Travel hopefully... but arrive fit and well
| by Catherine Chetwynd 06 Jul 2003 Topic: Travel |
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Catherine Chetwynd looks into travellers' health Since the World Health Organisation withdrew its warning against travel to Hong Kong and the southern Chinese province of Guangdong in late May, and the World Bank Group lifted travel restrictions to Singapore, the threat of SARS has looked as though it may be receding. In fact, the main problem with the disease is that it is new and therefore little is known about it. Says director of Fleet Street Travel Clinic, Dr Richard Dawood: 'The danger lies in the fact that we do not know how to control it, there are no appropriate drugs, only old-fashioned quarantine measures.' Nonetheless, continues Dawood, 'because the virus is believed to be capable of surviving on hard surfaces for many hours, hand hygiene is essential. 'Masks may be useful if someone is visiting a hospital - or possibly on a plane, if people are coughing - but they are not necessary on the street unless in an area where there is a high level of community transmission.' For those who want to buy a mask, Dawood recommends American type N95, the European equivalent FFP2, or the next level up, FFP3. There are, of course, longer standing threats to the health, including malaria, which can also be fatal. The negative coverage given to Larium, when it was discovered that some people had an adverse reaction to it, has left the impression that it is the only anti-malarial drug. Not so, says medical director of Royal Free Travel Health Centre, Dr Jane Zuckerman: 'There is a choice, including Malarone and Doxycycline, an antibiotic now licensed as a malarial prophylaxis. It is important that travellers make sure they are protected. If they are given a medication that does not suit them, they can change.' She also points out that the course continues after travellers have returned home, and adds: 'The medication does not provide 100% protection and bite avoidance measures are also necessary.' Sprays and other protection are available in most chemists. Add deep vein thrombosis (DVT) to the mix and you would imagine most people are lucky ever to get to their destination alive, let alone survive the trip. But there is plenty travellers can do to ensure they look after themselves. First, assess how high risk you are. Women on the pill, anyone who has had recent surgery, those with recognised clotting problems, or any combination of those, are more likely to suffer. Early check-in Those not travelling business class may check-in early enough to ask for an aisle seat or one by an emergency exit. Safety requirements demand that passengers given the latter are able bodied, so these seats cannot be pre-allocated, as check-in staff have to be able to see that travellers are fit enough to move quickly in the event of an emergency. Since October last year, Virgin Atlantic Airways has been charging £50 per leg (of journey, not person) for the privilege. There are no signs of other airlines following suit. The important fact to note is that inactivity is the salient factor, not aircraft. Jane Zuckerman explains what happens during inactivity: 'The blood pools at the ankles. Normally the veins carry the blood and the muscles act as a pump, but if you are stationary, the muscles are not working.' BA and Virgin both show videos of exercises passengers can do in their seat without laying waste their neighbour. Another possibility is Air Walker, an inflatable cushion devised by Huntleigh Healthcare and designed by chairman Rolf Schild, who suffered a DVT following an operation. The idea is to 'walk' on it, pushing the heel and ball of the foot up and down. Says Richard Dawood: 'Airlines are beginning to accept that there is a relationship between cramped seating conditions and the risk of DVT, although it is not confined to the physical act of flying.' Anyone who has symptoms in their legs such as pain, redness and swelling, or any combination of these, should act on them instantly. Dawood advises: 'Keep well hydrated, avoid alcohol and caffeine in flight, wear elasticated stockings and do not take sleeping pills if sleeping upright. Those who are predisposed to clotting should take an aspirin or have an injection of a blood thinning agent.' Dawood and MP John Smith, who has taken a close interest in the problem, have developed an Internet mechanism to allow travellers to calculate their risk factor (www.fittofly.info). As a recent incident on a bmi flight showed, it is possible to have a heart attack on board without suffering DVT. The airline claims to have made aviation history when a traveller became the first commercial airline passenger to have an electrocardiogram (ECG or heart trace) recorded in flight and transmitted by satellite to physicians on the ground in the US. The doctors made an immediate diagnosis of heart attack and, under their supervision, cabin staff administered emergency treatment. This sophisticated equipment is a more recent development but airlines have carried defibrillators for some years. These are used to give a shock in the event of there being no heartbeat. Richard Dawood describes them as 'intelligent, they read the ECG, diagnose and give verbal instruction, and a failsafe ensures they cannot be used where there is a heartbeat'. Less dramatically, keep up-to-date with inoculations. Hepatitis A is one of the commonest vaccine preventable diseases. Not having the jab can have far reaching effects. Says Richard Dawood: 'There is no good medical treatment once someone has got the disease. It is likely to have a serious impact on your working and rational performance. Typically, people are ill for six weeks, and there is about a 2% risk of liver failure in those over 40.' With the initial inoculation and booster, travellers are then protected for 10 years, so it is low maintenance. Good news for those travelling to cholera infected areas is the licensing of a new, effective vaccine expected in the UK in October. It is in drinkable form and also protects against some types of travellers' diarrhoea. Since its predecessor was never clearly demonstrated to have reduced either the number of cases, or the severity of the illness, this is an improvement. Regardless of the risks they are exposed to, travellers are ultimately responsible for their own health. This may appear to be stating the obvious but familiarity breeds contempt. The last word goes to Jane Zuckerman: 'Seek advice six to eight weeks before you travel to ensure you stay well; and if you feel unwell on your return, seek medical advice promptly and tell the healthcare professional that you have travelled and where you have been, so that they can consider a differential diagnosis.' Good communication is all.
Contacts
Useful reading Catherine Chetwynd is a freelance journalist specialising in business travel, conference, incentive and exhibition writing. She also writes for The Times and the Financial Times. | |