Staying healthy abroad

When you have invested so much time, energy and money into organising time away, it would be such a shame if a bout of illness wrecked your enjoyment or affected your travel plans.

Whether it be for pleasure (a holiday) or necessity (a field trip, business trip) there is a plethora of information and travel requirements that St. Bartholomew's Medical Centre, Cowley Road and The Medical Centre on campus can help you with so that you can have a good time and come home feeling fit and well.

Health Issues Before You Travel

Dental care

A dental check-up just before you travel pre-empts the risk of painful and expensive treatment abroad and avoids experiencing fears about the safety of needles or dental equipment.

Immunisations

must be planned ahead - allow 6-8 weeks before departure. There are all sorts of vaccines. Some immunisations cannot be given together or require more than one dose - hence the need for planning ahead. For example: ideally, Polio and Yellow Fever should be given 3 weeks apart but can be given on the same day and a Yellow Fever vaccination certificate only becomes valid 10 days after the immunisation has been given. Immunisation against Hepatitis A is effective 2 weeks after the one dose course.

What you need depends on where you're going and as travel requirements change from month to month you need current, dependable advice such as that provided by your Medical Centre.

Information

We recommend that you try and find out as much as you can about the countries you are visiting, if necessary phone the British Embassy and ask. Your personal safety is important and knowing where to visit or not to, may prevent unwanted difficulties. The Lonely Planet series of books provide comprehensive coverage of many chosen destinations.

Internet

This site provides you with some basic health advice but there is a lot of information on the internet accessed via a search engine.

Useful websites include:

MASTA maintain a computerised database of information on 84 diseases and health hazards in over 250 countries

NHS Choices Health advice for travellers including form E111 and E128

Health Protection Agency Comprehensive site covering all aspects of infectious diseases at home and abroad. Please access before travelling.

Insurance

Health insurance is not vastly expensive and can make the difference between medical cover abroad and no cover leaving you to pay the bills. Even in countries that we have a reciprocal agreement with, you can still incur costs. Therefore the advice is to arrange health insurance to suit your destination.

Health issues while you are away

Alcohol

When you're on holiday in an unfamiliar place the risks involved with getting drunk are increased. When you drink alcohol your body can become dehydrated, your reactions are slower. Avoid swimming or sleeping in the sun after drinking alcohol; don't be tempted to drive any kind of vehicle; holiday reps report that muggers target tourists who are drunk and walking back alone to their accommodation, so keep an eye on your friends and stay together. In some resorts if you are found drunk you will be taken away by the local police.

Food and water hygiene

Wherever we travel in the world Be aware and BEWARE! Enjoying new and exciting tastes and flavours can be fun but also risky as no fewer than two-fifths of international travellers suffer from diarrhoea abroad!! about 30% of these are bed - bound and 40% are forced to change their plans.

Contaminated food and water are responsible for the transmission of Cholera, Typhoid, Hepatitis A as well as traveller's diarrhoea.

In most cases traveller's diarrhoea is caused by many different micro-organisms including bacteria, viruses, and protozoa. They either damage the gut or interfere with the normal mechanisms that control water flow across the gut wall.

Food

Precautions will reduce the risk significantly - Always wash your hands before handling or eating food - Whether you are back-packing or self-catering the principles of food hygiene are the same: Cook it, Peel it, Boil it or Forget it!!

The key questions you must ask yourself, if confronted with an array of delicious, mysterious looking foods is whether:

• you think it's safe to eat - is it yesterday's evening meal, heated up, rearranged and reheated as today's lunch? Has it been left out in the open or spent several hours being kept warm? Does the food look as if it required lots of handling in the preparation? The food won't look rotten but all are likely to be contaminated. Is the food thoroughly cooked and hot
• your own hands are scrupulously clean and dry
• the crockery and cutlery are clean

Milk Products especially unpasteurised milk and ice cream or yoghurt made from unpasteurised milk, should be avoided as brucellosis and tuberculosis are a problem in some regions.

Meat should be freshly and thoroughly cooked and in the case of red meats, until no red colour remains.

Rice if freshly cooked, is generally safe but not if it has been reheated for the next meal. Bacillus Cereus, which can contaminate rice here in Britain, can survive the first cooking process by producing heat resistant spores which then germinate when the leftovers are put to one side. The bacterial growth changes the rice into a very nasty mixture that causes vomiting.

Salads, fruit and vegetables are frequently contaminated. Due, in the tropics, to the practice of using human faeces as a fertiliser. Even if this practice is not prevalent in the area you are travelling in, fruit and vegetables are frequently contaminated by the handlers in storage or preparation. Carry your own cutlery set, in particular a knife to peel fruit with, use sealed bottles of water to wash fresh foods in or treat the water (see below). Avoid uncooked vegetables but feel free to eat any fruit that grows aloft, that you peel and eat without needing to touch - bananas are just great.

Shellfish feed by filtering large quantities of sea water and they are therefore able to accumulate nasty amounts of bacteria and other micro-organisms from contaminated water. Generally avoid them but if you do eat them ensure that they have been boiled thoroughly for at least 10 minutes. It might be helpful to mention that only 4% of shellfish growing areas in the Mediterranean now produce seafood that is fit to eat.

Water

Can be contaminated. In many countries water presents a problem to travellers: whether to drink or not to drink the local water is on everyone's mind. Diarrhoeal diseases - typhoid, cholera, poliomyelitis, hepatitis A and worm infections are all water related illnesses and unless you are sure, buy bottled water in sealed containers to drink, wash food, clean teeth, make ice (check the seals around bottled water are untampered with before you use them!). It is usually safe to drink hot drinks, packaged or bottled soft drinks. Avoid ice unless it is made from uncontaminated water. If in doubt treat water with an iodine solution using 4 drops of 2% iodine to 1 litre of water, allowing it to stand for 30 minutes. Alternatively take easy to carry filters with you that both filter and disinfect the water.

Avoid drinking the water in swimming pools, lakes or rivers.

Personal hygiene

Hand washing, before meals and after using the lavatory are essential precautionary measures. It is also important for women to be scrupulously clean when using or changing any of their internal sanitation. Similarly, if using condoms - do ensure that both of you have clean hands and avoid introducing unwanted germs. Wrap used items up in a secure bag and dispose of them hygienically ("nappy sacks" are excellent for this purpose). Always travel with your own toilet roll.

Sexual health

Contraception

Please discuss your contraceptive method with a nurse or doctor before you travel. If your contraceptive fails you or you have unprotected sex and do not want to become pregnant emergency oral contraception must be taken within 72 hours, the earlier the better, so contact the local medical facilities for advice on how to obtain it. Using a condom together with another contraceptive helps protect you from both unwanted pregnancy and sexually transmitted infection.

Sexually Transmitted Infections including HIV and Hepatitis B

Be aware and Take Care : Always use a condom
79% of heterosexual HIV infection is contracted abroad. Someone with HIV can look well for up to 15 years. Hepatitis B is a world wide problem and is transmitted in similar circumstances: there is a vaccine available against HepB but you need to plan this well in advance of travelling.

Precautions

• Avoid unprotected vaginal or anal sexual intercourse.
  Always use condoms so take them with you. To guarantee quality look for the EU and British kite mark. Free supplies are available from The Medical Centre for those students trying to protect themselves or their partners from sexually transmitted infections. Keep the condoms cool. Avoid contact with oil (such as suntan oil) as the rubber will perish in less than 15 minutes. Negotiate use before sexual contact, not during. It is OK to say no to sex or no sex without a condom. Understand your own sexual behaviour or desires if under the influence of too much alcohol. Be Prepared and don't wake up regretting your sexual encounters and with more than you bargained for.
• Do NOT share needles, avoid tattooing equipment.
• Take a travel kit with you which contains sterile emergency equipment and give it to the medics attending you.
• If you need a blood transfusion check that it is: a) essential; b) screened blood.

Sun care

Avoid Sunburn: the key message is look after yourselves in the sun and go for the "Slip Slap Slop" approach: - Slip on a T-Shirt Slap on a hat Slop on some sun block and stay out of the sun between 11am - 3pm. Protect against both UVA - responsible for ageing and UVB - responsible for burning by buying sunscreens with a high SPF of 15 and above. Keep them cool because the SPF is affected by heat and decreases in strength if exposed to direct heat. Store in a cool box or under cover. Be especially protective of children.

Cover up with loose, tightly woven clothing, a wide brimmed hat and sunglasses. Loose fitting clothing provides greater UV protection generally than tight clothing. Choose loosely woven fabric that you cannot see through if you hold it up to the light. Darker colours provide better protection than lighter colours but also tend to absorb heat. The fashion for longer skirts and free flowing layers of clothes is a great way of protecting your skin, looking and feeling cool.

Be aware that the protection levels change when the fabric becomes wet. The protection factor of cotton can sometimes decrease by 50% when wet. The sun's rays penetrate through clouds and people can burn whilst swimming.

Siesta as the locals do and stay out of the midday sun.

Sunglasses should absorb at least 95% of UV radiation and carry the British Standard accreditation BS2724: 1987. UVA and UVB are both harmful to the eyes - after the initial irritation long term exposure can harm the retina, cornea and lens of the eye and may lead to cataracts.

Mole Check

Have any moles that are causing concern checked. A kind of skin cancer known as malignant melanoma shows itself by a change in the normal look or feel of a skin mole. When found early and treated quickly malignant melanoma is curable. So DON'T DELAY - GO TODAY to see your GP.

This is what you are looking for:

7 point checklist:

1. Is an existing mole getting larger or a new one growing? After puberty moles usually do not grow.
2. Does it have a ragged outline? Ordinary moles are a smooth, regular shape.
3. Does it have a mixture of different shades of brown and black? Ordinary moles maybe quite dark brown or black but are all one shade.
4. Is it bigger than all your other moles Check your moles for these changes and if the mole or dark patch does not return to normal within two weeks see your GP.
5. Is the mole inflamed or with a reddish edge? An ordinary mole is not inflamed.
6. Is it bleeding, oozing or crusting? Ordinary moles do not do this.
7. Is there a change in sensation, like a mild itch? An ordinary mole is not usually itchy or painful.

Please check your partners back. For example: sports men and women can be exposed to a lot of sun and need someone to check their backs.

Specific Health Hazards Abroad

Malaria

Malaria is a disease caught from mosquitoes. 2,000 people return each year to the U.K. with Malaria, a few actually die. Malaria produces fever which can lead to complications which can be fatal.

As yet, no anti malarial measures can guarantee absolute protection so a lot depends on you and how conscientious you are in your efforts to avoid being bitten.

Anti malaria precautions involve a concerted prevention strategy and include taking essential prophylactic medication in the form of tablets and adopting avoidance strategies. Therefore, if you are going to travel to a malarious area, Take Anti Malaria Precautions.

Essential Medication:

Anti malaria tablets are taken a week before travelling, during your stay and for 4 weeks after leaving. The Dept. of Health has decreed that no one is entitled to an N.H.S. prescription for anti-malaria preparations. This applies equally for holidays, field trips, and voluntary work. Some malaria tablets can be bought in the chemists others need a private prescription.

It has to be said that no anti malarial is 100% effective.

The type of anti-malaria tablet needed depends upon which countries you are visiting. MASTA will provide you with an up to date list of different prophylactics. GP's, Nurses, Pharmacists and Travel Clinics will ensure that you take the appropriate ones with you.

Aim to take your anti-malaria tablets after meals as it minimises any minor side effects.

Essential Avoidance Strategies:

(Greatly reduces your chances of being bitten)

Mosquitoes tend to bite between dusk and dawn therefore:
Buy and use a good insect repellent containing DEET (diethyltoluamide: NB to be sprayed onto the clothing of under 5s NOT onto their skin.) or a preparation called Mosi-guard natural (eucalyptus based which can be used directly on the skin of under 5s) as recommended by the malaria reference laboratory.

• DEET impregnated wrist and ankle bands are available to buy in specialist shops.
• Wear long trousers and long sleeved shirts/blouses in the evening ensuring that the material is not too thin otherwise the mosquito's proboscis will pierce it. Light colours are less attractive to mosquitoes. Refined lemon eucalyptus oil on skin also repels them.
• When sleeping avoid being bitten and sleep under a mosquito net (unless you are in a hotel which has properly fitted air conditioning or mosquito screens).
• Impregnate the net with permethrin to make it much more effective.
• Insect repelling devices such as a pyrethroid mosquito coil, which you burn through the night, are also useful.
• Kill any mosquitoes you see or hear in your room before retiring for the night with a knockdown spray.
  (Babies and young children are particularly susceptible to malaria and therefore avoid unnecessary trips to malarial countries with children. Keep all medicines out of their reach.)

Seek Medical Advice

If you travel to a malarious area and suffer from any fever and or flu - like symptoms whilst abroad (headaches, shivering, generalised aching, vomiting, diarrhoea) seek medical advice from the local medical services promptly and state where you have travelled.

Travellers Returning From Malarious Areas:

If you have travelled to a malarious area and suffer from any fever and or flu - like symptoms within 1-2 years of your return (headaches, shivering, generalised aching, vomiting, diarrhoea) please see your GP. (Do not treat your symptoms with aspirin etc.) and state which countries you have visited. You could have Malaria.

If you are a blood donor wait 6 months after returning from a malarious country before you try to donate blood again. You will be then be tested for malaria as you donate and informed as to your status. They require blood to be free of malaria for one year.

Advice

For further advice and a comprehensive run down of all anti malaria precautions and all travel hazards you can ask the practice nurses either on campus:
Phone 483193 in term time
and/or St. Bartholomew's Medical Centre all year: phone 242334

Malaria advice prepared by the PHLS Malaria Reference Laboratory:
24 hour help line telephone number: 09065 508 908 (calls are charged at 100 pence per minute) or
Masta's Travellers' Health Line Telephone: 09068 224100

Other Health Hazards

Parasites and diseases

The Hook Worm However liberating it may feel to walk bare foot in Africa, south East Asia, the Caribbean - don't be tempted! Beware the hook worm - they can penetrate intact skin and causes a red track, itchy and blistering foot.

Lyme disease is spreading: usually associated with wooded and grassy areas of Europe such as The Black Forest, Germany and North America. Now known to be in the New Forest here in England. Lyme disease is a disease caused by bacteria (Bonelis burgdorferi). It is passed by the bite of a tick infected with the bacteria. Lyme disease is not contagious from person to person. Early symptoms of Lyme disease appear 3 to 32 days after a tick bite. The early symptoms include: A bull's-eye shaped rash with a clear centre (usually at the site of the tick bite) profound fatigue, stiff neck and aching in joints and flu-like symptoms. Prompt treatment with antibiotics taken by mouth can cue the infection. To avoid being bitten avoid grassy and marshy woodland areas, use an insect repellent with the ingredient DEET on your clothes and routinely check for ticks on yourself and those around you (including pets) immediately after being outside. Wear long trousers and tuck the legs into socks and wear long sleeved shirts.

Rabies is a viral infection of the nervous system, carried by all sorts of warm blooded animals including dogs, cats, bats, foxes, monkeys in all the continental regions of Asia, America and Africa plus many countries in Europe have rabies in their animal population. (Australia, New Zealand, Japan and the UK are currently rabies free). Rabies kills about 60,000 people world wide each year. Humans can contract the disease if bitten, scratched or licked on broken skin from an infected animal. It is not spread from person to person. Rabies is a very serious infection and very serious condition. Once the symptoms of rabies develop the disease is almost always fatal. It is preventable so travellers should ALWAYS stay away from ALL animals and in particular stray dogs, cats or monkeys. Seek advice as to whether you will need rabies vaccine before travelling (necessary if you are planning visits to developing areas where you are likely to be 24 hours away from any medical help). Anyone who is bitten, scratched or licked by a warm blooded animal in a country where there is rabies should: Clean the wound thoroughly by scrubbing with soap and water, use copious amounts of water to flush the wound. Use alcohol if possible. Seek medical help immediately : go to the nearest doctor or hospital: even if you have been vaccinated you need additional medical treatment with a post exposure course of injections which must start immediately. The disease usually takes long enough to develop in humans to allow the body's immune response to be stimulated by the vaccination before the symptoms of rabies manifest themselves. In case of difficulty contact the nearest British Consul official. The likelihood of infection is determined by the extent of rabies in the area, the species, whether the attack was unprovoked, the closer to the face the greater the risk since the virus has a shorter distance to travel to the brain - avoid having that photo opportunity with a monkey on your shoulder!

Schistosomiasis (bilharzia) found in fresh water lakes and rivers in Africa, The Middle and Far East, South America: A parasite that penetrates the skin causing, in some cases, an acute fever with aches a few weeks after infection (Katayama fever). Then the individual may develop bloody diarrhoea or blood in the urine. Seek specialist help. Avoid swimming in fresh water lakes and rivers in tropical areas.

Snake bites: wipe the site of the bite, cover with a broad firm bandage, move the limb as little as possible, seek medical help. Snakes rarely bite without provocation.

The Tumbu fly: found in East and Central Africa lays its eggs on clothes - particularly clothes which have traces of sweat or urine in them. They target clothes hanging out to dry often laying the eggs around elasticated areas. The eggs hatch on contact with the skin, burrow in, form a boil like blemish on the skin but instead of containing pus the boil contains a live maggot identified at the surface of the boil by 2 black dots. Favourite sites are the scrotum, waist, arms and back. Avoidance at all costs just involves ironing all your clothes, even your underwear, with a hot iron. Campsites usually have irons as do hotels or dry your clothes indoors (the maggot can be removed by placing water or oil over the 2 black dots, in fact the maggots breathing apparatus, and gently squeezing it until it pops out!).

The Medical Centre provides free condoms to all students trying to protect themselves and their partners from HIV, Hep.B and other sexually transmitted infections.

Before travelling please see a nurse at the Medical Centre.