TRAVELERS MEDICAL KIT
Although international travel conjures up images of exotic locations and different cultures, unexpected medical emergencies can occur, for which travelers should prepare medical kits before departure. Travelers with chronic illness or disabilities should request a medical summary of their condition. Needed prescription medications and emergency plans should also be discussed during a Travel Planning Appointment, which should be scheduled at the University Health Services (UHS), since travelers may visit areas that are far from English-speaking physicians. A list of English-speaking physicians worldwide can be obtained through the International Association for Medical Assistance to Travelers (IAMAT).
Here’s a list of suggested items to include in your traveler’s medical kit. Be sure to pack the medical kit and any prescription medicines in "carry-on" baggage in case checked luggage is lost during transit.
- Carrying Case. Preferably a waterproof zip lock freezer bag to hold the supplies listed below.
- Insect Repellent. Choose a repellent that contains 20-35% DEET.
- Water Disinfectant Tablets. Iodine tablets or chlorine solution.
- Diarrhea Treatment such as Imodium or Lotomil. A product such as Pepto-Bismol tablets can be taken for diarrhea prevention.
- Laxative. For relief of "traveler's constipation" brought on by changes in eating schedule and diet.
- Sunscreen. Select a brand with an SPF of 15 or greater.
- Pain relievers such as Tylenol or Ibuprofen for relief of minor pain and headaches.
- Decongestant medicine, for relief of nasal congestion from colds and allergies.
- Cough Suppressant such as Robitussin DM.
- Band-Aids, Gauze, Tape and Antibiotic Cream. For minor cuts and scratches.
- Anti-Itch Agents. Hydrocortisone cream can relieve itching from insect bites.
- Anti-Fungal treatment - such as Lotrimin AF for "ringworm" or "jungle rot."
- Oral Thermometer. Crucial for assessing illness while traveling.
- Swiss Army Knife. Even more useful if tweezers and scissors are included.
- Pre-moistened Towelettes. Used for washing hands in areas lacking safe water.
- Moleskins. To prevent blisters.
- Condoms (Latex) and Sanitary Napkins. These items should be bought before leaving the United States since they may not be available in developing parts of the world.
- Eyeglasses. For eyeglass wearers, an extra pair of glasses should be taken.
- Motion sickness medicine such as Dramamine [top]
JET LAG REDUCTION
Jet lag refers to the physical and mental effects the body suffers when traveling rapidly across numerous time zones. The condition results from the disruption of the traveler's normal sleep-wake cycle. As a result, the traveler may experience indigestion, daytime sleepiness, headaches, and changes in blood pressure, fatigue, and poor concentration. Symptoms generally begin when there is a 2-hour difference and typically increase with the number of time zones crossed.
Jet lag reduction involves the adjustment of major time cues. These include diet, light, exercise, drugs, and social interactions. Adjusting these time cues before and during travel can diminish the effects of jet lag and help the body reset its internal time clock to function in a new time zone.
- Diet: Starch and sweet foods high in carbohydrates can cause sleepiness. High protein foods tend to make one more alert.
- Light: Bright light signals the body to be active while darkness signals that it is time for rest.
- Exercise: Physical exercise stimulates the body and makes it more alert.
- Drugs: Depending on the drug, medicines can alter the biological clock significantly. If you take prescription drugs regularly, be sure to discuss a proper medication schedule during the Travel Planning Appointment.
- Social Interactions: Conversation with others tends to be stimulatory and results in being more alert.
To Reduce Jet Lag When Traveling West:
Begin preparing for long distance travel three days before departure.
Breakfast and lunch should be high protein meals, while dinner should be high in carbohydrates.
- This is considered the “feast” part of the program.
- Consume more calories than normal. For breakfast and lunch, eat foods that are high in protein and low in carbohydrates. Dinner should be a high carbohydrate meal.
- Snacking is permitted- high protein foods in the morning, caffeine is allowed only in the afternoon, and high carbohydrate foods in the evening.
- Go to sleep at your regular bedtime.
- This is a “fast” day; caloric intake should be a fraction of the previous days.
- Breakfast and lunch should be high protein meals, while dinner should be high in carbohydrates.
- Caffeine is allowed in the afternoon, but no evening snacks are allowed.
- Go to sleep at your regular bedtime.
- This is the day before departure. It is also a feast day, so follow the instructions given for Day 1.
- You may want to stay up past your normal bedtime.
- If your flight schedule allows, try to sleep in a little.
- If you are a coffee drinker or enjoy caffeinated beverages, have two to three cups when you awake, and then avoid these drinks for the rest of the day. This caffeine “jolt” will get your body ready for flying west.
- The morning of this day is a fast day. Eat low calorie, high protein food. Avoid eating until breakfast is served the next day in your destination city.
- If your flight does not leave until late in the day, keep daytime activities to a minimum.
- If it will be daytime when you arrive at our destination, try to sleep on the plane. Use a blind-fold to block out the light and wear earplugs to minimize noise.
- If it will be night when you arrive, try to stay awake as much as possible during your trip so you can sleep when you reach your destination.
- The following day, eat a high protein breakfast and resume a normal schedule. Resist the urge to sleep in the middle of the day.
To Reduce Jet Lag When Traveling East:
For the three days prior to your departure, follow the same instructions listed above for travel to the west.
- On the day of your flight, get up as early as possible and eat as little as possible. Caffeine should be avoided.
- If you own two watches, set one with the home time and one with the destination time.
- Stay active in the early part of the day and follow the time of the departure city. At 6 p.m. follow destination time.
- Try to sleep on the flight until it is breakfast time in your destination city.
- Treat this day as a feast day. Avoid caffeine, snacking, and get to bed on time.
- The following day, eat a high protein breakfast and resume a normal schedule. Resist the urge to sleep in the middle of the day.
This information was obtained from the brochure “From the U.S. to Seoul, How to Beat Jet Lag,” prepared by the U.S. Olympic Committee Sports Medicine Council, General Chronobionics, Inc. 1988. [top]
FOOD AND WATER PRECAUTIONS
Be sure you understand how to treat water and prepare foods to avoid illness.
Raw and improperly cooked food allows bacteria (Salmonella) to grow and release toxins that are harmful to humans. Food can also harbor parasitic organisms (Giardia lamblia) and viruses (hepatitis A). Since all of these pathogens are heat sensitive, travelers should eat only hot, well-cooked foods. When traveling in developing countries or areas you suspect to have poor sanitation, please follow the guidelines listed below.
Choose These Foods:
- Well-cooked meat, fish, rice, and vegetables (always make sure that the center of the item is thoroughly cooked)
- Fresh baked goods – breads, rolls, unfilled pastries
- Cooked fruits, vegetables, and nuts with intact skins and shells (peel the skins yourself or soak in mild chlorine solution of ½ teaspoon chlorine bleach to a quart of water for 15 minutes and air dry on clean surface)
Avoid These Foods:
- Dairy products (e.g., ice cream, milk, cheese, baked goods with creamy fillings)
- Raw fruits, vegetables, and leafy salads not cleaned by you
- Raw or uncooked meat, fish, shellfish
- Foods left standing at room temperature (e.g., buffet foods, cold meat platters)
- Foods prepared by street vendors
Water-containing beverages are also major sources of enteric pathogens. Travelers planning extended trips in developing countries should check with the U.S. Consulate about the safety of the local water and available alternatives. Please follow the guidelines listed below if you are traveling to underdeveloped countries.
Boiling is the most reliable way to treat contaminated water.
- For water of uncertain purity, heat vigorously until boiling occurs for one minute.
- For additional safety after the boiling point is reached, keep the water covered and hot for several minutes.
When it is not feasible to boil water, iodine and chlorine chemical treatments provide significant protection against viral and waterborne disease.
- Tincture of Iodine – Use a 2% solution, add 5 drops per quart or liter of clear water, double the dosage for cloudy water and let stand for 30 minutes. Cloudy water should be strained through a clean cloth to remove sediment and then treated with heat or iodine. Very cold water also requires a double dosage and needs prolonged contact time. Let stand for at least 30 minutes before use.
- Chlorine Bleach – Use a 4-6% concentrate, add 2 drops per quart or liter of clear water, double the dosage for cloudy or very cold water. Let stand for 30 minutes and allow prolonged standing time for very cold water.
- Note: Chlorine treatment alone, may not kill some enteric viruses and parasitic organisms.
Choose These Beverages:
- Hot beverages, (e.g., tea and coffee made from boiled water)
- Canned or bottled beverages (e.g., soft drinks, juices, beer, wine, mineral water)
- Local water that has been purified by you or that you know has been adequately treated.
Avoid These Beverages:
- The local water (water from the local water system or well resources)
- Ice cubes made with local water
- All dairy products (especially non-pasteurized milk)
- Use a straw and drink directly from a can or bottle when glassware appears unclean. Be sure to clean and dry any drinking surfaces before contacting them with your mouth.
- Where water may be contaminated, do not brush your teeth or take medications with the local tap water. Instead, use boiled or bottled water.
- Alcohol in punches and other mixed drinks does not reliably kill bacteria and parasites.
- Do not swim in pools unless adequately chlorinated. Avoid swimming or wading in fresh water lakes and streams. Bodies of still, non-moving water may be infested with parasitic organisms
- Contact lens wearers should wash their hands with purified water before touching their lenses. [top]
ILLNESSES DUE TO TRAVEL
Approximately one third of all travelers to developing countries suffer from traveler’s diarrhea (TD). Infectious bacteria, parasites, and viruses are the primary causes of TD. Normally, TD is a self-limited illness that causes 3 to 4 days of watery diarrhea. Common symptoms associated with TD include abdominal cramps, nausea, headache, and a low-grade fever. Rarely is the condition life-threatening.
Following the food and water precautions listed above can greatly decrease the likelihood of developing TD. However, even meticulous attention to food and water consumption does not guarantee that you will be symptom-free. Travel from industrial countries to developing countries may cause sudden changes in the types of microorganisms that inhabit one’s gastrointestinal tract. As a result, TD may occur to rid the digestive system of harmful agents.
Treatment for Diarrhea:
- Take an over-the-counter medication, like Pepto-Bismol or Imodium, to help reduce cramping and control diarrhea (only if they don’t cause you adverse reactions). Follow the label directions and do not take these medications for more than 3 to 5 days.
- Avoid solid foods and dairy products for 24 hours.
- Do not take doses of Pepto-Bismol and antibiotics at the same time. Bismuth subsalicylate, the main component of Pepto-Bismol, may significantly decrease the absorption of the antibiotic.
- Use Pepto-Bismol with caution if you are taking aspirin or are sensitive to aspirin.
Travelers suffering from TD must make a concerted effort to avoid dehydration. Drinking plenty of safe liquids and eating salted crackers can maintain fluid and electrolyte levels.
- The World Health Organization Oral Rehydration Solution (ORS) is an effective way of treating and preventing dehydration. ORS packets for 1-L solutions are available over-the-counter in many developing countries.
- Adding Gatorade powder or other fluid replacement salts to treated water and drinking at least 8 ounces per hour is also effective.
- Alcohol and caffeine-containing beverages should be avoided when suffering from TD.
Schistosomiasis is an infection that can be acquired from swimming in fresh water in certain parts of the world. The areas where Schistosomiasis is most common include Brazil, Egypt and most of sub-Saharan Africa, Southern China, the Philippines, and Southeast Asia. A flatworm (fluke) that uses specific fresh water snails as an intermediate host causes the infection. Infected snails release a large number of larvae that are capable of penetrating unbroken skin of human hosts. Even brief exposures to contaminated water can result in infection. Travelers are advised not to bathe, swim or wade in fresh water in areas that are known to have this problem. Salt-water swimming is safe.
Symptoms usually occur 2-3 weeks after exposure, and most acute infections are symptomatic. Acute symptoms may include fever, lack of appetite, abdominal pain, weakness, diarrhea, nausea and cough. Chronic infection can cause disease of the lungs, liver, intestine and bladder. Occasionally, people develop an itchy feeling immediately upon leaving the contaminated water.
There is no practical way for the traveler to recognize infected water. It is best to just avoid fresh water in countries where Schistosomiasis exists. In such areas, heating water to 122F for 5 minutes or chlorinating water will make it safe for bathing. If water is left to stand for three days, the larvae will die in that time period and the water will be safe for washing.
When traveling to tropical countries and hot climate areas, avoid prolonged periods in the sun during the first few days of travel and especially during peak tanning hours (10 am to 2 pm). Limit sun exposure to periods of 10-30 minutes.
- Always wear a sunscreen with a sun protection factor (SPF) of at least 30. The higher the SPF rating, the greater the protection. Apply sunscreen to skin, lips, ears, and around the eyes. Do not use a sunscreen containing PABA if you are sensitive to benzocaine, sulfonamides, or aniline dyes.
- Perform strenuous physical activity only during the cooler parts of the day (i.e., early morning and late afternoon).
- If physical activity cannot be postponed in hot weather, the traveler must drink more than thirst dictates. Drinking 2 cups of safe water before exertion is advised. To avoid dehydration and heat illness, consume a cup or more for every 20 minutes of activity.
- Wear white or light-colored cotton clothing and a wide brimmed hat to minimize heat absorption.
Heat Exhaustion and Heat Stroke
Both conditions result from overexposure to heat. Water and electrolyte loss from exercise in hot weather is a common cause of heat exhaustion. Common symptoms include excessive sweating, nausea, confusion, thirst, elevated temperature, and fatigue.
Heat stroke is a true medical emergency and results from extreme elevations of body temperature. As a result, the body systems are overwhelmed by heat and impaired functioning results. Common signals include temperatures greater than 106° F, red, hot, dry skin, and altered consciousness.
If you suspect heat exhaustion:
- Contact a physician or seek medical help immediately.
- Stop all activity and seek a cool, sheltered location (away from direct sunlight).
- Loosen any restrictive clothing.
- To lower body temperature, immersions in ice water or cold tap water are the most effective measures.
- Alternatively, the traveler can be wetted down with cold water and fanned.
- If alert, the traveler must replenish depleted fluid levels. Cold, purified water and fluid replacement beverages are adequate. A target intake of 1 to 2 L over 2 to 4 hours is reasonable.
- The traveler should continue to rest for the next 24 hours and force fluids.
- If symptoms persist, a physician should be contacted immediately.
Rapid ascents to altitudes above 8000 feet (2400 m) may cause acute mountain sickness (AMS). Symptoms include:
- Headache, feeling “hung over”
- Lack of appetite
- Trouble sleeping
- Shortness of breath
- Excessive fatigue
- Swelling of the hands, face, and ankles
These symptoms may begin at the time of ascent, but most often occur 6-48 hours after climbing. With the avoidance of strenuous exertion, symptoms usually subside in one to seven days while staying at the same altitude.
More severe conditions of pulmonary edema (fluid in the lungs) and cerebral edema (swelling of the brain) may occur at altitudes above 8000 feet. Symptoms may include fatigue, shortness of breath, cough, and headache, loss of coordination, and confusion. These symptoms usually occur during the 2nd to 4th days of climbing to altitudes greater than 8000 feet. Both conditions require immediate medical attention.
- Staging: Spend two to five days at an intermediate altitude, 6600 ft (2000 m).
- Slow Ascent: Above 9900 ft (3000 m), ascend only 1000 ft (300 m) per day. It is also important to rest for 24 hours on day three or four after attaining altitude. Avoid strenuous overexertion for the first few days at altitude. Rapid ascent by car or plane is very risky.
- Diet and Liquids: Be sure to drink plenty of safe liquids while increasing altitude. Eat a normal diet that is low in salt.
- Acetazolamide (Diamox) and Dexamethasone are two prescription drugs your physician can prescribe to prevent AMS.
- If mild AMS occurs, ascent must be halted so that acclimatization can improve. Acclimatization can take from 12 hours to 3 or 4 days.
- If symptoms worsen despite an extra 24 hours of acclimatization, descent is required. Descend as far as necessary for improvement.
Travelers should not use intravenous drugs or share needles. Tattoos, acupuncture treatments, and injections for medical or dental procedures are very risky because the equipment used may not be sterile.
Avoid the use of locally produced immune globulin and blood-clotting factors in countries where the blood supply is not routinely tested for communicable diseases. If a blood transfusion is necessary, contact the nearest American Consulate for advice. [top]
AQUATIC HAZARDS: HELPFUL HINTS
- If schistosomiasis is present, water must be treated before bathing:
- heat to 122° F for 5 minutes;
- iodize or chlorinate;
- or let water stand for 3 days.
- Do not swim in pools unless adequately chlorinated.
- Prevention of swimmers’ ear: combine equal parts of Vinegar (5 percent Acetic Acid), Isopropyl Alcohol in sterile bottle with dropper. Only for external ear canal. Do not use if blood or fluid is coming from ear or if you suspect ruptured eardrum.
- If you suspect decompression sickness: Breath 100 percent oxygen, even if you feel well, go to the nearest medical facility then call Diver’s Alert Network (DAN) at (919) 684-8111 for nearest available decompressing chamber location and phone number (U.S. only). [top]
INSECT AND ANIMAL PROTECTION
Mosquitoes: Mosquitoes are most active during dusk and dawn, on cloudy days, and in shaded areas. Avoiding outdoor activity during these periods will reduce the risk of being bitten. Wear long-sleeved shirts (tucked in), long pants, hats, and apply a permethrin containing repellent to clothing. Follow the guidelines listed below for applying insect repellents.
Ticks: When traveling in tick-infested areas, pants should be tucked into socks and boots should be worn. Light colored clothing facilitates tick detection. Permethrin and DEET containing repellents also provide tick protection. During activity and at the end of the day, travelers should inspect themselves for ticks. Early removal of attached ticks may prevent infection.
Other Insects: Always wear shoes to protect against hookworm, fungus, jigger, and fleas.
Insect Repellents Guidelines:
- Apply permethrin-containing repellents to clothing sparingly. One application will last through 5 washings or 6 months in clothes that are not washed.
- Apply DEET containing repellents sparingly to any exposed skin. Choose repellents that contain 20-35% DEET. Avoid high concentration DEET repellents since they may cause adverse skin reactions.
- Avoid inhaling repellents and wash your hands after application. Do not apply repellents to wounds or broken skin.
- If a reaction to insect repellents occurs, wash the treated skin and call a physician. Take the repellent container to the physician.
- Note: Insect repellents do not protect against bees and spiders.
Snakes: Snakes are most active at night and during warm weather. When traveling in snake-infested areas, wear long pants and boots. If walking at night, use a flashlight. Attempts to kill or harm snakes should be avoided.
Scorpions: Scorpions are nocturnal feeders that avoid high-intensity light. Their stings result in painful localized reactions that can cause paralysis and convulsions but are rarely fatal. Be sure to shake out and inspect your shoes before putting them on. Snakes and scorpions tend to rest in shoes and clothing.
If bitten by either a snake or a scorpion:
- Seek medical attention immediately.
- While waiting for medical help, a pressure bandage and immobilization of the affected limb are recommended.
Wild Animals: Animals rarely attack humans without provocation. Avoid contact with wild animals and do not attempt to corner or capture them. Rabid animals normally show abnormal eye movements, excess salivation, staggering gait, and convulsions. Rabid animals will also approach humans.
If bitten by an animal:
- Seek medical help immediately.
- Apply a pressure bandage to the wound to control bleeding.
- Use copious amounts of safe water and soap to cleanse the wound and reduce infection.
- See a physician about the need for antibiotic treatment.
- After cleansing, cover the wound with a sterile bandage or clean dry cloth.
- If you fear a rabies infection, contact the U.S. Consulate for information on available vaccines. [top]
AFTER YOUR TRIP
UHS encourages all travelers to make an appointment for a general medical review upon return from abroad. You can make an appointment at University Health Services by calling 258-3141. If you were given medications while you were abroad, be sure to bring them with you.
Malaria: After returning from travel, complete your malaria medication. Incubation times for malaria vary greatly and can last for up to one year after the initial infection. Malaria symptoms include fever, chills, headache, nausea, abdominal pain, diarrhea, and mimic a "flu-like" syndrome. If these symptoms occur, be sure to inform your physician that you were traveling in an area endemic for malaria. [top]