Water water every where. . . . .

I've been getting an education this month from my 4 year old on how dirty water can make you ill. She's in training at nursery for the Sport Relief Mile and in her own way, understands that there is a little girl called Zainab in Sierra Leone that has to walk miles in the sun, just to get some water that often makes her sick.

There are many things that I cover during an appointment with a traveller but the importance of clean water is always one of them. Whilst some diseases like hepatitis A, polio and cholera can largely be prevented by vaccination there are many more water borne diseases including travellers’ diarrhoea that cannot be prevented by having a vaccine and there is a big reliance on what an individual does to prevent them getting ill. You can catch diseases by swimming, showering or drinking water that is contaminated so the water that you drink should always be bottled, boiled or sterilised, even when brushing your teeth. Avoid ice cubes as they can be made from unsafe water.

For some clients that I see, obtaining reliable bottled water will be pretty straight forward. For others, such as someone participating in a volunteer project for example, obtaining their water and making it safe to drink will be more of a challenge. Where will water be obtained? How far will you have to go to get it? Will you be able to boil water or will you need to chemically treat it so that it is safe to use?

Whilst unsafe water can make you ill, water is also vital if you want to get well and it's important to not get dehydrated if you have diarrhoea. Rehydration sachets mixed with safe water will help to prevent this.

If you’re running the Sport Relief Mile then good luck.  You're helping children and adults get access to something we in the UK take for granted - safe, clean water. 

This week I attended a careers event for 600 school children in Renfrewshire which has had me reflecting on my nursing career and the path it has taken. I often get asked if I am still a nurse and how I came to be working as a travel nurse.

Well I've been nursing since I left school 21 years ago.  I initially specialised in accident and emergency nursing  - a great speciality and an area that I very much miss working in.  However, although I loved my job as nursing sister in a busy A/E department, I needed a job that was going to work around a shift working husband and family life. 

I applied to work in a small travel clinic very much thinking it would be a 'make do' place to work in until I could return to A/E.  As it turned out, I loved the speciality of travel medicine so much that I set up my own private clinic in Glasgow in 2003.  Along the way I have undertaken extensive training in travel medicine and have a recognised and highly specialised diploma awarded by the Royal College of Physicians and Surgeons (Glasgow). In fact all of our nursing team here have completed and been awarded this diploma, something we are naturally very proud of.

So I'm no longer a specialist in A/E nursing but I am a specialist nurse in travel health and over the last 9 years my clinic has evolved to be the leading private travel clinic in Glasgow. We help hundreds of travellers each month get protected for their foreign trip and I love spending time with clients, finding out about their travel plans, knowing I can help them stay well when they are abroad.

Yellow Fever Confusion?

Yellow Fever is the vaccine that causes the most confusion for our clients.  Travellers attend the clinic believing they need the vaccine when in fact they don’t and more concerning, many travellers think that they don’t need the vaccine when they are very much at risk of yellow fever and should be getting protected.

So what are the facts of yellow fever vaccination?

Yellow Fever is found in some countries within South America and Africa.

The fact that a country has no requirement for a traveller to get yellow fever vaccination does not mean that there is no risk of yellow fever.

Yellow Fever vaccination is given for 2 reasons:

 1: to protect an individual from getting the disease

2: to protect countries from having the disease imported or spreading within a country.

Often, countries that require proof of yellow fever vaccination to enter do not actually have the disease.   Because they do not want the disease introduced, travellers arriving from or transiting through a country that has yellow fever might be required to show proof of yellow fever vaccination.

It is spread by mosquitoes that bite during the day and early evening.

In some countries, the risk of yellow fever can vary throughout the country.

Contracting yellow fever can be fatal

Prevention is through vaccination which is safe, effective and lasts for 10 years.

The vaccine can only be given at registered yellow fever centres where an assessment of a traveller’s trip will be carried out to determine if the vaccine is required.

How early is too early?

I am often asked how far in advance of a trip travellers should get travel advice. In general, my reply is 6-8 weeks before you go. However, this week I visited a school to start off the preparations for their trip to Nepal in July.

Why so early? Well it's likely these students will need a course of vaccines that should be given over months rather than weeks. I tend to find that for school trips, May to July are difficult months to schedule vaccines, with parents and students wanting to avoid any side effects interfering with important school exams. My advice to this group of travellers is to start several months in advance of the trip.

Other travellers that should consider getting advice at a much earlier stage are those that have existing health conditions. It can take a bit of time to liaise with other specialists which might be necessary before giving certain vaccines or anti-malarial tablets.   The clinic will very much appreciate the advance notice and can start the ball rolling. 

On a final note is it every too late?  No - it’s never too late.   Even at the last minute vaccines and advice can be very beneficial. 

Flu Facts

I can't believe that it is nearly October and that time of year when my fridge is full of flu vaccine.  You might not think of flu as the kind of vaccine that I give to travellers but for those going on for example a cruise or the religious pilgrimage to Hajj, I actively encourage them to get protected. 

For some people, catching flu can have very serious implications so the Department of Health provide a free flu vaccine for those: over 65 years, pregnant woman, individuals with conditions such as asthma, diabetes, heart, kidney, liver, neurological disease or a weakened immune system.  If you are entitled to have the vaccine on the NHS give serious thought to having it and what might happen if you didn't and caught flu.

I have no intentions of being off work sick for a fortnight with flu so I had my flu vaccine this week, as did the rest of the team.  We have all lived to tell the tale and although my arm was slightly red and tender it was nothing that stopped me doing anything that I normally would.  If like me you are not entitled to the vaccine on the NHS but want to avoid having flu then get in touch as we do have some doses available. 

There are lots of myths that surround the flu vaccine, the biggest one probably being that the vaccine gives you flu.  There is no live virus in the injection so you cannot get flu from it.  What is possible is that you can catch flu from someone before the vaccine has had time to protect you.  For that reason, you should get the vaccine as early as you can, before the numbers of people spreading flu creeps up.

The flu strains that circulate each winter change from year to year.  The vaccine  therefore changes each year. This years vaccine has the swine flu strain in it so you will be protected against it if you have the flu vaccine.

For more information see here.

The Travel Clinic

Tickets, Money, Passport, First Aid Kit

Following on from my last post and what to do if you get ill abroad, how many of us actually take a first aid kit with us when we travel?  I pride myself on the contents of my first aid kit but it was useless on our last holiday when my 4 year old got stung as it was left behind in the kitchen cupboard.

Accidents and injuries abroad are a very common reason for travellers needing medical help abroad so pack a kit and carry it with you.  It's of no use if it's left behind in the hotel room. 

You don't need to take a complete chemist shop with you but a well thought out kit will allow you to treat common injuries and illness.  Common things commonly happen so don't forget basic things like plasters, bandages and good old paracetamol. It's amazing how much better you can feel once you have taken some pain killers.

First aid kits can be bought pre-assembled or you can put your own kit together.  Please see the link for what to put in a first aid kit.

On that note, I am off to check my first aid kit is topped up for my holiday next week and not left behind in the cupboard!

What do you do if you are ill abroad?

Having spent the last week ill whilst on holiday got me thinking.  What would I have done had I not been in the North of Scotland and unable to access a GP as a temporary resident? Although vaccines are important to protect your health whilst abroad it is easy to forget that  accidents, injuries and common illness (in my case tonsillitis) are frequently the reason travellers need to see a doctor whilst abroad.

Travel insurance is vital. Shop around for your policy and declare all pre-existing conditions as this could be the very thing that you require treatment for.  There is little point having a policy that has excluded an existing illness.  The Foreign and Commonwealth Office has some great information of travel insurance and some scary statistics on what you might have to pay should you have no insurance and end up requiring an air ambulance bring you home.  Remember that the European Health Insurance Card (EHIC) if you are visiting Europe only entitles you to state medical treatment and a separate travel insurance policy is a must.  You don't need to pay a fee through an third party company for an EHIC card as it can be done for free via the NHS. 

If you are on a package holiday, hotels and tour reps can help you find a local doctor.  For those that are travelling independently contact your travel insurance medical help line and ask them for help in sourcing a doctor at your location.  For our travellers that are spending lengthy periods of time abroad on a work contract for example or have or have an exisiting condition, we suggest registering with a family doctor and be prepared in advance.  It is likely you will need to see a doctor at some point and if you do become ill you already know where you need to go for medical attention.  The last thing you want is to end up in an under resourced clinic where equipment may be re-used or not sterilised effectivley.  Many travellers choose to take with them sterile needle kits to ensure that any injections are clean and safe. 

Finally, I have put below a few resources that hopefully, you will never need but will be very glad of should you become ill abroad.

International Assistance for Medical Travellers Abroad (IAMAT) is a great resource.  Being a member provides access to their affiliated, licensed English speaking doctors throughout the world.  The

International Society of Travel Medicine also has a clinic directory where members can list their clinics.

The Blood Care Foundation is a charitable, not for profit organisation, registered in the United Kingdom in 1991. The Foundation operates a Blood Care Programme, which is designed to provide screened blood, in an emergency, to its members in any part of the world.