Healthcare

On this page
1.Precautionary Measures -- Which vaccinations to get...and when
2.Pakistan-- Eating...and its consequences
3.Indian & Pakistani Cities-- Breathing...and its consequences!
4.Death by Coconut-- Death from above
5.Water-- The stuff of life
6.Mosquitos--and how to survive them
7.Medical Packs

Precautionary Measures
You will need to make several trips to the Tropical Diseases Clinic (in Holland called the GGD).  Ask them to complete a vaccination record book for you to take with you.  The International Certificate of Vaccination against Yellow Fever has a section for other vaccinations, and is a very useful item to have.

If you usually take any medication as a matter of course, (insulin, anti-hystamines etc.,) take it with you.  You may not find what you need, or the local version may not be as effective as your usual brand!  Check with consulates about availablility of medication in their country.

The first hospital visit will be 8/10 weeks before departure.  Ask about Malaria prophylactics.  You will probably need Paludrine.  You should also be given vaccinations against the following:

i)    Diptheria
ii)   Tetanus
iii)  Polio
iv) Typhoid
v)  Rabies (*see foot note)

The second visit should be 5/7 weeks before departure for vaccination against:

i)    Hepatitis A (Twinrix)
ii)   Hepatitis B

Also ask about Tuberculosis.  There are options you need to think about.

The third visit should be 1 week before departure:

i)    Hepatitis A booster
ii)   Hepatitis B booster

At this stage try and get the clinic to give your vaccination record a Cholera stamp.  It is not necessary, as you are resident in a Cholera free area, but corrupt border officials will use the opportunity to extract a bribe if you don't have a cholera stamp!  The other problem you could encounter is being refused entry to a country, if you are entering it from a cholera zone. e.g. going from India to Pakistan on the way home!

The fourth visit should be within a few weeks of your return home.

i)    Hepatitis A final booster (Twinrix)
ii)   Hepatitis B final booster

You should also remember to inform any doctor of where you have been, should you have to see one after you get back home.  Many diseases take a long time to mature and for the symptoms to show.

OK, so now you've read all this.  Don't take my word for it, ring your local hospital and ask them their advice.  They know best.  Its no good coming crying to me after you're dead because I gave you bad info!!

* If you are bitten by any mammal that is behaving in a demented fashion, and/or with foam flecks around its mouth, the odds are that you will need treatment against Rabies.  Even if you have the (VERY EXPENSIVE) vaccination before you leave home, it is still necessary to see a doctor at a well equipped hospital for treatment as soon as possible but within 24 hours, if you wish to live!
 Remember.  All warm blooded animals can carry Rabies.
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Pakistan.
No matter what you do, you will probably get sick in Pakistan through eating or drinking in local cafes and restaurants.  Standards of hygiene are at zero.  Be prepared for this by taking plenty of re hydration fluids with you.  Once out of Europe, you will find them hard to get.  Do not rely on 'sports' drinks.  Make sure you have plenty of diarrhoea cures.
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Indian and Pakistani Cities
Pollution is a major problem in Lahore, Delhi, and Bombay.  If you suffer from Asthma, be warned.  Neither of us suffer from this condition, but suffered from breathlessness, flu like symptoms, and massive headaches in these cities.  The fumes from the thousands of two stroke vehicles and from diesel trucks etc., are a huge problem.  I would recommend that anyone who suffers from respiratory problems, does not visit these cities, especially in the summer months.
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Death by Coconut
Believe it or not, if you are wandering about under cocnut trees, you run the risk of death.  By falling coconut.  The worlds second largest seed (Coco de Mer, a close relative of the cocnut is larger) spreads itself by simply falling out of the tree, in the hope of landing in the sea, or a river, and then coming to shore somewhere suitable for the nut to take root and develop.  If however, you are under the tree at the moment one of the nuts falls, you could have your skull cracked open by the one kilo plus seed having just dropped about fifty or so feet!
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Water
Without it, humans die in a few hours.  Some of the water in India and Pakistan will kill you even quicker!   Whatever you do, take a water filter, or some sort of trustworthy purifier.  Our Seagull Water Purifiersystem worked fabulously, never once letting us down.  It purified village well water, ground water and very dubious Delhi city mains water.  We can recommend it most heartily!!  A top quality product that actually does what its makers claim.

Driving across Turkey, Iran, Pakistan and India involves crossing several deserts.  The desert region known as Balochistan (southern Iran and southern Pakistan) extends for some 2500 kms.  Thats three or four days driving if you go at it non stop!  Water here is very scarce.  In the temperatures that occur here (up to 50c, 40c being common) human bodies can loose several litres of water an hour.  Make sure you have enough water for each person to drink about 10 to 15 litres a day.  Less than 5 is running the risk of serious dehydration.   Water in southern Iran tends to be slighty salty.  Purifiers and filters cannot remove salt.  Just add a little fruit juice or syrup to get rid of the taste.
Oh, nearly forgot.  Don't swim in still water.  You'll be at risk from Bilharzia.  Nasty little parasite that gets into you through your 'body apertures' or cuts in your skin.  Only swim in the sea (sharks) or in rivers (crocodiles) to avoid this particular problem.
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Mosquitos
Malaria kills people.  Malarial infected mosquitos are spreading.  No longer just a tropical problem as the disease is now to be found in the Balkan states.  You MUST take precautions.  The first time you get a bite, get out the mosquito net that night.  Make sure you buy one that is impregnated with Permethrin.  You'll need it for Pakistan and India for sure.  Turkey can be a problem too.  Even if you have not experienced any mosquito bites, once you get to Iran, start the Paludrin.  Remember, there is no cure for some varieties.  Indian mosquitos just love soft European skin.  It does not exude chile and is not toughened by sun and years of mossie bites.
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Health Packs
To avoid contracting HIV or any of the other diseases transmitted by second hand needles etc., carrying a collection of sterilized needles and other surgical items is a must.  If you are unlucky enough to need an injection or some sort of surgery, just ask (demand!) that the doctor use your kit.  The kit shown here is available from Beyst BV, PO box 120, 2130 AC, Nieuw Vennep, Holland.

At the bottom of the page is a list of recommended items to include in a basic Medical Pack.

Malaria, Denge Fever, Rabies, Menengitis, Hepatits, Cholera, Yellow Fever, Typhoid Fever, and many other diseases will kill you in hours if you let them.  Thats not to mention the legion of snakes, spiders and other creepy crawlies that abound in tropical places.  More common, but still serious if left untreated, are parasitic worms  (tape, thread and round) which infest stomach and intestines.  They are very common in countries where general hygiene standards are low, and the chances of getting one or more of them are quite high.
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Sexual Health
Condoms, of course, are a must.  The only real chance of having a sexual encounter in most Asian countries is with a prostitute, and some 85% of them are estimated to be HIV+.  Females should be aware that many men in eastern countries regard western women as 'easy'.  They have heard that women from the West indulge in casual sexual relationships, and think that any western woman will do it with them if they ask.   Be warned that a refusal often brings a torrent of abuse, and sometimes is ignored completely unless the femasle in question is seen to be angry and offended by the proposition.  My advice?  Avoid situations that could lead to any sort of intimacy (alone with a man, getting friendly etc.,) and take a hint from the local women as to what to wear.
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One last word of advice.  If you have any health problem at all, get it seen to at once.  Left untreated, many conditions become serious very quickly.  Cuts and bites can become septic in a matter of an hour or two.

Useful site is: International Traveler's Clinic

Bon Voyage!
 

Small Medical Kits

I have tried to include a description of each item and some uses.

• Combat Dressings
• Large gauze dressings
• Small gauze squares
• Roller Bandages elastic + cotton (2in/4in/6in)
• Triangular Bandages
• Band-Aids -assorted sizes and shapes (i.e. finger tips)
• Sleek Tape 1 in. (waterproof, plastic/elasticated tape)
• cotton buds (q-tips, cotton tips)
• thermometer (rectal or pacifier for children)
• Chlorhexidine and cetrimide (antiseptic) or Povidone-Iodine
• Antibacterial Soap
• Lignocaine 1% (local anesthetic) (USA = Lidocaine)
• Augmentin (antibiotic) (a broad spectrum antibiotic)
• Acetaminophen (mild analgesic)
• Dicolphenic (mod analgesic) (a nonsteroidal anti-inflammatory)
• Oral Rehydration powder
• Loperamide (anti-diarrhoeal)
• Benedryl &/or Claratyne (antihistamines, short + long acting)
• Adrenaline auto injector or Anakit (USA = epinephrine)
• Morphine Sulphate (strong pain killer) if available
• Gamma Benzene Hexachloride (lice/scabies tx)
• Clotimoxazole (anti-fungal)
• Contraceptive pills/Condoms
• Paramedic scissors
• Surgical scissors
• Needle holder
• Sm curved clamps
• Tissue forceps
• Scalpel blades
• Emergency Obstetric Kit (includes bulb suction)
• Vicryl 2/0 suture material
Your choice of suture material is up to you. Vicryl is a synthetic dissolvable one, but takes up to 4-6 weeks to dissolve, so I think it is the ideal survival thread. But a variety of non-dissolvable sutures are available which will last forever.
• 5ml syringes
• 20g needles
• Oil of cloves (tooth ache)
• Emergency dental kit (commercial preparation)
A smaller kit for your bug-out bag could be made up from the above. Include some combined dressings, a couple of bandages, Band-Aids, tape, some tylenol, Benedryl and some loperamide.