South Pacific – Other precautions

Dr Colleen Lau
Food and Water-borne Diseases

The same precautions with food and water for developing countries apply in the Pacific Islands: Cook it, peel it, boil it, or forget it! However, it is not always easy to follow these rules at all times during travel. Depending on your trip, your travel doctor might recommend vaccinations for Hepatitis A, typhoid, and travellers’ diarrhoea. It is always a good idea to have a simple medical kit with medications for treating traveller’s diarrhoea, and correct treatment could mean that you are better in a few hours rather than being sick for days or even weeks.

Kayaking in Pago Pago Harbour, American Samoa – Chosen by Lonely Planet as one of the top 15 experiences in the Pacific Islands!
Blood-borne and Sexually Transmitted Infections

Hepatitis B is common in the Pacific Islands, and an estimated 25 to 30% of the local population have chronic Hepatitis B infection. Travellers should consider Hepatitis B vaccination if they plan to live or work in the Pacific, or expect to have close contact with the local population. All Australian children are now routinely vaccinated for Hepatitis B. Sexually transmitted infections are common, and HIV is also becoming a problem.

Others

There is no risk of rabies on the Pacific Islands, but dog bites are common on some islands, and American Samoa has the unenviable reputation of having the highest incidence of dog bites in the world! Scuba diving is a popular activity, but there are few decompression chambers in the Pacific in case of mishaps. The Divers Alert Network provides information and insurance for scuba divers. Ciguatera fish poisoning is caused by marine microalgae in the tropics, and can cause nausea, vomiting, abdominal pain, diarrhoea, muscle cramps, paraesthesia, and a reversal of hot and cold sensation. It is riskier to eat large fish because they accumulate for toxin by eating smaller fish. As a general rule, if the fish fits onto a dinner plate, Ciguatera is unlikely to be a problem. It is best to avoid eating large reef fish such as barracuda and grouper. More information on ciguatera can be found in the June 2009 edition of the TMA Newsletter.

Natural hazards such as cyclones, earthquakes, and volcanic eruptions are part of everyday life, but serious disasters are relatively rare. Indeed, volcanic activity is responsible for creating many stunning and incredible landscapes throughout the Pacific, including extinct craters filled with rainforests and bats, tiny islands with sharp jagged peaks piercing the sky, abandoned villages half buried by old lava, and active volcanoes that are still erupting today.


Tinakula, Temotu Province, Solomon Islands. On a rest day from fieldwork, the local team on the Solomon Islands showed me their active volcano, which was about an hour’s boat ride from where we were working. Tinakula is only 3.5km wide, but rises 850m above the ocean, and has been uninhabited for decades because of eruptions. Even from a far distance, it is clear that Tinakula is highly active, with smoke pouring out from the top of its cone. But the true forces of nature could only be appreciated from up close, where rumblings from the volcano could also be heard and felt, and hot rocks seen spurting into the sky, and then tumbling down the hill into the ocean with a big steaming splash.

… Prepared by Dr Colleen Lau, TMA Perth and Brisbane

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South Pacific – Leptospirosis

Dr Colleen Lau

Leptospirosis is a bacterial infection that is often misdiagnosed as dengue because symptoms can be very similar. The bacteria are carried by animals (including rodents, pets, livestock, and wildlife), and excreted in their urine. Humans can become infected by direct contact with animals, or contact with water and soil that has been contaminated by animal urine. The risk of infection is especially high after flooding, because floodwaters can spread the bacteria, and wash them into rivers and streams. During flooding, people often have to wade in water and therefore have cuts, wounds, and waterlogged skin, all of which increase the risk of infection. In the Pacific Islands, recent outbreaks have occurred after cyclones and flooding on some islands including Fiji and New Caledonia. People participating in outdoor activities are also at risk because of contact with fresh water and soil. The risk of infection can be reduced by wearing protective clothing and boots, cleaning and covering wounds, and avoiding swimming in freshwater streams and rivers after heavy rainfall. The bacteria do not survive in seawater, so there is no risk of leptospirosis from swimming in the ocean.

Leptospirosis research team at work in American Samoa. Left: Unloading fieldwork gear on the remote Manu’a Islands in the far east of American Samoa. Right: Collecting blood samples and questionnaire data. Our study collected data from over 800 people from 5 islands in American Samoa, and found that about 15% of people have had previous leptospirosis infections. The study investigated environmental factors that increased the risk of leptospirosis transmission, produced maps to predict high-risk areas, and provided information to improve public health interventions.

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Island Hopping in the South Pacific

Dr Colleen Lau is one of the founding travel doctors of the TMA Perth Clinic, and also works at the TMA Brisbane Clinic. Over the past 3 years, she has travelled around the South Pacific for tropical medicine research projects and consultancies, and has just completed a PhD in infectious disease epidemiology at the University of Queensland. In this article, Colleen provides us with information on health hazards in the South Pacific, and some snapshots from her research trips in American Samoa, Vanuatu, and the Solomon Islands.

Travel Health Precautions for the South Pacific

If you expect to find remote islands, underwater adventures, friendly smiling faces, flower garlands, tropical sunsets, coconut trees, and cocktails in the South Pacific, you will not be disappointed. On a world map, the islands look like tiny dots in the vast ocean. Close up, they are home to incredible diversity in culture, history, language, landscape, economy, and wealth. Consequently, sanitation, hygiene, and the quality and availability of health care also vary dramatically between the island nations. Although the Pacific Islands conjure images of tropical paradise, most of them are developing nations, and there are health issues that travellers should be aware of. Prevention is always better than cure, and the risk of many of the health hazards can be significantly reduced by simple precautions.

Rainmaker Mountain, American Samoa. After a 2-hour uphill hike, the view from the top of Mount Alava is breathtaking. Everything is lush and green, because American Samoa is one of the wettest inhabited places in the world, with an annual rainfall of over 3000mm. For my leptospirosis research project, I spent 3 months there during the ‘dry’ season, and it rained every single day!
Mosquito-borne Diseases
  • Dengue occurs throughout the South Pacific. In most tropical areas around the world including the Pacific, the frequency and size of dengue outbreaks have increased in recent years due to a combination of demographic, environmental and climatic factors. In one of my studies from American Samoa, about 95% of adults had antibodies to dengue viruses, indicating that they had been infected some time in the past. Dengue can cause fevers, a rash, sore bones/joints/muscles, headache, and a flu-like illness. A very promising dengue vaccine is currently being tested, and will hopefully be available in a few years’ time.
  • Malaria is found in Vanuatu and the Solomon Islands, but there is no risk in Fiji, Samoa, American Samoa, Tonga, French Polynesia, Cook Islands, or the Micronesian Islands. In Vanuatu, malaria is found in virtually the whole country, but is low risk in Port Vila and Tafea Province (including Tanna Island, where the famous active volcano Mt Yasur is located). Malaria is also found throughout the Solomon Islands, but is low risk in Temotu Province in the far south. In Tanna and Temotu, an AusAID-funded Malaria Elimination Program has significantly reduced the number of malaria cases. If travelling to Vanuatu and the Solomon Islands, you should speak to your travel doctor about antimalarial medications. Malaria is a potentially fatal infection, but is treatable if diagnosed early. If you develop any fevers during or after travelling to the tropics, see a doctor as soon as possible.
  • Chikungunya virus has spread over the past few years from East Africa to the Indian Ocean Islands and Asia, and local transmission was recently identified in New Caledonia and Papua New Guinea. There is therefore a risk that the virus will continue to spread to surrounding countries including Australia and the Pacific Islands. The infection can cause quite disabling symptoms including fever, rash, joint pain and stiffness, and severe tiredness. A large Ross River virus outbreak swept through the Pacific Islands in 1979/1980, but there have been few reports of infection since then.

    When travelling in the South Pacific, it is therefore very important to take precautions against mosquito bites by using DEET-containing repellents, wearing protective clothing, and using mosquito nets or screened accommodation. Perfumes can attract mosquitoes and should be avoided.


Village health post (left) and Tanna Hospital (right), Tanna Island, Vanuatu. Health care and medical supplies are limited, especially in the more remote islands. It is always best to carry a few basic supplies, and the most common items that travellers need are medications for diarrhoea, colds and flus, and pain-killers, and simple dressings for minor wounds and injuries.

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Travel Right, Travel Light

… Provided by Dr Joan Chamberlain, TMA member Rockhampton

 

Often people put a lot of time into their itinerary and flights but forget about pre travel advice and preparation. Also forgotten at times is consideration to your luggage and packing.

Consideration should be given to your destination, activities, length of flight and luggage requirements.

1. Choosing Luggage

Although each traveller will have different needs some principles remain the same. Choose a good quality bag. You will get what you pay for and you want to get your best mileage out of it. If for under the plane, light weight, two sets of handles, and preferably with wheels and pull out handle. You will not always have trolleys or assistance at your destination. If back pack for under plane, ensure you bag does not have straps or portions that can get caught or torn on automated conveyers or transport belts. Be careful not to have baggage tags that can also be caught. Find another way to ID you luggage. Also ensure that zippers do up well and are unlikely to undo with handling. You do not want to own the bag on the carousel with the under pants taped to the outside.

Put your contact details inside the bag or ensure it is well covered. You don’t need to advertise your details. E.g. If you have a bag with a name place, put your card with details towards the inside.

Watch your luggage. Never leave it. More luggage is stolen from the ground than lost from transportation.

2. On flight bag…what to carry

You and your under plane luggage can be parted. Your onboard luggage and your handbag are easier to keep tabs on. Make sure the bag complies with the airlines limits. They can refuse to carry, charge hold fees etc if not compliant. Name everything. Ensure your bag is well labelled. Enclose eye wear, tooth brush and paste, hair brush or comb, moisturiser and a change of underwear. Lost luggage and arrival clothes are not fun for 2 days waiting for lost luggage. A fresh set of under clothes is vital. Ensure medications, travel letters and a copy of documentation is also kept on board. Valuables should not be stored in the hold, take them on board. Phone, camera, jewellery, passports, money, travel checks etc should be carried in your hand bag or in a body belt. Pack a book or activity for in flight.

3. Carry what you know you need, not the spares

Most people just carry too much. You really only need a minimal number of underpants, not one for every day. Most times you can rinse or wash. The same with day clothes, evening wear, rationalize. Spare toiletries? Try buying them. What about the accessories. Do you want to carry these everywhere just in case? Get a seasoned travel friend to revise your bag and show you how to pack it, or read a book on it.

4. Travel with expectancy, good attitude and flexibility

I am yet to have a travel experience where all goes well and according to plan.

Take your attitude and flexibility pill before you go, especially with lost luggage. Handle schedule changes gracefully and ask for assistance with ongoing flights etc as needed.

Don’t harass the ones trying to assist you. You may be surprised to know that when the customer’s attitude is aggressive, accusing and harassing to the ground crew at the arrival destination, where they had nothing to do with the luggage becoming lost, some luggage will JUST never be found. A pleasant and polite attitude asking for their assistance without accusation will do more to track down your luggage than anything else. Always report lost luggage early and with good attitude.

Trauma with time becomes humour and a good story at the next party!

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Melatonin And Jet Lag

Melatonin is the hormone of darkness – a hormone from the pineal gland in the brain which controls the body’s internal clock. Melatonin levels increase when it is dark outside and this causes you to feel sleepy. A great deal of research is being undertaken on melatonin to clarify its role in treatment of jetlag.

In the United States, melatonin is available without a script and outsells vitamin C. In Australia, some melatonin is available on a script. In Dec 2002, a literature review found that 5mg of melatonin, taken at the target bedtime at the destination (10pm-midnight), for 2-5 days after arrival, decreased jetlag resulting from flights crossing five or more time zones. It seemed to work best in persons who were travelling eastward.

Melatonin is not recommended if you have epilepsy or take the drug warfarin. Science News 2008 published information about a food related ‘clock’ in the brain, that overrides the light based ‘clock’. A period of fasting for about 16 hours (e.g. no eating during the flight) and then eating as soon after landing seems to help travellers adjust to the new time zone more quickly than they would otherwise do.

… From “Travelling Well”. Available here for your kindle from Amazon

 

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Europe – Tick Encephalitis

 

Recently a US family have been awarded $41.7 million in compensation for their daughter catching Tick Encephalitis on a school trip to China. More info.

The disease is quite rare in China but is not uncommon in Europe. Most Australians have never heard of this disease! Tick Borne Encephalitis is a serious disease carried by tick bites in Europe. 1-10% of ticks in affected areas may harbour the virus, and whilst many sufferers have no effect, the disease can cause brain damage and death.

If you are travelling to Europe in the summer (risk season is April to October) and spending a month or more in the forests, vaccination may be recommended. The vaccine is not readily available in Australia, but in Europe the vaccine against TBE is the largest selling private vaccine. There have been 35 million doses prescribed since 1980. Austria has a national program for routine vaccination. Consult your local TMA clinic for more information. More info.

Areas with TE
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A Dental Experience In Thailand

 

Surrey Hills Senior Clinic Receptionist

I decided to research dental treatment in Thailand after being quoted on a (costly) treatment plan by my Australian dentist.

A colleague who had previously had dental treatment in Thailand, and my brother-in-law who lives part of the year there, encouraged me and reassured me that the high end Thai dental clinics were safe and offered a full range of dental services.

I contacted the clinic recommended to me, firstly by email and promptly received a reply from the dentist assigned to me, requesting the medical and dental history and x-rays etc. that she required to plan and quote.

Meanwhile, I sought travel medicine advice, with particular regard to ensuring I was up to date with Hep A and B immunisations. I also took a course of antibiotics with me to take at the first sign of any infection (which fortunately wasn’t necessary).

The dentist continued email contact with me, with an excellent command of English and reassuring manner. Closer to the time she phoned me a few times confirming how best to book my trip around treatment. It was to start in Bangkok the day I arrived in Thailand, then I would travel to Phuket for a beach holiday and the work would be completed there, including removing the temporary crowns applied in Bangkok, and replacing them with my new ones. Finally Zoom whitening of my remaining teeth was to be done. An unexpected complication was, upon examining me the dentist was unhappy with the integrity of pre-existing root canal treatment of a tooth done in Australia. She arranged a car to take me to an endodontic specialist in Patong that day. I felt momentarily anxious because I hadn’t researched this new place. Anyway, I proceeded and the tooth was retreated to ensure I didn’t encounter trouble beneath the new crown in coming years. Fortunately, the professionalism, equipment and clinical environment at the endodontic clinic also appeared faultless.

In the end I returned to Australia with a complete dental makeover, completed in 2 weeks costing between 30 and 50% of what I would have paid at home. The group of clinics have a very informative website, but didn’t mention, and which I discovered to my delight, that most of the treatment was done in an elevated room with panoramic views over a beautiful beach, and any discomfort I may have experienced was counted by the attentive dental assistants massaging my feet and hands. Perhaps it’s unremarkable there, but what a treat for us Aussies.

I was farewelled with a mouthguard to use at night and a Zoom maintenance treatment to use after 12 months. I had an issue with a tooth a year later and emailed the dentist for advice. By the end of the day she had replied, advising it was not a tooth treated in Thailand, but she gave good and detailed advice and emailed me a week later to ensure that I had seen a dentist here.

Cheaper treatment is available but may come with an increased risk. My overall experience was very positive and extremely cost effective.

 

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Volubilis, Morocco

Prepared by Dr Deb Mills – TMA member Brisbane

Volubilis is a partly excavated Roman ruin in northern Morocco. Built in a fertile agricultural area, it was developed from the 3rd century BC onwards as a Phoenician/Carthaginian settlement. It grew rapidly under Roman rule from the 1st century AD onwards and expanded to cover an area of about 40 hectares (100 acres) with a 2.6 km (1.6 mi) circuit of walls. The city gained a number of major public buildings in the 2nd century, including a basilica, temple and triumphal arch. Its prosperity, which was derived principally from olive growing, prompted the construction of many fine town-houses with large mosaic floors. More info.
I am a fan of ancient ruins, and this site was one of the highlight of my trip to Morocco. It is a short trip from Fez or Meknes, either by private car or bus. Morocco is a country for mosaics but this site has some rather well preserved mosaics from roman times. The ruins are substantial enough to give a very vivid picture of the locals who lived in the city at that time. The rich Romans seemed to have built a very comfortable life for themselves. The ruins are still surrounded by farmlands which makes a most picturesque setting. There are no signs or maps on any of the structures when I was there, so it helps to have a guide to get the best stories and make the most of your visit.

 

TIP: Arrive as early in the morning as you can (7am) before the bulk of tourists … as we were leaving … 5 large tourist buses arrived!

 

You may be interested in Dr Deb’s one minute video: Why travellers seem to be complacent about their health. It was filmed in Volubilis. Watch it here.


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Egypt – Hot air balloon disaster

We are all saddened by the tragic story of the 19 tourists killed in Egypt after their balloon flight went horribly wrong.WHO reports Tourists are 10 times more likely to die as the result of an injury than from an infectious disease

; injuries cause 23% of tourist deaths compared with only 2% caused by infectious diseases. Contributing to the injury toll while traveling are exposure to unfamiliar and perhaps risky environments, differences in language and communications, less stringent product safety and vehicle standards, unfamiliar rules and regulations, a carefree holiday or vacation spirit leading to more risk-taking behaviour, and overreliance on travel and tour operators to protect one’s safety and security. 

Safety in the air takes major attention to every tiny detail, obsessional training of pilots and maintenance crew, tightly enforced government regulations, expensive and well maintained equipment and so on. This article in Sydney Morning Herald on the balloon disaster in Egypt is worth reading for anyone planning balloon flights. 

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Hangover Cures – Do They Work?

Dr Deb Mills – Brisbane TMA Member

In about 4000BC, agriculture started, some say to make Beer as well as food.

They don’t call it inTOXicated for nothing … those enjoyable drinks also contain cell poisons that can affect all body systems for up to 72 hours. 

Even after your alcohol has fallen to zero, there are still some measurable effects on manual dexterity, memory, reaction time, visual-spatial skills, and attention.

We also recommend that persons avoid alcohol for 48 hours before or after vaccinations to get the best result from vaccines.

There are a host of interesting hangover cures that have been proposed over the years

BEFORE DRINKING

  • Lemon in armpits before drinking (!)

AFTER DRINKING

  • LIQUIDS – cucumber/ tomato /cabbage/ banana peels/ buffalo milk/ coffee / tea with
  • ADDED: tripe/ raw eggs/ dried bullock penis/ sheep eyes/ rabbit droppings
  • FLAVOURINGS: pepper / salt / garlic/ Worcestershire sauce
  • FOODS: pickled herring, pickled plum, cod, deep fried canaries!
    or even …
  • PUNISH THE BOOZE: place 13 black pins in the cork of the bottle
    or
  • MORE BOOZE: ‘Hair of the dog’

Do they work? Or does consuming all these unpleasant things just take your mind off the bad headache?

Needless to say, the above cures do not have much of an evidence base to support them.

A recent study in the BMJ found NO compelling evidence exists to suggest that any conventional or complementary intervention is effective for preventing or treating alcohol hangover. The most effective way to avoid the symptoms of alcohol induced hangover is to practise abstinence or moderation.

Alcohol seems to increases the likelihood of sexually transmitted disease and unintentional injury in travellers. (more info)

Even locally, the figures show that an Australian who consumes more than 8 standard drinks a day is twice as likely to die from injury than chronic disease.

As with many things, alcoholic drinks should be consumed in moderation.

These are Australian Guidelines

  • For healthy men and women, drinking no more than two standard drinks on any day reduces your risk of harm from alcohol-related disease or injury over a lifetime.
  • Drinking no more than four standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion.

Ideally these guidelines should be followed on holidays as well!

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Travel Health Information

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