Travel Health: Guide to Travel Health

This guide was written by travel health expert Doctor Seb Kalwij and covers the basic issues that you should know about before you travel.

However, this section is no substitute for a visit to your own doc. Your local GP should run a travel clinic. We suggest that you contact him / her to find out when it is.

We would advise that a good eight months before your trip you:

Dr Sebastian Kalwij

Dr Sebastian Kalwij is gapyear.com's travel health expert. He's been involved with travel health projects all over the World, and is now a GP in London.

Dr Seb writes...

"In this guide I cover the basic health issues that you should know about before you travel. However, this guide is not a substitute for a personal consulation with your GP. You should seek personal, professional advice about these issues, and if you experience health problems whilst travelling.

Visiting your GP before you travel

A minimum of one month before you set off, you should visit your GP for advice about vaccinations etc. However, if you want to be completely immunised against Hepatitis A and B, it's best to be seen seven months before travelling as you'll need boosters one month and six months after the initial jab.

It's important to plan your travels in advance. Some people decide on the spur of the moment to travel or join friends. This may leave you unprotected against some illnesses (mainly Hepatitis A and B). Vaccinations and anti-malarial tablets can be expensive and you may have to save up for them.

Before you visit your doc, get as precise an idea as possible of where you are going to. For example, Phuket has a different risk for many illnesses than the remote jungle in the North of Thailand, and beach holidays are completely different from jungle safaris. Time of the year is important too - you may need different protection in the dry season from in the wet season.

The more information you've got the better advice you'll get. Obviously plans may vary along the way (you may want to stay longer in a place you like, or travel to a more remote place when you feel more confident). If this is the case it may be possible to stock up on more medication or get vaccinated en route, e.g. in most capital cities.

Travel health kit

Travel light is my advice. I advise taking a sterile needle kit if you're going to countries where the risk of HIV or Hepatitis B is high (most Asian and African countries). The kit contains sterile needles and syringes which can be handed to medical staff who will use this for your treatment when needed. It's not a DIY kit! If any of the items need to be used, replace them at the soonest opportunity.

A pair of tweezers will be handy to remove splinters or needles from sea urchins. Some alcohol wipes are a good way to disinfect certain small wounds and cuts. In terms of medicine: take some motion sickness tablets, Dioralyte sachets and Imodium (for diarrhea).

Some people insist on taking antibiotics. This may or may not be a good thing to do. Most gappers are not medically trained and you may end up taking the wrong antibiotic for the wrong ailment. This may increase anti-biotic resistance in general and delay you seeking proper medical attention.

Staying healthy in the sun

We all know the phrase: 'Only mad dogs and English men stay out in the midday sun'.

Welcome as the sun is to those living in grey climates, it can be your worst enemy. Avoid being out in the sun full stop between 11am and 4pm. You can use this time to have lunch, a siesta or visit an indoor sight such as a temple or museum.

Be generous with sun tan lotion. Re-apply after each swim and every two to three hours. Wear a sun hat, sunglasses and if possible long linen shirts and trousers. You don't see many locals dressed in shorts and T-shirts: it may seem a paradox but long sleeves and long trousers are in fact more comfortable to wear in the heat than beachwear.

Slow down your pace... relax... don't rush about. Stay longer in one place and get a feel for it properly: there's no point in exhausting yourself with long, hot bus or train journeys trying to see a whole continent in a few weeks.

Drinking water

The main cause of diarrhea amongst travelers is drinking unclean water. Water can be contaminated with bacteria in many ways. A nice-looking stream or lake may be a sewage drain for a small settlement. Water from wells may be stagnant or untreated. Cutlery and dishes may have been washed in dirty water.

In many places you can buy bottled water, but at a pound or two a day it can seem costly when you're on a backpacker budget. If you do, make sure the bottle is sealed properly. Vast profits are being made by people selling ordinary tap water in mineral water bottles. Also think of the plastic waste trail you will be leaving behind.

The best way to treat water is to filter it (through a cloth) and boil the water for at least 10 minutes. This may be time-consuming but depending on where you stay and how long for you can prepare larger quantities at a time. It may be impractical and expensive, however, if you have to use your own gas-stove.

Iodine tablets are a good, cheap way to treat local water. The taste isn't very nice, but it will save you from a night on the toilet with cramps and diarrhea.

Mosquitoes

Most mosquitoes bite around sunrise and sunset (and some time thereafter). It's best to avoid getting bitten as this is unpleasant and may give you a tropical infection.

Mosquito nets and long sleeves are the two things you need to remember.

Mosquito nets come in all sizes. Go for the one with the smallest holes and with some hooks attached. If your hostel or guesthouse provides bednets, check for holes.

Wear long sleeves and light cotton socks... even if it's hot!

Stay indoors during the worst time. Turn your lights off at night as they attract mossies. Consider taking mosquito repellent or coils to burn. Or you could travel with very smelly cheese (that's another story).

The dreaded Delhi Belly

Diarrhea is unformed stools more than twice per day. It may be accompanied with feeling nauseous and vomiting, fever, abdominal cramps and blood and mucous.

If you're suffering from diarrhea you can get dehydrated quickly, particularly in hot countries. Make sure you drink enough and some extra to replace the water you are losing.

Maintain good hygiene: wash your hands all the time to avoid re-infecting yourself.

Avoid long bus and train journeys. Try to stay somewhere comfortable and cool. Inform others (friends, hostel staff) so you are not suffering by yourself in an anonymous hostel room in the back streets of a big city.

Diagnosis is important. Delhi Belly is a generic nickname for diarrhea. The cause could be food-poisoning, a virus, Salmonella, an amoeba etc etc. Depending on the cause you may recover quickly without much treatment or you may go downhill rapidly. If diarrhea lasts more than two days you must seek medical attention. A stool sample will be needed and depending on the cause you may need some antibiotics (not effective in food poisoning or viral diarrhea). Local doctors have the most knowledge about local diseases.

Imodium is not a treatment or cure for diarrhea, it merely masks the symptoms, and may be useful if you develop diarrhea while on a long bus journey.

Depression

Depression is not a tropical illness, but some people find that travelling isn't the positive experience they have hoped for. Friends may argue, a holiday romance may have turned sour; there may be periods of loneliness or homesickness. Being confronted with poverty on a daily basis can be depressing. You may feel useless coming from a consumer society and not being able to help local people. Long bus and train journeys may give you too much time to think about life. There are many reasons why one can get depressed whilst abroad. It is important to recognise this and discuss it in openness with friends, family and healthcare professionals.

To avoid getting depressed whilst travelling, make a plan or add a structure to your journey. You can think of this before you travel. Try to get something long-lasting out of your travels, such as learning Spanish in Latin America, or Balinese dancing. Spend a bit longer at a certain place to settle in and meet local people.

Take care of yourself, and happy travels!"