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224 IN AFGHANISTAN ••

Infectious Diseases

and severe sore throat. Sometimes a mem- brane forms across the throat requiring a tracheostomy to prevent suffocation. Vaccin- ation is recommended for those likely to be in close contact with locals in infected areas. The vaccine is given as an injection alone, or with tetanus, and lasts 10 years. Diphtheria outbreaks are not uncommon in Afghani- stan, particularly in and around IDP camps.

HIV

HIV is spread via infected blood and blood products and through sexual intercourse with an infected partner. There is a small risk of infection through medical proce- dures, such as blood transfusion and im- properly sterilised medical instruments. At the time of researching this book, Afghani- stan had less than 100 officially recorded cases of HIV, but screening was limited to blood donors and the real figure is pre- sumed to be far higher. Increasing drug use and lack of public information may lead to greater infection rates. Be aware that clinics in Kabul treating expats regularly report other sexually transmitted diseases.

Leishmaniasis

Spread through the bite of an infected sand fly, leishmaniasis can cause a slowly growing skin lump or ulcer, leading to dis- figurement. It may develop into a serious life-threatening fever usually accompanied with anaemia and weight loss. Sand fly bites (most common between dusk and dawn) should be avoided whenever possible. Kabul is the largest centre of cutaneous leishmaniasis in the world, although WHO- distributed insecticide-treated bednets are attempting to address the problem, in tan- dem with its malaria-control programme.

Malaria

There is a significant malaria risk in Af- ghanistan between May to November in parts of the country below 2000m (includ- ing Kabul). Outbreaks most commonly occur after rains or flooding, especially in rural areas. Spread by a parasite transmitted by the bite of an infected mosquito, both

Plasmodium vivax and P. falciparum strains

exist in Afghanistan. Remember that ma- laria can be fatal and the risk of contracting the disease far outweighs the risk of any antimalarial tablet side effects.

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The most important symptom of ma-

laria is fever, but general symptoms such as headaches, diarrhoea, cough and chills may also occur. Diagnosis can only be confirmed through a blood sample. Two strategies should be combined to prevent malaria – mosquito avoidance, and prophylactic anti- malarial medication. Travellers are advised to prevent mos- quito bites by taking these steps:  Use a DEET-containing insect repellent on exposed skin. Natural repellents like citronella can be effective, but must be applied more frequently than those con- taining DEET

 Mosquitoes bite between dusk and dawn: sleep under a permethrin-impregnated mosquito net

 Use mosquito coils  Spray your room with insect repellent

 Wear long sleeves and trousers (not a problem with Afghanistan’s dress code) in light colours

There are a variety of antimalarial medi- cations available. Before travelling, seek medical advice about the right medication and dosage for you. Women should take particular advice if pregnant or taking the contraceptive pill. Note that chloroquine and sulfadoxine-pyrimethamine resistance has been recorded in Afghanistan.

Doxycline A broad-spectrum antibiotic. Potential side- effects include photosensitivity (a tendency to sunburn), indigestion, nausea, and thrush in women. More serious side effects include ulceration of the oesophagus – you can prevent this by taking the tablets with a meal and plenty of water, and never lying down within 30 minutes of tak- ing them. Doxycycline must be taken for four weeks after leaving the risk area. Larium (Mefloquine) This has received much bad press among travellers, some justified but most not, and the weekly tablet suits many people. Side effects are rare but can include depression, psychosis and fits, so anyone with a history of these conditions should not take it. Larium must be taken for four weeks after leaving the risk area. Malarone This drug is a combination of Atovaquone and Proguanil. Side effects are uncommon and mild, most com- monly nausea and headache. It’s the best tablet for short trips to high-risk areas, and must be taken for one week after leaving the risk area.

Poliomyelitis

Generally spread through contaminated food and water. It is one of the vaccines

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given in childhood and should be boosted every 10 years, either orally (a drop on the tongue), or as an injection. Afghanistan is one of the few countries in the word where polio is still endemic. Polio may be carried asymptomatically, although it can cause a transient fever and, in rare cases, potentially permanent muscle weakness or paralysis.

Rabies

Spread through bites or licks on broken skin from an infected mammal, rabies is fatal and endemic to Afghanistan. Animal handlers should be vaccinated, as should those travelling to remote areas where a reliable source of post-bite vaccine is not available within 24 hours. If an animal bites you, gently wash the wound with soap and water, and apply iodine-based antiseptic. If you are not vaccinated you will need to receive rabies immunoglobulin as soon as possible and seek medical advice. Vaccina- tion does not provide you with immunity, it merely buys you more time to seek ap- propriate medical help.

Tuberculosis (TB)

Along with Malaria, TB is one of the most serious health issues facing Afghanistan. Medical and aid workers, and long-term travellers who have significant contact with the local population should take precautions against TB. Vaccination is usually given only to children under the age of five, but pre-and post-travel TB testing is strongly recommended for adults at risk. The main symptoms are fever, cough, weight loss, night sweats and tiredness.

Typhoid

This serious bacterial infection is spread via food and water. It gives a high and slowly progressive fever and headache, and may be accompanied by a dry cough and stomach pain. Be aware that vaccination is not 100% effective so you must still be careful what you eat and drink.

ENVIRONMENTAL HAZARDS

Air Pollution

Air pollution is an increasing problem in Afghanistan’s cities, particularly in Kabul where a combination of dust and the pol- lution from vehicle congestion and massed generators gets everyone coughing. If you

IN AFGHANISTAN •• Environmental Hazards 225

have severe respiratory problems speak with your doctor before travelling. Air pollution can cause minor respiratory problems such as sinusitis, dry throat and irritated eyes. If troubled, leave the city for a few days and get some fresher air.

Altitude Sickness

Lack of oxygen at high altitudes (over 2500m) affects most people to some extent. The effect may be mild or severe and occurs because less oxygen reaches the muscles and the brain at high altitudes, requiring the heart and lungs to compensate by work- ing harder. Symptoms of Acute Mountain Sickness (AMS) usually (but not always) develop during the first 24 hours at altitude. Mild symptoms include headache, lethargy, dizziness, difficulty sleeping and loss of appetite. AMS may become more severe without warning and can be fatal. Severe symptoms include breathlessness, a dry, ir- ritative cough (which may progress to the production of pink, frothy sputum), severe headache, lack of coordination, confusion, irrational behaviour, vomiting, drowsiness and unconsciousness. There is no hard- and-fast rule as to what is too high: AMS has been fatal at 3000m, although 3500m to 4500m is the usual range. Note that quick ascents and descents – such as traversing the Salang Pass between Kabul and north- ern Afghanistan in a vehicle – are extremely unlikely to cause AMS. Treat mild symptoms by resting at the

same altitude until recovery, or preferably descend – even 500m can help. Paracetamol or aspirin can be taken for headaches. If symptoms persist or become worse, how- ever, immediate descent is necessary. Drug treatments should never be used to avoid descent or to enable further ascent. Diamox (acetazolamide) reduces the

headache of AMS and helps the body ac- climatise to the lack of oxygen. It is only available on prescription and those who are allergic to the sulfonamide antibiotics may also be allergic to Diamox.

The British Mountaineering Council (www.the

bmc.co.uk) has an excellent series of down- loadable fact sheets on altitude sickness.

Sunburn

Even on a cloudy day sunburn can occur rapidly, especially at high altitudes. Always

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