Health on the Road

Travel healthiness hang on your pre leaving preparations, your day-to-day health care while traveling and how you handle any medical problem or emergency that does develop. While the list of potential dangers can seem quite frightening, with a little luck, some basic precautions and adequate information few travelers experience more than upset stomachs.

Our children have traveled with us in Africa, Australia, New Zealand, the Pacific, numerous places in Asia and in North and South America and never had any health problems.

TRAVEL HEALTH GUIDES

There are a number of books on travel health:

Staying Healthy in Asia, Africa & Latin America, and Moon Publications. Probably the best all-around guide to carry, as it’s compact but very detailed and well-organized.

Travelers’ Health, Dr. Richard Dawood, Oxford University Press. Comprehensive, easy to read, authoritative and also highly recommended, although it’s rather large to lug around.

Where there is No Doctor, David Werner, and Hesperian Foundation. A very detailed guide intended for someone, like a Peace Corps worker, going to work in an underdeveloped country, rather than for the average traveler.

PRE-DEPARTURE PREPARATIONS:

HEALTH INSURANCE:

A travel insurance policy to cover theft, loss and medical problems is a wise idea. There are wide varieties of policies and your travel agent will have recommendations. The international student travel policies handled by STA Travel or student travel organizations are usually good value. Some policies offer lower and higher medical expenses options but the higher one is chiefly for countries like the USA which have extremely high medical costs.

Check the small print:

  1. Some policies specifically exclude “dangerous activities” which can include scuba diving, motorcycling, even trekking. If such activities are on your agenda you will need another sort of policy. A locally acquired motorcycle license may not be valid under your policy.
  2. You may prefer a policy which pays doctors or hospitals directly rather than you having to pay on the spot and claim later. If you have to claim later make sure you keep all documentation. Some policies ask you to call back (collect) to a center in your home country where an immediate assessment of your problem is made.
  3. Check if the policy covers ambulances or an emergency flight home. You may also need to cover the expanse of an additional person to accompany you in the case of certain illnesses. If you have to stretch out you will need two seats and somebody has to pay for them!

MEDICAL KIT

A little, straight medical kit put together with special thought for children’s ailments is a wise thing to lug.

Make sure that you know the appropriate children’s dose of any medicines you are carrying, and that they are in fact suitable for children.

Preferably, antibiotics must be directed only under medical command and should never be taken indiscriminately. Take only the recommended dose at the prescribed intervals and continue using the antibiotic for the prescribed period, even if the illness seems to be cured earlier. Antibiotics are quite specific to the infections they can treat. Stop immediately if there are any serious reactions and don’t use the antibiotic at all if you are unsure that you have the correct one for the infection.

In many countries, if a medicine is available at all it will generally be available over the counter and the price will be much cheaper than in the West. However, be careful when buying drugs in developing countries, particularly where the expiration date may have passed or correct storage conditions may not have been followed. Bogus drugs are common and it’s possible that drugs which are no longer recommended, or have even been banned in the West are still being dispensed in many developing countries.

In many countries it may be a good idea to leave unwanted medicines, syringes, etc. with a local clinic, rather than carry them home.

HEALTH PREPARATIONS:

Make sure you and your children are healthy before you start traveling. If you are embarking on a long trip make sure your teeth are OK; there are lots of places where a visit to the dentist would be the last thing you’d want to do.

If children wear glasses take a spare pair and the prescription. Losing glasses can be a real problem, although in many places you can get new spectacles made up quickly, cheaply and competently.

If your kids require a particular medication take an adequate supply, as it may not be available locally. Take the prescription or, better still, part of the packaging showing the generic rather than the brand name (which may not be locally available), as it will make getting replacements easier. It’s a wise idea to show you legally use the medication – it’s surprising how often over-the-counter drugs from one place are illegal or even banned in another country without a prescription.

MEDICAL KIT:

Infant analgesic – with measuring cup or dropper

Antihistamine (such as Benadryl) – valuable as a decongestant for colds, allergies, to ease the itch from insect bites or stings or to help prevent motion sickness. Antihistamines may have a sedative effect and interact with alcohol so care should be taken when using them.

Antibiotics – useful if you’re traveling well off the compressed track, but it must be prearranged and you should carry the prescription with you. Some people are allergic to commonly prescribed antibiotics such as penicillin or sulfa drugs.

Kaolin preparation (Pepto-Bismol, Imodium) – for stomach upsets.

Rehydration mixture – for treatment of severe diarrhea. This is particularly important if traveling with children who dehydrate easily. An electrolyte mixture is available in sachets.

Antiseptic (like Dettol or Beta dines), mercurochrome and antibiotic powder or similar “dry” spray – for cuts and grazes.

Calamine lotion – to ease irritation from sunburn, bites or stings.

Bandages, Band-Aids, gauze and cotton wool – for minor injuries.

Scissors, tweezers and a thermometer/fever strips – mercury thermometers are prohibited by airlines.

Insect repellent, sun block, suntan lotion, Chap Stick – check that it is suitable for children’s skin.

Water Purification Tablets:

Diaper rash cream, teething gel – for predictable ailments.

Worm treatment, lice shampoo, and anti-fungal powder – for treatment of minor but irritating health problems.

A couple of syringes – in case you need injections in a country with medical hygiene problems. Ask your doctor for a note explaining why you are carrying them.

IMMUNIZATIONS:

Vaccinations provide protection against diseases you might meet along the way. Some nations no vaccinations are necessary, but the further off the beaten track you go the more necessary it is to take precautions.

It is important to understand the distinction between vaccines recommended for travel in certain areas and those required by law. Essentially the number of vaccines subject to international health regulations has been dramatically reduced over the last 10 years. Currently yellow fever is the only vaccine subject to international health regulations. Vaccination as an entry requirement is usually only enforced when coming from an infected area.

Occasionally travelers face bureaucratic problems regarding the cholera vaccine, even though all countries have dropped it as a health requirement for travel. Visiting some countries it may be wise to have the vaccine despite its poor protection, such as when traveling to Africa.

On the other hand a number of vaccines are recommended for different areas of travel. These may not be required by law but are recommended for your own personal protection.

All vaccinations should be recorded on an International Health Certificate, which is available from your physician or government health department.

Plan ahead for getting your vaccinations: some of them require an initial shot followed by a booster, while some vaccinations should not be given together. It is recommended you seek medical advice at least six weeks prior to travel.

Most children from Western countries will have been immunized against various diseases during childhood but your doctor may still recommend booster shots against measles or polio, diseases still prevalent in many developing countries. Apart from these, special vaccinations are not normally given to children under 12 months of age. Talk to your doctor.

Regardless of how you feel about inoculations, if you plan to take your children traveling you are placing them at some risk. In some parts of the world the infant mortality rate is horrendous and diseases which are no longer a problem in the West, due to widespread vaccination programs, are still very serious health risks.

In some countries immunizations are available from airport or government health centers. Travel agents or airline offices will tell you where.

The possible list of vaccinations includes:

Smallpox: Smallpox has now been wiped out worldwide, so immunization is no longer necessary.

Cholera: Not required by law but occasionally travelers face bureaucratic problems on some border crossings. Protection is poor and it lasts only six months. It is contra-indicated in pregnancy.

Tetanus & Diphtheria: Boosters are necessary every 10 years and protection is highly recommended.

Typhoid:

 Available either as an injection or oral capsules. Protection lasts from one to three years and is useful if you are traveling for long periods in rural, tropical area. You may get some side effects such as pain at the injection site, fever, headache and a general feeling of being unwell. A new single-dose injectable vaccine, which appears to have few side effects, is now available but is more expensive. Side effects are unusual with the oral form but stomach cramps may be one of these.

Infectious Hepatitis:

 The most common travel-acquired illness which can be prevented by vaccination. Protection can be provided in two ways – either with the antibody gamma globulin or with a new vaccine called Havrix (currently unavailable in the U.S.). Havrix provides long-term immunity (possibly more than 10 years) after an initial course of two injections and a booster at one year. It may be more expensive than gamma globulin but certainly has many advantages, including length of protection and ease of administration. It takes about three weeks to provide satisfactory protection – hence the need for careful planning prior to travel. Gamma globulin is not a vaccination but a ready-made antibody which has proven very successful in reducing the chances of hepatitis infection. Because it may interfere with the development of immunity, it shouldn’t be given until at least 10 days after administration of the last vaccine needed; it should also be given as close as possible to departure because it is at its most effective in the first few weeks after administration and the effectiveness tapers off gradually between three and six months.

Yellow Fever: Protection lasts 10 years and is recommended where the disease is endemic, chiefly in Africa and South America. You usually have to go to a special yellow fever vaccination center. Vaccination is contra-indicated during pregnancy but if you must travel to a high-risk area it is probably advisable. Check with your doctor.

Meningitis: This vaccination is recommended for visitors to Nepal and for visitors to some areas of Africa and Brazil. It is given as a single injection and gives immunity for up to three years duration.

Tuberculosis: TB is widespread throughout the developing world. Most Westerners will have been vaccinated at some time during their school years. For children vaccination is not deemed necessary unless they will be spending prolonged periods (say up to a year) in an area of risk.

BASIC RULES

Care in what you eat and drink is the most important health rule. Stomach upsets are the most likely travel health problem (between 30% and 50% of travelers in a two-week stay experience this) but the majority of these upsets will be relatively minor. Don’t become paranoid; trying the local foods is part of the experience of travel, after all.

WATER, JUICE & DAIRY PRODUCTS

The number-one rule is doing drink the water, and that includes ice. If you don’t know for certain that the water is safe always assume the worst. Reputable brands of bottled water or soft drinks are generally fine, although in some places bottles refilled with tap water are not unknown. Only use water from containers with a serrated seal – not tops or corks. Take care with fruit juice, particularly if water may have been added. Milk should be treated with suspicion, as it is often unpasteurized. Boiled milk is fine if it is kept hygienically and yogurt is always good. Tea or coffee should also be OK, since the water should have been boiled.

WATER PURIFICATION

The simplest way of purifying water is to boil it thoroughly. Vigorously boiling for five minutes should be satisfactory; however, at high altitude water boils at lower temperatures, so germs are less likely to be killed.

Simple filtering will not remove all dangerous organisms, so if you cannot boil water it should be treated chemically. Chlorine tablets (Puritabs, Steritabs or other brand names) will kill many but not all pathogens, including giardia and ameobic cysts. Iodine is very effective in purifying water and is available in tablet form (such as Potable Aqua), but follow the directions carefully and remember that too much iodine can be harmful.

If you can’t find tablets, tincture of iodine (2%) or iodine crystals can be used. Four drops of tincture of iodine per liter or quart of clear water is the recommended dosage. The treated water should be left to stand for 20 to 30 minutes before drinking.

Iodine crystals can also be used to purify water but this is a more complicated process, as you have to first prepare a saturated iodine solution. Iodine loses its effectiveness if exposed to air or damp so keep it in a tightly sealed container. Flavored powder will disguise the taste of treated water and is a good idea when traveling with children.

FOOD

There is an old colonial adage which says: “If you can cook it, boil it or peel it you can eat it…otherwise forget it”. Salads and fruit should be washed with purified water or peeled where possible. Ice cream is usually OK if it is a reputable brand name, but beware of buying it from street vendors in developing countries in case the ice cream has melted and been refrozen. Thoroughly cooked food is safest but not if it has been left to cool or if it has been reheated. Shellfish such as mussels, oysters and clams should be avoided as well as undercooked meat, particularly in the form of mince. Steaming does not make shellfish safe for eating.

If a place looks clean and well-run and if the vendor also looks clean and healthy, then the food is probably safe. In general, places that are packed with travelers or locals will be fine, while empty restaurants are questionable. Busy restaurants mean the food is being cooked and eaten quickly with little standing around and is probably not being reheated.

NUTRITION

If your food is poor or limited in availability, if you’re traveling hard and fast and missing meals, or if your children simply lose their appetite, they can soon start to lose weight and place their health at risk.

Make sure you have a well-balanced diet. Eggs, tofu, beans, lentils (dal in India) and nuts are all safe ways to get protein. Fruit you can peel (bananas, oranges or mandarins for example) is always safe and a good source of vitamins. Try to eat plenty of grains in the form of rice and bread. Remember that although food is generally safer if it is cooked well, overcooked food loses much of its nutritional value. If your diet isn’t well balanced or if food intake is insufficient, it’s a good idea to take vitamin and iron pills.

In hot climates make sure your children drink enough – don’t rely on them feeling thirsty to indicate when they should drink. If you are breast feeding be prepared to feed much more frequently, or remember to give frequent additional drinks from a bottle. Always carry a water bottle with you on long trips. Not needing to urinate or very dark yellow urine is a danger sign.

Excessive sweating can lead to loss of salt and therefore muscle cramping. Salt tablets are not a good idea as a preventative, but in places where salt is not used much, adding salt to food can help.

EVERYDAY HEALTH

A normal body temperature is 98.6 degrees Fahrenheit, or 37 degrees Celsius; more than 2 degrees higher is a “high” fever. A normal adult pulse rate is 60 to 80 per minute (children 80 to 100, babies 100 to 140). You should know how to take a temperature and a pulse rate. As a general rule the pulse increases about 20 beats per minute for each Celsius degree rise in fever.

Respiration (breathing) rate is also an indicator of illness. Count the number of breaths per minute: between 12 and 20 is normal for adults and older children (up to 30 for younger children, 40 for babies). People with a high fever or serious respiratory illness (like pneumonia) breathe more quickly than normal. More than 40 shallow breaths a minute usually means pneumonia.

In Western countries with safe water and excellent human waste disposal systems we often take good health for granted. In years gone by, when public health facilities were not as good as they are today, certain rules attached to eating and drinking were automatically observed, such as washing your hands before a meal. It is important for people traveling in areas of poor sanitation to be aware of this and adjust their own personal hygiene habits.

Clean your kids’ teeth with purified water rather than straight from the tap. Avoid climatic extremes: keep them out of the sun when it’s hot, dress them warmly when it’s cold. Avoid potential diseases by making sure they are dressed sensibly. They can get worm infections through walking barefoot or dangerous coral cuts by walking over coral without shoes. Avoid insect bites by covering bare skin when insects are around, by screening windows or beds or by using insect repellents. Seek local advice: if you’re told the water is unsafe due to jellyfish, crocodiles or bilharzia, don’t go in. In situations where there is no information, discretion is the better part of valor.

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