ABC of healthy travel. First aid while abroad.
Authors: E Walker, G Williams
Journal: BMJ (1983)

The traveller has more episodes of illness than when at home.This increase is due to exposure to organisms not prevalent at home, adjustment to different climates and cultures, and increased trauma of accidental, biting, and stinging varieties.Most of these illnesses are mild and will not require medical consultation, but some will be severe or gx D become chronic.a or vz '-J We Travellers often do not know how to seek medical advice while abroad -fi t l * and may be reluctant to do this because of language difficulties, costs, doubts about the quality of service, or remoteness.English speaking doctors are, however, available in most cities (lists are available, see final article), and hotel receptions, tour company couriers, British embassies, and consulates will know where to obtain medical advice.Although an illness may be minor or self limiting it can still cause distressing symptoms amenable to simple treatment.For this reason most travellers carry some drugs and first aid equipment.The extent of any such first aid box will vary both with the worries and the intent of the traveller.We will consider only basic essentials and not discuss the specialist requirements of groups such as those making expeditions to remote areas.We have assumed that severe symptoms would lead to self referral to a doctor. Illnesses of infective origin Gastrointestinal illnessesTravellers diarrhoeaDiarrhoea affects many people travelling from areas with high standards of public hygiene to areas with lower ones.The incidence of travellers' Drugs for prophylaxis diarrhoea among British travellers is higher in those going to Africa or the Streptotriad 1-2 tablets twice daily Indian subcontinent, for example, than in those going to Mediterranean Doxycycline 1 tablet daily (100mg) countries.It occurs within a few weeks of arrival and the commonest cause Co-trymxazole 2 tblets twicedasly iS enterotoxinogenic Escherichia coli.Shigella, Salmonella, Campylobacter, Cotioz 2and rotavirus are isolated from a smaller percentage of cases, and a few Drugs for treatment cases are caused by Giardia lamblia and Entamoeba histolytica.Some Diphenoxylate with atropine (Lomotil)places have their special hazards such as Vibrio parahaemolyticus in Japan.Co-trimoxazole Prophylaxis-Some broad spectrum antibiotics and bismuth subsalicylate are effective in reducing the incidence of travellers' diarrhoea.Antibiotics are not routinely recommended because of their potential for selecting antibiotic resistant bacteria.But antibiotics would benefit those who need to be fit for a short specified period, such as businessmen, entertainers, and athletes, and should be considered for the elderly or infirm.Bismuth subsalicylate is thought to reduce the intestinal secretion induced by toxins and hence is also effective symptomatic treatment.It has become available in Britain (Pepto-bismol) but is bulky to carry in the dose at which it was tested-60 ml four times daily.-Treatment-Patients whose diarrhoea is associated with any of the following symptoms should seek prompt medical advice: prostration, persistent vomiting, high fever, the passage of blood and mucus per rectum, and frequent copious watery stools in the young child.Although -there may be some vomiting associated with the onset of diarrhoea in milder illness, this does not usually persist.Essential treatment is the replacement of fluid loss, particularly in the young and elderly.Over a short period even water is satisfactory though a solution containing electrolytes, such as fruit juice, weak soups, or diluted milk, is preferable.A homemade electrolyte preparation can be made from one level teaspoonful of salt and 1039