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Preparations   Routeplanning   Health   Safety   Money   Red Tape   Checklists   Links		Health On this site, we have summarized the most important information we have gathered during the preparation for our trip. Apart from the tips, tricks and links listed below we have also included: our travel pharmacy, as well as: our vaccination schema General tips: Avoid non-streaming water (lakes) in tropical areas: they contain diseases such as bilharsiose If you see rats near the water, don't go for a swim: rats can spread diseases like Weil After returning from your trip to tropical areas, do a general checkup at a clinic for tropical diseases to exclude malaria and other diseases. Repeat this checkup after 1 to 2 years, since some diseases have long incubation times. Before going on a trip to the tropics, visit a doctor and dentist for a checkup. Try to avoid having to go to a doctor or dentist in the country you travel to (some travellers have been infected with Hepatitis C at the dentist!) Rub your feet with glycerine-kamphorspiritus before going for a longer walk: this will prevent blisters Small wounds should also be taken care of, since wounds take longer to heal in tropical climate and could get infected in the meantime. Anti-diarrhoea medication should always contain loperamide (e.g. Immodium, Diacure). Taking carbon-pills has no effect on traveller's diarrhoea. When you have a fever, rather take paracetamol than aspirine (which dilutes the blood!), especially when you have knuckle fever. Precautions against legionella: before using the shower in a hotel, first open all bathroom windows and doors, then hold the shower-head near the drain and let the shower run (water should be at least 60° Celcius) for a couple of minutes. When you go to the beach, never sit directly on the sand, but always use a towel. Otherwise, sand flees will lay their eggs under your skin, giving you itching rashes for days on end! When you have both fever and diarrhoea, always visit a doctor!! You might have malaria tropica, which is lethal! In many countries the international vaccination pass (yellow booklet) is required. "Doctor Finder-service" of American Express: when you are ill you can phone AmEx, who will find you the nearest English-speaking doctor and make an appointment for you if needed. A similar service is offered by most western embassies and consulates. If your own embassy is not available you can also turn to any other western embassy, if you are from the EU you can turn to any of the member state's embassies. Adapting to heights (mountains): Ascend slowly and plan in days of rest (no ascending) Drink a lot (at least 4 to 6 liters) When you suffer from altitude sickness (fever, throwing up > brain oedema or even coma): descend to under 3000 m. Medicine against altitude sickness: Diamox Adapting to depths (diving): Unexperienced divers should never dive deeper than 15 to 20 m. Never dive alone! Ascend slowly and do NOT hold your breath during ascending Adapting to tropical climate: Drink a lot: your urine should be clear and light of color, if not you know that you are dehydrating. Eat a lot of salt Avoid the sun between 11:00 and 15:00 hrs Look for cool places where you can stay: your sweat glands need to recover every now and then to prevent a heat-attack. Oral Rehydration Solution (ORS) can be bought at the pharmacy but also mixed by yourself: mix one liter of black tea with one teaspoon of salt and ten teaspoons of sugar. Heat-attacks: your body temperature goes up to over 41° Celcius as your body does not have the chance to cool down anymore: When you have overexerted yourself in tropical heat or have sweated so much, that your sweat-glands are exhausted. Symptoms: at first the skin is hot and moist, then grey and cold. At some point you will collaps / lose your consciousness. First aid measurements: bring the patient to a cool spot, apply wet bandages and make him drink bouillon, fruit juice, tea or ORS (electrolyt-solution). DO NOT MAKE HIM DRINK WATER!! This can drown the brains and only worsens the symptoms! Food, drink and general hygiene: Always boil, filter and treat water with Micropur before drinking it or use it for cooking. If you buy bottled water, make sure the bottle is new and has not been opened yet. Never eat raw (unboiled), unpeeled or unwashed food, esp. meat, fish, seafood, vegetables, fruit and milkproducts. Boil your food fast and let it boil for at least 15 minutes At altitudes over 3000 m water boils at less 100° Celcius. To kill off bacteria let it boil for at least 3 minutes. Always secure your food against flies. They carry various ugly bacteria! People with abdominal pains / diarrhoea should stay out of the kitchen and should wash their hands regularly. Use clean (dish) towels every day. Do not consume non-pasturized or non-sterilized milk or milkproducts. Do not take fruit juice mixed with water, ice cubes or raw meat. Only eat fruit which was prepacked or which you washed before. Vegetables and fruit should be washed with water and soap or chlorine: this prevents infections with hepatitis A or typhus. If you cannot avoid eating salad (e.g. because that would insult your host): citron acid and vinegar reduce the danger of infection. Wash your hands with desinfecting soap, e.g. Unicura or Sacrotan. When you often suffer from abdominal problems, yoghurt might be of help. Be careful what yoghurt you take though: after all it is a milk product! Make sure you wash your hands regularly and keep them from your mouth, face and eyes. Take special care not to touch any (small) wounds with your hands! If you eat from the stalls at the streetside, make sure you go to the best visited one (higher return = fresher food) and avoid the fake western-foodstalls. The herbs in the local food keep a lot of insects at bay, which is not the case with western food. It is also advisable to have a look at the owner of the stall: if he looks healthy, his food will be relatively safe too. Hepatitis, for instance, can be detected by yellowish eyewhite. Insects, snakes and other pests: Several worm-types (hookworm, threadworm) you get by walking barefoot, others (tapeworm) by eating raw meat or fish You can get liver- and lungcysts by touching the fur of dogs or cattle Contact with still water (e.g. in small lakes) can lead to bilharziasis, which affects your liver. The bites of lice, flees or mite can lead to heart muscle infection Ticks may transfer borreliose or meningitis. Long trousers alone won't be enough to keep ticks away; you will also need to wear high shoes, tuck your trousers in your socks and spray your socks with anti-insect spray. Spiders: In the countries we go to, only the brown spider (mediterranean area) is really dangerous Symptoms of a spider bite: fever, blisters, muscle weakness, kidney disorder Spiders like dark corners, e.g. in bathroom or toilet, or food (esp. fruit) Treat spider bites with an antiserum or, if that is not available, with cortison and painkillers Beware if you go to Sydney: the spiders there (funnel web and red back) are pretty vile! For a description, click here Snakes: Grass- / Ringed snakes (e.g. cobras): the bite paralyzes the nerves and lead to breathing problems Vipers: their bite lead to swellings, blood dilution, kidney disorders and tissue damage Spitting cobras: these snakes spray their poison from afar into your eyes, which can lead to eye infections and blindness. If this happens to you, rinse your eyes with clean (!) water immediately and go see a doctor asap. You can prevent snake bites by wearing long trousers and closed shoes, making a lot of noise and not making any sudden movements when you are near a snake. Treat snake bites as described here Scorpions: Scorpion-bites won't kill, but they will hurt! The best way to treat one is a cortison-injection. Scorpions like to hang out in sand, under or between stones and in walls. At night they have a tendency to crawl into your shoes and clothes Pain from an insect-bite can be lindered by putting vinegar, citron acid or an ice cube on the wound, then put e.g. Azaron on it. Always check your clothes and shoes on spiders and scorpions before putting them on! Malaria: Symptoms of malaria tropica: Within a few hours you get abdominal pain, fever, a yellowish skin and eventually coma Without treatment, the patient dies. Prevention: Cover your skin as much as possible: long sleeves, long trousers, closed shoes. Do not wear clothes made of thin material (musquitos will sting through!), but rather wear linen or cotton >> Linen is less warm and sweaty than cotton. Use anti-insectsprays for the non-covered skin (face, hands) and for the wrists and ancles (the veins run just below the skin there), even if you are wearing socks. Be carefull with pyrethroid sprays or (electrical) vaporizers: these work well, but can cause damage in the long run. Musquito spray works for about 2 to 3 hours, after that you should spray again! Do not apply musquito spray based on DEET directly on the skin, since DEET is being absorbed by the skin and is poisonous in the long run. Rather use bandages soaked in DEET to wear around wrists and ancles or use a spray based on eucalyptus oil (which has no negative long-term effect and can be bought at the pharmacy) Keep windows and doors closed between dusk and dawn Use a musquito net, which you spray at least twice a year with musquito spray (e.g. Permethrin) for extra safety. Make sure you do not lie against the net, the musquitos will then be able to sting through! In Scandinavia (esp. Sweden), you will need a very fine net (holes max. 0,6 mm˛) since the musquitos are really small there. In tropical areas you can use nets with holes up to 1,2 mm˛, so that the air can still circulate. Good musquito nets can be bought at the army, e.g. US Army-Navy Surplus Nets Ventilators or air conditioners also keep musquitos away. High-frequency buzzers do NOT work! Medicine: Which medicines you use depends on the route you take: the tropical institute can give you some good advice there. Most medicines must be started one week before entering a malaria area, and stopped one month after leaving it. Other diseases: Hepatitis A / infectuous jaundice: Get vaccination. Attention: total vaccination program takes at least one year! Prevent by keeping a strict hygiene and avoid eating raw food Treatment: stay in bed and away from alcohol: jaundice is a liver disease! Hepatitis B or serumhepatitis: Get vaccination. Usually you get a combination vaccination for hepatitis A and B (Twinrix) Transmitted via blood (transfusions!) or sperm Can be lethal Hepatitis C: Same symptoms as hepatitis B, but no vaccination available!! Hepatitis D or deltahepatitis: Only occurs in conjunction with hepatitis B. Vaccination for hepatitis B also prevents hepatitis D Hepatitis E: Epidemic disease, occurring in e.g. flooded areas No vaccination available. Hepatitis E is not lethal and does not cause permanent damage Bacterial meningitis: get vaccination Pocks: extinct, no vaccination available anymore Pest: Can be treated with antibiotics Leprosy and tuberculosis: Only transmitted to people who are weak and underfed or who have long-term physical contact with infected people. Get a BCG-vaccination against T.B. for longer trips Cholera: Only transmitted to people who are weak and underfed Transmitted via dirty water Vaccination does not really work and has many side-effects: not recommended The Swiss and Swedish vaccination is better, but not allowed everywhere (e.g. not in Germany) Some countries require a cholera-vaccination: make sure you have a contra-indication from the tropical institute. Typhus: get vaccination >> the so called "oral vaccination" only works for 1 - 2 years, the injected one lasts 3 years both vaccinations only offer a 50 to 60% protection typhus is caused by the "Salmonella Typhi", which is found in contaminated food and drinking water can be treated with antibiotics, but some people have died nevertheless, so don't bet on it. Yellow fever: only in Africa and South-America. Most Asian countries require a vaccination if you have travelled in yellow-fever areas before. Beware: only very few hospitals are allowed to vaccinate against yellow fever! Rabies, tetanus, diphtheria, whooping cough, polio, japanese encephalitis: Get a vaccination Rabies always ends deadly!! No treatment is possible, the only thing that can save you after a bite is to clean the wound with water and soap, desinfect it with alcohol and get the needed vaccinations within 24 hours! Getting the vaccination in advance allows you more time, but you would still need to see a doctor and renew your vaccinations immediately! In many countries, inferior vaccination material is used. If you cannot get a proper vaccination, go home immediately and refresh your vaccinations there AIDS (and hepatitis B and C): Transmitted via blood or sperm Blood on the intact skin should be washed away with soap and alcohol (>45%) immediately Blood on the mucous membrane (eg. inside the mouth) should be washed away immediately. Don't use alcohol, since this would affect the membrane! Make sure new needles are used for injections! Some hospitals do not sterilize their needles very well! Wounds: press the wound and let it bleed out for at least one minute. After that, desinfect with alcohol > 80%. Meningoencephalitis (Meningitis caused by ticks): Get a vaccination. Attention: total vaccination program takes at least one year! Tips for your travel pharmacy: In warm countries medicines do not last as long as stated on the package. Beware of fake medicines in e.g. Thailand: usually these do not work or are even dangerous! Always carry the most important medications from your travel pharmacy with you, so that you always have it at hand in case of need. Store the pharmacy dry, cool and dark, e.g. in a refridgerator. Action items: Visit tropical institute Get international vaccination booklet (yellow booklet) Check travel insurances on repatriation after accidents or illnesses and for legal assistance in the countries you visit Get an international medical passport that lists your allergies, blood type and other medical details Buy a musquito net Get the travel pharmacy ready Visit a first-aid course and read a first aid book Do a general checkup just before departure   Links to information about tropical medicine:   Language     Illnesses per country / continent and how to prevent and treat them.   Also latest developments in travel-medicine and spreading of epidemics.   http://www.cdc.gov/travel/   Illnesses per country / continent and how to prevent and treat them.   http://www.travelstreet.com   Excellent information about countries, diseases, treatments etc.   Includes latest developments in travel-medicine and spreading of epidemics.   http://www.travelmed.de   Excellent information about countries, diseases, treatments etc.   (linked to travelmed.de)   http://www.crm.de   Tropical clinic of Munich's site, excellent source of information.   http://www.fit-for-travel.de   Everything you need to know about malaria.   http://www.malaria.org/   WHO's fact sheet about malaria.   http://www.who.int/health-topics/malaria.htm/   Information about countries, diseases and their prevention.   Also addresses for vaccinations in Holland.   http://www.lcr.nl   Detailed information about vaccination materials and malaria prevention.   http://www.serviceapotheek.nl   Short information about preparing your trip. Practical country list and addresses.   http://www.gezondopreis.nl/   Product information about e.g. insect-repellants (DEET!) and musquito nets.   http://www.tropenzorg.nl   Vaccinations, travel pharmacies, safety tips and diseases all over the world. NL/EN/FR/ES   http://www.itg.be/itg/   Short information about the tropics, sun burn, diseases and travel pharmacy.   http://www.kring-apotheek.nl