International travel is easier than ever, and the number of people who travel abroad to remote and exotic locations continues to increase. This leaflet offers some basic health-related advice on preparation to those who may be travelling off the beaten track, or to environments to which they are not normally accustomed. It also offers advice on first aid kit preparation for remote locations. This is not so that you can bypass medical help and treat yourself. It is so that if you seek medical help from other travelling doctors and nurses, they can advise you what medicines you need to take and you will then be able to follow that advice.
What preparation and advance planning are required?
Remote travel is easy and accessible these days. However, once you get off the plane you may find yourself in a very different environment from the one you are used to. Time spent in preparing, and understanding your destination and the conditions you can expect will help ensure you get the most out of your trip.
Consider what medical support is available. If travelling with a group or expedition find out what level of medical support is being offered. Remember, even if a doctor is attending your trip they are unlikely to be equipped with a large supply of medication. Consider what you are likely to need.
- Not all destinations are as safe as home. In addition to political problems there may be hostility towards 'rich' travellers or sensitivities around dress codes and behaviour. Before travelling, consult the Foreign and Commonwealth Office website for advice on conditions at your destination. If travelling in areas where there is political instability or disorder notify the British Embassy or British Consulate in that country of your intention to travel.
- If you will be travelling 'off the beaten track' leave an itinerary, even if only approximate, with a friend or family member and arrange to 'check in' at regular intervals.
- Be aware that remote travel involves a degree of risk over and above that of a 'normal' trip. In the event of serious illness it could be hours or days before you can be evacuated.
The most common reasons that travellers get into serious difficulty when abroad is from traffic-related accidents and injuries such as falls. Relaxing into 'holiday mode' and forgetting your usual caution can be a part of the problem, particularly if alcohol is involved.
- Make sure that you are psychologically prepared for your trip. It can be difficult to adapt to being away from family and friends, in the company of strangers and in an uncomfortable or difficult environment. If you have a history of any psychological problems such as alcohol dependency or depression, make sure that you feel that these issues are under control before you plan to travel.
- Consider particular challenges of your planned journey, such as extremes of temperature, humidity and altitude. Make sure you are fully prepared and physically able to meet the challenges you are planning.
Health check and fitness to travel
- If you have ongoing health or fitness issues, see your doctor well before you travel. You can then make sure that he or she agrees that you are fit to make the journey.
- Make sure that you have declared any existing medical conditions to your travel insurer.
- Remember, if you travel against medical advice you may invalidate your insurance.
- If you take regular medication make sure you have a sufficient supply for your trip, building in an allowance for any travel delay.
- If your medication includes controlled drugs be aware that it is not always possible to take these with you. Get advice before you travel: the USA in particular has a long list of prohibited medications. Carry medication in your hand luggage if possible.
- If you have diabetes and use insulin remember that your insulin cannot travel in the hold of the plane. It may freeze there and become less effective.
- Take medical advice on how to adjust your insulin if travelling between time zones.
- Carry a medical letter with details of the condition and any treatment. Ideally, a list of any therapy with medicines and their generic names and dosages should be included.
Remember the risks of long-haul air travel in terms of deep vein thrombosis and pulmonary embolus. When travelling by air try to move around the cabin at intervals. Consider using flight socks to reduce the risk still further.
- When travelling to remote locations a tooth problem can be distressing and impossible to solve.
- If you will be travelling off the beaten track then make sure that you have had a dental check-up. This should detect any lurking problems within a reasonable interval before your trip.
Eye protection: contact lenses
- If you use contact lenses consider whether conditions will allow you to manage your lenses hygienically.
- Take a pair of spectacles with you just in case. Consider whether it would be sensible to switch to spectacles for the duration of your trip. Daily disposable lenses may be another option.
- Travellers to altitude may find that contact lenses become uncomfortable because of the drier air at altitude. Take lubricating drops in addition to your lens steriliser.
- If travelling to mountainous regions where there is snow take a pair of good sunglasses. These will protect against snow blindness, a painful condition caused by over-exposure to ultraviolet light.
Pregnancy and remote travel
- Consider whether, if pregnant. you really need to travel to a remote or unsafe location. No pregnancy is risk-free. If there are problems in a remote place they may be difficult or impossible to solve in the way they could be solved at home.
- Some infectious diseases are more serious in pregnant women, and some vaccinations cannot be given.
- Make sure that your travel insurer knows that you are pregnant.
- Most airlines will carry pregnant women up to 28 weeks without a doctor's letter, and up to 34-36 weeks with one.
Children and remote travel
- Taking children to remote and exotic places is both exciting and educational for the child. However, children also face risks to health and welfare.
- Seek medical advice for your children before you travel.
- Children are very susceptible to lack of fluids in the body (dehydration) if they develop traveller's diarrhoea.
- Children's skin is more susceptible to sunburn, especially at high altitude.
- Children are just as likely as adults to suffer from altitude sickness.
- Children are less wise than adults when it comes to physical risks like swimming in fresh water or crossing a busy road.
- Children are less likely than adults to show caution with strange animals and are therefore at greater risk of rabies
- Always take high temperature (fever) seriously when travelling with a child in a remote location.
- Consider whether your child is old enough really to appreciate the trip you are planning.
- Consider whether there is enough medical provision at your destination to keep your child safe.
- If children become unwell, seek advice - children do not always have the same symptoms as adults if unwell. Very young children may have difficulty describing symptoms.
Humanitarian aid workers and remote travel
- If you are travelling overseas to provide disaster relief of humanitarian support you face greater health risks than regular tourists. This is because of your close contact with the local population, and the fact that you are going into a hazardous environment.
- You may also have to contend with the aftermath of natural disaster yourself.
- Travel with an approved aid organisation, and attend their briefings before you leave. Look after your health whilst there. If not, you not only cannot help, you become a part of the problem you hoped to assist with.
- Visit your GP or practice nurse some months before departure to plan a vaccination schedule.
- Depending on where you are travelling to there are likely to be a number of specific vaccines that you require. For example, yellow fever and japanese B encephalitis.
- If you are travelling off the beaten track you should always consider and discuss the need for protection against typhoid, hepatitis A, hepatitis B and rabies.
- Your diphtheria, tetanus and polio immunisations may also need boosting.
- Your immunity against tuberculosis may need to be reviewed.
- Some vaccinations require a course of two or three injections over a period of several months. Also, many cannot be given at the same time as one another.
- Follow the recommended schedule for the countries you will be visiting.
Diseases against which you cannot be immunised
- There are a great many diseases against which vaccination is not available. These include dengue fever, viral haemorrhagic fevers, schistosomiasis, HIV, sleeping sickness, and leishmaniasis.
- Visit the NaTHNaC Travellers information website for country-specific advice and to understand how you may minimise your risk of exposure to any or all of these.
- This will include use of insect repellent to avoid insect-borne diseases such as dengue fever, avoidance of swimming in fresh water where there is schistosomiasis, and avoidance of unsafe sexual encounters to minimise exposure to HIV.
- Consult the NaTHNaC website for up-to-date advice on the malaria regimen recommended for the countries you will be visiting.
- There is normally a choice of medication. Make sure that you can tolerate the medication you choose before you go.
- Remember that malaria prophylaxis does not offer absolute protection: minimising exposure to mosquito bites is also important.
- Remember that if you are visiting a malarial country where you once lived, even if for many years, you will not have maintained your immunity to malaria. This fades to nothing when you leave.
Yellow fever vaccination and certificate
- Your practice can advise you whether you need yellow fever vaccination
- Some countries require you to show a certificate of yellow fever vaccination on immigration: make sure you are prepared if this is the case.
Which medical conditions are related to travel?
- Probably the greatest health challenge of remote travel comes from food and water. Traveller's diarrhoea is the usual result of eating food or drinking water contaminated with germs such as bacteria, viruses and parasites that cause illness. In many remote locations it is impossible to avoid this condition.
- See separate leaflet called Traveller's Diarrhoea for more information.
Advice on eating and drinking
- Be scrupulous about hygiene, washing hands before eating and after using the bathroom.
- Eat only food that's cooked and served hot: avoid food served at room temperature.
- Eat only hard-cooked eggs, not soft-cooked (runny) or raw.
- Eat fruits and vegetables you have peeled yourself. Avoid salads and unpeeled raw fruits.
- Pasteurised dairy products are fine but unpasteurised food is not.
- Avoid food from street vendors, including flavoured ice.
- Avoid 'bushmeat' (local wild animals - eg, bats, monkeys).
- Drink water, sodas, or sports drinks that are bottled and sealed (carbonated is safer).
- Drink water that has been disinfected (boiled, filtered, treated).
- Use only ice made with bottled or disinfected water. It most often isn't made this way, in which case go without.
- Drink hot rinks like coffee or tea
- Avoid tap or well water, water fountains, ice, unpasteurised milk
- Sometimes travellers behave carelessly in sexual encounters abroad. If you think there is a chance you may be sexually active with people who are strangers to your usual life, even if you think think it highly unlikely, take condoms with you on your trip.
- Remember that oral contraceptives may fail if you have diarrhoea or vomiting.
- Remember that sexually transmitted diseases including HIV are widespread amongst sex workers in many developing countries.
Skin and the sun
- If travelling to high altitude, the thinner air means that the sun's rays are intense. Severe sunburn can occur even if the temperature is very low.
- Protect yourself particularly from the midday sun (11 am-3 pm). Cover your skin, wear a hat and use the highest factor sunblock you can obtain.
- Protect children's skin - it is thinner than that of adults. Ideally, wear a hat, but if not protect the tops of ears.
Travelling to high altitude
- Travel to high altitude brings particular challenges. These partly relate to low pressure and low oxygen levels and partly to extreme environmental conditions.
- The low oxygen levels at high altitude make exercise more tiring. If you have a heart or lung condition that is not troublesome at sea level it can become a problem when expending effort at altitude.
- See separate leaflet called Altitude/Mountain Sickness for more detail.
Travelling to very hot climates
- Travelling in a hot climate is particularly tough for children and the elderly.
- Particular risks are lack of fluids in the body (dehydration) and heatstroke.
- Risks are greater if undertaking strenuous activity in the heat of the day.
- Heat exhaustion and heatstroke cause headache, dizziness, feeling sick (nauseated), and sweating. As the condition gets worse, dry skin, collapse and confusion. Heatstroke is a life-threatening condition and needs urgent medical help. Patients need to be rested, given sufficient fluids (hydrated) and cooled.
- Small children may just become quiet and listless.
Bites and stings
- Diseases are not the only things that can affect your health. Biting and stinging creatures are widespread in the world. They may represent a danger to health, as may larger animals.
- Remember in particular to check boots for insects in the morning.
- It is always best to assume that all snakes are both aggressive and venomous and never to handle insects or spiders you do not recognise.
- It is also best to assume that all dogs, cats and monkeys may have rabies. Avoid approaching them, however appealing.
- Remember the dangers posed by some marine animals including jellyfish and sharks. Some of these creatures carry powerful poisons (toxins). Only swim in areas where you have been told it is safe to swim.
- Arm yourself against insects: take an effective insect repellent (at least 20% DEET) and cover your arms and legs as much as possible to minimise biting.
- Garlic and citronella do not prevent mosquitoes from biting.
- The risks of mosquito-borne disease are always greater where there is disease in the human population. There have, for example, been recent large outbreaks of dengue fever in Southeast Asia. Consult the NaTHNaC website for the risks where you are travelling.
- Use mosquito nets and, if you are indoors, insect repellent devices such as candles and pyrethroid coil burners.
- Avoid bites: especially after sunset when malarial mosquitoes bite.
Illness after your return
Some tropical diseases have long incubation periods (meaning that it can be many days or even weeks between exposure and developing symptoms). If you develop unexplained illness or high temperature (fever) after remote travel, seek medical help and tell your doctor where you have been. Falciparum malaria, which is the severe form of malaria, is a serious cause of fever and chills in returning travellers. Whilst this normally occurs within a month of return, this is not always the case.
What should I have in my first aid kit for a remote trip?
Putting together a useful first aid kit is an important part of preparation for a remote holiday. You will need your doctor's assistance in doing this, as some medications need to be prescribed.
Consider, in addition, asking your doctor to prescribe 'just in case' medication for conditions you know you are likely to suffer. Also, for conditions that are rendered more likely by the environment you will be in. For example, if you suffer from frequent bladder infection (cystitis) or thrush (candida) it is sensible to take a course of your usual treatment.
You will have to pay for 'just in case' treatments, as use outside the UK falls outside the remit of the NHS.
Personal first aid kit for a remote trip
The following lists a comprehensive first aid kit for two people travelling together to a remote environment. It is based on the advice given in 'Pocket First Aid and Wilderness Medicine', a book written by two well established expedition doctors with experience of remote locations.
The intention of such a kit is not that you bypass medical help and treat yourself when unwell. It is so that if you seek medical help from other travelling doctors and nurses, they can advise you what medicines you need to take and you will then be able to follow that advice.
Your doctor is unlikely to issue you with prescription-only medicines unless he or she has explained when you might use them and advised you strongly to make every effort to seek independent medical advice before using them. Self-treatment is a last resort, as it is very difficult for anyone, even doctors, to make treatment decisions about themselves. In remote environments you will often meet other groups who will have a medic or experienced expedition first-aider with them. These individuals will be able to advise you.
- Pocket First Aid and Wilderness Medicine: Drs Jim Duff and Peter Gormly (2007). This is an excellent handbook covering what to do as a layperson in most medical situations you might encounter.
- Thermometer (or 'FeverScan®')
- Tweezers (pointed-end)
- Sewing needle
- Safety pins x 2
- 10 ml syringe, 2 ml syringe and needles (in packets, sterile)
- Protective gloves - 1 pair
- Sticking plasters - 1 pack
- Blister plasters - 1 pack assorted
- Gauze squares 5 cm x 5
- Sterile non-stick dressings x 5
- Sanitary pad x 1 (for absorbent padding)
- Cotton bandage 10 cm x 1.5 cm
- Crepe bandage 10 cm x 1.5 cm
- Duct tape - 1 small roll
- Wound closures (Steri-Strips®) - 1 packet
- Alcohol swabs x 5
- Sunscreen (high-factor if at altitude)
- Burn cream - eg, silver sulfadiazine or aloe vera gel
- Insect repellent (ideally containing at least 20% DEET)
- Lavender oil - mild antiseptic for wound sterilisation
- Antihistamine tablets - eg, chlorphenamine 4 mg x 10
- Hydrocortisone cream 1% 15 g tube
- Single course of one broad-acting antibiotic - eg, azithromycin 500 mg 3 tabs or ciprofloxacin 500 mg 10 tabs (take your doctor's advice - some antibiotics cannot be taken by children or pregnant women): for severe bacterial diarrhoea
- Single course of co-amoxiclav or amoxicillin: for chest infections
- Metronidazole 400 mg 15 tablets (for stays of more than 3-4 weeks); for gastroenteritis caused by giardia or amoeba (a doctor needs to advise you if you may have this sort of diarrhoea)
- Antibiotic ointment (eg, fusidic acid) 15 g tube
- Antifungal cream (eg, clotrimazole) 15 g tube
- Loperamide 2 mg (for diarrhoea) - pack of 10
- Senna tablets x 5
- Small bottle of antiseptic (eg, Dettol® or Savlon®)
- Antibiotic eye ointment (eg, chloramphenicol)
- Indigestion remedy (eg, ranitidine) 150 mg: 10 tabs
- Buccastem antisickness tablets x 5
- Paracetamol 500 mg x 10
- Ibuprofen 400 mg x 20
- Dioralyte oral rehydration salts x 10 sachets
- Throat lozenges 1 packet (eg, Strepsils®, Vocalzone®)
Additional medication for very high altitude trekking
- Acetazolamide 250 mg tablets (Diamox® - for prevention and management of altitude sickness) x 10-20.
- Discuss with your GP and trekking group whether your very high altitude trek also necessitates carrying dexamethasone tablets or nifedipine tablets. Both are used in altitude sickness emergencies by doctors and nurses experienced in altitude medicine.
Dr Mary Lowth
Dr Mary Lowth
Dr Hayley Willacy