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Going on Holiday

Going on Holiday

First and foremost it is important to stress don’t go anywhere abroad without your own personal insurance. That sounds really obvious advice and yet I hear horror stories of people who go without any insurance and then for whatever reason end up with the most enormous hospital bill.
 
E111/EHIC:

The European Health Insurance card, or EHIC – is now the replacement for the E111, you can apply for this at your Post Office.

If you're going to a European Economic Area (EEA) country or Switzerland, you should also make sure carry your European Health Insurance Card (EHIC) as well as private health insurance.

The EHIC card entitles you to sometimes free or at least reduced cost medical treatment in most of Europe. It does not cover cost of repatriation.

It's not always easy to get treatment abroad, so you should always make sure you have planned ahead. If you have an existing medical condition make sure you take a written note of your condition and the medication you are taking for it.

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European standard emergency number:


112 is now the European standard emergency number, it would be good idea to make a note of this if you are going to visit another European Community member state.

The UK also has bilateral agreements with a number of other countries, including many Commonwealth countries and countries in the former Soviet Union.
When you travel to most of the rest of the world (including the US, Canada, the Middle East, Asia and Africa), you must make sure you have private health insurance. These countries have no healthcare agreements with the UK.
You may need to check with the Embassy or High Commission of the country you are visiting in case they have any restrictions on taking your medication into the country.

If you are flying and need assistance make sure you have a companoin who will travel with you as air crew are not able to take responsibility for the administration of medication. If you need a wheelchair or more leg room make advanced notice of this to the airline concerned.

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Immunisations
:

If you are taking a holiday or have decided to go travelling for a period then it is important that you plan ahead and visit your GP surgery or health centre and ask about immunisations that you need to have prior to leaving.

www.immunisation.nhs.uk – visit this link to see what you may need to have.

Don’t leave it till the last minute either you need to visit at least eight weeks in advance of your holiday date. You may need to have been injected/commenced tablets for a period of time before you leave.

www.nathnac.org – this site is the national travel and Health network centre site
www.who.int   -world health organisation

www.dh.gov.uk – this site is the Department of Health’s website a very useful resource

Medical essentials:

It is important when going abroad to take a medical kit with you, it is better knowing you have covered all those eventualities rather than trying to find a pharmacy open abroad and you don’t speak the language! – make sure that you pack your daily medicines in your hand luggage just in case your main case goes missing.

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Basic first aid kit
:

  • Plasters, tweezers, small scissors, and a thermometer. For Allergies/ bites/ stings/prickly heat – An Antihistamine
  • For Constipation- A laxative
  • Diarrhoea – re-hydration solution and  Imodium for mild symptoms
  • For heartburn- an antacid
  • For headaches – a painkiller of your choice
  • A dental kit – temporary filling/ oil of cloves
  • Antiseptic wipes are always useful for minor abrasions
  • Take enough supplies of your daily medications to last the duration of your holiday- keep them in their original packaging.
  • Water purification tablets
  • Syringes and needles (if visiting remote regions)

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Re-hydration fluid
:

If you are away on holiday and unable to get to a pharmacist or haven’t taken re-hydration medication with you; and you have found yourself in a situation where you are suffering from diarrhoea this solution is a reasonable substitute until you can reach a pharmacy.

You will need:

  • 1 litre of boiled water.
  • 8 level or 4 heaped teaspoons of sugar- it can be white, brown or even  honey
  • 1/2 teaspoon of salt.
  • Juice from a lemon or orange.

The liquid should taste like tears, and can be taken as a substitute until you can get a preparation from the pharmacy. This solution should be drunk even if vomiting is occurring.


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Taking medication while away
:

If you are travelling to a location where the time difference is up to four hours you do not need to change your medicine routine – unless you are away for more than three days.

If you are away for more than three days or there is a time difference of more than six hours you will need to revise your medications.

A lot of this is just common sense – if you take your diuretics/water retention pills in the morning you should still take them in the morning and likewise if you take medicine for constipation expecting it to work in the morning take it at bedtime.

The contraceptive pill:

If you are taking the mini-pill and take it more than three hours later you will need to take additional contraceptive precautions for the rest of the month.

If you fly West to East  take it every24hrs

If you are flying East to West you will need to move the time you take your pill by an hour or two each day until it is being taken at a convenient time and not 4am!

Combined pill:
the time frame for alterations is 12hrs-
If you’re not sure which you are on ask your pharmacist

Diabetics: will need to test their blood sugar levels and adjust treatment accordingly

Antibiotics: These will need to be taken six hourly as normal.- Talk to your doctor if you are going away for a long period or have suffered from a recurrent condition which may require antibiotics.

Most other medications have flexibility as long as they are taken at regular intervals If in doubt consult with your GP surgery or pharmacist

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Water safety:

  1. You can avoid most infections by following the basics
  2. drink boiled water or water that has been sterilised or treated
  3. Hot drinks -coffee and tea are safe
  4. Water can be purified by bringing it to a boil- you can use this for cleaning your teeth once cold
  5. Carbonated/ fizzy water and other bottled drinks are usually safe
  6. Avoid ice in drinks unless you made them with bottled or boiled water

Food safety:

In high risk areas you will need to avoid

  • Salads such as lettuce are sometimes contaminated
  • Uncooked fruits and vegetables unless peeled
  • Food that has been exposed to flies
  • dairy products like milk, cheese, ice cream unless pasteurised
  • Avoid eating raw or undercooked fish and shellfish
  • Make sure food is thoroughly heated before you consume it.
  • Make sure you food is freshly made
  • Food from street vendors unless you see it prepared properly

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Specific illnesses to be aware of whilst travelling abroad
:

  • Hepatitis - Viral hepatitis is a liver inflammation that can cause jaundice. There are several forms of the disease, including hepatitis A (sometimes called infectious hepatitis), hepatitis B and hepatitis C. Hepatitis A is caused by a virus and has an incubation period of approximately 40 days.  Click here Read more here
  • Malaria - is spread by the bites of infected mosquitoes and can be fatal, if you are visiting a country which is a malarial region, you should take anti-malarial medication. Click here to read more                                                                                           
  • Rabies - Rabies is an acute viral infection of the nervous system. Once the symptoms appear, rabies is usually fatal. Click here to read more

  • HIV/AIDS - Acquired Immune Deficiency Syndrome (AIDS) is caused by the human immunodeficiency virus (HIV). There is no vaccine or cure for HIV infection. Click here to rea more

  • Dengue Fever - Dengue Fever, also known as Break Bone Fever is an infection transmitted by mosquitoes and affects approximately 20 million people a year with about 24,000 people dying worldwide each year.            Click here to read more

  • Cholera -  Is a bacteria which is contracted  from contaminated food or water, vomiting and diarrhoea follow. Click here to read more

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Hepatitis A:

Is common in places where water supplies and sewage disposal are of a low standard, and where personal / food hygiene standards are poor. Southern and Eastern Europe, Africa and parts of the Middle and Far East are high-risk areas.

Transmission:

Hepatitis A is passed from person to person by eating food or drinking water contaminated (infected) with the virus. The illness can spread easily within families and where people live closely together. Therefore washing hands is paramount in preventing the spread.

The virus is passed out in the bowel motions of an infected person, which is why it is important to wash your hands after going to the toilet. Drinking water can be contaminated with the virus, consequently the water should either always be boiled first or bottled water should be purchased.

Fruit, vegetables and uncooked food washed in contaminated water can cause infection, especially in hot countries. If you are choosing the salad ensure you are at a reputable restaurant. Shellfish can be infected if it comes from sea contaminated with sewage, so beware of uncooked or undercooked seafood. Cooked food is safe, but can be contaminated if it has been handled by someone with the virus.

Symptoms:

The incubation for this is from 2-6 weeks after infection .Mild flu like symptoms initially occurs- sometimes weight loss, diarrhoea and vomiting developing into jaundice ( yellow skin and whites of eyes) with pale faeces and dark urine. Sometimes itchy skin and joint pain can also occur.

Treatment:

There is no specific treatment for Hepatitis A . Getting adequate bed rest and drinking plenty of fluids is the best treatment. Most people recover spontaneously and completely and do not require further treatment. It is recommended that alcohol and certain toxic substances to the liver like fats initially should be avoided.  Once you have had Hepatitis A you will have a natural immunity from it.

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Malaria
:

This is a parasite there are different types which grows at an alarming rate once it reaches the liver it then returns to the blood stream and continues to grow and multiply in the blood stream.

Transmission:

The mosquito that carries the parasite is a particular one called the Anopheles mosquito. When the next mosquito comes and bites you the parasite which is now in your blood stream transfers and so the cycle continues.

The symptoms:

are often mistaken for Influenza symptoms include fever and, in some cases, complications affecting the kidneys, liver, brain and blood. The symptoms of the most life-threatening type of malaria are usually experienced between one week and two months after infection. There are other, less severe types of malaria, which can cause symptoms more than a year later. The most serious forms of the disease can affect the kidneys and brain and can cause anaemia, coma and death.

Treatment:

The World Health Organization recommends that treatment be started within 24 hours after the first symptoms appear. Most medications used in treatment are active against the specific parasite forms which are infecting the people’s blood. The medicines can be taken at home therefore there is no need for hospitalisation once diagnosis has been made and stabilised. Medical supervision should still be observed.

Large areas of Central and South America, Brazil, Sri Lanka, Vietnam, Colombia and the Solomon Islands., Africa, the Middle East, the Indian subcontinent, Southeast Asia, and Oceania are considered high risk malaria areas.

Measures which you can take to reduce your contact with mosquitoes:-

  • Make sure you take with you and use a mosquito repellent with DEET (diethyltoluamide) in.
  • As much as possible keep all extremities covered with light clothing.
  • Sleep underneath mosquito netting and use screens on windows.
  • Take your anti-malarial tablets at the correct dose for the correct length of time

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Rabies:

Rabies is a virus the lyssa virus which attacks the nervous system of the victim – Rabies is common in all the continental regions of Asia, America and Africa. Greenland and many countries in Europe have rabies in their animal populations. Scandinavia, Britain, Japan, Australia and New Zealand are all rabies-free.

Transmission:

people can be infected by the bite of an animal usually a dog/fox, unusually monkeys and bats. Cats can also pass the disease on by scratching a person or other animal, so beware of the stray cats your children might want to pet. In developing countries also avoid stray dogs. Anyone with a rabies infection must be treated in a hospital.

Symptoms:

The symptoms can appear anywhere between 2- 12 weeks and can be flu like in as much as you get muscle aches ,chills etc. The one difference will be the itching or tingling which comes from the initial bite/scratch site. A wide variety of symptoms will tthen occur including agitation, anxiety and confusion. Latterly large quantities of saliva and tears occurs with progressive inability to speak or swallow, at this point the person is terminally ill  and death usually happens between 2-10 days after onset on symptoms. Occasionally people are known to have survived however they usually have severe brain damage.

Rabies is very frightening as by the time the symptoms appear, the disease can not be cured and almost always ends in death. If you have the vaccination early enough the body’s immune system should have long enough to respond before the symptoms appear.

Treatment:

If you have been bitten or scratched there is every chance that you can be treated before the symptoms develop, normal first aid should be given, washing the wound with lots of water and soap too if it can be tolerated. If there is any possibility that the animal is infected with Rabies the wound must be treated by a doctor. Immediate treatment after exposure to infection is the only way to stop the fatal disease developing, by giving a specific immunoglobulin (passive immunisation) and by administration of a normal vaccination (active immunisation).

It is important before you travel you ensure you are up to date with your vaccinations, if you are going into an area where medical cover is limited.

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HIV/AIDS
:

HIV is the human immunodeficiency virus that causes AIDS. It is a member of a group of viruses called retroviruses; HIV infects cells and uses the nutrients provided by those cells to grow and reproduce. AIDS (acquired immunodeficiency syndrome) is a disease in which the body's immune system breaks down and is unable to fight off certain infections.

When a person is infected with HIV, the virus enters the body and lives and multiplies mostly in white blood cells, our immune cells. As the virus grows, it damages or kills these and other cells; this weakens the immune system leaving the patient vulnerable to opportunistic infections and other illnesses.

Many people remain asymptomatic for 10 to 12 years, following contracting the disease. There are now over 40 million people living with HIV or AIDS worldwide. Most of them do not know they carry HIV and may be spreading the virus to others. Over 13 million children have been orphaned by the epidemic, a high proportion of which reside in Africa.

HIV the virus is carried in body fluids, blood, semen, vaginal secretions, and breast milk. The virus is transmitted from one person to the other and enters via the blood stream, this can occur through:-

  • linings of the vagina, rectum, mouth, and the opening at the tip of the penis
  • intravenous injection with a syringe
  • through a break in the skin, such as a cut or sore 
  • Unprotected sexual intercourse (either vaginal or anal) with someone who is HIV infected.

The virus is not easy to pass from one to another, it is not transmitted through coughing/sneezing , and not by everyday contact i.e. sharing eating utensils
HIV the virus is present in vomit, faeces, urine and sweat and tears. - Transmission from these is highly unlikely but care needs to be taken when handling any body fluids- gloves should be worn. Mosquitoes do not transmit HIV

If you are sexually active, protect yourself from HIV infection by practicing safer sex. Whenever you have sex, use a condom when used properly, condoms are extremely effective. Purchase a quality latex brand prior to leaving on your holiday, and keep available. Do remember though only use water-based lubricants as Oil, Vaseline, or hand lotions cause the condom to become useless.

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Dengue Fever:

This disease used to be called "break-bone" fever because it sometimes causes severe joint and muscle pain that feels like bones are breaking, hence the name.

Transmission:


Dengue is not contagious from person to person. You become infected by being bitten by the Aedes species mosquito which unlike other mosquito species, bites during the day.

Symptoms
:

Dengue Fever has flu-like symptoms with headaches and fever, eye pain, backache, and joint pains. Some people also get rashes and vomit. These symptoms can last 2 to 3 days and an infected person may feel tired for up to 3 months.

There are four types of dengue virus: DEN-1, DEN-2, DEN-3, and DEN-4.In addition to typical dengue, there are dengue hemorrhagic fever and dengue shock syndrome
The condition is rarely fatal but there is one form of the disease, Dengue Haemorrhagic Fever (DHF). DHF is often characterised by the same symptoms but in addition there will be marked damage to blood and lymph vessels as well as bleeding from the nose, gums, or under the skin, causing purplish bruises. This form of dengue disease can cause death.

The Symptoms of dengue shock syndrome which is the most severe form of dengue disease, includes all of the symptoms of dengue and dengue hemorrhagic fever, but in addition there will be fluids leaking outside of blood vessels , which leads to massive internal bleeding and the patient will go into shock. This form of the disease usually occurs in children (sometimes adults) experiencing their second dengue infection. It is sometimes fatal, especially in children and young adults.

Treatment:


There is currently no vaccine for this disease most people will recover completely within 2 weeks, treatment should include painkillers but it is recommended that Aspirin should not be taken. Holiday makers should use insect repellents which contain DEET and wear long sleeved shirts and trousers while in high risk areas to try and avoid being bitten.

It is now endemic in more than 100 countries in Africa, Caribbean, Central and South America, Middle East, South-east Asia, India, China, Australia and the South and Central Pacific.

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Cholera:

Cholera is an infection of the intestines, it has a very short incubation time between one to five days –usually two days and causes severe diarrhoea. It is caused by bacteria known as Vibro Cholerae, and is caused by drinking contaminated water or eating food which has been prepared by people who are carrying the disease, who haven’t washed their hands properly.

Transmission:

by the bacteria being excreted in the faeces, and subsequently into the water supply. Bacteria will also be present on the hands and if not washed properly transmitted onto food.

Symptoms:

are initially mild stomach pains accompanied with normal diarrhoea, sometimes a mild temperature occurs but no vomiting. This rapidly progresses into vomiting and severe diarrhoea which goes on for a number of hours, the watery diarrhoea looks milky and you can loose up to a litre of fluid an hour this way, it is this fluid loss that can be very serious. Children and the elderly are at highest risk of developing severe dehydration requiring hospitalisation and intravenous fluids (a drip).

Treatment:

needs to be prompt and is usually a matter of replacement of the fluids which have been lost, and most mild cases of cholera make a good recovery, Antibiotics may be given to  help with symptoms and reduce the diarrhoea. Severe dehydration can results in confusion, muscle cramps, flaccid skin and a croaky voice. In children they may well suffer from convulsions. Clean water and re- hydration salts are the most important elements.

Vaccine:

There is a vaccine available although for the majority of holiday makers basic food and water hygiene (Link) precautions are sufficient to prevent infection. If you are an enthusiastic backpacker visiting areas which have poor or limited medical provisions it would be advisable to be vaccinated. Cholera is very common in Asia and Africa and densely populated regions with poor sanitation.

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