide spray. 4. Mosquito coils that burn smouldering pyrethrum can be useful in preventing mosquito bites at night or use synthetic pyrethroid containing electric mats. Antimalarial Tablets Start your antimalarial tablets two to three weeks before you Remember to take enough of your usual medication. travel, so that any reactions can be reported to your doctor. These are some suggestions about what you should consider Take them with a meal and regularly. It is important that you taking with you on holiday and can be used as a checklist. continue taking the tablets for four weeks after you have First aid dressings Gauze squares, non-adherent returned, to cover the incubation period. dressings, bandage, fabric When To Suspect Malaria plasters, adhesive tape, scissors, Some of the main signs and symptoms of malaria are a flu-like tweezers and safety pins. illness with fever, chills, sweating, and headache. Antiseptic Wipes, dry powder or spray: Seek medical attention for any fever 1-week after arriving in Savlon, betadine, and tincture of malaria zone. iodine. On your return home, remember to suspect malaria if feverish Use for cuts and grazes. symptoms begin, especially in the first three months following Calamine lotion Use for sunburn and/or skin your return. The possibility of malaria persist for up to one irritation. Painkillers Use for temperatures, pain and inflammation. Painkillers continued Paracetamol or aspirin (aspirin Water sterilisation Water filter or sterilising tablets. should not be given to children Iodine is better than chlorine under 12 yrs). based tablets at killing amoebic Calpol or other infant formula for cysts. children or babies. Sterile injection kit Needles and syringes; may Thermometer include cannula. Oral rehydration therapy in sachets and different flavours. Antibiotics The need for antibiotics should be Use for fluid replacement in discussed with your doctor. diarrhoea. Dioralyte and Rehidrat. See below for homemade Possibly required mixture. Contraceptives or condoms Antifungal cream Miconazole cream/powder, Acetazolamide For altitude sickness. clotrimazole cream/powder. Antihistamines Chlorpheniramine, astemizole. For travel to malarial areas Promethazine (Phenergan) for Antimalarial tablets children. Insect repellent Containing DEET; This can be Oil of cloves For toothache. bought in various strengths: Ephedrine nasal drops For children with blocked noses Autan, Jungle Juice, Expedition. or catarrhal ears. Eucalyptus preparations such as Insect repellent Mosi-guard. Travel sickness remedy Promethazine, cinnarizine. Wrist and ankle bands Soaked in insect repellent. Indigestion remedy Mosquito net Soaked in insecticide: permethrin Protective sun cream, or icon. For those travelling sunblock and lip cream rough. Personal medication A doctor’s letter should Stand-by malarial If travelling to remote areas more accompany a larger amount of treatment than 24 hours from medical personal medication, or syringes help. and needles.

For Travel to less developed countries Antidiarrhoeals Not recommended for children. Home-made oral rehydration mixture for diarrhoea Arret, Diocalm Ultra, Imodium or Lomotil. Codeine phosphate 1 litre of water ) needs a doctor’s letter explaining 1 level teaspoonful of salt ) all mixed together why it is necessary. 4 heaped teaspoonfuls of sugar ) Further Reading Nomad (Pharmacy) Ltd SAFA Limited Health Advice for Travellers. Department of Health. T5 1995 3-4 Turnpike Lane 59 Hill Street Leaflet. Available free from post offices. It also contains an London N8 0PX Liverpool L8 5SA application form for the certificate E111. Tel: 0181 889 7014 Tel: 0151 708 0397 Stay Healthy Abroad: The essential guide for all travellers. Ryan R. Health Education Authority 1995. Philip Harris Medical Ltd Williams Medical Supplies The Traveller’s Handbook. Gorman S. and Brandenburger C. Hazelwell Lane Unit 6 (eds) Wexas 1994 Stirchley Springhead Enterprise Park Very comprehensive. Birmingham Springhead Road The Tropical Traveller. Hatt J. Penguin 1993 (3rd edition). B30 2 PS Northfleet Tropical travel tips. Tel: 0121 433 3030 Kent DA11 8HD First Aid Manual. St John Ambulance. St Andrew’s Tel: 01474 535330 Association, British Red Cross Society. Dorling Kindersley 1987.

National Suppliers of Medical Goods

Homeway Medical Ltd Lifesystems The White House 4 Mercury House Littleton Calleva Park Winchester Aldermaston HantsSO22 6QS Berks RG7 4QW Tel: 01962 881526 Tel: 01734 811433

Industrial Pharmaceutical Medical Advisory Service Service Ltd for Travellers Abroad Bridgewater Road (MASTA) Broadheath Keppel Street Altrincham London Cheshire WA14 1NA WC1E 7HT Tel: 0161 928 3672 Tel: 0171 631 4408