Travel Health

The winning story came from David Chapman. David won a great First Aid Kit from The Travel Doctor and two bonus prizes - Travelling Well by Dr Deb Mills and a travel mozzie net. All the runners up won First Aid Kits.

Included within the stories are travel health tips, which have been kindly contributed from Dr Deborah Mills' Travelling Well guide. Dr Mills is the medical director of the Brisbane Travel Doctor clinic, and one of the pioneers of travel medicine in Queensland, Australia.

Winning Story:		Inca Trail Blues by David Chapman
Runners Up:		Java to Bali by Vanessa Neale Water Mischief by Catherine Herriott Ramses Revenge by Naida Entwistle Turkish Race by Jason Knott Stratford Horror by Meg Holland Water Nightmare by Hugh Chilton Bugs that Bite by Lydia Krelle First Trip by Di Bates Nepalese Buses by Jane Matthews Rome Blues by Sally Ainsworth

Inca Trail Blues by David Chapman

My plan to trek the Inca Trail in Peru was almost blown away. Thinking all precautions had been taken, including a visit to the GP, vaccinations and medication for every contingency; the dreaded Montezuma's Revenge struck. Was it the meal of guinea pig, the Pisco sours or the other exotic food? Care was taken and only bottled water drunk. Tap water used to clean my teeth was the culprit. For six days travelling was sheer agony. To add injury to insult whilst arising from the low 'throne', I did my back in!

I was able to purchase stronger medication over the counter from a chemist. The symptoms were relieved within 24 hours. I had lost a dangerous 5 kg and was the proud owner of several pairs of khaki underdaks. Two days later I started the 40km Machu Picchu walk.

This year I head for Nepal. Fortunately I now live 600km closer to the Travel Doctor and have purchased a Gastro Pack in readiness for the dreaded Delhi Belly!

		Health Tips Avoid undercooked meat and seafood, raw vegetables and salads Boil or purify drinking water if in doubt Never eat ice unless you know it is made with treated water Brush your teeth with bottled water and keep your mouth closed in the shower Ensure cooked food is served steaming hot To ensure safe water, take with you: Water purification - Iodine tablets, alum, vitamin C powder Water purifier Clean and sturdy one litre water bottle Clean straws To treat stomach problems, take with you: Rehydration sachets (e.g. Gastrolyte) Loperamide (Imodium) - temporary 'stopper' for diarrhoea Norfloxacin (Noroxin) - antibiotic kills most diarrhoea germs Tinidazole (Fasigyn) - antibiotic kills giardia diarrhoea germs Maxolon or Stemetil - to treat nausea Antispasmodic, e.g. Buscopan Indigestion tablets, e.g. Quick-eze, Mylanta Laxative, e.g. Coloxyl and fibre supplement, e.g. Metamucil

Java to Bali by Vanessa Neale

I had my bowel-shattering moment when I was on the bus from Java to Bali. Big uhh oh. Fortunately, I had chosen a luxury coach for this leg of the trip, so I had the option of sprinting for the bathroom.

My relief on getting there in time was short-lived. The toilet was one of those hole-in-the-ground contraptions that require you to squat and aim. This is okay after a few weeks of practice, except that the road was none too good and the bus was shaking like an earthquake. I froze at this unexpected complexity, wondering how it could get any worse. I got my answer when I realised to my horror that the contents of my stomach wanted out at both ends. I'll spare you the details of the resulting mess.

A couple of days beforehand, I had treated myself to a chicken dish at an expensive restaurant. At the time I had wondered, fleetingly if it was properly cooked. I'll never know for sure if that's why I got sick, but the experience has made me wary of anything I order, no matter how much it costs.

Water Mischief by Catherine Herriott

Two years ago I travelled to Egypt. In the last couple of days I didn't feel so good. I'd eaten and drunk boiled everything, except for mineral water. It was labelled as being from a deep well in the desert, but in a 4 star hotel we stayed at one night, we caught a waiter refilling a bottle from the tap! It was too late, we all got sick.

I had to survive a 5 hour flight to London, filled with Lomotol. My stomach ached. I couldn't sit down. I stood up near the loo for 5 hours. I did Tai Chi to keep my mind off things. In Oxford I went to see a doctor but was told they didn't give out antibiotics. The manager of the hostel said to go to the hospital. Once again, no antibiotics. I was told I'd get better without them. It was a long haul, exhausting and quite frightening.

All I can say is, if in doubt, don't. If you're sure, still don't! But it won't stop me from travelling again.

Ramses Revenge by Naida Entwistle

On a boat trip down the Nile, our guide encouraged us to go for a swim in the river saying that we wouldn't get sick, because where we were the river was flowing and not stagnant. So we did and slowly, one by one, everybody in our group got vomiting and diarrhoea.

I was okay until the last night, when I felt a strange rumbling in my stomach. The next morning we were supposed to be getting up at dawn to ride donkeys into the Valley of the Kings. At midnight, I found myself on the toilet with a bucket on my lap and my poor cabin mate listening to my pains. The guide gave me a tablet to stop the vomiting. But I was too seedy at dawn to get up. When I eventually arose at around 9.00am I opened the door of our bathroom to find that all the toilet pipes had backed up into our toilet and the floor was a foot deep in sewerage. So I hired a boat and taxi for around $20 and still got to see the Valley of the Kings - a happy ending!

Turkish Race by Jason Knott

I was on a bus journey from Olympos to Goreme in Turkey. I had felt a little queasy that morning but by midday was feeling much better and quite ravenous, so I dug into a shish kebab at the fanciest petrol station restaurant I have ever seen.

Back on the bus, a game was organised whereby we made a guess at our arrival time in Goreme for 1 million Turkish Lira - winner takes all. Later that afternoon I began to get severe stomach pains and sweat profusely.

An urgent call was made to stop the bus at the next petrol station. I leapt through the door with Chariots of Fire music in my head, not due to my speed to the toilet but because I was being timed! They were going to take my toilet time off the finish time for the competition.

Needless to say, the toilet was just a pit with an unconnected hosepipe - but I didn't care. Five minutes and twenty-three seconds later, after honks from the bus horn I was back on board. I didn't win the competition though!

Stratford Horror by Meg Holland

While on a Rock Eisteddfod tour with 200 students, we were booked to see a performance in Stratford-upon-Avon. Everyone bolted down a quick dinner from one of the fast food outlets near the theatre. Whatever myself and several friends chose from the dodgy Indian takeaway played havoc with our stomach and we spent the second half of the play languishing in the foyer with frequent visits to the bathroom.

All this horror changed though when waiting for the bus we were shocked to see Prince Charles come out of the theatre after seeing the show. He kindly stopped to chat to a bunch of exceedingly green around the gills Australian students. Got some great photos and it was the only time it has been worth feeling that terrible.

		Health Tips The reality of travellers' diarrhoea (TD) is that your bowels may want to empty 6 - 10 times a day, they may bloat, gurgle and cramp up, causing considerable pain. Your stomach may be affected and make you feel nauseous, you may have an urgent need to rush to the toilet and you may even vomit. You may develop a temperature (over 37°C) and feel generally terrible, tired, weak or washed out. The commonest time to get TD is three days after arrival. Acute traveller's diarrhoea generally lasts 2 - 3 days (range of 1 - 5 days) and will go away without treatment. Proximity to a toilet and adequate supplies of toilet paper are essential. However, the greatest mistake travellers make when they get this condition is to suffer unnecessarily. Treatment The following suggestions will minimise your discomfort: Remember, diarrhoea is contagious - wash your hands meticulously after going to the toilet and before eating. Do not share towels, toothbrushes, drinks, water bottles, plates, spoons etc. For the first 24 hours - if the symptoms are mild avoid pills, rest, and follow the eating and drinking guidelines below. If it is the toxin type of food poisoning, your symptoms will go away without treatment. What to drink - maintain adequate fluids by drinking soups and sugar-flavoured mineral waters with salty crackers, without taking formal oral rehydration solutions. Aim to drink at least four litres of liquid per day. Most important with TD - no booze! Oral rehydration therapy, e.g. Gastrolyte is especially useful for young infants, the elderly and in anyone with extremely profuse diarrhoea, e.g. 10 water motions per day. What to eat - It is therefore recommended you drink fluids and eat starch. This includes cooked rice or rice cereal, cooked oats or porridge, wheat (toast) or mashed potato. Salty crackers are a great standby. Ripe bananas are also recommended, as they are a good source of potassium. Avoid spicy foods and minimise dairy products until your motions look normal. There are two types of tablets for diarrhoea: stoppers and antibiotics. Stoppers: paralyse the bowel and ease the symptoms, e.g. loperamide (Imodium), Buscopan. Antibiotics: kill germs and treat the cause, e.g. norfloxacin, ciprofloxacin. Stoppers can be used safely if you only take them when: Diarrhoea is very inconvenient Your temperature is normal (37°C); and There is no blood or mucous in the motions. Antibiotics can be used with stoppers. An antibiotic is recommended if you have travellers' diarrhoea - 3 or more loose motions in 24 hours plus one additional gut symptom as previously described. See a doctor if you are not much better after finishing the antibiotic, particularly if you have a fever or temperature. See a doctor if: Your temperature is over 40°C Your bowel motions contain blood You experience sudden onset of profuse, very watery diarrhoea - dehydration can develop within a few hours You are unable to drink enough fluid to compensate for what is lost through diarrhoea The diarrhoea lasts longer than two weeks.

Water Nightmare by Hugh Chilton

We had setup camp for the night on the shores of a beautiful lake. The water looked so clean and fresh that we didn't bother to filter/boil it. After we had finished dinner one of the girls in my group got a bad stomach ache and it turned out she had pretty bad diarrhoea. Within a couple of hours we had all come down with it and couldn't dig a latrine as we had no trowel. The next morning our group leader told us we couldn't risk contaminating the water so had to clean up all the waste and carry it out with us. I've never drunk untreated water again.

		Health Tips The best way to avoid gastro problems is to drink safe water. Don't ever drink from streams. Avoid tap water in developing countries, especially in rural areas. Don't clean your teeth or open your mouth in the shower. Avoid ice in drinks or cocktails unless it is made with treated water (freezing preserves germs, rather than killing them). Safe drinking water: Buy bottled water and check the seal is in place - some locals may refill old bottles with local water and sell them as 'treated'. Boiling water: boil for one minute - this will ensure it is safe to drink. Treat with a chemical disinfection such as Iodine. Follow the three-step process closely.

Bugs that Bite by Lydia Krelle

My sister and I stayed at a number of different hostels (independent and YHA). She awoke one morning to find she had been bitten extensively by bed bugs. As if the thought of having been a tasty meal wasn't bad enough, she developed a severe allergic reaction to their toxin and ended up looking and feeling like she had chickenpox - miserable, sore and intensely itchy. It took two weeks to resolve, she needed to cover up with long sleeved shirts to prevent appalled looks on the train and it put a hiatus on our travels.

		Health Tips Prevention: Choose accommodation with screens Avoid mosquitoes Day biting mosquitoes carry Dengue Fever. In Africa, try to avoid large (tsetse) flies In areas where scorpions occur, check your shoes before putting them on. In tick or leech affected areas, always use repellents when bushwalking and check your body each night for 'hangers on'. Check you bedding is clean (head lice can be picked up from contaminated sheets). Insecticide treated sleep sheets are available and are a most effective way to minimise your contact with the bed bugs, lice or fleas, which may be present in some low budget hotels. Never sleep inside mud (adobe) huts in the Americas. Treated bed nets are very effective, however sandflies can pass through ordinary mosquito nets. Treatment for insect bites is firstly to wash the site of the bite and apply antiseptic. Provided the bite is not infected, steroid creams can be applied twice a day for the first 24 hours to decrease the itch and irritation. Stingose gel will also ease the itch. Hold an ice cube on the itchy spot to give instant relief.

First Trip by Di Bates

I packed prescriptions and over $250 worth of essential medications for my first trip alone overseas. Six weeks into the best time of my life, I developed a chest infection. At 4am, struggling for breath, I presented at a New York hospital ER. No wait, no fuss, no hassle for payment, just oxygen, Ventolin, cortisone tablets and a prescription.

In Boston, a week later though, I waited for six hours one day in a public hospital ER for five minutes with a doctor. Then trouble struck in the form of an aggressive administrator who would not accept my travel insurance details. I was forced to pay US$370. When my asthma spray ran out in Vancouver, I discovered that Australian prescriptions are invalid overseas, and Ventolin in Canada needs a script. A visit to a medical centre cost CA$100.

Lesson learnt: if you want no hassles and no wait, go to a hospital ER in the very early hours of the morning.

		Health Tips Take plenty of supplies of regular medications with you, clearly labelled. YHA recommends a travel insurance policy with QBE Insurance

Nepalese Buses by Jane Matthews

It's ten days now since I left Australia. I love Nepal! Survival so far has required oral rehydration solution, rabies vaccine boosters, local anaesthetic, tetanus shot, eleven stitches, and lots of moral support, but really I'm fine!

First up, diarrhoea. Hmm. Essential part of cultural experience...

Recovered. Went to visit Monkey Temple. Fantastic views, interesting architecture. And monkeys. One of which bit me. Hard. On the thigh. Fought it off with a big stick and watched it die at my feet. It seemed a couple of rabies boosters might be in order...

Then it was time to bus to the hills to trek. Due to unfortunate seat allocation (i.e. none) we were in the driver's cabin. Boyfriend pleased, declared this best anti-motion sickness location.

When the brakes failed on a steep winding descent, we first to know. Bounced in/out of ditch, glanced off bus coming other way. Driver finally successful in engineering sudden close encounter with mountain wall. Everything still and silent, and covered in shattered glass.

Boyfriend unscathed. Me, lacerated. Nepalese ambulance experience, indescribable. Local anaesthetic and stitches. Boyfriend fainted.

Next? Recuperation and Plan B - to fly!

		Health Tips Rabies Prevention: If you are planning on visiting a rabies-infected country then you should ensure you receive the pre-exposure rabies vaccine. The duration for this vaccine is 2 - 3 years. Be especially wary of dogs, cats, bats and monkeys. Playing with animals cannot give you rabies but if you are bitten, scratched or licked over broken skin, then you could catch the virus from the animal's saliva. All animal bites or scratches should be treated as potentially rabies infected until proven otherwise, as even a vaccinated animal can carry rabies. See a doctor if you are bitten by an animal in a rabies infected immediately as you will need a post-bite rabies vaccine, even if you were vaccinated with a rabies vaccine before you departed. Do not delay. Ensure all injections are given with sterile needles and syringes. Tetanus Prevention: Tetanus is caused by a bacteria which enters the body through a wound which then grow in dead tissue and release a muscle poison and causes all of the muscles of the body to go into terrible spasms. Even a tiny scratch can lead to tetanus, though it is more common in burns, and deep or infected wounds. You can be protected from tetanus by vaccination. The initial course of vaccinations is three injections in childhood. After the initial series of vaccines, one booster injection is needed every five to ten years if travelling overseas. People who have been recently vaccinated for tetanus should be protected from contracting the disease. If you suspect you have been exposed to the disease you should seek medical attention immediately. Tetanus can be fatal or at the very least, it requires treatment in intensive care.

Rome Blues by Sally Ainsworth

I had been travelling as part of a motorbike charity ride when I took ill. My boyfriend continued on while I was hospitalised in Rome. I had checked into a hotel where I left my bag and passport assuming I'd be back in an hour after blood tests.

At the hospital I was immediately admitted. Only one person spoke English, then their shift ended and I cannot speak Italian. I stayed in hospital for 11 days. The hotel would not release my bag or passport, charged me for the room because I had the key but suggested I send a taxi over with it. I had no clean clothes. My money was stolen while I was having medical tests. I had picked up glandular fever, a liver and stomach infection all from unknown sources. My family escorted me home and once home I fought with the travel insurer for months because they said 'I wasn't sick enough'.