Archive for the ‘Clinic Stories’ Category

A Year in South America

Brian and Debbie don their back-packs and pretend they are young – a year in South America.

Intrepid travellers from way back, my husband and I, at 53 years old, found ourselves rattling around in our huge empty nest, encumbered by possessions, job security, and misguided ideas that our adult children still needed us. We were feeling a tiny bit ‘old and achy’.
It had been a long journey since we’d first bumped back-packs in Europe in 1980. Four children and 30 years later, we had lost our ‘Mojo’ so, we took a year off from our teaching jobs and armed with our freshly gleaned Lonely Planet Guide, fledgling Spanish, overly-heavy back-packs, and traveller’s medical kit (thanks Dr. Julie Bourke); we landed in Buenos Aires just after Christmas 2009.

And thus began the adventure of our mid-lifetime! We had scribbled a loop clockwise around the continent, including all 13 countries with side trips to Antarctica, Easter Island, Galapagos and Cuba allowing roughly a month in each of the big countries and highlighting a few “must-sees” like Macho Picchu and Iguaçu Falls.

For us all the fun of travelling has always been, getting down and dirty and mixing it with the locals in their everyday lives – catching local transport, sleeping in hostels and cheap hotels, and eating in the local food-stalls.
This kind of rough travelling is not for every ‘oldie’. It was tough and not without its dangers!

At first it was hard to sleep in public – in strange beds. I’m not sure if modern unisex dormitories and bathrooms represent progress?

Sleeping soon became a non-issue as we toughened up. Pounding the pavements for hours every day, trekking up and down mountains, cycling and horse-riding made us so tired, we could sleep on a stone!

Wherever possible we caught local transport, from the world-class buses of Argentina and Brazil with airline-like service – to the bone-rattlers of Bolivia and Ecuador, jam packed with people, produce and peddlers- selling everything from hot food to God (evangelists), as the drivers careened down the mountains, at break-neck speed with one hand on the wheel, the other on their mobile phones.

Dealing with endless dysfunctional and often dirty toilets, or simply trying to find one at all was a daily challenge!

The only regret I have about being Australian is how dumb we are with other languages. Listening to Europeans slip in and out of 5 lingos in a conversation has always filled me with shame and envy.Fumbling along in our basic Spanish, we decided to home-stay in Sucre, Bolivia and attend language school for 2 weeks. After that, we ‘upped the ante’ and persevered till our heads ached.

Then one magic day, we realized we had passed through a barrier and could understand a great deal of what was being said around us. I can not explain what a thrill that was! Speaking the lingo takes the ‘tourist’ stigma away and opens so many doors to experience the hospitality and kindness of the wonderful local people.
Although border crossings and late night bus travel can be scary, we were rarely frightened, except when we were caught in 2 natural disasters.
Firstly the earthquake in Chile, ‘shook us to the bone’. We were in a cheap and rickety old hotel in Valparaiso, asleep, when the whole building began to shake….. then rock….. and then belt the furniture from one side to the other! The plaster ceiling showered down on us and the walls cracked from top to bottom. We eventually made a run for it down the swaying cracking stair-cases to the square outside. The after-shocks went on for days. Towns went into lock-down and looters and armed guards controlled the streets. Brian had his day pack stolen. Scary stuff!

We now have a new understanding as we watch news coverage of those kinds of events.The 2nd time we thought our number was up was when we were trekking to ‘the lost city’ in the Columbian jungle. A huge mudslide engulfed the dodgy-built bunk-house, where we were resting after lunch. I swear I broke the world land- speed record as I leapt up over boulders and up the ridge as the whole mountain came down! I couldn’t find Brian! He had run the other way!The local guides frantically started digging in case someone was trapped underneath. Miraculously everyone had escaped! Many in our group lost everything. It was a long muddy 3-day trek back to civilization in shared clothes and various improvised footwear held on by gaffer tape! We still keep in contact with the 17 magnificent people on that trek (from 14 countries). We developed a wonderful camaraderie and respect through that shared hardship. Humour abounded as we hugged each other in the nightly soggy giant ‘spoon’ to keep warm.

As for illness, we picked up a couple of tummy bugs, suffered from mild altitude sickness several times and Brian had the horror of discovering a hook worm winding its way under the skin on his little toes! Teach him to walk around bare-footed!

South America has it all:- trekking in the awesome Andes; battling the wild winds of Patagonia; marching Incan trails to Machu Picchu; discovering Columbia’s lost city; sweating it out in the Amazonian jungles of 5 countries; catching and eating piranha (before they eat you!); chugging up the Mighty Amazon itself in Brazil on a supply boat; the seductive music and rhythm of the Latino Salsa and Tango; the enduring Catholicism, cathedrals and cobble stones of the great Spanish Conquistadores; the ingenuity of the Incas; the white wonderland that is Antarctica; the quirky culture of Cuba (a society cut off from the real world); the amazing animals of Galapagos; enigmatic Easter Island; the boisterous Bolivian markets; the surrealism of the high altitude salt plains of the Atacama Desert; the sexy culture of iconic Ipanema Beach in Rio de Janero … I could go on and on …

We left old and achy feeling like the best years of our lives were over and returned, a year later, feeling young and invincible! We can do anything!

Next stop – Africa!

… Prepared by Debbie Mann Yeppoon State High School, Queensland

• Posted on August 27, 2013
• Posted in Yeppoon
• Tags: South America

Racing To Paradise – Fremantle to Bali

… Prepared by  TMA Member Wembley, WA: Dr Shane Leavy

The Fremantle to Bali Yacht Race was held for the first time this year after a 14-year hiatus. Having sailed as a kid and more recently raced across the Atlantic I was more than keen to be a part of this adventure.I recently joined the team at Capstone Health with Matt Atkins and Dave Rowse and as such I was keen to put into practice my burgeoning travel medicine skills to go with those I’ve gained from my time in Emergency Medicine. All in all I couldn’t think of a better way to practice what you teach!

As owner and skipper of “Farr Lap of Sydney”, I persuaded my land lubber father, Dr Richard Leavy and friend, fellow emergency doctor and sailor, Dr Stephen Grainger to join the crew.

Farr Lap was one of 22 yachts that competed in the 1400 NM (3000 Km) race to Bali. It was the adventure of a lifetime, getting the crew organised and the yacht ship shape and ready for such a journey was an adventure in itself. Fremantle to Bali is 3 times the distance of the Sydney to Hobart with nowhere to seek safe haven once the WA coast is departed off the Exmouth Peninsula.

Adding to the adventure, whilst sailing at the top end of the fleet, Farr Lap began to take on water, more water than had come through the hatches during the first few days of unseasonal norwesters. A decision was made to stop in Exmouth to repair a small crack, which was found to be the cause of their problems.

Reaching Bali in 11 days and a respectable mid fleet position, we spent a restful week in hotel luxury sharing salty sea tales with the rest of the fleet. We then departed for a month of cruising the exotic Indonesian Archipelago, which included Lombok, the Gili Islands and Sumbawa. Waking in hammocks swinging on the yachts’ deck amongst the local fishing boats and seeing the sun rise over Volcano Rinjani was truly an unforgettable experience.Thankfully all the advice and preparation we put in, not only for our boat but also for the rest of the fleet paid off as we managed to avoid any major medical catastrophes and with a little bit of luck we also avoided any minor medical inconveniences along the way simvastatin dosage. (The odd episode of seasickness excluded of course).

The challenges involved in not only the effort of completing the race successfully, but the organizational tasks of preparing our crew and those of the fleet for potential traumatic medical emergencies and also for any travel related problems for the time around the Indonesian islands for many of the boats, were bigger than I had originally planned for, but also incredibly satisfying once it all came together without incident.

Asked if we would do it again for the next race in two years time? All our hands are raised!

• Posted on August 27, 2013
• Posted in Wembley
• Tags: Bali

Trekking Ethics

It is a fact that more porters suffer from accidents and altitude sickness than western trekkers and that every year porters die unnecessarily on the job. Many are affected so badly by frost bite or snow blindness that they are unable to work again and unable to support their families.

Whether its Nepal, Pakistan, Tanzania, Peru or any other trekking destination, the problems faced by trekking porters share are the same, whether they be inadequate wages, a lack of appropriate clothing, footwear or safety equipment or a lack of medical care should they fall ill or become injured.

Choosing a Trekking Company

Before you book your trek ask the travel company what their porter policy is (see below for questions to ask). Contact organisations which offer ethical trekking agreements to which trekking companies can sign up. Finally, if you see porter mistreatment then complain loud and long on the spot and once home complain to your travel company. Send a report of the incident to IPPG with as much detail as possible.

Questions to ask trekking companies:

1. Does the company follow IPPG’s five guidelines on porter safety (detailed on their website)?
2. What is their policy on equipment and health care for porters?
3. What do they do to ensure the trekking staff is properly trained to look after porters’ welfare?
4. What is their policy on training and monitoring porter care in the country you intend to visit?
5. Do they ask about treatment of porters in their post trek feedback questionnaire to clients?

So is the answer to avoid using porters on your trek? Of course not discover here. If you act responsibly and choose an ethical company, employing porters is a very good way to assist some of the world’s poorest communities and create jobs for meagre subsistence farmers to supplement their income so the more porters you can employ the better!

Despite their hard graft, you’ll discover that the grace and enthusiasm of your porters will add a wonderful dimension to your trek.

More Information
International Porter Protection Group: www.ippg.net
Australian Himalayan Foundation: www.australianhimalayanfoundation.org.au
Porters’ Progress UK: www.portersprogress.org

…

• Posted on August 27, 2013
• Posted in Wembley
• Tags: Nepal, Peru, Tanzania

The University Traveller

… Prepared by  TMA  Clayton, Vic:  Dr Craig Blandy,

Travel Risk has a Social Denominator

The university traveller travels to a university in another country for their studies or work. Over 2 million people travel for this purpose each year. The Australian Government Outbound Mobility Study (2008) states that there are 400,000 inbound people living in Australia on student or educational work visas and around 30,000 outbound. Most of these people link their academic and travel ambitions into a cultural experience. Australian universities are vibrant and culturally diverse communities that have evolved over the past decade as major contributors to world education.

Monash University operates a University Health Service for all students and staff. The Clayton campus has a population of nearly 20,000 with student enrolments and staff from nearly every country. These world people allow us, at the health service, the privilege to be the virtual traveller, enriching our travel experiences with their stories of home. It also allows us an insight into the influence of normal social customs and cultural exchange as risk factors in travel.

The desires and the risks of travel appear to have common denominators that are based in the learned social existence of the country of residence. Overall infectious disease is not the major risk to the health and wellbeing of travellers. The risks are embedded in the normal social behaviours of the landed destination abutted with those of the visitor. Those things that are known to the resident and are unknown to the visitor; or even those things experienced by the resident and not by the visitor.

There is a consistent message of understanding the nuances of the society; its rhythm. Most of the health risks of each group can be categorised in the same way; whether the person be here or there.

Preparation for Travel

Research
Most inbound university travellers spend months studying the local nuances of life in Australia prior to arrival and are not easily misled by the early teasing of fellow students with stories of “drop bears” and “street kangaroos”. There is an American-Australian slang dictionary that is usually well studied to minimise social embarrassment such as the oft quoted example of the young man introducing himself to a young woman with “Hi … I’m Randy (Randolph)”.

Monash students travelling to overseas campuses of Monash University and overseas universities receive orientations to achieve a destination and cultural familiarisation.

First Principle: Understand the rhythm of the destination

Local Laws

Medications and Drugs
Australian customs law allows a person to bring with them up to 3 months of medication with evidence of its proper prescription in the country of residence. Many North American students are prescribed various medications for a range of mental health issues. Some of these medications are illegal in Australia. Australian customs law permits these students to carry with them a 3 month supply and then an Australian doctor needs to be consulted to gain special access to the medication. Each year there are students visited by efficient Australian customs officers following attempts to import medications, legally prescribed in another country, that range from marijuana to amphetamine derivatives. All travellers need to be aware of local laws; in this case ours.

For the outbound Australian it is illegal to take pharmaceutical benefit medications from Australia other than for personal use. Read more here.

A common request made to doctors is a letter listing the persons prescribed medications. This letter needs to describe the medication, form, strength and quantity needed. At the University Health Service we seek consent to declare the reason for use of the medication on the letter. Despite this letter, and the legitimate prescription of your medication in Australia you may still find yourself in close confrontation with foreign customs or police, just like some of our inbound students. In Greece it is illegal to transport codeine in any form, regardless of its clinical indication, and Singapore’s prohibition on chewing gum extends to Nicorette. So contact the embassy of the country you are visiting to ensure the medicine is legal in their jurisdiction. It is a good idea to carry medication in the original packaging to minimise confusion.

Second Principle: Understand the customs and laws

The Road

The major health risk to all travellers is road related injuries. The dangers of road and pedestrian travel have been addressed in the TMA Newsletter of August 2010; road travel in Vietnam. In Vietnam the traffic does not stop, like a school of fish it parts and goes around objects and those who have socially adapted responses to these patterns see it as organised, functional and in continuous flow. If you live there it has a predictable mass movement. In Bangkok it is more likely that mass movement is a complete stop, but it is consistent.

The student from Asia is not used to the pulse regulated movement of Australian city roads. It has a different rhythm; known to the resident and not to the visitor. It appears chaotic here with vehicles travelling at different speeds, in different lanes, changing lanes, and with incoherence in movement. How can a pedestrian find a path through a flow of traffic that has no tune? Why is a car required to stop just after just getting to speed? Given the predictability of the stop it makes little sense to get there quicker.

Many of the return travel consultations seen at the university health service involve accidents that occurred overseas; half of these relate to transport; roads, scooters, bikes and even walking. The risk that leads to the accident is often the lack of understanding of the rhythm of the road. In the main cities of Eastern Europe a pedestrian crossing offers the right to cross the road when it is clear; not a right to cross the road.

In the Baltic States it is a legal requirement for pedestrians to display reflectors, although this relies on vehicles having lights. Transgressors of either law face the same penalty and that penalty is increased by a factor of ten if either is under the influence of alcohol. The Nordic countries also advise reflectors.

Third Principle: Understand the Road

The Beach

Many visiting students cannot swim or do not know of the real dangers of the Australian seaside. They have a fear of Australian sharks and for this reason spend most of their time in the shallows, the rock pools or at the water’s edge. Some students have been injured peering into “blow holes” or experienced intensive medical care after collecting the blue-ringed octopus fascinated by its capacity for glowing blue rings. These are risks known to the resident and unknown to the visitor.

Outbound students have been known to organise travel plans around holiday destinations and walking on the beach can provide different risks; known to the resident and unknown to the visitor.

Chigoe “Jigger” Flea

The jigger flea is found in tropical and sub-tropical climates, particularly in many parts of Latin America, the Caribbean, and sub-Saharan Africa. In Brazil, it can be found both in northern and southern regions. At 1mm it is not seen by human eyes. It burrows into the skin for blood meal whilst incubating the offspring and swells to become a blister or even a callous. These nearly always become infected.

Hook Worm

At the edge of the beach, where the city merges with the sand are found the products of city life. Immersed in the sand the hookworm  may be waiting to complete its life cycle in the human. They are more common and more frequent in warm destinations where feral animals roam and barefoot walking is hazardous from more than the hookworm. There was a recent outbreak on a Miami beach traced to feral cats.

Fourth Principle: Understand places of recreation

Going Home

Our health service has the curious role of giving travel advice to world travellers on completion of their studies. Some have been away from home for five years and started a family. Natural immunity to exotic diseases such as malaria, typhoid and hepatitis A is diminished and their children have started life in a community relatively free of infectious diseases. Everyone needs their vaccinations updated including the vaccines they did not receive as children in their home country. There is also the risk that the rhythm of home may be forgotten.

Our university outbound travellers eventually become inbound. Most of their presentations relate to the following principle:

The Rhythm of Travel

Communities follow a socially constructed way of life; a rhythm. To reduce your travel risk at your destination learn the rhythm of the community and apply this to the road, the beach, the food and the law.

• Posted on August 27, 2013
• Posted in Clayton
• Tags: University

Antarctica 2012

Dr Jason Rajakulendran, TMA member Sandringham, Victoria:

As I marvelled over another penguin documentary in 2010, I wondered.. for what length of time would Antarctica remain as it does today? A place of unparalleled isolation, natural beauty and biological diversity yet relatively untouched by human activity. In a win for common sense, an Antarctic treaty exists between the various countries vying for territorial claims. It specifies that the continent be used primarily as a place of research and not for resource mining until at least 2041. This question pushed me to book a trip about twelve months prior (increasingly the need due to booming Eco-tourism) and find out for myself. My easiest option was to depart on a ship from the Argentine port of Ushuaia after acclimatising in the Patagonian wilderness.

• Posted on August 27, 2013
• Posted in Sandringham
• Tags: Antarctica

RUM Project … Spot Quiz

What you are supposed to do with old or expired drugs that may be laying around your house?

A) flush them down the toilet
B) put them in the household rubbish
C) thrown them in a fire
D) give them to the RUM Project
E) use them anyway – waste is bad

The correct answer is D 
It is not safe or environmentally friendly to put expired medication in the household rubbish, and especially do not flush them down the toilet. Medicines can contaminate the environment when discarded via landfill sites and sewerage facilities. Many medications are supplied packaged in blister plastic made of PVC, which, when incinerated, produce dioxin (usually found in Agent Orange).

RUM in this circumstance is not what we mix with coca cola, RUM stands for Return Unused Medicines. It is a free service, funded by our taxes. Your local Pharmacy has special yellow bins to receive the medicines, which are then sent for high tech disposal in Victoria. RUM guidelines advise it is best to remove cardboard outer packaging (and place in the household recycling paper bin). Then, take the meds to shops next time you go, and deliver the used tablets, bottles and blister packs… to your local pharmacy. Many TMA member clinics will collect expired drugs when restocking kits, and drop them at the pharmacy for you. More info.

• Posted on August 27, 2013
• Posted in Brisbane
• Tags: Medications

Travelling Children

Travelling Children

One study also highlighted high rates of fatigue, itching, nausea, and sunburn while children were abroad; symptoms of which were not common in adults. Interestingly, one study found children received four times more insect bites than their in parents. Adolescents (aged 15-19 years) behaved more independently, undertook more adventure travel and backpacking, and were more likely to acquire glandular fever, sexually transmitted diseases, and suffer trauma.

• Posted on August 27, 2013
• Posted in Brisbane
• Tags: children

Waterways at the Centre of the Earth – From Panama to Darien

Goondiwindi TMA Clinic

Cressy Clinic is a truly country practice, situated 5 km out of Goondiwindi, across a couple of grids, and often with a few roos outside in the paddock!

Dr Rowena Sheppard has been a general practitioner in Goondiwindi for 23 years, with one of her many hats being the ability to provide accessible travel related medical services to the local community.

• Posted on August 27, 2013
• Posted in Goondiwindi
• Tags: Panama

South African Holiday

TMA Member – Geelong Dr Paul Davey

Dr Paul Davey the medical director of The Travel Medicine Alliance Clinic Travel Health Geelong has recently travelled to South Africa riding a motor bike for three weeks around this amazing country. Here are his thoughts regarding the safety of this destination.

South Africa is a wonderful place for an adventure and a holiday. I decided to travel there after talking to some clients who had recently returned. They had loved their trip but then made the observation that they were glad they had travelled now as they weren’t sure of what was going to happen to the country, and to its political stability when Nelson Mandela dies. I have for a long time advised my traveler clients that if they want to travel and the opportunity to go is present then go. If a trip is delayed obstacles can arise and we may never end up going. I decided I should follow my own advice and booked the trip.

Safety in South Africa

Lots of people who haven’t been to South Africa expressed concern re the safety of travelling in South Africa. We checked this out with the tour operators who gave very sensible advice.

“Most of the crime that occurs in South Africa takes place in the poor township areas and mainly affects the local people. We recognize that personal safety is an issue. In the big cities precautions are needed and we suggest the following: Don’t flaunt wealth; Don’t walk around the cities at night; Travel by taxi to destinations at night. With caution you can stop bad experiences happening.”

We had a wonderful time in South Africa, and following the above advice and being cautious meant that on no occasion did we feel that our safety was threatened. In the smaller rural towns we perceived no risk at all. The people were amazingly friendly and every South African we met loved their country.

General Advice

Dr Paul Davey has offered two general travel advice suggestions following on from his African Travel.

Seek Expert Travel Medical Advice

Whilst at a private game park in the Kruger National Park region, we met an Australian couple arriving late in the afternoon. They looked exhausted and I asked if they had come far and they explained how they had been staying only about 40 km away but had had to travel 600kms that day. As they were leaving in the morning for the short drive they had mentioned how after visiting the game park they were travelling on to Victoria Falls. They were then asked if they had been vaccinated against Yellow Fever. They hadn’t and when told that they wouldn’t be permitted back into South Africa unless they were vaccinated they had to make a 300 km trip to a medical centre where they could receive this vaccination. Before leaving Australia they had been to their local doctor and had asked regarding the need for this vaccination. Their doctor had checked regarding this and advised them that it wasn’t required. Unfortunately for them the immigration requirement by the South African government changed last year and it is now a compulsory vaccination against Yellow Fever if returning from Victoria Falls.

Travel Insurance is a MUST

During a motor bike trip our lead rider crashed into a truck whilst travelling at 120km/hour. Following this accident and whilst attending to the rider I attended a small medical clinic in Swaziland and then a larger clinic in South Africa before he was evacuated back to Pretoria. Our friend required road ambulance and air ambulance transfer and then open heart surgery to treat his injuries. The local facilities were basic at the level of a school first aid clinic. Transport to first class facilities was essential. The cost of the evacuation and treatment would have been astronomical. Travel Insurance in general and also specific insurance designed to cover the costs associated with increased risk activities be they motor bike riding, or mountain climbing or snow skiing or boarding is essential for all overseas travel.

… Prepared by Dr Paul Davey, Geelong TMA

• Posted on August 27, 2013
• Posted in Geelong
• Tags: Africa

Kayaking in Remote Solomons 
- Morovo Lagoon

Prepared by TMA Member Maitland

Public Health Physicians also need travel health advice. Another satisfied (and healthy) Chromis customer. And the beautiful fish is our symbol. Check our website www.chromis.com.au for more information on us and our services.

• Posted on August 27, 2013
• Posted in Maitland
• Tags: Solomon Islands