With temperatures hitting 45°C and over in the summer months, heatstroke and heat exhaustion are serious dangers for travellers used to cooler climes; for most people it takes at least two weeks to adapt.
Swelling of the feet and ankles is common, as are muscle cramps caused by excessive sweating. Prevent these by avoiding dehydration and excessive activity in the heat.
Drink rehydration solution or eat salty food. Treat cramps by stopping activity, resting, rehydrating with double-strength rehydration solution and gently stretching.
Dehydration is the main contributor to heat exhaustion. Symptoms include a feeling of weakness, headache, irritability, nausea or vomiting, sweaty skin, a normal or slightly elevated body temperature, and a fast, weak pulse. Treatment involves getting the sufferer out of the heat and/or sun, fanning them and applying cool wet cloths to the skin. Lay the sufferer flat with their legs raised, and rehydrate them with water containing a quarter of a teaspoon of salt per litre.
Heatstroke is a serious medical emergency. Symptoms come on suddenly and include weakness, nausea, a hot, dry body with a body temperature of more than 41°C, dizziness, confusion, loss of coordination, fits and eventually collapse and loss of consciousness. Seek medical help, and cool the person by getting them out of the heat, removing their clothes, fanning them and applying cool wet cloths or ice to their body, especially to the groin and armpits.
Prickly heat is a common skin rash caused by excessive perspiration getting trapped under the skin. Treat it by moving out of the heat and into an air-conditioned area for a few hours and by having cool showers. Creams and ointments clog the skin, so they should be avoided. Locally bought prickly-heat powder can be helpful.
Bedbugs don’t carry disease, but their bites are very itchy. They live in the cracks of furniture and walls, and then migrate to the bed at night to feed on you. You can treat the itch with antihistamines.
Lice inhabit various parts of your body but most commonly your head and pubic area. Transmission is via close contact with an infected person. Lice can be difficult to treat, and you may need numerous applications of an anti-lice shampoo such as permethrin. Pubic lice are usually contracted from sexual contact.
Ticks are contracted after walking in rural areas. They’re commonly found behind the ears, on the belly and in the armpits. If you have had a tick bite and experience symptoms such as a rash at the site of the bite or elsewhere, fever or muscle aches, you should see a doctor. Doxycycline prevents tick-borne diseases.
Bee and wasp stings mainly cause problems for people who are allergic to them. Anyone with a serious bee or wasp allergy should carry an injection of adrenaline (eg an Epipen) for emergency treatment. For others, pain is the main problem – apply ice to the sting and take painkillers.
Eating in restaurants is the biggest risk factor for contracting traveller’s diarrhoea. Ways to avoid it include eating only freshly cooked food, and avoiding shellfish and food that has been sitting around on buffets. Peel all fruit, cook vegetables and soak salads in iodine water for at least 20 minutes (avoid iodine if you are pregnant or have thyroid problems).
Air pollution, particularly vehicle pollution, is an increasing problem in most of India’s major cities. If you have severe respiratory problems, speak with your doctor before travelling to any heavily polluted urban centres.
Traveller’s diarrhoea is the most common problem that affects travellers – between 30% and 70% of people will suffer from it within two weeks of starting their trip. In over 80% of cases, traveller’s diarrhoea is caused by a bacteria, and therefore responds promptly to antibiotics. Treatment with antibiotics will depend on your situation – how sick you are, how quickly you need to get better etc.
Traveller’s diarrhoea is defined as the passage of more than three watery bowel actions within 24 hours, plus at least one other symptom such as fever, cramps, nausea, vomiting or feeling generally unwell. Treatment consists of staying well hydrated; rehydration solutions such as Gastrolyte are best for this. Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin will kill the bacteria quickly. Loperamide is just a ‘stopper’ and doesn’t get to the cause of the problem. It can be helpful, though, for example if you have to go on a long bus ride. Don’t take Loperamide if you have a fever, or blood in your stools. Seek medical attention quickly if you do not respond to an appropriate antibiotic.
Considering it’s such a serious and potentially deadly disease, there is an enormous amount of misinformation about malaria. You must get expert advice as to whether your trip will put you at risk. For most rural areas, the risk of contracting malaria far outweighs the risk of any tablet side effects. Before you travel, seek medical advice on the right medication and dosage for you.
Malaria is caused by a parasite transmitted by the bite of an infected mosquito. The most important symptom of malaria is fever, but general symptoms such as headache, diarrhoea, cough or chills may also occur. Diagnosis can only be made by taking a blood sample.
Two strategies should be combined to help prevent malaria – mosquito avoidance and antimalarial medications. Most people who catch malaria are taking inadequate or no antimalarial medication.
Travellers are advised to take to the following steps to prevent mosquito bites:
A variety of medications are available:
Specialised travel-medicine clinics are your best source of information; they stock all available vaccines and will be able to give specific recommendations for you and your trip. The doctors will take into account factors such as past vaccination history, the length of your trip, activities you may be undertaking, and underlying medical conditions, such as pregnancy.
Most vaccines don’t give immunity until at least two weeks after they’re given, so visit a doctor four to eight weeks before departure. Ask your doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all the vaccinations you’ve received.
Yellow fever is the only vaccine required by international regulations. Proof of vaccination will only be required if you have visited a country in the yellow-fever zone within the six days prior to entering India. If you are travelling to India from Africa or South America you should check to see if you require proof of vaccination. The World Health Organization (WHO) recommends that travellers to India be up to date with measles, mumps and rubella vaccinations. Other vaccinations it recommends:
Adult diphtheria and tetanus Single booster recommended if none given in the previous 10 years.
Hepatitis A Provides almost 100% protection for up to a year; a booster after 12 months provides at least another 20 years’ protection.
Hepatitis B Now considered routine for most travellers. Given as three shots over six months.
Polio Only one booster is required as an adult for lifetime protection.
Typhoid Recommended for all travellers to India, even if you only visit urban areas. The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot. Tablets are also available; however, the injection is usually recommended as it has fewer side effects.
Varicella If you haven’t had chickenpox, discuss this vaccination with your doctor.
Immunisations recommended for long-term travellers (those going away for more than one month) or those at special risk:
Japanese B Encephalitis Three injections in all. Booster recommended after two years.
Meningitis Single injection. There are two types of vaccination: the quadrivalent vaccine gives two to three years’ protection and the meningitis group C vaccine gives around 10 years’ protection. Recommended for longterm backpackers aged under 25.
Rabies Three injections in all. A booster after one year will then provide 10 years’ protection.
Tuberculosis (TB) Adult long-term travellers are usually advised to have a TB skin-test before and after travel, rather than vaccination. Only one vaccine needs to be given in a lifetime.
Recommended items for a personal medical kit:
There’s a wealth of travel-health advice on the internet. LonelyPlanet.com (www.lonelyplanet.com) is a good place to start. Some other suggestions:
Centers for Disease Control and Prevention (CDC; www.cdc.gov) Good general information.
MD Travel Health (www.mdtravelhealth.com) Provides complete travel-health recommendations for every country; updated daily.
World Health Organization (WHO; www.who.int/ith/) Its superb book International Travel & Health is revised annually and is available online.
It’s a good idea to consult your government’s travel-health website before departure, if one is available:
New Zealand (www.mfat.govt.nz/travel)
South Africa (www.dfa.gov.za/consular/travel _advice.htm)
Lonely Planet’s Asia & India – Healthy Travel is pocket-sized and packed with useful information about pre-trip planning, emergency first aid, immunisation and disease information, and what to do if you get unwell while on the road. Other recommended references include Traveller’s Health, by Dr Richard Dawood and Travelling Well (which is also online at www.travellingwell.com.au) by Dr Deborah Mills.