Travel Tips

In addition to vaccinating yourself against disease and illness before travelling overseas, we strongly recommend you read up on this information to help better equip yourself in order to prevent the contraction of disease and/or illness while on holiday.

DVT is a condition where a clot forms, usually in your lower leg, but it can be in your thigh, pelvis region or even your abdomen.

This can stop the flow of blood in the area and potentially can become dislodged and move to your lungs, causing something called a pulmonary embolism or PE.

This can be a very serious and life threatening condition

Who gets a DVT?

Who is at risk? Certain factors make a DVT more likely to occur. They are more common in people aged over 40 and in people who are obese, or who have already had a DVT.

Other factors include:

  • Smokers
  • People with cardiovascular disease like CHF-congestive heart failure, a recent heart attack or stroke or recent surgery (in the last 3 months)
  • Those who are pregnant, especially in the last trimester, or who have had a baby in the last 6 weeks
  • Women that use birth control or contraceptive pills, hormone replacement therapy or tamoxifen post breast cancer
  • People who are currently being treated for cancer

Signs and symptoms

Unfortunately the symptoms can be silent. If there are symptoms they could include:

  • Pain at the site that is noticeable, or worse when standing or walking
  • Redness, swelling and warmth in the affected leg
  • There may be pitting oedema (your finger impression stays after pressing your finger on the leg) in the affected leg
  • If the clot was to dislodge and move towards the lungs, you may feel it is hard to breathe, or feel you need to breathe faster
  • There may be an increased heart rate
  • Dizziness or anxiety
  • A cough that produces pink or frothy fluid. This is serious - you would need to ask for help immediately

These are not always a sign of a deep vein thrombosis, but anyone who experiences them should contact a doctor immediately.

General Preventive Measures

  • Exercise the legs regularly
  • Maintain weight that is appropriate for you
  • Avoid sitting or lying for prolonged periods

Preventive Measures For Travellers

Although the added risk of developing a DVT caused by travelling is considered low, it can be reduced even further by exercising the legs at least once every hour during long-distance travel. For example taking regular driving breaks or walking up and down the aisles in planes or coaches.

The muscles of the lower leg can be exercised while sitting by pulling the toes towards the knees then relaxing, or by pressing the balls of the feet down while raising the heel.

Other Preventive Measures

  • Do not take sleeping pills
  • Drink plenty of water to preven dehydration and avoid alcohol and caffinated drinks
  • Wear loose-fitting clothing
  • Keep the legs uncrossed
  • If you have time in between flights, walk around at the airport.
  • Wear compression stockings, particularly for those at higher risk
  • Some Doctors recommend taking certain medications to help prevent DVT, however this should be discussed during your appointment at Travel-Bug or with your GP. For many people the above simple preventative tips may be all that is needed
  • Anyone who develops swelling or pain in the leg, or breathing problems after travel should seek medical advice urgently

Treating a DVT

Treatment aims to prevent:

  • The clot becoming larger
  • The blood clot breaking loose and travelling to the lungs
  • New clots from forming
  • Post-thrombotic syndrome

Medicines

  • The most common treatment is anticoagulant (blood thinning) medicines, which reduce the blood's tendency to clot. These are usually taken for three to six months. Regular blood tests are needed to check the levels of the drug in the blood.
  • These medicines can prevent new clots from forming and old clots from growing larger, but they do not dissolve the clot. The body will do this itself over time.

Compression Stockings

These are used to relieve pain and swelling, as well to prevent post thrombotic syndrome. They may need to be worn for several months.

Putting Your Feet Up

Most people with a DVT are advised to place a cushion under their feet while resting or sleeping, so that the feet are raised higher than the hips. This helps to reduce the pressure in the vein of the calves.

Further Information

Department of Health - www.doh.gov.uk/dvt

 

A vaccine, recently available in Australia, is taken ORALLY and covers about 2/3 of cases of bacterial diarrhoea, often known as 'Bali Belly'.

Although designed for the prevention of Cholera, this side benefit has great implications for those who wish to do something to prevent 'Bali Belly', the most common illness in travel to developing countries.

Method

  • 1 Dose, followed 1-4 weeks later by a second dose
  • Avoid food and drink (water is ok) for 1 hour before and 1 hour after taking the vaccine.

Effective

  • After the second dose

Cost

  • $105 for a full course, $69 for a booster dose

You may be able to claim a refund if you have private health cover with pharmaceutical cover, approximately 50-60% is paid depending on the type of policy and cover.

The only other alternative is to wait until 'Bali Belly' hits, as it does to about 60% of travellers to developing countries.

To control the disease you will need to take an antibiotic,  as well as Imodium to keep symptoms at bay. This of course means that your holiday may be ruined as you will be unwell with the disease for 1-5 days. This new vaccine actually prevents many of these cases of gastroenteritis.

With Emirates Airline operating daily flights from Adelaide to Dubai, more South Australians will now be visiting this city in the desert, often as a stopover before visiting Europe and Africa.  Dubai is located in the United Arab Emirates and is among the most modern and tolerant cities in the Middle East. However, the country is built on Islamic traditions and religion so please read the following advice to stay out of trouble and to really appreciate the city in the desert.

 

  • Dress Conservatively - Bikini/swim wear is allowed on the beach but no topless or nude bathing. However, both men and women need to dress more conservatively when walking around in public. Indecent clothing is not only disrespectful to the local Emiratis, but also illegal. Men should always cover their chest and women should avoid too figure-hugging clothes and need to keep thighs, stomach and shoulders covered. For example, be aware you may be asked to leave a shopping mall, if it is deemed your clothing is too revealing.

 

  • Alcohol - Can be consumed only by Non-Muslims in licensed bars and restaurants (normally in or attached to hotels) and only in a private house if the owner/renter has an alcohol license. No drinking of alcohol is permitted whilst walking in the street, and public drunkenness is also illegal. The legal age to drink alcohol in Dubai is 21 years

 

  • Drugs - There is zero tolerance towards drugs with possible life imprisonment.

 

  • Medication - Always carry a doctor's letter for prescribed medication and keep it in original packaging. Codeine is illegal. Check the UAE embassy website for further information.

 

  • Signs of Affection - It is illegal to have a sexual relationship if you are not married. Holding hands for married couples is accepted but kissing and public displays of affection should be avoided as it is considered an offence against public decency.

 

  • Driving - The UAE has a zero tolerance towards drinking and driving, possible imprisonment. Hand gestures or road rage are taken seriously. Taxis are everywhere and relatively cheap. There is also the metro running from the airport to most of the tourist spots.

 

  • Safety - Dubai is a relatively safe country but always adhere to personal safety advice in any city.

 

  • Taking Photos - Always ask permission before you take photos of any local people.

 

  • Ramadan - During the "holy month" Muslims fast between dawn and sunset. Eating and drinking in public places are forbidden for both Muslims and non-Muslims. Some restaurants are open in order for non-Muslims to eat and drink but are largely screened off to ensure privacy.The breaking of the fast at sunset is called Iftar. Iftar buffets are widely advertised in restaurants and hotels and most enjoyable and interesting for the tourist. The exact dates for Ramadan change each year as it is based on the lunar calendar.

 

Useful Information

The currency is the Dirham, approximately 1AUD = 2.72716 AED.

80% of Dubai's resident population hails from overseas with over 150 nationalities.

All tourists from Australia (Aussie passport holders) are issued a free visit visa upon arrival at the airport.

The UAE consist of 7 states with Abu Dhabi as the capital.

The time difference between Adelaide and Dubai is 5.5 hours.

The traditional dress for women is the abaya, a long black robe with a hijab (the head-scarf which covers the neck and part of the head). Men wear the dishdash (long white robe).

 

Things to Do

  • Wild Wadi Water Park
  • Afternoon tea at the Burj
  • Dubai Museum
  • Big Bus Tour
  • Desert Safari
  • Swimming with dolphins at The Atlantis
  • Jumeriah Mosque
  • Dancing fountains
  • Burj Khalifa

Visit http://www.visitdubai.com for more information and

Don't forget to book an appointment at Travel Bug Vaccination Clinic for up to date travel health advice before visiting Dubai!

 

Food and Water Precautions

Precautions concerning food and drinking water will reduce your risk of contact with food and water borne disease such as Hepatitis A, Typhoid, Cholera and traveller's diarrhoea.

Overseas travellers frequently suffer from gastric (stomach) upsets that are caused by viruses, bacteria and parasitic worms not found in Australia. These are transmitted by:

  • Improperly prepared foods
  • Untreated water
  • Poor personal hygiene

Food Precautions

  • Avoid pre-cooked and reheated foods
  • Avoid cold meats, salads, mayonnaise, seafood, milk and other dairy products
  • Eat only thick skinned fruits that you have peeled yourself
  • Ensure that you wash your hands with soap and water prior to eating or handling all food

Water Precautions

  • Whenever possible drink bottled water only and make sure the bottle is properly sealed
  • Water that has been boiled for 10 minutes is the best to ensure safe drinking water when bottled water is not available and is good for brushing your teeth.
  • Water purification tablets should be used as directed
  • Canned/bottled drinks and drinks made with bottled water are safe
  • Avoid ice in your drinks as well as ice cream and ice-blocks

Gastric upsets can be identified by abdominal cramping, diarrhoea, fever, nausea or vomiting. If you experience more than six loose stools and/or have blood in the stool, seek medical advice immediately

Treatment of these symptoms includes re-hydration and rest. Preparations such as Gastrolyte and diluted fruit juice are good for re-hydration but be sure to make any preparations exactly as directed. Failure to re-hydrate can lead to further dehydration and possible hospitalisation.

Medications such as Imodium, Stemetil, Panamax co and Noroxin can be used as directed.

High Altitude Sickness

If you are traveling to a destination with an altitude of over 2500m, you will be at risk of altitude sickness, pulmonary oedema or serious central nervous system disorder. These risks are negligible below 2500m, possible between 2500 and 3500m and likely over 3500m. There are no reliable predictors for individuals; potentially all travelers have the same risk. Previous tolerance of high altitudes is the only guide that is reliable. The cause of altitude sickness is a reduced oxygen level in the air.

Symptoms

  1. Headache, loss of appetite, nausea, insomnia, dizziness, swollen ankles, ataxia and apathy
  2. Shortness of breath, reduced exercise tolerance (usually these occur on the second day and indicate fluid building up in the lungs: this is a medical emergency)
  3. If untreated, the brain will swell, causing coma

Prevention

It is important to acclimatise. Above 2500m, ascend slowly. Limit each night's camp to 300m or less above the previous night's camp altitude. If you wake with symptoms in category 1 or 2, descend immediately, but not alone. Symptoms can progress rapidly and can be fatal. A decompression bag is often used when descent is not possible (usually with a foot pump - this effectively lowers the altitude by 1000m by increasing the oxygen levels). You should still descend after 1-2 hours in the bag.

What Can You Do To Improve Your Chances?

You can take medication to trick your body into breathing more quickly, hence 'acclimatising' the body in advance. This medication is called DIAMOX (Acetazolamide) 250mg; half a tablet in morning and half a tablet at lunchtime, starting 1 day prior and continuing for 3-5 days at altitude. It is inexpensive and will give you an edge on your symptoms (they will occur at a higher altitude than otherwise). Remember, group tours ascend at a set rate, and not all people can cope with the same rate of ascent. Rest days are often incorporated into tours, but they are not really for rest, they are because the ascent rate has been too great. Be careful!

Diamox contains sulfur and a test dose is recommended prior to travel. These are available at our clinic free of charge and if you react to it you will be at our clinic, not on a mountain pass. Our specialists will explain how this works at your appointment.

NB: Do not fly into high altitude destinations and then start climbing (eg, Cusco). A few days of acclimatisation are essential. The tours actually insist on this, so they have become aware of the pitfalls.

How High Is It?

Any altitude can be acclimatised to, given enough time. After all, many have conquered Mt Everest which is 8,848 meters above sea level. To do this many weeks must be spent ascending and waiting for the body to adjust. Below are common destinations people currently go to which are above the limits the body can deal with if one just was to "fly in".

Cusco 3300m
La Paz 4200m
Base Camp Mt Everest 5200m
Mt Kilamanjaro 5400m
Lhasa 4200m
Lake Titicaca 3800m

Commonly people will have skiied or climbed to quite high altitudes on a previous holiday. if you have not slept at altitude, you are not going to know if you will be ok. The highest ski village I have found is 2850m in Valle Nevada, Chile. Most ski villages are below 2000m.

Problems are very rare below 3000m.

Bites, stings and contact of some insects cause unpleasant reactions and some may transmit diseases. Mosquitos, ticks, black flies, sand flies, tsetse flies, fleas, mites and lice transmit disease.

  1. Apply insect repellent containing DEET (e.g. RID, Bushman's) to exposed skin. Avoid eyelids, lips and damaged skin. Some insect repellents come combined with sunscreen - good for daytime protection
  2. Wear long sleeved clothing and long pants / dresses (light coloured) and socks
  3. Avoid going outside when mosquitoes are most active: between dusk and dawn
  4. Avoid perfumes and aftershaves as the aroma may attract some insects
  5. Close doors and windows at night or protect them with screens
  6. Spray inside room / house with aerosol insecticide (for flying insects) at dusk, after closing doors and windows
  7. Overhead fans or air conditioners are effective in hindering mosquitoes from landing
  8. Use a mosquito proof bed net (preferable impregnated with insecticide - eg. permethrin), with edges tucked under mattress. Ensure the net is not torn
  9. Treat clothes with insecticide eg permethrin
  10. Burn mosquito coils or mosquito mats
  11. Keep away from stagnant or standing water (mosquito breeding grounds)

Note: for ticks wear long clothing and socks and, put insect repellent on ankles under clothing

Mosquito borne diseases include: Malaria, Japanese Encephalitis, Rift Valley Fever, Dengue Fever (daytime mosquito) and Yellow Fever (daytime mosquito in Africa and South America only)

Various medications can be used to prevent malaria. Here is some information to help you in the complex process of deciding which drug is best for you.

Doxycycline

  • This medication will work in a large number of areas, and is one effective drug for the difficult Thai/Myanmar and Thai/Cambodia borders
  • Taken 1 tablet per day starting 2 days prior to entering a malarious area, every day while there and for 28 days after leaving the malarious area.
  • Contraindicated in pregnancy or if under 8 years of age.

Side Effects:

  • A small number of people are more prone to sunburn. If so, take the medication with your evening meal, rather than in the morning, apply sunscreen and avoid sun exposure.
  • Some women develop thrush so thrush cream (Canestan) can be taken just in case
  • Women should also be warned that it reduces the contraceptive effects of the pill for the first 2 weeks whilst taking it
  • Nausea and vomiting occur occasionally and can be reduced by combining medication with a meal, remaining upright after dosage, and drinking lots of water.

This preparation will cost slightly over $1 per tablet.

Malarone

  • Appears to be very safe, effective and to have few side effects, but is expensive (about $7 - $8 per tablet).
  • Taken 1 tablet per day, starting 2 days prior to entering a malarious area, every day while there and for 7 days after leaving the malarious area.
  • Contraindicated in pregnancy.

Side effects

  • Almost none, but take after a meal to reduce any side effects (Gastrointestinal side effects are reported at higher doses used for treatment of malaria ie: 4 tabs/day for 3 days). Our clinic has this preparation available and because of the cost, can provide individual tablets. You do not have to buy a whole box if it's not needed - they come in packs of 12.

Lariam

  • This drug is usually well tolerated and can be used for long term prevention.
  • Taken 1 tablet per week, starting 1-2 weeks prior to entering a malarious area, continuing during and for 4 weeks after leaving the malarious area.
  • Adverse events can be predicted while you are still at home by taking one tablet daily for 3 days (or 3 doses a week apart), and adverse effects should be apparent after the 3 doses have been taken.
  • Contraindicated in epilepsy, depression, anxiety, psychotic illness.
  • Cautions: cardiac conduction defect, or if taking calcium channel or beta-blockers. Driving, diving and piloting may be difficult.

Side Effects

  • These have been exaggerated in the media, but include insomnia, nightmares, irritability, and depression. These can affect one in 200-500 in a disabling fashion. Psychosis does however occur in 1:12000. 2 Cases of psychosis have been reported in people taking it for the second time and the psychosis continued after cessation of the medication. This is disturbing information. However, 97% of travellers are able to tolerate the drug without discontinuing it
  • Alcohol, cannabis etc. may exacerbate side effects so are best avoided for 36 hours after a dose
  • The dose may be halved and taken every 4 days to help reduce side effects, and it is very important to take with a meal and to be well HYDRATED.

Cost about $8/tablet.

Pregnancy

Malaria increases the risk of adverse outcomes in pregnancy so should be avoided if at all possible.

Safe

  • Both Lariam and Chloroquine are considered safe in all stages of pregnancy.

Unsafe

  • Doxycycline is not safe as it affects the teeth of babies and inhibits bone growth.
  • Primaquine passes across the placenta so can cause haemolytic anaemia in a G6PD deficient foetus.
  • Malarone is not to be used in pregnancy.

Children

Children are easy targets for mosquitoes so should take medication.

Safe

Malarone 11-20 kg - 1/4 tablet per day
21-30 kg - 1/2 tablet per day
31-40 kg - 3/4 tablet per day
Lariam 0-15 kg - 5mg/kg/week
15-19 kg - 1/4 tablet per week
20-30 kg - 1/2 tablet per week
31-45 kg - 3/4 tablet per week
Chloroquine 5mg/kg/week
Doxycycline 2mg/kg/day

Unsafe

  • Doxycycline is not suitable for children under the age of 8yrs as it can cause teeth staining

The same pre and post trip times apply to children and adults

Fever in a child in a malarious area should be taken very seriously as malaria can kill children very quickly

Self Treatment

Malarone: 4 Tablets per day for 3 days.

Many things need to be done well before you leave - and then of course there is packing!

6 months out

  • Get fit! At least you can start! (You should have done this anyway.)

4 months out

  • Obtain and begin reading materials regarding trip. Hikers, adventurers and even beach addicts will gain increased value and enjoyment from the holiday with a little more knowledge. Also, learn a few phrases of the native language.
  • Send passport and Visa applications off, they take forever!
  • Some countries require validity of passport for 6 months at time of entry, so check the expiry date NOW! Please note some Visas require a blank page (and some say 2 pages!) in your passport.

2 months out

  • Start vaccinations. If you start later it will no doubt cost more and not work as well. Also, sort out travel insurance and special needs on planes, e.g. oxygen and wheelchairs.

Toiletries

  • Any item deemed dangerous will be taken off you and you will never see it again, so consider this carefully.
  • Any liquid will also be relegated to the hold luggage or confiscated too. Remember: toothpaste is considered a liquid.
  • Shaver/ blades/ mirror (not in hand luggage)
  • Brush/Shampoo and conditioner/ soap
  • Toothbrush and toothpaste
  • Nail scissors/ tweezers (not in hand luggage)
  • Deodorant (aerosol not in hand luggage)
  • Toilet paper/ plastic bag for litter
  • Laundry detergent
  • Chap Stick/ lip balm
  • Clothes
  • Consider the extremes of temperature possibilities, and pack some things for unseasonable weather. Think about:
  • Scarves/ hat/ gloves/ jacket
  • Jeans/ shirts/ bathers/ sarong/ night garments/ underwear
  • Footwear/ thongs
  • On the plane you should wear comfortable clothing, no belt and shoes you can take off and put on easily (airport security methods are now very annoying!)

Accessories

  • Sunglasses/ sunscreen/ towel
  • Phone/ phone charger/ adapter
  • Camera/ film/ spare memory
  • Note book/ pen/ torch/ novel/ phrase book
  • CD/ MP3 player/ IPOD
  • Handkerchief/ tissues
  • Money belt
  • Pocket knife (not in hand luggage)
  • Alarm clock (if not taking phone)
  • Glasses (prescription)
  • Plastic Bags
  • Umbrella
  • Small sewing kit
  • Inflatable pillow
  • Travel games

Documents

  • Passport/Tickets/itinerary and vaccination book
  • Money (2 forms in case first fails you)
  • Insurance papers/ drivers licence/ photo ID
  • Travel agents phone number
  • Photocopies of all documents should be taken and a copy left at home, and posting on the internet is also a good idea!

Medical Kit - (Available here)

  • Noroxin: Antibiotic for diarrhoea and vomiting
  • Imodium: For traveller's diarrhoea
  • Paracetamol: For pain or fever
  • Many other items (see separate list)
  • Water purification tabs/ bandage/ tape
  • Insect repellent/ antihistamines
  • Antibacterial wipes/gels/ antibiotic cream/ Betadine
  • Personal medication AND spares
  • All medication should be labelled with your name

NO PERISHABLE ITEMS

Last Minute

  • Arrangements for pets, deliveries, keys, neighbours and itinerary copy to others
  • Locate passport/ tickets/ wallet/ keys before retiring on eve of trip

To be used with the general Travellers Checklist

Accessories

  • Sun Hat
  • Sunglasses- UV filters and polarised are best
  • Snow skiing goggles
  • Pegless clothes line
  • Sun screen/ lip balm/ zinc cream
  • Small personal wash kit with towel
  • Pocket knife/ corkscrew
  • Earplugs
  • Sewing kit
  • Books/ music
  • Pen/ paper
  • Spare batteries for camera, phone etc
  • Plastic bags
  • Head lamp + spare batteries

Medication

  • Antibiotics/ pain killers/ anti inflammatory
  • >Gastro/ throat medications
  • Altitude pills
  • Blister kit/ Trekkers feet kit/ general first aid kit

Camping/Trekking Items

  • Water carrying items eg camel pack
  • Foam sleeping mat - two if extreme
  • Down sleeping bag
  • Trekking poles- adjustable
  • Ice axe/ plastic mountaineering boots/ crampons
  • Gaiters that fit your boots
  • Climbing gear - check carefully
  • Clothes
  • Warm woollen hat/ beanie/ balaclava
  • Thermal liner gloves/ wind stopper fleece gloves
  • Fleece mitts with waterproof shell
  • Thermals- top and bottom
  • Goretex Jacket/ separate rain over jacket
  • Long pants and shirt
  • Socks/ underwear
  • Trekking Boots eg Mountain design Razor Backs GTS
  • Other boots for nights in camp
  • Trekkers feet kit (only $40 from Travel-Bug)

Although it can be somewhat exhausting, travelling with children can also be a very rewarding experience. Planning ahead can make a big difference when it comes to making the trip enjoyable. Most of the health issues that child travellers encounter are not from exotic diseases but from trauma, respiratory tract infection or diarrhoea. It is wise for parents to do a first aid course.

Diarrhoea

Children, particularly babies, are very susceptible to dehydration from fluid loss. Prevention of diarrhoeal illness involves attention to hygiene and choice of food and water.

Treatment:

Includes replacement of fluids with an oral re-hydration solution. Gastrolyte sachets mixed with boiled (boiled for 10 min) or bottled water, alternatives include juice or lemonade diluted 1:4 parts water.

Age Daily fluid intake
Babies < 2 months 600mL
3-6 months 1000-1400mL
> 6 months 1400-2400mL
  • Breast feeding and formula feeding should continue, and be supplemented with clear fluids from a bottle, cup or spoon.
  • Seek urgent medical advice if the child is listless, unexplainably drowsy, has dry mouth, prolonged high fever, and for a baby under 1 year of age with vomiting and diarrhoea for more than 24 hours

High Fever

A child with a temperature above 38oC should be given paracetamol-dosage as per weight/age (never exceed dose recommended). Undress the child to a nappy and keep cool, but do not chill. Rest and fluids are essential. Medical assessment may be required if fever continues to determine and treat the cause.

Medical Kit for Children

Include: Sunscreen, Insect repellent, Thermometer, Paracetamol, Gastrolyte, Wet Ones

Avoid: Dairy, fatty foods, and wheat products.

If hungry, feed children with small amounts of rice crackers (substitute with toast or plain biscuits if rice crackers unavailable), steamed rice, bananas, or papaya.

If vomiting, give small sips of oral re-hydration solution frequently or encourage children to suck on ice chips (made from bottled water).

 

Here are some links with useful information:

http://www.smartraveller.gov.au/children/

http://www.holidayswithkids.com.au/

http://www.lonelyplanet.com/travel-blog/community/?p=352

http://www.travelwithyourkids.com/

Since August 2006, restrictions on liquids, aerosols and gels that can be carried on a plane have been put in place around the globe to prevent the threat of liquid explosives.

Always check with your airline what restrictions are in place before packing particular items.

Domestic restrictions are less onerous than the restrictions placed on international travellers.

Certain medications are exempt, though an authorisation letter from your Dr is a good idea. Generally quantities of less than 100mL for fluids MAY be ok but don't leave it to chance, do your homework and pack appropriately.

For more information go to: http://travelsecure.infrastructure.gov.au/international/lags/

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