It goes without saying that travellers should always seek qualified medical attention if
any illness they are suffering from gets worse despite their own remedies, or, for
that matter any of those mentioned in this book! Large hotels usually have access
to doctors, typically a local family doctor or private clinic. In remote areas, the
nearest qualified help will be a rural dispensary or pharmacist, but seek advice
from local expatriate groups, your consulate or embassy for details of local doctors.
Mission hospitals usually offer excellent care and they often have English-speaking
doctors. In large towns, university-affiliated hospitals should be used in preference
to other hospitals. The International Association for Medical Assistance to
Travellers produces useful lists of English-speaking doctors overseas
(www.sentex.net/~iamat/ci. html).
If you feel that your medical condition is deteriorating despite (or because of) local
medical attention, consider travelling home or to a city or country with more
advanced medical expertise - sooner rather than later.
Medication
Medicines sold in tropical pharmacies may be sub-standard. Always check the expiry
date and check that medications that should have been refrigerated are not being
sold on open shelves. There is a growing market in counterfeit drugs and locally-
prepared substitutes are often of low potency. Stick to brand names manufactured
by large international companies, even if these cost more. Insist on buying bottles
that have unbroken seals and, wherever possible, purchase tablets or capsules
that are individually sealed in foil or plastic wrappers. It is difficult to adulterate or
substitute the contents of such packaging.
It is usually wise to avoid medications that include several active pharmacological
ingredients, most of which will be ineffective and will push up the cost. Medication
that is not clearly labelled with the pharmacological name as well as the brand
name of ingredients is suspect (e.g. Nivaquine contains chloroquine).
Fevers
Fever may herald a number of exotic infections, especially when accompanied by a
rash. Fever in a malarious area should be investigated by blood tests, even if you
are taking antimalarials. A raised temperature is more commonly due to virus
infections such as influenza, or localised bacterial infections that have obvious
localising features such as middle ear infections or sinusitis (local pain), urinary
tract infections (pain or blood passing water), skin infections (obvious) or chest
infections including pneumonia (cough, chest pain or shortness of breath).
If medical attention is not available, the best antibiotic for amateurs is cotrimoxazole
(Bactrim or Septrin) which contains a sulphur drug together with trimethoprim. This
covers all the above bacterial infections as well as typhoid fever. Travellers who
are allergic to sulphur drugs could use trimethoprim alone or coamoxyclav
(Augmentin) which is a combined oral penicillin preparation.
Local infections
Athlete's
Foot: Can become very florid in the tropics so treat this problem
before departure. The newer antifungal creams e.g. Canesten, are very effective
and supersede antifungal dusting powders, but do not eliminate the need for
sensible foot hygiene. In very moist conditions, e.g. in rain forests, on cave
explorations or in small boats, lacerated feet can become a real and incapacitating
problem. A silicon-based barrier cream in adequate supply is essential under these
conditions.
Blisters: Burst with a sterile
blade or needle (boiled for three minutes or hold in a flame until red hot). Remove
dead skin. Cover the raw area with zinc oxide plaster and leave in place for several
days to allow new skin to form.
Ears: Keep dry with a light plug of cotton wool
but don't poke matches in. If there is discharge and pain, take an
antibiotic.
Eyes: If the eyes are pink and feel gritty, wear dark glasses
and put in chloromycetin ointment or drops. Seek medical attention if relief is not
rapid or if a foreign body is present in the eye.
Feet: Feet take a hammering so boots must fit and be
comfortable. Climbing boots are rarely necessary on the approach march to a
mountain; trainers are useful. At the first sign of rubbing put on a plaster.
Sinusitis: Gives a headache (feels worse on stooping),
'toothache' in the upper jaw, and often a thick,
snotty discharge from the nose. Inhale steam or sniff tea with a towel over your
head to help drainage. Decongestant drops may clear the nose if it is mildly
bunged up, but true sinusitis needs an antibiotic so seek advice.
Skin infections: In muddy or wet conditions, many travellers
will get some skin sepsis or infections in small wounds. Without sensible hygiene
these can be disabling, especially in jungle conditions. Cuts and grazes should be
washed thoroughly with soap and water or an antiseptic solution. Large abrasions
should be covered with a vaseline gauze, e.g. Jelonet or Sofratulle, then a dry
gauze, and kept covered until a dry scab forms, after which they can be left
exposed. Anchor dressings are useful for awkward places e.g. fingers or heels. If a
cut is clean and gaping, bring the edges together with Steristrips in place of
stitches.
Teeth: When it is difficult to brush your teeth, chew gum. If a
filling comes out, a plug of cotton wool soaked in oil of cloves eases the pain;
gutta-percha, softened in boiling water, is easily plastered into the hole as a
temporary filling. Hot salt mouth-washes encourage pus to discharge from a dental
abscess but an antibiotic will be needed.
Throat: Cold dry air irritates the throat and makes it sore.
Gargle with a couple of aspirins or table salt dissolved in warm water, or suck
antiseptic lozenges.
Unconsciousness
The causes range from drowning to head injury, diabetes to epilepsy. Untrained
laymen should merely attempt to place the victim in the coma position
- lying on their side (preferably the left side) with the head lower
than the chest to allow secretions, blood or vomit to drain away from the lungs.
Hold the chin forward to prevent the tongue falling back and obstructing the airway.
Don't try any fancy manoeuvres unless you are practised, as you
may do more harm than good. All unconscious patients, from any
cause, but particularly after trauma, should be placed in the coma position until
they recover. This takes priority over any other first aid manoeuvre.
In cases of fainting, lay the unconscious person down and raise the legs to return
extra blood to the brain.
Injury
Nature is a wonderful healer if given adequate encouragement.
Burns: Superficial burns are
simply skin wounds. Leave open to the air to form a dry crust under which healing
goes on. If this is not possible, cover with Melolin dressings. Burn creams offer no
magic. Deep burns must be kept scrupulously clean and treated urgently by a
doctor. Give drinks freely to replace lost fluids.
Sprains: A sprained ankle ligament, usually
on the outside of the joint, is a common and likely injury. With broad Elastoplast
'stirrup strapping', walking may still be possible.
Put two or three long lengths from mid-calf on the non-injured side, attach along
the calf on the injured side. Follow this with circular strapping from toes to mid-calf
overlapping by half on each turn. First Aid treatment of sprains and bruises is
immobilisation (I), cold e.g. cold compresses
(C), and elevation (E); remember
'ICE'. If painful movement
and swelling persist, suspect a fracture.
Fractures: Immobilise the part by splinting to a rigid structure;
the arm can be strapped to the chest, both legs can be tied together. Temporary
splints can be made from a rolled newspaper, an ice-axe or a branch. Pain may be
agonising and is due to movement of broken bone ends on each other; full doses
of strong pain killers are needed.
The aim of splinting fractures is to reduce pain and bleeding at the fracture site and
thereby reduce shock. Comfort is the best criterion by which to judge the efficiency
of a splint, but remember that to immobilise a fracture when the victim is being
carried, splints may need to be tighter than seems necessary for comfort when at
rest, particularly over rough ground.
Wounds at a fracture site or visible bones must be covered immediately with sterile
material or the cleanest material available, and if this happens, start antibiotic
treatment at once. Pneumatic splints provide excellent support but may be
inadequate when a victim with a broken leg has a difficult stretcher ride across
rough ground. They are of no value for fractured femurs (thigh bones). If you
decide to take them, get the Athletic Long Splint which fits over a climbing boot
where the Standard Long Leg splint does not.
Wounds (deep wounds): Firm pressure on a
wound dressing will stop most bleeding. If blood seeps through, put more
dressings on top, secured with absorbent crêpe
bandages and keep up the pressure. You should elevate the injured part if
possible.
On expeditions to remote spots, at least one member of the party should learn to put
in simple sutures. This is not difficult - a friendly doctor or
casualty sister can teach the essentials in ten minutes. People have practised on a
piece of raw meat and on several occasions this has been put to good use. Pulling
the wound edges together is all that is necessary, a neat cosmetic result is usually
not important.
Swimming
Safe swimming: Try to swim
in pairs: a friend nearby in the water is more likely to distinguish between waving
and drowning.
When to swim: Drowning
seems rather too obvious a risk to mention here but it is simultaneously the most
common and the most serious risk of any water sport, and in many cases alcohol is
involved. Don't swim drunk. Some authorities still maintain that
swimming after meals runs a risk of stomach cramps, although this is now a
minority view.
Where to swim: Safe
swimmers find local advice before taking to the water. Deserted beaches are often
deserted for a reason, whether it be sharks, invisible jellyfish, or vicious rip tides.
Beware of polluted water as it is almost impossible to avoid swallowing some.
Never dive into water of unknown depth. Broken necks caused by careless diving
are a far greater hazard to travellers than crocodiles.
Freshwater swimming: Is not
advisable when crocodiles or hippopotamuses are in the vicinity. Lakes, ponds,
reservoirs, dams, slow streams and irrigation ditches may harbour bilharzia
(schistosomiasis). This is a widespread infection in Africa, the Middle East and
parts of the Far East and South America, and is a genuine hazard for swimmers.
Strong currents: In the sea and
rivers, watch out for tides and rips: even a current of one knot is usually enough to
exhaust most swimmers quickly. Swimming directly against a strong current is
especially exhausting, and, if possible, it is best to swim across the flow, and so
gradually make your way to the shore.
Snorkelling: Snorkelling is a
great way to see the seabed, provided that a proper mask is used, enclosing the
nose. Eye-goggles can cause bruising and eye damage from the pressure of
water. A more serious risk is the practice of hyperventilating (taking several deep
breaths) before diving, in the hope of extending a dive. This can kill. Normally, the
lungs tell the body to surface for air when the carbon dioxide level is too high.
Hyperventilation disrupts this mechanism, so the body can run out of oxygen
before the lungs send out their danger signals. This can lead to underwater
blackouts, and drowning.
Scuba diving: Scuba divers
should be sure that local instruction and equipment is adequate and should always
swim with a partner. Do not fly within three hours of diving, or within 24 hours of
any dive that requires a decompression stop on the way back to the surface.
Travellers who anticipate scuba diving in their travels are strongly advised to have
proper training before setting out.
