Author Archive

Traveller’s Thrombosis

 … Prepared by Dr Cormac Carey – TMA member Toowoomba

Travellers Thrombosis or Deep Vein thrombosis (DVT) is a rare but dangerous medical problem which occurs when blood in the legs of travellers clots. The serious problems occur when the clot dislodges from the leg and moves to the heart or lungs where it interferes with their performance.

While it is several years since “Economy Class Syndrome” entered our travel jargon the recent release of newer and safer anti- clotting agents make it pertinent to reappraise our approach to this issue. In practical terms, risk factors need to be identified and their importance weighed against appropriate medical advice for each individual traveller.

Risk factors for travellers thrombosis

The following factors may increase an individual travellers’ risk of suffering a thrombosis during travel:

  • Flights longer than 5 hours
  • Family history of abnormal clotting
  • Genetic clotting disorders
  • Recent lower limb surgery
  • Recent soft tissue injury of lower limbs
  • Pregnancy or shortly after delivery
  • Recent abdominal or pelvic surgery
  • Cancer
  • Female smokers who take the contraceptive pill

Persons with more than one risk factor are at even higher risk; E.G. Use of hormone replacement therapy in a woman, coupled with a genetic predisposition can lead to a thirteen times increased risk compared to the average traveller.

Perhaps the most important risk of all is having had a past episode of a Deep Vein Thrombosis with no recognised obvious trigger.

Some travellers have no particular risk factors. In that case, exercises as described on the aircraft instruction cards, plus plenty of water e.g. 200mls per hour are sensible precautions.

Low Risk Travellers

This would include persons over 40 years of age, overweight, or who have had recent minor surgery.
This group would be recommended to do as per low risk plus flight socks or grade 1 wear compression stockings
Note that persons with diabetes should seek medical advice before wearing any compression stockings.

Medium Risk Travellers

People aged over 50 years, previous DVT or pulmonary embolism (clot on lung), recent lower limb injury, treatment for heart failure, or women who have had a baby less than 6 weeks earlier.
Consideration should be given to booking an aisle seat, and wearing grade 2 compression stockings. Such stockings provide 20-30mmHg compression and only need to be knee high. They should be tried well in advance of the flight, as they can be difficult to put on when new.

High Risk Travellers

This category includes persons who have had DVT within the past twelve months, persons with a lower limb in a plaster cast or immobilizing splint, who have had a recent stroke or heart attack or major surgery within previous three months.
In addition to exercises, fluids, and aisle seat, consideration would usually be given to taking injections of low molecular weight heparin to lessen clotting during flight. Patients already on warfarin do not need heparin as well.

Persons who are hesitant to give themselves an injection prior to a flight, or who will have trouble carrying and storing injectible medication, will be happy to know there is now a medical breakthrough. There are new oral anti-clotting agents e.g. rivaroxaban. This is a prescription medicine that has been shown to prevent deep vein thrombosis in patients following hip and knee replacement surgery. Common dose for travel is one tablet daily, on the day before the flight, the day of the flight and the day after the flight.

Like all medications including the injectible heparin there is a potential for bleeding in the event of an injury, or a risk of interactions with other medications. The treating travel medicine doctor would consider these factors.


There is still no evidence that aspirin is helpful in preventing DVT as it affects the platelets and stops arterial clotting, but has very little effect on clotting in the veins. Users may experience side effects and be lulled into a false sense of security. If a person has significant risk, they should be on effective anticlotting medication as noted above.

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Exercise in Type 1 Diabetics

… Prepared by Dr Norman Hohl – TMA member Gold Coast

A fascinating presentation in Perth late yesterday at the Australian Diabetes Conference by a Paul Fournier showed the progressive fall in glucose for 2hrs after moderate exercise in Type 1 Diabetes, can be prevented by a 10 sec maximum intensity sprint immediately after the moderate exercise. This could be of critical benefit for travellers who find themselves unexpectedly without their carbohydrate emergency supply at hand.

(For regular sports, or adventure travellers, he showed convincingly that a 4 sec burst of max intensity sprinting every 2 minutes during moderate exercise, also decreased significantly the hypoglycaemia occurring in the 2hrs after.)

Clearly this is only for the emergency as carrying the glucose is better, but the unintended can happen, particularly when travelling, and this could prevent loss of consciousness.

A unique resource is now available for specific effective practical advice on exercise for type 1 diabetes. This is really an amazing web-based tool, that I am sure any Type 1 diabetes (T1D) traveller would find invaluable, as well as those who are fearful or confused about exercise and are not travelling.
Have a look at site here.

Allan Bolton has put enormous personal effort into writing this and has had to charge a subscription fee to make it viable. He is lobbying to get it available free without biased sponsorship deals, but currently it costs $85, but any T1D who likes sport and travel, or parent who wants their child to be active and liberated would find it well worthwhile.


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If You Can’t Afford Insurance You Can’t Afford To Travel

… Prepared by Dr Robyn Dawson TMA Member Burnie, Tasmania

Australians are making 6 million overseas trips each year. The first half of this year saw 1.5 million more travellers departing Australia than incoming tourists.

In keeping with Australian’s larrikin reputation, travellers are becoming more adventurous, exploring more remote and dangerous destinations with more challenging activities.

To assist persons in trouble overseas, the Department of Foreign Affairs provides Consular services. The number of services in a year has been know to exceed 35,000, spanning 163 countries.

Situations where assistance has been requested have included loss of property or passports, natural disasters (tsunami, earthquake, flood), civil unrest or terrorism, airline strikes, crime, serious accident, disabled cruise ship, serious illness or even death.

Thailand is a very popular destination, with its attraction of sun, surf and bars. However DFAT figures show that Thailand is the most dangerous country for Australians, with 343 deaths recorded from July 2005-June 2010. Causes reported include; Accident 62, Illness 147, Murder 5, Natural 48, Suicide 11, Unknown 70.

Trailing Thailand is Vietnam with 236 deaths, USA 229, Greece 239, Phillipines 225, Indonesia 195, Germany 188, UK 164, Hong Kong 155, China 144.

Travellers take uncharacteristic risks e.g. Driving scooters without helmets, wearing shorts and sandals. There is always the lure of drinking excessively on holidays and experimenting with drugs and casual sex.

The take home message is TAKE CARE – BEWARE. Travel Insurance is absolutely necessary.

In case of an emergency a medical evacuation could be required and this can be very expensive. If you are not covered by travel insurance the cost is yours. It is estimated that only 14% of travellers have all recommended vaccinations. Full medical preparation and insurance will give you peace of mind.

Be prepared and you will enjoy the adventure.


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Sri Lanka Tour

… Prepared by Dr Robyn Dawson TMA Member Burnie, Tasmania

Here I am sitting poolside somewhere between overheated and hot just from the exertion of walking from the hotel room up through the reception and dining room of this magic old English colonial hotel with a romantic story to keep you on the edge of your seat. I will have to leave you there for another time.

As I look across the inviting pool of Mt Lavinia Hotel to the rolling surf where the Arabian sea meets the Indian Ocean, to the skyline of a bustling city, I give away my location as being in Sri Lanka. With almost three weeks behind me in this land of contrasts I am reluctantly packing to catch the early morning flight to Singapore.

Ones first impressions are that at least 2 things are missing here …

  1. Seagulls which are replaced by a plethora of noisy black ravens, even on the beach, and
  2. Road rules. One sees many and varied modes of transport with “L” plates. I am not sure what they are learning except survival. You can do anything if you have a horn!

We started and ended our time in five star luxury that thrills the wallet, but spent 15 days on an Intrepid tour that covered all the major historic places. These included Anuradhapura, Polonnaruwa, Kandy, Colombo and Dambulla, each with their fascinating mix of ancient kingdoms, Portuguese, Dutch and English influence. Most of the lodgings were 2 star but clean and acceptable. Cheap tasty meals made up for reduced aesthetics and lack of fluffy white towels.

Just when almost “Templed” out our guide took us trekking through beautiful cool mountain tracks to the tea plantations and cascading waterfalls to stay in an original Managers Bungalow. We were entertained by our guides with local music (one of those special moments in the life of a traveller).

We visited spice gardens; saw a turtle rehabilitation centre; climbed 200m to a citadel in Sigariya; and then spent 2 days at a beach in pounding surf. We learnt to eat without knife and fork and not to roll our eyes when rice and curry where being suggested yet again. I wonder if my new found skill will go down well at home.

Another special occasion was when our guide, and now friend Bruno, took us to a family friend’s home and we all helped to cook a lively meal and learn the differences in curries, and how to make coconut cream and milk. His wife also joined in – we were family now.

Considering some of the off beat places we ate at and the prevalence of many stray mangy dogs and monkeys we were grateful for good advice from our travel doctor before our departure.

So now the thoughts of home and work are fast becoming a reality, we say goodbye. There is still much to explore here and while peace prevails here we promise to return.

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Elephantiasis – Sri Lanka

… Prepared by TMA Member Yeppoon, Qld: Megan Young (medical student)

Travelling to third world countries as part of a medical attachment can be a life changing event with life long learned skills and memorable experiences. This 64 year old gent was happy to share his story with Megan Young, our final year medical student, presently attached to a hospital in Sri Lanka. He has suffered this condition for 22 years. The risk to visiting travellers is quite low.

Lymphatic filariasis, also known as Elephantiasis, is a parasitic nematode infection spread me mosquitoes, in which the worms obstruct the lymphatic system, causing severe chronic lymphoedema. It may result in deformity and cause disability and is associated with social stigma. (WHO)

Wucheria bancrofti is responsible for around 90% of lymphatic filariasis infections, but Brugia malayi and B. timori may also be the cause. Infection occurs when mosquitoes (Culex, Anopheles and Aedes species) carrying the larvae of filaria bite a human, transferring larvae into the blood. The larvae enter the lymphatic system, where they mature into adult worms, where they form ‘nests’ which obstruct the lymphatic system causing lymphoedema, and, in more severe cases, elephantiasis (where the skin and tissues thicken). This occurs over a period of several years. Lymphoedema may occur in the limbs, genital and breasts. (WHO)

Lymphatic filariasis occurs in 83 countries in the tropics of Asia, Africa, and the Pacific and in certain regions of the Caribbean and South America.

Risk for Travellers:
Risk for travellers to endemic areas is low; however, lymphatic filariasis can occur in travellers who stay for extended periods in endemic areas.

There is no vaccination or prophylactic medication for lymphatic filariasis. It must be prevented throughprevention of mosquito bites.

Treatment of lymphatic filariasis is through mass drug administration (MDA) of albendazole 400mg with either ivermectin (150 – 200 mcg/kg) diethelcarbamazine citrate (6mg/kg). Treatment also aims to reduce lymphoedema and prevent secondary infections in the affected limb. (WHO)

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Immunisation – Children and Travel

… Prepared by TMA Member Yeppoon, Qld: Dr Julie Burke

Travelling with children can be very rewarding. People of all ages and cultures are drawn especially towards children, often making the family travel experience especially fulfilling.

Travelling with children does, however, pose some extra challenges. Ensuring optimum preventative care with pre travel vaccinations can eliminate some of these extra stressors.

Routine Schedule of Vaccinations

All travelling children should be immunised in accordance with the Australian National Immunisation Programme. If you can not find documentation of your child’s vaccinations; this can easily be retrieved from the Australian Childhood Immunisation Register. Travel doctors will tend to adopt the policy of “no documentation means not immunised” and vaccination will be recommended; as evidence shows the risk of adverse events if a child is inadvertently revaccinated far outweighs the risk of the disease.

Routine schedules are designed to vaccinate children at the earliest age when they respond with optimal, long-term protection. Little ones are more susceptible to disease but usually have little chance of exposure in Australia. However, travelling to developing countries, the risk of exposure may greatly increase. Almost all of the routine vaccines can be given early and more frequently than the schedule suggests.

Measles, for example; is an exotic disease in Australia, but is regularly re-introduced by young travellers, especially from regions where there is no national programme to eliminate it. The Measles/Mumps/Rubella vaccination can be given as young as 9 months of age but with a booster 3 months later.

Since late 2008, an Australia-wide whooping cough epidemic has seen an increase in hospitalisations of infants with life-threatening whooping cough. It is highly infectious; making little travellers highly vulnerable in crowded airports/aeroplanes/countries.

Polio has been eradicated from most of the world but still circulates in many developing countries, particularly Africa and the Indian sub-continent and, to a lesser degree, Indonesia and the Arabian Peninsula.

The routine whooping cough/diphtheria/tetanus/hepatitis B/polio vaccination given at at 2, 4 and 6 months can be given at 6 weeks; 10 weeks; and 18 weeks without affecting the booster immunity. The 3rd dosage may even be given as early as 14 weeks if the child at high risk; but an extra booster to cover for the hepatitis B component of the vaccination would be necessary.

Rotavirus; the predominant cause of severe dehydrating gastroenteritis in infants and young children in both developed and developing countries; can also be prevented through an accelerated schedule; the first dose of this can be given as young as 6 weeks with interval between dose between 1st, 2nd, and 3rd dose at 4 weeks minimum.

Meningococcal disease is both sporadic and epidemic throughout the world. with meningococcal C associated with small clusters in schools and child care centres. On the schedule; the protection against group C meningococcus is a single dosage of vaccine at 12 months; but this can also be given early 2-3 doses (dependant on the specific vaccine) starting at 6-8 weeks of age.

Travel-specific Vaccinations

Vaccinations such as Hepatitis A, Typhoid, Rabies, TB Japanese Encephalitis, and Influenza may be recommended to your child for country-specific disease cover and accelerated schedules may also be possible for these vaccinations.

Influenza, for example is one of the most common travel-acquired vaccine-preventable illnesses and vaccination should be considered in all children travelling overseas.

All persons aged up to 6 months should be vaccinated against influenza. The 2010 suspension of 2 influenza vaccines (Panvax and Fluvax) in Australia has been fully investigated; and the Australian Technical Advisory Group on Immunisation (ATAGI) has now recommended the use of 2 vaccines; InfluvacReg and VaxigripReg in children between 6 months to less than 10 years. Two doses one month apart are needed if under 10 and receiving influenza vaccine for the first time.

Such accelerated schedules are highly recommended for any families taking infants overseas for several months in their first year of life.

Travelling With Children Tip

Tired and hungry children do not do well with vaccinations! Well rested and fed children who have had Emla cream/patch applied to the area of vaccination area can make a huge difference to the pleasantness of a pre-travel consultation.

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A Year in South America

Brian and Debbie don their back-packs and pretend they are young – a year in South America.

Intrepid travellers from way back, my husband and I, at 53 years old, found ourselves rattling around in our huge empty nest, encumbered by possessions, job security, and misguided ideas that our adult children still needed us. We were feeling a tiny bit ‘old and achy’.
It had been a long journey since we’d first bumped back-packs in Europe in 1980. Four children and 30 years later, we had lost our ‘Mojo’ so, we took a year off from our teaching jobs and armed with our freshly gleaned Lonely Planet Guide, fledgling Spanish, overly-heavy back-packs, and traveller’s medical kit (thanks Dr. Julie Bourke); we landed in Buenos Aires just after Christmas 2009.

And thus began the adventure of our mid-lifetime! We had scribbled a loop clockwise around the continent, including all 13 countries with side trips to Antarctica, Easter Island, Galapagos and Cuba allowing roughly a month in each of the big countries and highlighting a few “must-sees” like Macho Picchu and Iguaçu Falls.

For us all the fun of travelling has always been, getting down and dirty and mixing it with the locals in their everyday lives – catching local transport, sleeping in hostels and cheap hotels, and eating in the local food-stalls.
This kind of rough travelling is not for every ‘oldie’. It was tough and not without its dangers!

At first it was hard to sleep in public – in strange beds. I’m not sure if modern unisex dormitories and bathrooms represent progress?

Sleeping soon became a non-issue as we toughened up. Pounding the pavements for hours every day, trekking up and down mountains, cycling and horse-riding made us so tired, we could sleep on a stone!

Wherever possible we caught local transport, from the world-class buses of Argentina and Brazil with airline-like service – to the bone-rattlers of Bolivia and Ecuador, jam packed with people, produce and peddlers- selling everything from hot food to God (evangelists), as the drivers careened down the mountains, at break-neck speed with one hand on the wheel, the other on their mobile phones.

Dealing with endless dysfunctional and often dirty toilets, or simply trying to find one at all was a daily challenge!

We learned to eat all manner of meat/ chicken and potatoes. Apart from the excellent ‘barbeque bife’ in Argentina and the odd spicy local delicacy like empanadas the food is … well … boring. People are poor and eat basic fare.Probably the biggest disappointment in a continent that produces some of the world’s best coffee is that incredibly, they mostly drink instant Nescafe!Life at the rough end of the travel spectrum, involves hassles at border crossings, and inevitably being robbed. Not many people can survive a year in South America without being relieved of some of their goods! We both lost our mini back-packs on separate occasions, cried with outrage …  and got over it. No one can be vigilant 24/7.

But life at the rough end is where all the fun is! We work on the premise, that people are basically good and that a smile goes a long way.

The only regret I have about being Australian is how dumb we are with other languages. Listening to Europeans slip in and out of 5 lingos in a conversation has always filled me with shame and envy.Fumbling along in our basic Spanish, we decided to home-stay in Sucre, Bolivia and attend language school for 2 weeks. After that, we ‘upped the ante’ and persevered till our heads ached.

Then one magic day, we realized we had passed through a barrier and could understand a great deal of what was being said around us. I can not explain what a thrill that was! Speaking the lingo takes the ‘tourist’ stigma away and opens so many doors to experience the hospitality and kindness of the wonderful local people.
Although border crossings and late night bus travel can be scary, we were rarely frightened, except when we were caught in 2 natural disasters.
Firstly the earthquake in Chile, ‘shook us to the bone’. We were in a cheap and rickety old hotel in Valparaiso, asleep, when the whole building began to shake….. then rock….. and then belt the furniture from one side to the other! The plaster ceiling showered down on us and the walls cracked from top to bottom. We eventually made a run for it down the swaying cracking stair-cases to the square outside. The after-shocks went on for days. Towns went into lock-down and looters and armed guards controlled the streets. Brian had his day pack stolen. Scary stuff!

We now have a new understanding as we watch news coverage of those kinds of events.The 2nd time we thought our number was up was when we were trekking to ‘the lost city’ in the Columbian jungle. A huge mudslide engulfed the dodgy-built bunk-house, where we were resting after lunch. I swear I broke the world land- speed record as I leapt up over boulders and up the ridge as the whole mountain came down! I couldn’t find Brian! He had run the other way!The local guides frantically started digging in case someone was trapped underneath. Miraculously everyone had escaped! Many in our group lost everything. It was a long muddy 3-day trek back to civilization in shared clothes and various improvised footwear held on by gaffer tape! We still keep in contact with the 17 magnificent people on that trek (from 14 countries). We developed a wonderful camaraderie and respect through that shared hardship. Humour abounded as we hugged each other in the nightly soggy giant ‘spoon’ to keep warm.

As for illness, we picked up a couple of tummy bugs, suffered from mild altitude sickness several times and Brian had the horror of discovering a hook worm winding its way under the skin on his little toes! Teach him to walk around bare-footed!

South America has it all:- trekking in the awesome Andes; battling the wild winds of Patagonia; marching Incan trails to Machu Picchu; discovering Columbia’s lost city; sweating it out in the Amazonian jungles of 5 countries; catching and eating piranha (before they eat you!); chugging up the Mighty Amazon itself in Brazil on a supply boat; the seductive music and rhythm of the Latino Salsa and Tango; the enduring Catholicism, cathedrals and cobble stones of the great Spanish Conquistadores; the ingenuity of the Incas; the white wonderland that is Antarctica; the quirky culture of Cuba (a society cut off from the real world); the amazing animals of Galapagos; enigmatic Easter Island; the boisterous Bolivian markets; the surrealism of the high altitude salt plains of the Atacama Desert; the sexy culture of iconic Ipanema Beach in Rio de Janero … I could go on and on …

We left old and achy feeling like the best years of our lives were over and returned, a year later, feeling young and invincible! We can do anything!

Next stop – Africa!

… Prepared by Debbie Mann Yeppoon State High School, Queensland

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Philippines and Thailand – Leptospirosis Risk


The Philippines is regularly battered by tropical cyclones that bring flooding to large portions of the country from late May to early December. Leptospirosis is a disease associated with freshwater flooding and is an infection commonly transmitted to humans from water that has been contaminated by animal urine (usually rats), and comes in contact with lesions on the skin, eyes, or with the mucous membranes.

From January to 24 Sep this year, there have been at least 2061 recorded cases of leptospirosis with 156 casualties in the Philippines whilst in Thailand at the moment as flood waters continue to menace Bangkok and its surrounds, as well as the hundreds of cases of acute diarrhoea that are being reported each day, there have been 2 deaths from leptospirosis.

The signs and symptoms of leptospirosis include fever, chills, and intense headache. These appear within 4 to 14 days after exposure to contaminated flood waters or even mud. These may be accompanied by red eyes, jaundice, tea-coloured urine, and difficulty in urinating. In extreme cases, complications like meningitis, renal failure, and respiratory distress may arise and lead to death.

Advice to travellers: Minimise exposure to floodwaters where possible and wear protective gears such as boots and long pants in wading through flooded areas to reduce the risk of infection as the bacteria usually find their way through abraded skin or open wounds. Antibiotics may be recommended as prevention for those at high risk of exposure; or as treatment for those experiencing early symptoms.

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Racing To Paradise – Fremantle to Bali

… Prepared by  TMA Member Wembley, WA: Dr Shane Leavy

The Fremantle to Bali Yacht Race was held for the first time this year after a 14-year hiatus. Having sailed as a kid and more recently raced across the Atlantic I was more than keen to be a part of this adventure.I recently joined the team at Capstone Health with Matt Atkins and Dave Rowse and as such I was keen to put into practice my burgeoning travel medicine skills to go with those I’ve gained from my time in Emergency Medicine. All in all I couldn’t think of a better way to practice what you teach!

As owner and skipper of “Farr Lap of Sydney”, I persuaded my land lubber father, Dr Richard Leavy and friend, fellow emergency doctor and sailor, Dr Stephen Grainger to join the crew.

Farr Lap was one of 22 yachts that competed in the 1400 NM (3000 Km) race to Bali. It was the adventure of a lifetime, getting the crew organised and the yacht ship shape and ready for such a journey was an adventure in itself. Fremantle to Bali is 3 times the distance of the Sydney to Hobart with nowhere to seek safe haven once the WA coast is departed off the Exmouth Peninsula.

Adding to the adventure, whilst sailing at the top end of the fleet, Farr Lap began to take on water, more water than had come through the hatches during the first few days of unseasonal norwesters. A decision was made to stop in Exmouth to repair a small crack, which was found to be the cause of their problems.

Reaching Bali in 11 days and a respectable mid fleet position, we spent a restful week in hotel luxury sharing salty sea tales with the rest of the fleet. We then departed for a month of cruising the exotic Indonesian Archipelago, which included Lombok, the Gili Islands and Sumbawa. Waking in hammocks swinging on the yachts’ deck amongst the local fishing boats and seeing the sun rise over Volcano Rinjani was truly an unforgettable experience.Thankfully all the advice and preparation we put in, not only for our boat but also for the rest of the fleet paid off as we managed to avoid any major medical catastrophes and with a little bit of luck we also avoided any minor medical inconveniences along the way simvastatin dosage. (The odd episode of seasickness excluded of course).

The challenges involved in not only the effort of completing the race successfully, but the organizational tasks of preparing our crew and those of the fleet for potential traumatic medical emergencies and also for any travel related problems for the time around the Indonesian islands for many of the boats, were bigger than I had originally planned for, but also incredibly satisfying once it all came together without incident.

Asked if we would do it again for the next race in two years time? All our hands are raised!

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Trekking Ethics

Prepared by  TMA member Wembley, WA:  Dr David Rowse

It’s that time of year when we get more trekkers through the travel clinic in search of advice about safety in the mountains for their coming adventure. These intrepid travellers will be either trekking by themselves or in groups and most will be seeking the assistance to help get them up and down the mountain safely. As a result in these mountain regions all over the world, thousands of locals work as trekking and climbing porters carrying extraordinary loads up and down trails.

However these porters are often considered among the lowest social positions within the community and too frequently are exploited by their employers who pay poor wages, do nothing to improve the working conditions and this results in very ill equipped with insufficient clothing or footwear

In 1997 there was a tragedy in which a young Nepali porter employed by a trekking company became severely ill with altitude illness. He was paid off and sent down alone. It took just another 30 hours for him to die. He was 20 years old and left behind a wife and 2 small children. The International Porter Protection Group (IPPG) was formed to prevent such tragedies.

It is a fact that more porters suffer from accidents and altitude sickness than western trekkers and that every year porters die unnecessarily on the job. Many are affected so badly by frost bite or snow blindness that they are unable to work again and unable to support their families.

Whether its Nepal, Pakistan, Tanzania, Peru or any other trekking destination, the problems faced by trekking porters share are the same, whether they be inadequate wages, a lack of appropriate clothing, footwear or safety equipment or a lack of medical care should they fall ill or become injured.

Choosing a Trekking Company

Before you book your trek ask the travel company what their porter policy is (see below for questions to ask). Contact organisations which offer ethical trekking agreements to which trekking companies can sign up. Finally, if you see porter mistreatment then complain loud and long on the spot and once home complain to your travel company. Send a report of the incident to IPPG with as much detail as possible.

Questions to ask trekking companies:

1. Does the company follow IPPG’s five guidelines on porter safety (detailed on their website)?
2. What is their policy on equipment and health care for porters?
3. What do they do to ensure the trekking staff is properly trained to look after porters’ welfare?
4. What is their policy on training and monitoring porter care in the country you intend to visit?
5. Do they ask about treatment of porters in their post trek feedback questionnaire to clients?

So is the answer to avoid using porters on your trek? Of course not discover here. If you act responsibly and choose an ethical company, employing porters is a very good way to assist some of the world’s poorest communities and create jobs for meagre subsistence farmers to supplement their income so the more porters you can employ the better!

Despite their hard graft, you’ll discover that the grace and enthusiasm of your porters will add a wonderful dimension to your trek.

More Information
International Porter Protection Group:
Australian Himalayan Foundation:
Porters’ Progress UK:


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