Travel clinic

Travel across Ra­jasthan can be an un­for­get­table ex­pe­ri­ence, but even in what is ar­guably In­dia’s clean­est state, there lurk health risks worth pre­par­ing for, says Dr Jane Wilson-howarth

Wanderlust Travel Magazine (UK) - - Contents -

Dr Jane shares need-to­know health ad­vice on vis­it­ing Ra­jasthan

‘Over 20,000 peo­ple die of ra­bies in In­dia an­nu­ally, and nearly all cases fol­low dog bites, so pre-de­par­ture ra­bies cover is worth­while’

Al­though In­dia of­fers trav­ellers a wealth of ex­pe­ri­ences, it can also present some health is­sues, too. And while Ra­jasthan is one of the health­i­est spots to visit on the sub­con­ti­nent, as with any des­ti­na­tion there are con­sid­er­a­tions to keep in mind.

SMOG & HEAT

Many trav­ellers to Ra­jasthan pass though Delhi (or one of the other megac­i­ties), where traffic rules are ‘un­usual’ – it may seem like there’s a com­plete lack of any sys­tem. Cars and mo­tor­bikes drive fast, other road users (in­clud­ing dogs and cows) are un­pre­dictable, and crashes are many. Be sure to do a quick check of the state of any taxi you get into.

The big cities can also be very pol­luted, so any­one with a his­tory of asthma, even if only as a child, would be wise to travel with an in­haler, just in case. Some peo­ple take pol­lu­tion masks.

Once you ar­rive in Ra­jasthan, the air will feel health­ier, but the sum­mer can be fiercely hot. Those un­used to the heat will take a cou­ple of weeks to ac­cli­ma­tise, but af­ter that you’ll sweat less, cope bet­ter and lose less salt.

In those first two weeks it is es­pe­cially im­por­tant to make a con­scious ef­fort to drink plenty, as thirst is a poor in­di­ca­tor of the body’s need for flu­ids. The best guide to hy­dra­tion is the colour and quan­tity of urine: ev­ery­one – trav­el­ling or not – should pass a min­i­mum of three good vol­umes of light-coloured urine per 24 hours. If pee­ing very fre­quently (say hourly), you are prob­a­bly drink­ing too much, so moder­ate your in­take and watch your out­put. If pass­ing very small vol­umes of urine fre­quently, this sug­gests a blad­der in­fec­tion, and an­tibi­otics will likely be needed, es­pe­cially if there is blood and/ or pain at the end of the stream.

If your taste for salt in­creases, add more salt to your food – or fresh lime so­das. Con­sider also bring­ing a re­fill­able wa­ter bot­tle; buy­ing ‘min­eral wa­ter’ only adds to the solid-waste disposal is­sues faced across the sub­con­ti­nent, and in­deed glob­ally.

FEEL­ING THE BITE

As­ton­ish­ingly, over 20,000 peo­ple die of ra­bies in In­dia an­nu­ally (com­pared to a global to­tal of over 55,000, re­ports the World Health Or­gan­i­sa­tion). Nearly all cases fol­low dog bites. Pre-de­par­ture ra­bies cover is a worth­while in­vest­ment, es­pe­cially as a full course of ra­bies vac­cine (and a booster) should give im­mu­nity for life.

Even if cov­ered, it is ob­vi­ously de­sir­able to avoid bites; and if threat­ened by dogs, it is best to face them, speak calmly and stoop down and pick up a rock. Most dogs will back off if they think you are armed with such mis­siles. Run­ning is the worst thing that you can do.

Dozens of snake species are found across Ra­jasthan. Sev­eral are mag­nif­i­cently marked but, to the un­trained eye, it isn’t easy to dis­tin­guish species and telling the dif­fer­ence between a deadly saw-scaled viper and a non-ven­omous sand boa re­quires skill and light.

Snakes largely hunt from dusk, so aren’t easy see by torch­light. Large, brown rat snakes are of­ten ac­tive dur­ing day­light hours and are com­monly seen all over the sub­con­ti­nent, but they are

harm­less. That said, it is best to avoid bites by be­ing prop­erly shod and by wear­ing long, loose trousers, es­pe­cially from twi­light on – when snakes start hunt­ing.

This ad­vice helps avoid in­sect bites, too, and re­duces the chance of ac­quir­ing one of the five ma­jor mos­quito-borne in­fec­tions present across In­dia. But be­cause Ra­jasthan has less sur­face wa­ter than other re­gions, the dan­ger is re­duced here: the malaria risk in par­tic­u­lar is low but not ab­sent; dengue is a pos­si­bil­ity; chikun­gunya and zika are like­wise present; and Ja­panese en­cephali­tis also oc­curs here.

The peak trans­mis­sion sea­son is dur­ing the mon­soon. Re­mem­ber that the dengue vec­tor is a day-biter, so cover up if you be­gin notic­ing bites, es­pe­cially while re­lax­ing in an idyl­lic ho­tel gar­den – or move away from the shade. Do also bring plenty of re­pel­lent and re­search your par­tic­u­lar risks.

Those with on­go­ing health chal­lenges should dis­cuss their travel plans with their doc­tors; for ex­am­ple, peo­ple who lack a spleen are at in­creased risk of dy­ing if they con­tract malaria. Those re­cov­er­ing from can­cer treat­ment may need to be reim­mu­nised and will have re­duced im­mu­nity to in­fec­tions that oth­ers would fight off.

STOM­ACH WOES

In­dia has quite a high hit rate for all the filth-to-mouth dis­eases, from trav­ellers’ di­ar­rhoea to dysen­tery, as well as the en­teric fevers (ty­phoid and paraty­phoid). Shun sal­ads as these are read­ily con­tam­i­nated dur­ing grow­ing and aren’t eas­ily de­con­tam­i­nated by wash­ing, even in clean wa­ter.

The gas­troen­teri­tis risk is great­est im­me­di­ately be­fore and dur­ing the mon­soon. I would rec­om­mend a course of three ty­phoid cap­sules be­fore any trip to In­dia. These are not very well known among GPS, and many travel clin­ics don’t of­fer them. GPS can pro­vide a pre­scrip­tion so that the cap­sules can be dis­pensed by a phar­macy.

Ty­phoid in­jec­tions only pro­tect against ty­phoid but half of the cases of en­teric fevers here are due to paraty­phoid, which isn’t cov­ered by the in­jec­tion. Sadly, the cap­sules are only ef­fec­tive in peo­ple over the age of six, and the way that they are dis­pensed in the UK means they are only ef­fec­tive for a year.

And fi­nally, do check up on what you may and may not do on en­ter­ing In­dia. A friend was re­cently ar­rested for in­no­cently bring­ing in a satel­lite phone, not re­al­is­ing he had com­mit­ted a crime in so-do­ing. The FCO site (https://tinyurl.com/ WL-FCO) is packed with good ad­vice on such laws, as well as where it is and isn’t safe to ven­ture.

Dr Jane Wilson-howarth is now based in the Kath­mandu Val­ley from where she is blog­ging at www.wilson-howarth.com/blog

top tip Many GPS don’t know this, but they can is­sue an NHS pre­scrip­tion for three ty­phoid cap­sules that pro­tect against both ty­phoid and paraty­phoid.

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