Health and Community Services Department
INTERNATIONAL TRAVEL CLINIC
Advice for Travel in Remote Areas
If you intend to take part in an expedition, or if you will be traveling in areas where help is difficult to obtain in an emergency, you may find it useful to consider the issues discussed below.
You should be aware that travel in areas, which are remote from medical facilities, involves an additional element of risk. In the event of a serious injury or illness it could be many hours or even days before evacuation is possible. You should consider the characteristics of the environment you will be in, such as altitude, extremes of temperature and weather, distance from outside help, and how these factors may affect the ease of rescue in the event of an emergency.
Depending on whether you are with a commercial trek, a youth expedition, traveling independently or in some other group, the provision for medical support can vary enormously. Some groups always have a doctor with them, others may have a nurse, paramedic or first-aide. You should ensure in any case that someone has thought about medical issues and that an appropriate first aid kit is carried. Preferably everyone on the trip should have a basic knowledge of what to do in an emergency. It would be advisable to get training in first aid before departure; courses are available which are aimed specifically at those traveling in remote areas. It is worth taking a small personal first aid kit in addition to the main expedition kit.
The best way to deal with medical problems is to prevent them happening in the first place. This is even more important if you are going somewhere where medical support is hard to obtain. It would be a good idea to have a medical check-up before going, and remember to take supplies of any medications, which you commonly need.
A dental check-up is especially important, and should be done at least three months before departure to give time for any necessary work. Tell your dentist that you will be going on expedition and for how long, and he may elect to fix small problems earlier rather than later in order to avoid potential complications in the middle of the jungle.
If you usually wear contact lenses, consider whether you will be able to keep them in a sterile condition when away. Often in an expedition environment this is not possible, and it may be wise to use spectacles instead. Contact lenses can also be a problem if the environment is dusty, such as a desert.
Physical and mental fitness
Most expeditions are likely to involve a considerable amount of physical exertion. It is very much worth preparing for this with a regular aerobic exercise program, for several weeks or months before departure. This will certainly increase your enjoyment of the trip and improve the chances of achieving your objectives.
Some people may find it difficult adapting mentally to an expedition environment, due to factors such as a lack of privacy and being cut off from family and friends. If you have a history of any psychological problems, including alcoholism or drug dependency, it is important to make sure that these are well under control before putting yourself into an unfamiliar environment. It may be worth seeking counseling before your plans are finalized. The extent of difficulties will vary between individuals, but being open to new and different cultures and being patient, rather than critical, will help you adapt to new and challenging adventures.
Depending on whether food is provided by your own expedition, or bought locally, the risks of infection will vary. If local cooks are employed check that they use hygienic methods to avoid contamination. You will usually need to treat drinking water by chemical means and/or filtration. Sterilized water should also be used for cleaning teeth and for washing dishes and cutlery. All expeditions should have an environmentally aware policy about the disposal of kitchen and human waste, which should be kept totally separate from cooking areas and water sources. Wash your hands, with water containing a disinfectant, before eating or handling food and always after using the toilet.
- Vaccinations take time: consult your doctor or nurse as soon as possible ideally 8 weeks before departure. Late bookings can leave insufficient time for vaccinations to become fully effective.
- Tetanus and diphtheria vaccination is important. For countries where these diseases are still common you should to receive boosters every 10 years and everyone should have completed their normal British childhood schedule.
- There is an increasing risk of tuberculosis for those visiting many of the high-risk areas and mixing with the local population. Remember protection from BCG vaccination is only achieved after about 4-6 weeks. Boosters are not normally required.
- Meningococcal type A vaccine is advised for those visiting risk areas in sub-Saharan Africa who will be mixing closely with the local population, as might be the case in your situation.
- Hepatitis A and typhoid vaccines are important for those who are not able to be careful about their food and water hygiene in risk areas, as is often the case with the more adventurous traveler.
- Japanese B encephalitis is spread by mosquitoes and is sometimes advised for those spending longer periods in risk, especially rural areas, as is often the case with the more adventurous traveler.
Malaria prevention requires careful avoidance of mosquito bites in addition to drug prophylaxis. Take suitable clothing, insect repellents and your own mosquito net or mosquito proof tent. For travel in remote, malaria-endemic areas it is advisable to carry drugs for the emergency treatment of malaria. You should discuss this with your doctor, and ensure that you know what signs to look for and how to use the medication. Malaria will not be a problem for many mountaineering and trekking expeditions as the mosquito vectors do not occur above 2000 meters.