Whether it’s the runs or puking, road accidents or sprained ankles, foreign tropical diseases or good old flu – getting ill whilst travelling is never fun. But it can be memorable. In a Backpacker Essentials competition, the winning stories raised all sorts of common health problems, so we’ve got the experts to give some tips on how to avoid getting sick or deal with the problem when it does occur.

Vomiting/diarrhoea

 By Caroline Hall, Sydney.

After a glorious couple of days at Agra where two of our group romantically got engaged at the Taj Mahal and we had dinner in a restaurant where Ghandi's niece was also eating, we were in high spirits and headed off to Khajaraho to see the erotically carved Hindu temples.

On the way the bus hit and killed a male peacock. The locals came out of their simple houses and abused us! Full moonlight made the carvings even better before we went to a nearby village for a 'special' meal. The food was hot, scrumptious and spicy, and spread out on cloths on the ground, where we sat. I began to feel awful soon after as did the people (who) sat either side of me! 

There were 3 places I had really wanted to see in India and we had visited two but the next day it should have been Varanasi, the third one. I saw the bathroom floor, the toilet and nothing of the Ganges or Bathing and Funeral Ghats as I vomited and vomited and collapsed! It seems that to avenge the loss of the sacred peacock we had been served it and it was diseased! Months of visits to tropical medicine specialists followed my return to Australia. Soda and lime juice kept me hydrated and it took me ages to eat Indian food again.

Advice from the Travel Health Advisory Group

For travellers, the main health problem associated with contaminated food and water is travellers’ diarrhoea.1 Remember the simple saying:‘Boil it, cook it, peel it or forget it’.

Precautions1

• Avoid reheated cooked food or cooked food that has been kept at room temperature for several hours.
• Select food that has been freshly and thoroughly cooked, and is still steaming hot.
• Avoid uncooked food, apart from fruit and vegetables that you can peel or shell, and avoid fruits with damaged skins. Avoid uncooked leafy vegetables (eg. salads).
• Avoid dishes containing raw or undercooked eggs.
• Avoid food bought from street vendors.
• Avoid ice cream from unreliable sources, including street vendors.
• In countries where poisonous biotoxins may be present in fish and shellfish, obtain advice locally.
• Boil unpasteurized (raw) milk before consumption.
• Wash your hands with soap and water before eating/preparing food.
• Boil drinking-water if its safety is doubtful; if boiling is not possible, a certified well-maintained filter and/or disinfectant agent can be used.
• Avoid ice unless it has been made from safe water.
• Avoid brushing teeth with unsafe water.
• Bottled or packaged cold drinks are usually safe provided they are sealed; hot beverages are usually safe.

For further information on travellers’ diarrhoea, visit the Well to Go website

Ears

By Michele Miller, Sydney.

“But Memsahib has no pierced ears!  Memsahib must have pierced ears to wear earrings!” 

I was at a village market a little north of Calcutta.  The earrings before me were so beautiful, so intricate, and so tempting.  I bought several pairs, mumbling that I’d get my ears pierced when I got home.

 “No, no, we have a village elder who will pierce your ears for you”, I was told emphatically.  It’s now or never I thought, and went along with their enthusiastic call for an instant ear-piercing session.  I should have been more circumspect, but I was only 20. 

The little old man who jabbed what looked like a rusty pin through my ears assured me he was an expert, but within two days my ears were festering and sore.  Travelling by train only made matters worse (can’t sleep with two sore ears), and guess who was without a first aid kit?!  This was my first attempt at backpacking and I was unprepared.

Luckily, I met a fellow Australian who produced the necessary antiseptic medications to tend my ears.  On his suggestion, I found a doctor to re-pierce the holes, but strangely, have never felt inclined to embrace body-piercing again… 

Advice from the Travel Health Advisory Group

“Travellers could put themselves at risk from a number of infectious diseases such as hepatitis C, hepatitis B or even HIV, if they practise unsafe behaviour such as piercing when overseas, especially with equipment that has not been sterilised.  

“If the pin used for piercing was rusty, the traveller also puts herself or himself at risk from tetanus. Tetanus is a potentially fatal disease that is caused when spores of the bacterium, Clostridium tetani, get into the body, usually through a skin wound.” 2 Bernie Hudson, Chair, Travel Health Advisory Group.  

Precautions and prevention

Vaccines are available for hepatitis B and tetanus. There is no vaccine to prevent hepatitis C infection or HIV. Travellers should consult their doctor or a travel health specialist at least 6 weeks before travel for advice and/or vaccination where required.

• Adopt safe sexual practices: avoid casual and unprotected sexual intercourse and use a condom.³
• Avoid the use of any potentially contaminated instruments for injection or other skin-piercing activities, such as acupuncture, piercing or tattooing.³

More information on Tetanus and Hepatitis B and Hepatitis C and HIV /AIDS

Tonsils 

By Sam Poynter, Hobart Tasmania

In 2002, I travelled on a 29-day Contiki tour through 11 European countries. During my trip, I developed a sore throat. Before long, it was so painful I could hardly eat or drink.

In Switzerland, I took a day trip with friends to Jungfraujoch and suffered altitude sickness. When we returned to the hostel, my friends insisted that I visit a local doctor to explain my symptoms. He took one look and insisted I visit a specialist in the nearby town of Interlaken.  

My tour manager and coach driver accompanied me to see the specialist, which was a horrible experience! He diagnosed quinsy, a severe abscess of the tonsils, which may result in blood poisoning. To remove the horrible pus, I had to lie back in the doctor’s chair holding a bowl while he cut open and drained the abscess with a scalpel - all without anaesthetic! It was so painful I nearly passed out.

When I returned home, I decided to have my tonsils out. The surgeon was so amazed by their size that he gave them to me in a jar! My experience from hell was certainly well remembered but I can’t wait to travel back to Europe soon.

Advice from the Travel Health Advisory Group

“Unfortunately for Sam, the treatment of quinsy is antibiotics and surgical drainage. By the time Sam had to see the surgeon, it was probably unlikely that antibiotics alone would have helped, hence the need to drain the pus. Often abscesses are drained without using an anaesthetic, so the doctor may have done everything correct, even if his bedside manner, language difficulties notwithstanding, was less than what Sam would have expected. The treatment was likely to have been life-saving. 

Many health problems cannot be predicted, but carrying a medical kit is essential.⁴ A medical kit can contain appropriate medications (including antibiotics), and must include specific and clearly written advice on how and when to use them. This should be discussed on an individual basis with your doctor before overseas travel. Use of such antibiotics can help avoid more severe illness by “nipping it in the bud” (as opposed to the mouth/tonsils in Sam’s case). Sam may have also avoided a more severe problem by seeing a doctor earlier in the illness, but this can often only be determined in retrospect.”

Bernie Hudson, Chair, Travel Health Advisory Group.

Flu 

By Michael Tink, Sydney. 

After two months spent touring New Zealand with a few friends, we headed south to hike the Milford and Routeburn tracks before leaving for Sydney. As we sat on the floor of Te Anau YHA making final preparations the night before our expedition, I began to notice a slight tickle in the back of my throat and realised I was getting a cold. I wasn’t too worried. I’d hiked with worse. 

By day two of our Milford trek my cold had developed into a full blown fever. I fainted on one of our more exhaustive days and dripping sweat kept me from sleeping at night. As our ferry pulled into Milford Sound, I made the difficult decision not to risk Routeburn. I would meet my companions back in Queenstown.  

I booked a seat on the next bus out of Milford. As I boarded the bus taking the nearest seat, I heard an obnoxious American voice behind me, “You stink son! Do you want to think about sitting somewhere down the back?” For a moment I was set to oblige, but then in true Aussie spirit I thought bugger him. “Sorry sir, the doctor said I’m not supposed to talk to people unnecessarily. I have a very contagious disease.” He spent the rest of the trip at the back of the bus next to the toilet. 

Advice from the Travel Health Advisory Group

Influenza is an acute viral respiratory infection caused by various types of the influenza virus. Influenza ranges in severity from an asymptomatic infection to a fatal disease.³  

Precautions and prevention

• Influenza vaccination, preferably with the type circulating in the areas to be visited, is recommended (see your doctor). Vaccination is particularly recommended in people aged 65 years and older. Travellers aged 65 years and older should ensure that their vaccinations against pneumococcal disease are current in view of the risk of pneumococcal pneumonia following influenza infection (see your doctor).⁵
• Vaccination is also recommended in the following groups (NHMRC):
  - Adults and children with chronic diseases, especially diseases of the heart, lung, kidneys or metabolic system (eg. diabetics)
  - Adults and children with immune deficiencies or those receiving immunosuppressive therapy⁵
• Whenever possible, avoid crowded enclosed spaces and close contact with people suffering from respiratory infections. ³

Further information on influenza.

Liver 

By Lauri Ball, Currarong, NSW

I was doing a grand tour of South America lasting some 55 days in all. On the way up the west coast through Chile, and then Peru, I started to get sick. Going across the Plains of Nasca in a very bumpy bus ride I started to go yellow in the whites of my eyes. Not a good sign. 

While landing in Quito, Ecuador I was taken off the plane and put into quarantine. It was a single room in a Catholic Hospital in the city. A Dr Pasmino told me in broken English that I was in a very bad state and that he would look after me. Sleeping for 20 hours a day, being woken for meals, only to fall asleep before I had finished the meal, I stayed there for a month. The doctor was taking bile readings from my liver at intervals and told me on the twentieth day that I should pull through as my liver was starting to regrow, after nearly disappearing completely.

The doctor came every day to see me, couldn’t do much, but he told me all about the bull fights which he loved, and keep my moral more or less up. I went from 70 kg to 45 kg and when I left the hospital I was so weak I stayed another month in a rest home to get some condition back. In all it was 12 months before my weight returned to normal and I didn’t have to sleep 12 hours a day. 

Advice from the Travel Health Advisory Group

Hepatitis A is a viral infection of the liver caused by the hepatitis A virus. The symptoms of hepatitis A infection are variable but may include fever, stomach discomfort, fatigue and jaundice (a yellowing of the skin and whites of the eyes). While the infection is usually mild or asymptomatic in very young children, it can be more severe in adults with illness lasting several weeks and recovery taking several months.³ 

Precautions and prevention

• Vaccination. A single dose of hepatitis A vaccine can be assumed to provide adequate protection if administered within 2 weeks of departure. A second dose given 6–18 months after the first dose of vaccine is recommended for long-term protection. A combined hepatitis A and B vaccine and a combined Hep A and typhoid vaccine are available (see your doctor.).⁵
• Travellers who are non-immune to hepatitis A (i.e. have not had the disease or are unvaccinated) should take particular care to avoid potentially contaminated food and water.³

Further information on hepatitis A. 

References:

1.      World Health Organization. International Travel and Health 2005. Environmental Health Risks. http://whqlibdoc.who.int/publications/2005/9241580364_chap3.pdf.

2.      World Health Organization. International Travel and Health 2005. Vaccine-preventable diseases, vaccines and vaccination. http://whqlibdoc.who.int/publications/2005/9241580364_chap6.pdf

3.      World Health Organization. International Travel and Health 2005. Infectious diseases of potential risk for travellers. http://whqlibdoc.who.int/publications/2005/9241580364_chap5.pdf

4.      World Health Organization. International Travel and Health 2005. Health Risks and Precautions: General Considerations http://whqlibdoc.who.int/publications/2005/9241580364_chap1.pdf

5.      National Health and Medical Research Council. The Australian Immunisation Handbook 8th ed. Canberra. Australian Government Publishing Service, 2003