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Bring one pair of comfortable walking shoes as well as a pair of sandals or Tevas. Before you leave home, break in your new shoes so you're not uncomfortable on the road.

Health On the Road: Part 4 (of 4)

Health Tips

Compliments of: "Travel With Children" by Maureen Wheeler (Lonely Planet Publications, 155 Filbert Street, Suite 251, Oakland, CA 94607. $11.95)


INSECT-BORNE DISEASES:


MALARIA

This serious disease is spread by mosquitoes. If you are traveling in endemic areas it is extremely important to take malarial prophylactics. Symptoms include headaches, fever, chills and sweating which may subside and recur. Without treatment malaria can develop more serious, potentially fatal effects.

Anti-malarial drugs do not prevent you from being infected but kill the parasites during a normal stage in their development.

There are a number of different types of malaria. The one of most concern is falciparum malaria. This is responsible for the very serious cerebral malaria. Falciparum is the predominant form in many malaria prone areas of the world, including Africa, South-East Asia and Papua New Guinea. Contrary to popular belief, cerebral malaria is not a new strain.

The problem in recent years has been the emergence of increasing resistance to commonly used anti-malarials like chloroquine, maloprim and proguanil. Newer drugs such as mefloquine (Lariam) and doxycycline (Vibramycin, Doryx) are often recommended for chloroquine and multi-drug resistant areas. Expert advice should be sought from your doctor, as there are many factors to consider when deciding on the type of anti-malarial, including the area to be visited, the risk of exposure to malaria-carrying mosquitoes, your children's current medical condition and their ages. It is also important to discuss the side-effect profile of the medication, so you can work out some level of risk versus benefit ratio. It is also very important to be sure of the correct dosage of the medication prescribed. Some people inadvertently have taken weekly medication (chloroquine) on a daily basis, with disastrous effects. While discussing dosages for prevention for malaria, it is often advisable to include the dosages required for treatment, especially if your trip is through a high-risk area that would isolate you from medical care.

Malaria is curable, as long as the traveler seeks medical help when symptoms occur. Contrary to popular belief, once a traveler contracts malaria they do not have it for life. One of the parasites may lie dormant in the liver but can be eradicated using a specific medication.

It may be worth taking your own mosquito net as a preventative measure, although you may not always find somewhere to hang it. If your child wakes up a lot in the night, you may find it hard to remember, in your befuddled state, to make sure the net is closed properly when you fall back into bed. Of course this is not so much a problem if you are sleeping under the net with your child. In areas with severe mosquito problems hotels often provide mosquito nets, "flea bags" as Kieran called them in Africa.

I close up the room (as much as possible) and spray it each evening before dinner. When we come back the smell, and hopefully any residue, has dispersed and any mosquitoes area dead.

Mosquito coils are useful; but buy them when you arrive as they are very fragile. I always burn a coil in the bathroom overnight, unless it is well sealed, as mosquitoes congregate where it is damp. Vaporizers are only useful where there is electric power. These small, portable gadgets vaporize insecticide tablets.

They don't produce smells or smoke but the insecticide is still released into the air. If you buy one before you leave home check that it uses the appropriate voltage and you have the right adapter.

It's a good idea to carry some preparation which will take the itch or sting out of insect bites. There are some good preparations and antihistamine creams which work well. If your child has an allergic reaction when bitten (Kieran has a strong allergic reaction; the bites swell up quite alarmingly and look very inflamed) you may find an antihistamine medication will help. Ask your doctor or pharmacist before you leave home, although many of these preparations are available over the counter in pharmacies everywhere. Some brand names are Sudafed, Actifed, Phenergan or Benadryl.

I find that when Kieran has one or two severe bites he will wake up crying and scratching several times during the night. This will occur for up to three nights when the bite finally fades. I now have a going-to-bed routine where I check Kieran after his bath, put calamine lotion on any bites and if he has some very large ones which have been bothering him during the day, I give him the required amount of antihistamine. It reduces his reaction to the bite and helps him to sleep.

SLEEPING SICKNESS

In parts of tropical Africa tsetse flies can carry trypanosomiasis or sleeping sickness. They pass it on by biting large mammals and are responsible for the lack of horses and cows in some areas.

The tsetse fly is about twice the size of a housefly and recognizable by the scissors-like way it folds its wings when at rest. The flies are attracted to large moving objects (like safari buses) to perfume or aftershave, and to dark colors. Only a small proportion of tsetse flies carry the disease but it is best to avoid being bitten. Swelling at the site of the bite, five or more days after being bitten, is the first sign of infection; followed within two weeks by fever. The illness is serious but responds well to medical attention. There is no immunization against sleeping sickness.

DENGUE FEVER

There is no prophylactic available for this mosquito-spread disease; the main preventative measure is to avoid being bitten. A sudden onset of fever, headaches and severe joint and muscle pains are the first signs of infection, followed by a rash on the trunk of the body that spreads to the limbs and face. After a further few days, the fever will subside and recovery will begin. Serious complications are not common.

YELLOW FEVER

the fever down and avoiding dehydration, but yellow fever vaccination gives protection for 10 years. Vaccination is an entry requirement for some countries, predominately for those travelers coming from an infected area. Vaccination is not recommended for children less than one year old.

CHAGA'S DISEASE

In remote rural areas of South and Central America this parasitic disease is transmitted by a bug which hides in crevices and palm fronds and often takes up residence in the thatched roofs of huts. It comes out to feed at night. A hard, violet-colored swelling appears at the site of the bite in about a week. Usually the body overcomes the disease unaided, but sometimes it continues and can eventually lead to death years later. Chaga's disease can be treated in its early stages, but it is best to take preventative measures: avoid thatched-roof huts, sleep under a mosquito net, use insecticides and insect repellents and check for hidden insects.

TYPHUS

Typhus is spread by ticks, mites or lice. It begins as a bad cold, followed by a fever, chills, headache, muscle pains and a body rash. There is often a large, painful sore at the site of the bite and nearby lymph nodes are swollen and painful.

Tick typhus is spread by ticks. Trekkers in southern Africa may be at risk from cattle or wild animal ticks. Scrub typhus is spread by mites that feed on infected rodents and exists mainly in Asia and the Pacific Islands. You should take precautions if walking in rural areas in South-East Asia. Seek local advice on areas where ticks pose a danger and always check your skin carefully for ticks after walking in a danger area, such as a tropical forest. A strong insect repellent can help, and serious walkers in tick areas should consider having their boots and trousers impregnated with benzyl benzoate and dibutylphthalate.


CUTS, BITES & STINGS:


CUTS & SCRATCHES

Skin punctures can easily become infected in hot climates and may be difficult to heal. Treat any cut with an antiseptic such as Betadine. Where possible avoid bandages and Band-aids, which can keep wounds wet. Coral cuts are notoriously slow to heal, as the coral injects a weak venom into the wound. Avoid coral cuts by wearing shoes when walking on reefs, and clean any cut thoroughly with sodium peroxide if available.

Make it a general rule that all cuts and grazes, no matter how insignificant they seem, are treated with antiseptic as soon as possible. Tony and I both have experienced little scratches becoming infected wounds which took a very long time to heal. Tony actually had to have a penicillin injection, three months after the skin was broken, to cure what had been a tiny scratch.

Creams and ointments should not be used as these just keep the wound greasy and prevent it from healing. If infection does occur you could try an antibiotic powder, but check that it has not passed its expiration date. Local pharmacies or first-aid centers can often treat cuts, scratches or minor wounds very competently. Bathing around in salt water helps to clean and sterilize a wound.

BITES & STINGS

Bee and wasp stings are usually painful rather than dangerous. Calamine lotion will give relief, and ice packs will reduce the pain and swelling. There are some spiders with dangerous bites but antivenins are usually available. Scorpion stings are notoriously painful and in Mexico can actually be fatal. Scorpions often shelter in shoes or clothing.

Certain cone shells found in Australia and the Pacific can sting dangerously or even fatally. Various fish and other sea creatures can either sting or bite dangerously, or are dangerous to eat. Again, local advice is the best suggestion.

SNAKES

To minimize your chances of being bitten always dress your child in boots or stout shoes, socks and long trousers when walking through undergrowth where snakes may be present. Warn your children not to put their hands into holes and crevices, and to be careful when collecting firewood.

Snakebites do not cause instant death and antivenins are usually available. Keep the victim calm and still, wrap the bitten limb tightly, as you would for a sprained ankle, and then attach a splint to immobilize it. Then seek medical help, if possible with the dead snake for identification. Don't attempt to catch the snake if there is even a remote possibility of being bitten again. Tourniquets and cutting the bite area to suck out the venom are now comprehensively discredited.

JELLYFISH

Use local advice to find out the best way of avoiding contact with these sea creatures with their stinging tentacles. The box jellyfish found in in-shore waters around northern Australia during the summer months is potentially fatal, but stings from most jellyfish are simply rather painful. Dousing in vinegar will de-activate any stingers which have not "fired". Calamine lotion, antihistamines and analgesics may reduce the reaction and relieve the pain.

BEDBUGS & LICE

Bedbugs live in various places, but particularly in mattresses and bedding. Spots of blood on bedclothes or on the wall around the bed can be read as a suggestion to find another hotel. Bedbugs leave itchy bites in neat rows. Calamine lotion may help. All lice cause itching and discomfort. They make themselves at home in your children's hair (head lice) or clothing (body lice). They are caught through direct contact with infected people or by sharing combs, clothing and the like. Lots of children in the West bring head lice home from school and they are even more prevalent in developing countries - how often do you see people grooming each other's hair and searching for lice? Your children's contact with local children may well be closer than your own contact with the locals so be prepared. You may think it's a good idea to carry an appropriate treatment shampoo with you. Infected clothing should be washed in very hot water.

LEECHES & TICKS

Leeches may be present in damp rain forest conditions. Trekkers often get them on their legs or in their boots; they attach themselves to the skin to suck blood. Salt or a lighted cigarette end will make them fall off. Do not pull them off, as the bite is then more likely to become infected. An insect repellent may keep them away. Vaseline, alcohol or oil will also persuade a tick to let go. You should always check your body if you have been walking through a tick-infested area, as they can spread typhus.


WOMEN'S HEALTH:


GYNECOLOGICAL PROBLEMS

Poor diet and lowered resistance due to the use of antibiotics for stomach upsets, vaginal changes during pregnancy and even contraceptive pills can lead to vaginal infections when traveling in hot climates. Keeping the genital area clean, and wearing skirts or loose-fitting trousers and cotton underwear will help to prevent infections.

Yeast infections, characterized by a rash, itch and discharge, can be treated with a vinegar or lemon-juice douche, or with yogurt. Nystatin suppositories are the usual medical prescription. Trichomoniasis is a more serious infection; symptoms are a discharge and a burning sensation when urinating. Male sexual partners must also be treated, and if a vinegar-water douche is not effective medical attention should be sought. Metronidazole (Flagyl) is the prescribed drug for treatment.

PREGNANCY

Most miscarriages occur during the first three months of pregnancy, so this is the most risky time to travel as far as your own health is concerned.

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