| Larry Goodyer is head of the Leicester school of pharmacy and superintendent of Nomad Pharmacy |
Just finished the preregistration examinsation or a year or two into your first job and fancy a break from pharmacy?
I did about a year after my first hospital post to see a bit of the world and came back ready to face the rest of my career. Whether for a month or a year, for many young people either before or after university or at an early stage of their career, it is worth joining the ranks of the independent adventure travellers before settling down. This will inevitably bring you into contact with extremes of climate and environment, as well as the poor hygiene conditions and medical facilities that exist in many parts of the world.
In this article I will focus on the general measures to equip you for some serious adventures overseas. In the article last year I described how to get together a medical kit “on a shoe string” so this time I will concentrate more on the clothing and other equipment you may need to stay healthy. Of course a visit to the GP to arrange vaccinations with the practice nurse will be essential and also perhaps to obtain a prescription for malaria prophylaxis. Community pharmacists are also becoming increasingly involved with advice and supplies related to travel medicine.
Where to go and what to do
You could simply strap on a rucksack and hit the road in the general direction of where you intend to go. This is exactly what many people do on trips around the world that may take years. I have dealt with people who travel by local transport over whole continents, deciding on the route along the way. Others travel by camper vans, motorbikes or even bicycles. In most of these unplanned undertakings inevitably there are avoidable, and sometimes disastrous, health-related problems. For some people these can all be part of the adventure, however at least starting with the correct equipment and supplies can help prevent health-related problems.
It is more likely, though, that you will have a better experience by joining up with a group of like-minded individuals who want the flexibility of independent travel, while having the benefit of the experience of someone used to the locality and being able to access places off the beaten track. This is best achieved through joining an overland company where you will share a large truck with 15–20 other people in an extended camping safari. Trips can take anything from a month to a year and popular destinations include Africa, South America and South East Asia. Although it will be the experience of a lifetime there will be special considerations to avoid potential health hazards. Everyone on the trip helps to prepare food to eat alfresco in the camp area as you travel. This has the advantage of not relying so much on local eating places which may expose you to a risk of acquiring a gut infection. On the downside, you are relying on your companions to contribute to the cooking, so that diarrhoea can spread through the party like wildfire if they are not scrupulous about food hygiene.
Malaria prophylaxis may need to be taken for an extended period and this can be done safely with the antimalarials available, although atovaquone/proguanil (Malarone) is only licensed to be taken for one month. Prophylaxis can be expensive so be prepared to add this to your budget, as well as the cost of certain vaccinations not available on the NHS. On the plus side most companies do travel with an extensive medical kit, so your own supplies can be reasonably modest, providing you are not planning to travel further on your own at the end of the expedition.
Most developing countries welcome tourism as an important source of income. If you are interested in doing something more benevolent, there are companies that will arrange for you to work on projects designed to help the local community in a developing country; one of the most well known among them is Raleigh International. Long-term projects can be in rural, remote areas. If you are a pharmacist you could go the whole way and join the Voluntary Services Overseas (VSO) organisation. It is always on the look out for health professionals such as pharmacists to give of their experience in developing countries. These types of project organisations are generally good at preparing people to work overseas and will advise on health needs. Remember, though, if working in one location there is an increased risk of exposure to the range of infections common in the local population. This makes prophylaxis especially important and there may be specific advice relating to your working conditions. For instance, if working in an area of poor sanitation, such as a refugee camp, the new oral cholera vaccine (Dukoral) may be indicated, which is not usually given in other travelling situations.
Finally if you are really feeling adventurous you could consider joining a scientific or exploratory expedition to areas far from civilisation. The Royal Geographic Society expedition advisory service is a good place to start looking. Medical provision is usually well planned and will often include an expedition doctor. Of course you will need to recognise that you may be in an inaccessible location should the worst happen.
What to take
Other than medical-related supplies such as medicines, first aid kit and repellents, etc, there are further considerations to prepare yourself for a healthy and comfortable trip.
The correct clothing is important and should match the environment of the destination. For cold climates the body cannot acclimatise and so you will need to rely on the correct clothing for survival. In general one should wear multiple layers of clothing, with that nearest the skin the thinnest and the outmost layer being waterproof.
In hotter climates the body will acclimatise after a time, so it is important to take things easy at first and at all times consume sufficient fluids to avoid heat-related disorders such as heat stroke. If engaged in a lot of physical activity large amounts of water may need to be taken and it is advised to drink beyond simply quenching thirst. Due to excessive sweating salt depletion can occur and in this situation it is advisable to increase salt in the diet. A good water canteen is essential when trekking in hot climates. In terms of clothing, sweat should be allowed to evaporate from the skin to cool the body. Cotton is generally advocated and there are new polycottons designed for use in tropical conditions. One of the problems with the tropics is that the humidity can prevent evaporation of sweat leaving you feeling damp for much of the day, particularly if trekking in a rain forest. At night it is important to remain dry if camping outside so waterproofs will be required when making camp. Also special jungle boots can be purchased allowing for good circulation of air and also protecting against the bites of chigger fleas and other nasties on the jungle floor.
One imperative for all trekkers and backpackers is properly fitting boots and rucksacks. Prolonged use of poorly fitting items can lead to a chronic wound which is difficult to heal, or even to cellulitis. Personal hygiene can be particularly important when living fairly rough, so a supply of toiletries should be carried. There are purpose-designed travel washes available for both the body and clothing, as well as “waterless” alcohol-based hand washes for situations where clean water is not available.
As I mentioned at the beginning of the article travel medicine is an important area for community pharmacists and if you develop a particular interest then you can join the British Travel Health Association.
Websites
• Royal Geographic Society
• Voluntary Services Overseas
• Raleigh international
• British Travel Health Association
• Nomad (look at external links)
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