Travel clinic Dis­tin­guish­ing travel health facts from dan­ger­ous hearsay can be hard – Dr Jane takes aim at travel’s big­gest health myths

There’s a huge amount of mis­in­for­ma­tion handed down on the trav­ellers’ grapevine – not to men­tion over the in­ter­net. Dr Jane Wil­son-howarth un­picks the most trou­bling myths

Wanderlust Travel Magazine (UK) - - This Issue - with Doc­tor Jane

‘I never get ill, so travel health in­surance is a waste of money.’

Wrong. Health in­surance pro­vides a helpline num­ber so any wor­ry­ing symp­toms can be dis­cussed with a clin­i­cian. They will also have a list of lo­cal clin­ics where you are likely to find a doc­tor who can speak English. These days, there is an ev­er­ex­pand­ing in­dus­try of health tourism. Busi­ness­men have set up fancy hos­pi­tals to at­tract for­eign­ers to come for hip re­place­ments or cos­metic surgery, and in the event of an ac­ci­dent you may be taken to one of these. Of­ten the first thing set up is a drip, so you can’t leave. Travel in­sur­ers ac­tu­ally have teams of clin­i­cians who ‘res­cue’ pa­tients from such dif­fi­cul­ties and can ar­range an air am­bu­lance home if needed. It is also pos­si­ble to ar­range for screened blood.

‘If I do get sick, I’ll just call an am­bu­lance.’

Un­wise. Am­bu­lance ser­vices are far from univer­sal, even in some big cities. In Kathmandu, for ex­am­ple, there is no equiv­a­lent to 999; you have to find the num­ber of a rep­utable hos­pi­tal, then phone them to find out if they have an am­bu­lance. This isn’t the kind of re­search you will want to do at the road­side with a bro­ken arm or if you are deliri­ous with a high fever.

If in doubt, the UK For­eign and Com­mon­wealth Of­fice web­site (gov.uk/ browse/abroad/ travel-abroad) con­tains a lot of good coun­try-spe­cific in­for­ma­tion and so does its US equiv­a­lent (travel.state.gov).

‘Tak­ing an­ti­malar­ial tablets means you don’t need to take care to avoid in­sect bites.’

Sadly in­cor­rect. There are plenty of in­sect-borne in­fec­tions on of­fer in the trop­ics and sub­trop­ics, and malaria tablets only pro­tect you from one of these. In­fec­tions caught by trav­ellers in very re­mote des­ti­na­tions may not even have been prop­erly recorded by med­i­cal science, and you re­ally don’t want to be fa­mous for be­ing the first known case of ‘Pukeyfever­rash Dis­ease’ in the world. Pro­tect your­self from bites as best you can (see p90 for our re­views of re­pel­lents).

‘I have an Euro­pean Health In­surance Card (EHIC), so I don’t need travel health in­surance.’

Okay, the EHIC cov­ers ba­sic emer­gency care in sig­na­tory coun­tries in Europe, but do you know which ones? And are you aware that you’ll nor­mally be ex­pected to pay up front? Then you will be able to claim some of the money back. And will this all be in­valid post-brexit any­way?

‘Only dogs carry ra­bies.’

In­cor­rect – any mam­mal, in­clud­ing bats and mon­keys, can carry ra­bies, as the fol­low­ing case re­port proves. A bat flew against the face of a 34-year-old med­i­cal doc­tor at a camp­site in Tsavo West Na­tional Park, Kenya. Af­ter­wards, she no­ticed two small bleed­ing wounds on the side of her nose. She washed the wounds us­ing wa­ter, soap and al­co­hol swabs. The park war­dens and the per­son­nel at the nearby clinic told her that, lo­cally, ra­bies was only car­ried by dogs and cats, but 23 days later her symp­toms started. She died of ra­bies in a Dutch hos­pi­tal 45 days af­ter the ini­tial scratch.

‘If bit­ten I have to get ra­bies jabs within a day or two; maybe I’ll just wait un­til I get symp­toms’

Dan­ger­ously in­cor­rect. Once the symp­toms start, death is pretty

much in­evitable. The in­cu­ba­tion pe­riod, though, is very variable and can be weeks or months. The closer to the brain, the less time you have. Any­one with a ra­bies-prone wound should go for the jabs as soon as pos­si­ble but it is never too late – un­less symp­toms have started.

‘Ra­bies immunisation is an un­nec­es­sary ex­pense.’

I dis­agree, although usu­ally you do know if you’ve been ex­posed to ra­bies, so could evac­u­ate for treat­ment if you get a bite or scratch. Immunisation (af­ter the pri­mary course and one booster) lasts for life, how­ever, so un­less you are a once-in-a-life­time trav­eller (and what Wan­der­lust reader is?), I reckon it is a good in­vest­ment. It gives you time and peace of mind.

‘Stay­ing in classy ho­tels pre­vents ill­ness.’

Not re­ally. In­ter­na­tional ho­tels can feel like you’ve en­tered a ster­ile bub­ble, but the or­gan­isms that cause out­breaks of le­gion­naires’ dis­ease, for ex­am­ple, can lurk in the air con­di­tion­ing. You prob­a­bly also heat-ac­cli­ma­tise less ef­fi­ciently if you hide away in rooms with the A/C on. In spa­cious ho­tels you are less likely to ac­quire in­fec­tions spread by droplets in crowded places, but ho­tels ac­com­mo­date, and are staffed by, peo­ple, so they’re hardly ster­ile.

‘Street food is usu­ally dan­ger­ous – food in ex­pen­sive ho­tels is not.’

No, it’s not that easy. Whether or not you get ill af­ter eat­ing food pre­pared by oth­ers de­pends on how the cooks han­dle the food and how thor­oughly it is cooked. Big ho­tels of­ten en­cour­age guests to take food from a buf­fet – it is easier for them – but this may have been kept only luke­warm or pre­pared hours be­fore you eat. If it’s con­tam­i­nated dur­ing or soon af­ter prepa­ra­tion, in­cu­bat­ing food at blood-heat over ‘tealights’ will al­low bac­te­ria to re­pro­duce to a dan­ger­ous level, and the re­sult is food poi­son­ing. Or­der a la carte, shun sal­ads and gar­nish, and en­sure your food is pip­ing hot.

‘Most ill­ness in trav­ellers comes from con­tact with con­tam­i­nated wa­ter.’

Nope. The ev­i­dence is that trav­ellers’ di­ar­rhoea comes most com­monly from un­hy­gienic food han­dling rather than the odd drop of wash­ing-up wa­ter or gulp from a tap. Re­mem­ber the ‘Peel it, boil it, cook it or for­get it’ rule. But do try to travel with your own wa­ter bot­tle (or con­sider buy­ing a Lifes­traw), so you don’t con­trib­ute to the global plas­tic wa­ter-bot­tle dis­posal cri­sis.

Dr Jane Wil­son-howarth lives in Kathmandu, where she dares to drink the ‘fil­ter wa­ter’ pro­vided in lo­cal restau­rants. Her blogs are at www.wil­son-howarth.com

Gut in­stinct Street food, such as that of Mar­rakech’s famed Je­maa El-fna square, isn’t riskier to con­sume – it all de­pends on han­dling and prepa­ra­tion

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