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222 IN TRANSIT •• Deep Vein Thrombosis

Typhoid Recommended unless your trip is for less than a week. The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot. Tablets are also available, but the injection is usually recommended as it has fewer side effects. Sore arm and fever may occur.

These immunisations are recommended for long-term visitors (more than one month) or those at special risk:

Japanese B Encephalitis Three injections, with a booster recommended after two years. Sore arm and headache are the most common side-effects. Meningitis Single injection. There are two types: the quadrivalent vaccine gives two to three years’ protection; the meningitis group C vaccine gives around 10 years’ protection. Recommended for long-term visitors aged under 25. Rabies Three injections in all. A booster after one year provides10 years’ protection Side effects are rare – occasionally headache and sore arm.


Following is a list of other items you should consider packing in your medical kit when you are travelling.  Antibiotics (if travelling off the beaten track)

 Antibacterial hand gel  Antidiarrhoeal drugs (eg loperamide)  Paracetamol (eg Tylenol) or aspirin  Anti-inflammatory drugs (eg ibuprofen)  Antihistamines (for hay fever and allergic reactions)

 Antibacterial ointment (eg Bactroban) for cuts and abrasions

 Steroid cream or cortisone (allergic rashes)

 Bandages, gauze, gauze rolls  Adhesive or paper tape  Scissors, safety pins, tweezers  Thermometer  Pocket knife  DEET-containing insect repellent for the skin


The following government travel health websites are useful resources to consult prior to departure:

Australia ( Canada ( UK (


United States (

for travel health information, along with

MD Travel Health (, which

provides complete travel health recommen- dations for every country.


Lonely Planet’s Healthy Travel Asia & India

is packed with useful information includ- ing pretrip planning, emergency first aid, immunisation and disease information, and what to do if you get sick on the road. Other recommended references include Travellers’ Health by Dr Richard Dawood (Oxford University Press) and The Travel-

lers’ Good Health Guide by Ted Lankester

(Sheldon Press), an especially useful health guide for long-term expatriates working in the region.


 Permethrin-containing insect spray for clothing, tents, and bed nets

 Sun block  Oral rehydration salts  Iodine tablets (for water purification)  Syringes and sterile needles (if travelling to remote areas)


There is a wealth of travel health advice on the Internet. The World Health Organiza- tion ( is an excellent resource


Deep vein thrombosis occurs when blood clots form in the legs during plane flights, chiefly because of prolonged immobility. The longer the flight, the greater the risk. Though most clots are reabsorbed unevent- fully, some may break off and travel through the blood vessels to the lungs, where they may cause life-threatening complications. The chief symptom of DVT is swelling or pain in the lower leg, usually but not always on just one side. When a blood clot travels to the lungs, it may cause chest pain and difficulty breathing. Travellers with any of these symptoms should immediately seek medical attention. To prevent the development of DVT on long flights you should walk about the cabin, regularly contract your leg muscles while sitting and drink plenty of fluids. Recent research also indicates that flight

socks, which gently compress the leg from the knee down, encourage blood to flow properly in the legs and reduce the risk of DVT by up to 90%.


Jet lag is common when crossing more than five time zones; it results in insomnia, fa- tigue or nausea. To avoid jet lag, set your watch to your destination’s time zone when you board your plane, drink plenty of (non- alcoholic) fluids and eat lightly. Upon ar- rival, seek exposure to natural sunlight and readjust your eating and sleeping schedule as soon as possible. Antihistamines such as dimenhydrinate (Dramamine) and meclizine (Antivert, Bon- ine) are usually the first choice for treating motion sickness. Their main side-effect is drowsiness. A herbal alternative is ginger, which works like a charm for some people.



Health care in Afghanistan is basic at best,

and there is a nationwide shortage of doc- tors. Although there are a handful of good hospitals in Kabul, medical facilities are not generally up to international standards and serious cases are likely to require evacua- tion. While most towns have pharmacies, it can nevertheless be difficult to find reliable medical care outside the cities. Take care when buying medication, as fake, poorly stored or out-of date drugs are common. Self-treatment may be appropriate if your problem is minor. If you think you may have a serious disease, especially ma- laria, do not waste time; travel to the nearest quality facility immediately to receive at- tention. Recommended hospitals are listed under Information in the major city sec- tions of regional chapters in this book; your embassy may also be a useful contact.


The strains of travel – unfamiliar food, heat, long days and erratic sleeping patterns – can all make your body more susceptible to stomach upsets. In terms of prevention, eat only fresh fruits or vegetables if they are cooked or if


Health 223

you have washed or peeled them yourself. Water should be treated before drinking. Meals freshly cooked in front of you (like much street food), or served in a busy restau- rant are more likely to be safe. It’s also very important to pay close attention to personal hygiene while on the road. Afghan meals are eaten with the hand, so always wash before eating (even the smallest restaurant will have water and soap) and after using the toilet. Antibacterial hand gel, which cleans without needing water, is a real travellers’ friend. If you develop diarrhoea, drink plenty

of fluids, preferably an oral rehydration solution – readily available in pharma- cies. Avoid fatty food and dairy products. A few loose stools don’t require treatment but, if you start having more than four or five watery stools a day, you should start taking an antibiotic (usually a quinolone drug) and an antidiarrhoeal agent (such as loperamide). If diarrhoea is bloody, persists for more than 72 hours, is accompanied by fever, shaking chills or severe abdominal pain you should seek medical attention.

Amoebic Dysentery

Amoebic dysentery is actually rare in trav- ellers but is often misdiagnosed. Symptoms are similar to bacterial diarrhoea, ie fever, bloody diarrhoea and generally feeling un- well. You should always seek reliable medi- cal care if you have blood in your diarrhoea. Treatment involves two drugs: Tinidazole or Metroniadzole to kill the parasite in your gut, and a second drug to kill the cysts. If left untreated, complications such as liver or gut abscesses can occur.


Giardia is a parasite that is relatively com- mon in travellers. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. ‘Eggy’ burps are often attributed solely to giardia, but work in Nepal has shown that they are not spe- cific to giardia. The parasite will eventually go away if left untreated, but this can take months. The treatment of choice is Tinida- zole; Metronidazole is a second option.



Diphtheria is spread through close respira- tory contact. It causes a high temperature

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