Tomorrow's Pharmacist (2004)

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Travel health on a shoestring

By Larry Goodyer

page 32-33

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Backpacking holidays have always been popular among young adults and, increasingly, it is common to take a “gap year” to travel and work overseas before or after they go to university. Many will be heading for tropical and developing countries, often with a flexible itinerary taking in a number of destinations over several months. Travellers should pay particular attention to preparations for potential health hazards in terms of a comprehensive medical kit and awareness of avoiding the various travel-related health hazards. This is perhaps an even more important issue than for those on package or single destination holidays, since it may be hard to predict local conditions and level of medical facilities. I also find that students tend to skimp a bit on medical kits and other health-related items due to lack of funds, so this article will describe some of the ways of providing the most economical kit.

Travellers’ diarrhoea

An episode or two of diarrhoea at some point during a trip to developing countries, particularly tropical areas, is almost inevitable. This is most likely to be the self-limiting “travellers’ diarrhoea” that lasts a day or two and is due to enterotoxic Escherichia coli (ETEC). For this sort of milder diarrhoea there is no real need for a healthy younger adult to take oral rehydration solutions; simply drinking plenty of fluids and eating bland foods should suffice. You can obtain a spoon to measure out sugar and salt to make your own basic rehydration therapy if required. An antidiarrhoeal such as loperamide can be invaluable to avoid the inconvenience of diarrhoea if you are moving from place to place. Watch out for blood in the stools or a more prolonged diarrhoea indicative of a dysentery that may require antibiotics.

Good food and water hygiene will help to minimise problems — remember the phrase “Peel it, cook it or forget it”. If bottled or boiled water is not available then chemicals can be used. I would tend to recommend an iodine-based water purifying chemical or system if planning to take water from lakes or streams, otherwise chlorine chemicals, eg, Puritabs, are fine.

Insect borne diseases

For those travelling to the tropics insect borne diseases are a major consideration and foremost among these is malaria. Take time to identify the correct malaria prophylactic for your trip. For many destinations a prescription will be required for those drugs effective against the dangerous falciparum form of malaria, ie, doxycycline, atovoquone/proguanil and mefloquine. These are all more or less equally effective so discuss the relative advantages and contraindications with the prescriber to find the one you are most happy to take throughout your trip. Doxycycline usually works out the cheapest of the three, but women should be aware of occasional incidences of vaginal thrush and a photosensitivity reaction in around 1 per cent of people.

Apart from malaria the other major mosquito-borne disease is dengue fever, which although rarely serious in young healthy adults could lay you low for many weeks. Other insect borne diseases you hear about like West Nile fever, sleeping sickness, leishmeniasis, etc, are rare in travellers but it is worth taking precautions.

The main way of protecting against insect, and particularly mosquito-borne diseases, is to avoid being bitten. The most effective measure is free: covering exposed areas of skin by wearing a long shirt and trousers, particularly in the latter part of the day and evening. Use a mosquito net treated with insecticide when on safari or sleeping in non air-conditioned hotels. Burning coils is the most economical way of clearing a room of mosquitoes. DEET-based insect repellents are not only the most effective but often the cheapest among those to be used on the skin, although it is worth looking at a few different brands to find the most economical if you expect to use them a lot while on your trip.

The other way that, particularly younger, people seem to contract tropical diseases is via contact with fresh water. Avoid swimming in fresh water in Africa due to the danger of bilharzia and in many parts of the world leptosporosis is a hazard of contact with water.

Medical kit

When buying your medical kit it is obviously cheaper to include generic over-the-counter medicines and I would recommend at least including an analgesic, loperamide and an antihistamine. A good iodine-based antiseptic is useful and Betadine paint is a popular economic choice, povidone-iodine dry powder spray being another but somewhat more bulky alternative. Other than simple sticking plasters and possibly a non-adherent dressing with tape, most other types of dressing are unlikely to be required. In general, good wound hygiene of even the smallest scratch or insect bite is essential in the tropics to avoid complications from wound infections. An antifungal cream is useful if trekking in the tropics as well as hydrocortisone cream for those who react badly to insect bites. All this should fit neatly into a small water-resistant pouch.

Vaccinations

Your other task is to arrange travel vaccines about six to eight weeks in advance of travel. Your general practitioner or university clinic can provide most vaccines free of charge. For those like yellow fever, rabies and Japanese encephalitis that may cost a considerable amount it is worth hunting around private vaccination clinics for the best deal.

A bit of advanced planning and thought can help you to cover most of your travel health needs while minimising the cost. One final piece of advice — do not be tempted to buy essential medicines while away simply because they are cheaper than in the UK. In many developing countries there are considerable problems with substandard and counterfeit drugs.