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: www.ippg.net
Australian Himalayan Foundation: www.australianhimalayanfoundation.org.au
Porters’ Progress UK: www.portersprogress.org


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The University Traveller

… Prepared by  TMA  Clayton, Vic:  Dr Craig Blandy,

Travel Risk has a Social Denominator

The university traveller travels to a university in another country for their studies or work. Over 2 million people travel for this purpose each year. The Australian Government Outbound Mobility Study (2008) states that there are 400,000 inbound people living in Australia on student or educational work visas and around 30,000 outbound. Most of these people link their academic and travel ambitions into a cultural experience. Australian universities are vibrant and culturally diverse communities that have evolved over the past decade as major contributors to world education.

Monash University operates a University Health Service for all students and staff. The Clayton campus has a population of nearly 20,000 with student enrolments and staff from nearly every country. These world people allow us, at the health service, the privilege to be the virtual traveller, enriching our travel experiences with their stories of home. It also allows us an insight into the influence of normal social customs and cultural exchange as risk factors in travel.

The desires and the risks of travel appear to have common denominators that are based in the learned social existence of the country of residence. Overall infectious disease is not the major risk to the health and wellbeing of travellers. The risks are embedded in the normal social behaviours of the landed destination abutted with those of the visitor. Those things that are known to the resident and are unknown to the visitor; or even those things experienced by the resident and not by the visitor.

There is a consistent message of understanding the nuances of the society; its rhythm. Most of the health risks of each group can be categorised in the same way; whether the person be here or there.

Preparation for Travel

Most inbound university travellers spend months studying the local nuances of life in Australia prior to arrival and are not easily misled by the early teasing of fellow students with stories of “drop bears” and “street kangaroos”. There is an American-Australian slang dictionary that is usually well studied to minimise social embarrassment such as the oft quoted example of the young man introducing himself to a young woman with “Hi … I’m Randy (Randolph)”.

Monash students travelling to overseas campuses of Monash University and overseas universities receive orientations to achieve a destination and cultural familiarisation.

First Principle: Understand the rhythm of the destination

Local Laws

Medications and Drugs
Australian customs law allows a person to bring with them up to 3 months of medication with evidence of its proper prescription in the country of residence. Many North American students are prescribed various medications for a range of mental health issues. Some of these medications are illegal in Australia. Australian customs law permits these students to carry with them a 3 month supply and then an Australian doctor needs to be consulted to gain special access to the medication. Each year there are students visited by efficient Australian customs officers following attempts to import medications, legally prescribed in another country, that range from marijuana to amphetamine derivatives. All travellers need to be aware of local laws; in this case ours.

For the outbound Australian it is illegal to take pharmaceutical benefit medications from Australia other than for personal use. Read more here.

A common request made to doctors is a letter listing the persons prescribed medications. This letter needs to describe the medication, form, strength and quantity needed. At the University Health Service we seek consent to declare the reason for use of the medication on the letter. Despite this letter, and the legitimate prescription of your medication in Australia you may still find yourself in close confrontation with foreign customs or police, just like some of our inbound students. In Greece it is illegal to transport codeine in any form, regardless of its clinical indication, and Singapore’s prohibition on chewing gum extends to Nicorette. So contact the embassy of the country you are visiting to ensure the medicine is legal in their jurisdiction. It is a good idea to carry medication in the original packaging to minimise confusion.

Second Principle: Understand the customs and laws

The Road

The major health risk to all travellers is road related injuries. The dangers of road and pedestrian travel have been addressed in the TMA Newsletter of August 2010; road travel in Vietnam. In Vietnam the traffic does not stop, like a school of fish it parts and goes around objects and those who have socially adapted responses to these patterns see it as organised, functional and in continuous flow. If you live there it has a predictable mass movement. In Bangkok it is more likely that mass movement is a complete stop, but it is consistent.

The student from Asia is not used to the pulse regulated movement of Australian city roads. It has a different rhythm; known to the resident and not to the visitor. It appears chaotic here with vehicles travelling at different speeds, in different lanes, changing lanes, and with incoherence in movement. How can a pedestrian find a path through a flow of traffic that has no tune? Why is a car required to stop just after just getting to speed? Given the predictability of the stop it makes little sense to get there quicker.

Many of the return travel consultations seen at the university health service involve accidents that occurred overseas; half of these relate to transport; roads, scooters, bikes and even walking. The risk that leads to the accident is often the lack of understanding of the rhythm of the road. In the main cities of Eastern Europe a pedestrian crossing offers the right to cross the road when it is clear; not a right to cross the road.

In the Baltic States it is a legal requirement for pedestrians to display reflectors, although this relies on vehicles having lights. Transgressors of either law face the same penalty and that penalty is increased by a factor of ten if either is under the influence of alcohol. The Nordic countries also advise reflectors.

Third Principle: Understand the Road

The Beach

Many visiting students cannot swim or do not know of the real dangers of the Australian seaside. They have a fear of Australian sharks and for this reason spend most of their time in the shallows, the rock pools or at the water’s edge. Some students have been injured peering into “blow holes” or experienced intensive medical care after collecting the blue-ringed octopus fascinated by its capacity for glowing blue rings. These are risks known to the resident and unknown to the visitor.

Outbound students have been known to organise travel plans around holiday destinations and walking on the beach can provide different risks; known to the resident and unknown to the visitor.

Chigoe “Jigger” Flea

The jigger flea is found in tropical and sub-tropical climates, particularly in many parts of Latin America, the Caribbean, and sub-Saharan Africa. In Brazil, it can be found both in northern and southern regions. At 1mm it is not seen by human eyes. It burrows into the skin for blood meal whilst incubating the offspring and swells to become a blister or even a callous. These nearly always become infected.

Hook Worm

At the edge of the beach, where the city merges with the sand are found the products of city life. Immersed in the sand the hookworm  may be waiting to complete its life cycle in the human. They are more common and more frequent in warm destinations where feral animals roam and barefoot walking is hazardous from more than the hookworm. There was a recent outbreak on a Miami beach traced to feral cats.

Fourth Principle: Understand places of recreation

Going Home

Our health service has the curious role of giving travel advice to world travellers on completion of their studies. Some have been away from home for five years and started a family. Natural immunity to exotic diseases such as malaria, typhoid and hepatitis A is diminished and their children have started life in a community relatively free of infectious diseases. Everyone needs their vaccinations updated including the vaccines they did not receive as children in their home country. There is also the risk that the rhythm of home may be forgotten.

Our university outbound travellers eventually become inbound. Most of their presentations relate to the following principle:

The Rhythm of Travel

Communities follow a socially constructed way of life; a rhythm. To reduce your travel risk at your destination learn the rhythm of the community and apply this to the road, the beach, the food and the law.


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Antarctica 2012

Dr Jason Rajakulendran, TMA member Sandringham, Victoria:

As I marvelled over another penguin documentary in 2010, I wondered.. for what length of time would Antarctica remain as it does today? A place of unparalleled isolation, natural beauty and biological diversity yet relatively untouched by human activity. In a win for common sense, an Antarctic treaty exists between the various countries vying for territorial claims. It specifies that the continent be used primarily as a place of research and not for resource mining until at least 2041. This question pushed me to book a trip about twelve months prior (increasingly the need due to booming Eco-tourism) and find out for myself. My easiest option was to depart on a ship from the Argentine port of Ushuaia after acclimatising in the Patagonian wilderness.

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