Emergency sterile medical kit for travellers

HEALTHY TRAVEL INFORMATION
on their own. Your GP or Practice Nurse wil advise you if anti-malarial tablets are needed (i.e. Being wel prepared before you travel wil ensure in high-risk areas) and which tablets are that you minimise the risk of preventable il health appropriate. Again you wil find clear advice about whilst abroad. Exposure to these risks wil depend on where you are travel ing, how long you http://www.fitfortravel.scot.nhs.uk/ are travelling for and your living conditions. Below you wil find advice on how to deal with the most Depending on where you are travel ing different common problems you are likely to encounter, anti-malaria tablets can be necessary. In some how best to prepare yourself for travel and how to areas resistance is a major problem and a ensure you return home in good health.
prescription for anti-malarials from a doctor will be necessary. More detail is given at the end of this The advice is of necessity quite general and
applies to healthy adults. Children's needs
can differ.
Even if you have taken the most appropriate tablets none of these anti-malarial precautions IMMUNISATION
can give absolute protection. So if you develop Make sure you are up to date with all necessary influenza-like symptoms, especial y associated immunisations. Most of these can usual y be with shivering/shaking attacks (rigors) while done by making an appointment at your local GP abroad, or even within a year of returning from a surgery. It is important you do this as soon as you malarial area, or after discontinuing prophylaxis, know you are travelling. Some vaccinations need you should seek medical attention urgently. You several weeks to be ful y active or a course of should tell the doctor of your recent travel to a injections may be required. A good source of independent travel advice tel ing you likely vaccination requirement on the web is http://www.fitfortravel.scot.nhs.uk/ Rapid long haul flights of more than 5 hours time difference result in appreciable jet lag, MALARIA PREVENTION
characterised by various symptoms including Malaria is widespread in tropical and sub-tropical fatigue and inability to sleep at the new night time, areas of the world and is spread by the bite of an headache, irritability, loss of concentration and infected mosquito. Infection produces fever and, gastrointestinal problems (indigestion, loss of in some cases, complications affecting the appetite and bowel irregularities). The body will kidneys, liver, brain and blood. Malaria can be take longer to adjust if the flight is eastwards fatal. Precautions should be taken if you are rather than westwards and adjustment is slowed going to visit, travel through, or even just stop by lack of sleep during the actual travel ing, the stress of travel ing and alcohol. It is clear that work performances after arrival can be affected Avoidance of mosquito bites is the single most and since it may take 5 days to ful y adjust, any important preventive measure, particularly with measures that will help prevent jet lag are increasing resistance of the disease to drug treatment. This can be simply achieved by taking the following precautions: use insect repel ent, preferably one containing counteract the dry cabin atmosphere that leads to dehydration which is further • keep your arms and legs covered with appropriate clothing (long trousers, sleeves stretch and exercise by walking frequently and dresses) especial y when out walking and during the flight in order to aid circulation and after sunset when the infecting mosquitoes sleep on the plane is recommended especially if you can sleep during the night sleep in properly screened rooms and employ time of your destination. If necessary a mild a “knockdown” spray to kil any mosquitoes in the room. Ideal y use a mosquito net (which may be impregnated with insecticide) around • for trips of less than seventy two hours, you the bed at night, ensuring that it has no holes should try to sleep at your normal night time, if at al possible. Taking brief (1-2 hours) naps are advised since longer periods of sleep wil Malaria Prevention tablets are vital in areas
tend to move your body clock onto local time. where the above measures, although still For longer trips, you should aim to move to essential, are unlikely to give adequate protection local time immediately upon arrival.
SUN EXPOSURE
be wary of salads, coleslaw, shel fish and Exposure to sun leads not only to premature ageing of the skin, but also increases the risk of melanoma and other skin cancers. This risk is greater in those who are fair skinned, or on certain avoid unpasteurised milk often used in local medications such as diuretics or tetracycline antibiotics commonly used to treat acne. Sunscreen preparations containing agents TRAVELLERS’ DIARRHOEA is a very common
protecting against the harmful effects of both UVA and troublesome complaint. If the diarrhoea is and UVB irradiation should be used at al times. accompanied by persistent vomiting, high fever or Eye protection is advised by wearing sunglasses the passage of blood in the stools, then prompt with ultraviolet light filters to reduce the long term medical advice should be sought. Otherwise, ensure that you remain wel hydrated by drinking plenty of fluids and avoiding milk. Anti diarrhoeals Two common problems associated with excessive such as Imodium are useful to reduce the sun are detailed below, with advice on how to deal frequency of diarrhoea in the short term, but if symptoms persist beyond 3-4 days, again seek medical advice. Research has shown that most SUNBURN – overexposure to the sun can cause
cases of travel er’s diarrhoea respond to two redness, tenderness and blistering of the affected doses of Ciprofloxacin 500mg taken at an interval area of skin. Further exposure should be avoided of twelve hours. Your GP may be prepared to until the symptoms have settled remembering that prescribe this as a private prescription if your trip UV light can stil cause damage by penetrating is 'high risk' and you discuss this with him before thin clothes, clouds, water and even shade. Cool showers and ‘after sun’ creams provide soothing relief. Avoid bursting blisters as this can Any diarrhoeal illness will result in significant loss of body fluids – partly from the diarrhoea itself as wel as from the tendency to stop eating and PRICKLY HEAT – this is a common, intensely
drinking. It is vital to prevent dehydration by itchy rash that occurs in hot climates, when the taking frequent smal drinks of mineral water or by skin becomes red with smal spots. The key to using oral rehydration salts (e.g. Dioralyte).
treatment is preventing sweating by reduced exertion, taking cool showers, dusting with talcum powder and wearing loose, cotton clothing. The prevalence of many sexual y transmitted Calamine lotion and antihistamine tablets such as infections is greater in most parts of the world Clarityn or Zirtek, available over the counter at than in the U K. You should regard casual sexual chemists, wil help relieve the itching. If you are relationships as risky and take great care to avoid prone to this problem you are advised to the potential for acquiring infection.
In particular most parts of Africa have extremely SAFE EATING AND DRINKING
high levels of HIV AIDS infection. This remains Wherever you are in the world you need to be an incurable illness. It isn't worth it!
careful what you eat and drink. Food and water can be contaminated in a variety of ways and this Condoms are an absolute necessity and whilst includes the water in swimming pools. Travel ers’ substantially reducing the risk of sexually diarrhoea, typhoid and hepatitis A can al be transmitted infection, do not offer complete caught by eating contaminated food or water. always wash your hands after going to the lavatory, before handling food and before eating; if you have any doubts about the water available for drinking, washing food or cleaning teeth, boil it or sterilise it with disinfectant tablets (boiling for five minutes is best) or use bottled water – preferably carbonated with gas in sealed containers; avoid ice unless you are certain it is made from safe water; eat freshly prepared food and ensure meat is cooked through; DEEP VEIN THROMBOSIS AND TRAVEL
gas! Allow some room for this expansion with Following the recent publicity on the effects of air travel on health, many people are concerned about their personal risk of Deep Vein Thrombosis • Even though DVT is often referred to as "Economy Class Syndrome", passengers in first and
A Deep Vein Thrombosis (DVT) is a clotting of the business class are equally at risk. The risk also
blood in a deep vein of the lower leg. If a clot develops applies to other forms of travel, such as coach or in the veins, it usually makes its presence known by bus travel where you stay seated for hours at a increasing pain and usually pronounced swelling in the affected calf. Medical attention should be sought immediately if this Avoid crossing your legs for more than brief occurs, especially after a long air flight or other journey. periods. It restricts blood flow. Remove your shoes, In some cases a DVT can be fatal if the clot breaks off and makes its way to the lungs where it can then affect the lung’s ability to take in oxygen.
Some simple exercises are described below.
It is hard to establish just how many people are affected by DVT after a long flight as no official records are kept. IN-FLIGHT WORKOUT
Certainly doctors have been aware of this increased These exercises are designed to encourage a safe and risk for many years. This is not therefore new convenient way to enjoy movement and stretch certain information simply that public awareness has recently muscle groups that can become stiff as a result of long increased due to the publicity surrounding recent It is recommended that you do these exercises for three Those in a higher risk category should see their or four minutes every hour and occasionally get out of doctor before they travel and discuss prevention. This includes people with a personal or strong family history of thrombosis, smokers, older Please try to perform these exercises with minimal travellers and individuals who have undergone disturbance to other passengers. Avoid a particular recent surgery (especially to lower limbs or exercise if it causes pain or cannot be done with ease. abdomen). A history of cancer or heart disease may also be important. Also travellers who are 1. Ankle Circles
obese, pregnant women and women taking oral Lift feet off the floor. Draw a circle with the toes, contraceptives (particularly those who smoke) are simultaneously moving one foot clockwise and the other foot counter clockwise. Reverse circles. Do each direction for 15 seconds. Repeat if desired. Some people in these "higher risk" categories mentioned above should discuss with their doctor 2. Foot Pumps
whether taking a small dose of aspirin before they fly (75mg) and perhaps wearing firm support Start with both heels on the floor and point feet upward stockings to reduce their risk is advisable. as high as you can Put both feet flat on the floor • These days, the personal entertainment available Lift heels high, keeping balls of feet on the floor. on many aeroplanes encourages us to stay rooted Continue these three stages with continuous motion in to our seats. However, try to exercise for three or four minutes every hour on long flights to exercise the muscles pumping blood back to the heart. A list 3. Knee Lifts
of suitable exercises you may like to try is given in Lift leg with knee bent while contracting your thigh muscle. Alternate legs. Repeat 20-30 times for each leg.
• If you suffer from poor circulation, try wearing some 4. Neck Roll
supportive stockings to encourage circulation. With shoulders relaxed, drop ear to shoulder and gently However it is important that you do not wear roll neck forward and back, holding each position about clothing that will cause any restriction of circulation. This can happen with ‘pop soxs’ worn just under the knees, or socks which are tight around the 5. Knee To Chest
Bend forward slightly. Clasp hands around the left knee and hug it to your chest. Hold stretch for 15 seconds. Too much alcohol, tea and coffee on flights causes Keeping hands around the knee, slowly let it down. dehydration which can also increase the risk of DVT. Also the air in a plane is very dry and the temperature warmer than we might normally have 6. Forward Flex
at home. It is very important to remain well With both feet on the floor and stomach held in, slowly hydrated during a long flight by drinking plenty of bend forward and walk your hands down the front of your legs toward your ankles. Hold stretch for 15 seconds and slowly sit back. Loose clothing is important on a long flight. Because of the reduced atmospheric pressure in a 7. Shoulder Roll
plane, parts of the body expand due to increased Hunch shoulders forward, then upward, then backward, then downward, using a gentle circular motion. TRAVELLING DURING PREGNANCY
in premature labour. Check that you have adequate medical insurance before you travel. You should always discuss any travel plans with Some policies exclude medical conditions your doctor but you may find the following VACCINATION DURING PREGNANCY
Flying itself is not harmful to your unborn child at Some vaccines can be given during pregnancy. any stage in pregnancy but the following points The risk of contracting a serious il ness must be weighed against the smal , theoretical risk to the pregnancy of the vaccine. In general, a live vaccine such as yellow fever is not given during thrombosis during pregnancy because of the pregnancy. Hepatitis A vaccine should also usual y be avoided during pregnancy unless the Immobility and dehydration can increase this risk of infection is high. If you are planning to risk further. Try to get up and walk down the conceive, you should inform your doctor prior to aisle periodical y and “circle” your ankles from time to time whilst sitting. Keep wel hydrated with non-alcoholic drinks; MALARIA PREVENTION
The most important aspect of malarial
immobility can also cause ankle swelling. prophylactics is mosquito bite precautions. This area is covered in some detail elsewhere in this reduce the chance of this developing. Ankle information leaflet. Chloroquine and Proguanil swel ing can also be a sign of a serious have been used fairly extensively in pregnancy medical condition and should be reported to a with no known adverse effects. Folic Acid doctor if severe. Ankle swel ing occurring in supplements should be taken with the Proguanil. one leg only could be a sign of deep vein The benefit of disease prevention far outweighs any smal theoretical risk. Like most drugs, malarial prophylaxis cannot be tested on pregnant • there are limits imposed by most airlines
women. The information on safety is compiled on flying in late pregnancy. British Airways
from anecdotal reports. Lariam (Mefloquine) has for example wil not allow travel beyond 32 been shown to cause foetal abnormalities in weeks on long haul flights. Many airlines wil animal studies and should therefore be avoided. expect a doctor’s letter confirming that the Doxycycline, which is sometimes prescribed for patients at risk of Chloroquine resistant malaria, should also be avoided in pregnancy.
MEDICAL CARE
You should take particular care with food and appointments in your antenatal care whilst water hygiene in developing countries. This topic you are away. Some pre-natal screening tests is also covered elsewhere. Gastro-intestinal infections, such as salmonel a, can potential y be a more severe il ness in pregnant women.
See your doctor or midwife for an antenatal GENERAL ADVICE
check just before departure. Check with them You tire more easily during pregnancy and this when you should have your next appointment. should be taken into consideration in planning Depending on the stage of pregnancy and the your itinerary whilst you are away. The combined length of your visit, you may need to make effects of pregnancy and jet lag can be quite arrangements for routine antenatal checks to debilitating. You should make sure that you plan • In developing countries, medical facilities available wil usual y be more basic. This is particularly true in the case of the care of the severely pre-term infant. You should discuss this issue with your GP if you are planning to travel between 24-32 weeks. The risk of suffering an early delivery at this stage of pregnancy is approximately 1.5% for a normal 'single baby' pregnancy. An ultrasound scan of the cervix at 23 weeks can identify some of the pregnancies that are at high risk of ending

Source: http://www.thehsgp.co.uk/pdf/hsgp-travel-advice.pdf