Typhoon Haiyan travel advice

Prepared by TMA member Narre Warren

It is now over a month since Typhoon Haiyan (called Yolanda in the Phillipines) struck the Philippines on 8/11/13. The worst hit provinces were Leyte and Eastern Samar, which experienced sustained winds of 270 kph, gusts of up to 312 kph, and a storm surge in coastal areas as high as 7 metres. Not all travel is for pleasure. Typhoon Haiyan travel advice is be prepared and be informed.

The official death toll from the Phillipines Government is approaching 6000, the injury toll 27000, and 1800 people as of mid December 2013 are still listed as missing. These figures are considered by most to be conservative.

Enormous international aid efforts are underway. Significant infrastructure damage has caused problems with sanitation, food supply, electricity, transportation, shelter, communications, security, and medical care.

This all has implications for people who are considering travelling with aid organisations, or in those visiting relatives and friends to help them. 

The following advice applies to both groups of travellers:

1                Take a kit with you from your travel medicine clinic to treat diarrhoea; diarrhoeal illnesses are likely to be more common after a disaster where serious flooding has occurred. Follow the usual safe food and water precautions advised by your travel clinic

2                Use mosquito repellents with more than 30% DEET to prevent mosquito borne illnesses such as Dengue Fever and Chikungunya. Mosquitos will breed in greater numbers around flooded areas. The areas worst affected by Typhoon Haiyan are the islands of Leyte, Samar and Cebu; they are not affected by malaria so malaria tablets are not required for these islands.

3                Be vaccinated for Hepatitis A and Typhoid; update your tetanus injections as debris clearing will often result in injury. Have a flu injection, and speak to your travel Doctor about other vaccines you may need.

4                Avoid injury—most deaths after a natural disaster are due to blunt trauma, crush-related injuries, and drowning. Use caution around damaged or down power lines, 

water-affected electrical outlets, and interrupted gas lines.

5                 Avoid stray or frightened animals. Seek medical help immediately if you are bitten or scratched by an animal and wash out the wound. Consider rabies vaccination before you go, or seek rabies vaccination within 48 hours of any animal bites.

 

 

• Posted on December 11, 2013
• Posted in Country, Narre Warren, Other, Travel health tips

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Decompression Sickness ( The ‘ Bends ‘ )

Prepared by TMA Member Boronia 

Decompression Sickness (DCS)  is also known as Acute Decompression Illness (ADI) or, more colloquially, as the ‘bends’ (because the pain involved can bend a person).

DCS in the setting of scuba diving or deep-sea diving, refers to an illness caused by an overly rapid ascent to the water’s surface.

During a scuba dive, the diver absorbs additional quantities of oxygen and nitrogen into the blood and tissues.  The nitrogen is dissolved into the bloodstream, where it remains during the dive.  Once a diver begins their ascent,  the surrounding water pressure decreases. If this transition occurs too quickly, the nitrogen does not have sufficient time to leave the bloodstream and be exhaled via the lungs.  Instead, nitrogen bubbles form in the bloodstream which can enter tissues throughout the body.  

Factors increasing risk of DCS

 

• Increasing Age
• Being female
• Poor fitness
• Obesity
• Dehydration
• Alcohol / hangover state
• Fatigue / sleep deprivation
• Sickness
• Heart muscle defects
• Ventricular wall defects
• Airways disease (eg. asthma)
• The rate of ascent
• Flying after diving
•  Repetitive dives
• Exercise after diving

 

Symptoms of DCS

 Approximately fifty percent of divers with DCS develop symptoms within 1 hour after surfacing, 90 % within 6 hours and 98 per cent within the first 24 hours.

Generally, the sooner the symptoms develop, the more serious the DCS is likely to be.

DCS symptoms vary significantly because nitrogen bubbles can lodge in different parts of the body.  The symptoms experienced are largely determined by the where the bubbles ultimately lodge. eg.  bubbles that lodge in the joints will cause joint pain; bubbles under the skin can cause a blotchy rash/itching; bubble formation in the spine may lead to limb weakness/ paralysis, etc.

 

• Joint pain (most common).
• Dizziness.
• Headache.
•  Nausea.
•  Vision disturbance.
•  Skin changes (blotchy rash, itching).
•  Disorientation.
•  Extreme fatigue.
•  Loss of consciousness.
•  Hearing problems.
•  Difficulty breathing, coughing.
• Tingling/numbness.
•  Muscle weakness.
• Paralysis.

 

Early Management of DCS

Seek medical treatment as soon as any symptom of DCS  is noticed.  If available, apply 100% oxygen by mask ASAP to help relieve some symptoms and reduce oxygen-deprived tissue injury. Treat dehydration, maintain blood pressure and prevent shock.

Hyperbaric oxygen therapy in a high pressure chamber reverses the pressure changes that cause the nitrogen bubbles to form. The bubbles redissolve and can then be exhaled by the lungs.

 

Prevention of Decompression sickness 

Avoid flying within 24 hours after diving (increasing altitude during a flight will further decrease pressure in the bloodstream, hence potentially increasing bubble formation and exacerbating injuries).

• Avoid alcohol before diving.
• Maintain good hydration.
• Be well rested prior to dive.
• Avoid diving when sick/weak 
• Dive within the limits set out in the diving tables. (Be wary of fudged diving tables.)
• Avoid hot baths, spas and saunas soon after diving.
• Choose dive destinations where hyperbaric chambers can be reached rapidly.
• Know the location of the nearest hyperbaric chamber.

 

Divers’ Emergency Service (DES)

This is a free phone consultation service for diving-related medical emergencies. They can also provide the location of the nearest hyperbaric chamber.

24 Hour Hotline:

ph: 1800 088 200 (toll free from within Australia)

618 8212 9242 (if calling from  outside Australia

 

 

• Posted on December 6, 2013
• Posted in Boronia
• Tags: Diving

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Sri Lanka

	Sri Lanka by Dr Jonathan Barrell, TMA Member Daylesford, Victoria The Democratic Socialist Republic of Sri Lanka, is an island country in the northern Indian Ocean off the southern coast of the Indian subcontinent in South Asia; known until 1972 as Ceylon. Sri Lanka has maritime borders with India to the northwest and the Maldives to the southwest. Sri Lanka has a documented history that spans over 3000 years. Its geographic location and deep harbours made it of great strategic importance from the time of the ancient Silk Road through to World War II. Sri Lanka is a diverse country home to many religions, ethnicities and languages. It is the land of the Sinhalese, Sri Lankan Tamils, Moors, Indian Tamils, Burghers, Malays, Kaffirs and the aboriginal Vedda. Sri Lanka has a rich Buddhist heritage, and the first known Buddhist writings were composed on the island. The country’s recent history has been marred by a thirty-year civil war which decisively but controversially ended in a military victory in 2009. We visited central and southern Sri Lanka in 2011 for 4 weeks. The people and cuisine and seaside villas such as www.ambalamavilla.com near Galle and www.kadjuhouse.com near Tangalle are fabulous. Highlights included the tiny tea country mountain village of Ella www.mountainheavensella.com, the very slow train to Nuwara Eliya,, and climbing the rock at Sigiriya just north of Kandy.In Colombo I would recommend  www.gallefacehotel.com  and www.mountlaviniahotel.com, the latter being a fabulous venue for wedding party photo shoots that last for days.Travellers to Sri Lanka do need to seek medical advice about their trip as diseases such as hepatitis A, typhoid, rabies and dengue do occur and are largely preventable click here to find your nearest TMA clinic Springs Medical Centre You can give us a call on (03) 5348 2227 or visit our clinic website click here

• Posted on October 13, 2013
• Posted in Country, Daylesford
• Tags: Sri Lanka

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Permethrin – a secret weapon against mosquitoes

Permethrin is a special insecticide that enables clothing to kill or repel mosquitoes

Wearing treated items will significantly decrease the number of bites you get. Treated bed nets have been shown to be four times more effective than untreated nets. When you wear treated clothes, you still need to use repellent on exposed skin. You can buy items pre-treated (especially bed nets) or treat items yourself with commercially produced permethrin packs. Follow the treatment instructions carefully to ensure the best effect. Do not throw any unused solution down the sink. It is toxic to fish. Follow the disposal instructions on the pack.

Treated articles which are immediately stored in a sealed plastic bag, will retain effectiveness for 12 months until usage is begun. A permethrin impregnated mosquito net is effective for 3-6 months of regular use. The solution wears off as well as washes off. Treated clothes are said to be active until the fourth normal wash. Do not iron treated clothes.

Is permethrin safe?
Yes. Permethrin is related to the naturally occurring pyrethrum from the flowers of a type of Chrysanthemum. Once the fabric is treated and dried, permethrin has no vapour action and nets can be used safely, even around sleeping children. Should a young child suck the net, they will not suffer any ill effects. Treated items are not more flammable. There are rare reports of persons developing a minor skin rash after wearing treated clothes.

• Posted on August 30, 2013
• Posted in Travel health tips
• Tags: Mosquito, Tips

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Mosquito Avoidance

Dr Deb Mills

Moisture, warmth, carbon dioxide and odour all attract ‘mozzies’, and some unlucky people seem to be genetically more delicious to mosquitoes.

Cover up – long sleeved, light coloured clothes
Try and avoid being outside when they are biting. If you are outside between dusk and dawn, wear treated, long sleeved shirts, long pants, and long socks. Light coloured clothes are best. Dark colours attract mosquitoes. Strong scents also attract them, so avoid perfumes etc.

30% DEET is the best
‘DEET’ (Diethyl toluamide) is clinically proven to be the most effective mosquito repellent to apply on your skin e.g. Repel™ or Rid™. Repellents work by blocking the receptors on the mosquitoes antennae. A concentration of 30% DEET is recommended for adults under conditions of intense mosquito exposure. Concentrations greater than 50% DEET are usually not recommended. In field trials, DEET products on the skin have been found to be more effective than coils, ‘mozzie plants’, citronella candles, sonic repellers, and UV light lures. DEET can damage plastics, synthetic fabrics, leather and painted or varnished materials so be careful with eye glasses, cameras etc. DEET has no effect on cotton, wool or nylon or skin(!) DEET has been on the market for 45 years and side effects are rare if used properly.

Apply regularly
Apply regularly as per instructions on the bottle (for 30% DEET usually every 4-5 hours). Don’t forget your neck and ankles. Use just enough repellent to lightly cover your skin. You do not need to saturate your skin. Never use repellent over cuts, wounds or inflamed skin. After application, wipe or wash the repellent off your palms to avoid inadvertent contact with your eyes, mouth and other sensitive areas. Don’t apply repellent to children’s hands if they are likely to put their hands in their mouth. Ideally, wash off the repellent when you no longer need it.

Sleeping precautions
Sleeping in air-conditioned or well-screened rooms is the ideal. Use a ‘knock down spray’ if necessary to remove stray mosquitoes. The next best plan is to sleep under a permethrin-treated mosquito net. Check there are no holes in the net, and tuck the edges under the mattress. If mosquitoes are already inside the net, spray them with insecticide before you go to bed. As a last resort burn mosquito coils, cover exposed skin in insect repellent, and sleep next to a fan.

Did you know … mixing sunscreen and repellent?

When sunscreen is required, apply sunscreen first, wait 20 minutes and then apply repellent. Combination products are not as effective.

• Posted on August 30, 2013
• Posted in Brisbane
• Tags: Mosquito

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Splitting tablets?

Dr Deb – TMA member in Brisbane  

A recent study looking at the accuracy of tablet splitting, found large variations in dose in some of the splits. Some tablets are easier to split than others, and some drugs are more dangerous than others if you get the dose slightly wrong.

The major finding of the study was this “Based on our results, we recommend use of a splitting device when splitting cannot be avoided, for example when the prescribed dose is not commercially available or where there is no alternative formulation, such as a liquid.”

Tablet splitters can be purchased from most pharmacies. More info.

 

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

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Spain

  prepared by Dr Joan Chamberlain, TMA member in Rockhampton.

Lessons learned on the Trip:

1. Be prepared and know the area you are going to. You will appreciate better what you see and find.
2. Many of the best experiences are not far away or too expensive. But be prepared to pay for inside knowledge when needed.
3. Most people will help you and appreciate you making the effort to speak at least a few basic words in Spanish eg hello, thank you, please, good buy and their name.
4. Never leave your possessions unattended and be vigilant.
5. It’s a long way to fly from Australia to Spain.

 

 

• Posted on August 27, 2013
• Posted in Rockhampton
• Tags: Spain

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Tran Siberian Express

Prepared by TMA member Gold Coast

Travel Health Doctors Gold Coast clients, Kate and Matt experienced the longest and arguably one of the most fascinating train journeys of all time – the Trans Siberian Express. The couple boarded the train in Frankfurt then onward to Warsaw and St Petersburg. The official journey then commenced in Moscow. From there Kate said she was amazed by the diversity of the landscape.

“It was so brilliant to see the unexpected variety in the landscape – such eye catching scenery from European forests through to Siberian forests, snow and desert” she said

Also what surprised them was, although not travelling in the height of the winter, the Gobi desert was covered mostly in snow and when it wasn’t snowy, the land was mostly rocky instead of sandy -only a small percent of the Gobi desert is actually sand. Throughout these rocky regions of the desert, a huge number of dinosaur relics can be found.

 

As self adventurers, highlights for Matt and Kate along the way included a three day horseride along the Mongolian step which proved a real eye opener for them.

“It was fascinating to see nomadic families move to greener and warmer pastures – just packing up their lives and livestock and moving in groups of three or four families to an area more sustainable” Kate said.

Away for nine weeks but spending three weeks touring Mongolia, Matt also lent a hand helping a farmer herd cattle along the way. To show their gratitude, the farmer insisted Matt and Kate accompany him home where he offered his “best yoghurt” – from a bucket just sitting outside. They thought for sure the yoghurt would render them sick for days but surprisingly were okay!

Travelling throughout Mongolia the couple do recommend employing local guides.

“Due to snow and the movement of nomadic tribes to let areas grow over with grass, the roads are ever changing and you would get hopelessly lost without a guide” Kate said.

At one stage they were blocked by a huge snowdrift and had to physically dig their way out before help arrived in the form of a local landrover which pulled their car to safety.

After this, the locals again extended their hospitality insisting on bringing them home to taste their proud home brew of warm, salty camel’s milk.

“Outside of the cities especially, the locals are so appreciative, interested in us and super friendly..

“We enjoyed tasting the local food, although you never really knew what you were ordering – one cafe had dishes called “Horse and Cart” and “The Merchant’s Daughter” ..which in fact was chocolate pancakes” Kate said.
Health wise the couple left prepared and were grateful not to experience any health issues as sometimes they were nearly three days’ drive to anywhere which could remotely help them.

Travelling for nine weeks, it’s difficult to condense such a life changing trip, but both Matt and Kate were amazed and humbled by the beauty and culture they experienced.

Travelling in September/October at the end of the tourist season, proved ideal with temperatures reaching -15 at night… instead of -40 which can occur in the Winter.

Considered the longest train journey in the world, the most extended stretch Matt and Kate spent on the train non-stop was 60 hours. Their tip is that you book both an upper and lower bunk instead of just upper bunks so you have more space to relax during the day.

“The train journey was ever-changing and we so enjoyed meeting some amazing people and glimpsing cultures and experiencing adventures we could only dream about” they said.

 

 

This report has been prepared by Travel Health Doctors, Southport.

• Posted on August 27, 2013
• Posted in Gold Coast
• Tags: Mongolia, Trans-Siberian Railway

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Safety of DEET (N,N,-diethyl-m-toluamide)

Insect repellents containing DEET are the most effective and the most commonly used world wide. DEET has been available commercially for over 50 years and has been studied extensively.

It is thought that DEET works by interfering with the mosquito antennae function, effectively making humans invisible to the mosquito. Generally, the duration of protection is related to the concentration of DEET. However, at a concentration of 50%, this effect plateaus. 30% DEET is the lowest effective dose.

DEET repellents have a very good safety record, when used as directed. When DEET is applied to the skin, some is absorbed into the circulation. However, if the same amount of DEET were to be taken by mouth, either accidentally, or non-accidentally, blood concentrations will be hundreds of times higher and seizures and death can result. Toxic effects have most often occurred as a result of ingestion, rather than skin application. Repellents should not be applied to the lips, mouth, sunburned skin, damaged skin, or deep skin folds, and hands should be washed after applying DEET.

The risk of disease due to the bite of an insect is far greater than the risk involved in applying DEET insect repellents to the skin. 30% DEET repellents are safe to use and are recommended for adults, pregnant women, breast-feeding women and children over 2 months of age.

• Posted on August 27, 2013
• Posted in Travel health tips
• Tags: DEET, Insect repellent, Mosquito

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Wife White Knuckles – Hurning to Brisbane – in 5 hour hops

Julie Wright, Admin Staff, TMA Member Brisbane

After 10 years of dreaming, and 8 months of planning, my husband and I embarked on the adventure of a lifetime in August of 2006. (Six weeks prior to departing Brisbane, we of course consulted with Dr Deb Mills to ensure our health was optimal! ) We shared the small cockpit of a single engine Beechcraft Bonanza F33A at 10,000 feet, across half the world. Our fuel tank only allowed a 5 hour flight range, so we had to make 29 stops in 31 days. Our flight path took us – Hurning (Denmark), Copenhagen, Baden Baden, Barcelona, Corsica, Amalfi, Athens, Santorini, Istanbul, Adana, Tabriz, Esfahan, Dubai, Muscat, Karachi, Ahmedabad, Nagpur, Colcutta, Chiang Mai, Bangkok, Phuket, Singapore, Jakarta, Bali, Kupang into Darwin and on to Archerfield airport, Brisbane. To experience the many different cultures in quick succession was a fascinating experience. However, despite our careful preparation, the different terrain, along with language barriers, and unforeseen weather conditions presented both mental and physical challenges. We became known as the “Crazy Aussies” by many air traffic controllers. Sometimes we were met with an incredulous “You’re flying to Australia in that?” from commercial pilots on the ground. We planned the route with a German company that organises flight paths and permissions for cargo aircraft around the world. They successfully applied for our permissions, even organizing us to transit through Iran where we made stops for fuel in Tabriz and Esfahan. To smooth our dealings with Army and security on the tarmac at various terminals, they suggested we wear a uniform, so from Istanbul to Darwin, my husband and I wore collared white shirts with epilates and navy pants. We were seen as flight crew. We were to need it sooner than we thought.

On one occasion we had some problems that resulted in our passport stamped with the words Illegal Aliens… Our aircraft was only rated to fly in good visibility. In Esfahan, Iran, our refueling and paperwork took so long, that it was well into the afternoon before it was finalised. Problem. We had no visa to stay in Iran, only permission to transit. We were marched inside the airport under army guard. We sat for six hours in a tiny room with a young fully armed guard right beside us. We overheard the head of the police and the government officials yelling into their phones, trying to sort out what to do with us. We phoned our contacts, they called the Australian consulate. This went on and on.

At midnight we were taken from the airport, thankfully to a hotel, still under police guard – at least the guard stayed outside the room! How could we sleep with visions of being trapped in Iran forever running through our heads. The next morning, we were returned to the airport. Yet another official met with me. This time, thankfully, he had a big grin. I think he was as happy as we were, that a solution had been found. Our passports had been blessed overnight with a 7 day visa. In fact the now smiling official even warmly welcomed us to stay a few days in Iran! We made all the proper polite comments and hurried to our aircraft. As we were waiting on the tarmac, running through our flight checks, we heard a huge roar from the runway. A mick fighter took off and flew vertically at great speed in front of us. What a sight! I looked over at the Iranian police, unsure why the tower had put the mick fighter up in the air before our take off. The officials were all smiling, pointing to the fighter in the air and hands on their hearts yelling, “Ours, ours!” with much pride. Now it was our turn, my husband and I sat waiting for the radio signal from the tower that would giving permission to take off. Silence…. We watched the fighter land and be towed off the runway. Only then, were we given permission to take off. As we looked over at the smiling Iranians, we realised that we had been honoured with a display and fighter ‘send off’.

I earned the nick name ‘wife white knuckles’ after episodes like that, along with sand storms in Tabriz, dust storms in Dubai and a raging torrential storm over Singapore. The realization of our dream would not have been possible without an extraordinary team of many helpers from across the world. In 2006, we, “the Crazy Aussies”, were the 187th in the world to fly this particular route in a small single engine aircraft.

• Posted on August 27, 2013
• Posted in Brisbane
• Tags: Iran, Isfahan, Istanbul

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