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FREMANTLE: 85 South St, Beaconsfield

Travel Health Blog

January 14, 2019

Carnival 2019 – Rio de Janeiro

The Rio carnival is a spectacular annual festival, this year taking place from Friday 1st to 9th of March (local time). A feast of parties, parades an

January 7, 2019

Kilimanjaro

The magnificent Mt Kilimanjaro is a dormant volcano in the African nation of Tanzania. Considered one of the ‘7 Summits’ it is the highest mountai

December 17, 2018

Meet The Team – Dr Rutherford returns from Sri Lanka

Sri Lanka was voted the number 1 place to visit in 2019 and I can see why. Having just returned from a family holiday, it was nice to go ahead of the

December 11, 2018

Xmas Opening Hours

With Xmas just a couple of weeks away many people are busily getting ready for overseas travel at the end of the month and in January 2019. Travel Hea

Carnival 2019 – Rio de Janeiro

The Rio carnival is a spectacular annual festival, this year taking place from Friday 1st to 9th of March (local time). A feast of parties, parades and balls, considered the last celebration before lent,  there are an estimated 2 million people on the streets of Rio each day. With so much on offer to see, do and experience travellers from all over the globe come to be part of the excitement and spectacle.

As with other similar events where large crowds from different countries gather in close proximity, risk of disease is heightened just by sheer numbers. Those attending should ensure their baseline vaccines are up to date (particularly measles and influenza) and that they have a current Yellow Fever vaccination certificate. Other vaccines may be recommended depending on itinerary (ie hepatitis A) and  measures should be employed to avoid mosquito borne diseases such as dengue fever and, particularly for those contemplating pregnancy,  zika virus.

Kilimanjaro

The magnificent Mt Kilimanjaro is a dormant volcano in the African nation of Tanzania. Considered one of the ‘7 Summits’ it is the highest mountain in Africa and also the world’s highest freestanding, reaching almost 6000m above sea level. Trips to Kili are often accompanied by side trips to see African game, such as in the famous Serengeti National park.

Reaching the peak of Kilimanjaro can be achieved by a number of different routes, varying in length. The shorter treks are usually cheaper but the longer treks allow more time to acclimatise to the altitude. Accurate figures of failure to reach the peak are difficult to find, ranging from 44 – 95% depending on the source but certainly the longer the trek the more likely you are to reach the pinnacle of the climb. Whichever trek you choose it’s important to make sure you book with a reputable and experienced tour group, be physically prepared for the climb and get comprehensive travel health advice before you leave.
With key climbing times being January to March and June to October, many people are preparing to leave soon. A discussion on avoiding, recognising and responding to symptoms of acute mountain (altitude) sickness are vital, with medication available to assist with its management. It’s a must that all baseline vaccines such as measles and tetanus are up to date and depending on total itinerary other vaccines may be recommended including: Yellow Fever, Hepatitis A (almost certainly), typhoid, meningitis and rabies.

Meet The Team – Dr Rutherford returns from Sri Lanka

Sri Lanka was voted the number 1 place to visit in 2019 and I can see why. Having just returned from a family holiday, it was nice to go ahead of the curve.

With a very pleasant tropical climate and distinct seasons dividing the two sides of the island nation, December in the southwest is dry season. Sri Lanka has an amazing variety of landscapes and climates; from the coconut palm lined beaches to the temperate high country in the middle, with fauna and flora changing dramatically as you go up into the mountains.  Historical sites to visit include Galle Fort, Nuwara Eliya and Kandy, as well as the numerous Buddhist temples throughout.

Despite some political unrest in Colombo, the people are extremely welcoming and friendly and the food is fantastic. We managed to surf, explore on scooters (avoiding the crazy local bus), climb mountains, visit tea plantations, see elephants and monkeys and cross the country on a very scenic old British railway line.

From a health point of view, food and water hygiene is paramount. Mosquitoes are everywhere except in the high mountains and being a Buddhist nation, dogs are everywhere,  so rabies remains a risk. Apart from some mild gastro, a chest infection and some coral cuts, we remained pretty well. The country seems to have good medical care throughout and public health is very important which is why it has been declared malaria free.

Loved Sri Lanka and will definitely visit again.

Dr David Rutherford

Director

travelling over christmas

Xmas Opening Hours

With Xmas just a couple of weeks away many people are busily getting ready for overseas travel at the end of the month and in January 2019.

Travel Health Plus traditionally closes at lunchtime on Xmas Eve and and apart from a short  morning session on New Years Eve (for those mid vaccine schedule), remains closed to give our wonderful staff a well earned rest and time to spend with their families over the festive season. You will need to keep this in mind if you are planning to come back to finish off vaccine schedules or pick up a kit or malaria medication for example. Be assured we resume normal hours on Wednesday 2nd January.

Travel Health Plus would like to wish everyone a very safe and healthy Xmas and we look forward to seeing you next time you travel.

 

mosquito

Japanese Encephalitis in Bali

There has been a lot of media attention around Japanese Encephalitis (JE) in Bali over the last week. On further inspection we stand by our usual recommendations for Bali, which has not changed over many years. That is, mosquito avoidance is very important when visiting  anywhere in the tropics. This includes during the day as well as dusk, dawn and overnight. Personal insect repellent should contain DEET (30%) or Picaridin and should be applied to exposed skin.  Wear long sleeved loose clothing and consider soaking clothes in Permethrin in advance of travel. These simple measure will help protect you against a number of different illnesses including Dengue, Chikungunya and Zika all of which are more likely than JE.

What we do know about JE in Bali is that the vaccine was added to the local childhood immunisation schedule earlier this year for the first time and this was based on background surveillance of the illness. Children were vaccinated because they are known to be at higher risk of developing neurological complications of JE.

While JE exists across Indonesia, it was found to be more common in Bali. The illness is transmitted by a type of mosquito which lives in rural or semi-rural areas in Asia and is more common in the wet season, which for Bali is November to April. As we have stated previously the risks remain low for short stay, urban travel to Bali when mosquito avoidance measures are followed.

Vaccination against Japanese Encephalitis is possible but not necessarily recommended for everyone. Date of departure and length of stay are taken into account for example as the vaccines take a little while to become effective. However those of you who travel to Bali for short but frequent trips, may be at increased risk due to accumulative exposure. For specific advice in relation to your circumstance and trip, you need to make an appointment to see one of our travel doctors so they can work out what’s best for you.

View our web pages for more information on travel to Bali and Japanese Encephalitis.

Dr David Rutherford

Director

Meet The Team – Nurse / Manager Paula reflects on crossing the road in Vietnam

Being a nurse specialising in travel medicine means having to keep up with international trends, disease outbreaks and emerging vaccines (among other things) and is a great excuse to attend conferences around the world. I usually try to spend a bit of extra time in the destination country and in 2014 was lucky enough to do that in Vietnam, after attending the 10th Asia Pacific Travel Health Conference  in Ho Chi Minh City. For those who have yet to experience crossing the road in Vietnam, Ho Chi Minh is definitely a baptism by fire and not for the faint hearted. Traffic is heavy and moves constantly, so with no breaks and few crosswalks  to provide an appropriate moment to get to the other side the trick is to simply step off the pavement into the oncoming traffic, walking steadily and in a straight line so that instead of you avoiding the traffic, the traffic avoids you. I had had a few days practice prior to my friend arriving for a tour of the south with me and she was initially horrified when, instead of stopping at the kerb of a busy road to look right, then left, then right again (I had a careful Mum), I looked straight ahead and stepped off in front of barrage of bikes, buses, cars and motorcycles.

It is quite scary but I have to admit also a little exciting – part of the vibe of a beautiful city, rich in history and culture. With lots of things to see and experience up and down the country, Vietnam should definitely be on your bucket list.

 

Hear From Our Patients – Kim-Louise in Africa

A much anticipated mother/son trip started off a little hairy, with two attempts to land the plane on Kenyan soil causing more than a few passengers to go a little green, myself included. Having finally touched down we were met by our tour group and moving on African time, hit the road. Despite a flat tyre and stopping on the side of the road to fix the truck brakes, so far it has all been a big success and is surpassing my expectations (despite having been to Africa before).


The animals are amazing and we have seen (to name just a few), lionesses hunting (at least 10), a group of cheetahs sunning, elephants with their babies, rhinos, flamingos, a pile of zebras, impala, warthogs, giraffe etc etc

A highlight has been a balloon ride. Staying low to see the animals we got so close the basket almost touched the shrubs. The champagne breakfast was beautiful and the “loo with a view” was quite unexpected. The tour so far is excellent, the food amazing (I’m using that word a lot) and yes, we are all taking our malaria tablets.

Travelling from Kenya to Uganda our experience just gets better. Saw a leopard……finally.

Trekked through the jungle and found chimps- they weren’t as excited to see us as we were to see them. One threw a big tree branch and it hit 2 of us.

A hippo was munching outside our tent last night – how unreal. Some of our team were not so much excited as terrified, but Damian and I think it’s all brilliant. Did I mention I am sharing a two man tent with my 22 year old son and it’s going well. 

Yet to see the gorilla’s, but its coming and we have done all this and still not touched the medical kits….

Kim-Louise Burke

Be protected for travel to Brazil.

Brazil is one of the most exciting travel destinations in the world, with its mix of cultural and natural attractions enticing millions of visitors each year. From vibrant Rio De Janeiro through to white sandy beaches and lush rainforests, the adventurous spirit of this country offers so much to the curious traveller. The diverse ecosystems of Brazil boast the greatest collection of plant and animal species on earth, with a great network of national parks operating across the county. When visiting Brazil, it’s important to be aware of the health risks, with precautions needed and a number of vaccinations recommended.

Brazil is the fifth largest nation in the world, and the only country that has both the equator and the Tropic of Capricorn running through it. The diverse environments and topography of Brazil give it a wide ranging climate, including six major climate sub-types. While it’s mostly tropical Brazil is also home to desert, equatorial, semiarid, oceanic, and subtropical areas. When visiting Brazil it’s important to be aware of climate conditions, with rainfall and humidity posing a number of health challenges.

Even though there is no real dry season in Brazil, there are significant variations in rainfall throughout the year. The ideal time to visit varies according to the region, with southern Brazil experiencing most of its rainfall between December and February, the Amazon and Pantanal between December to March, and northern and eastern Brazil between March and June. It doesn’t really matter which time of year you visit Brazil however, with warm temperatures recorded all year round and rain typically falling in short sharp bursts.

While Brazil is a fairly safe place to visit at any time of year, it’s important to take appropriate health precautions, and make sure you’re up to date with your vaccinations. Two childhood vaccines that often need updating are tetanus and measles. In addition, an influenza vaccine is recommended for travel at any time of year, even in people who would not normally get it for the Perth winter flu season. The reasons for this is both an increased exposure to airborne viruses when travelling, and the more significant impact of having the flu whilst travelling, in terms of consequences for your holiday.

Other vaccines are also required when visiting Brazil. Everyone ought to be immunised against hepatitis A, and all travellers will generally have the Yellow Fever vaccine. There has been an increase in Yellow Fever activity recently in Brazil and the vaccine is very effective in preventing this serious mosquito borne virus. In addition the certificate that comes with the vaccine may need to be shown when crossing borders. The vaccine can only be administered in government licensed clinics in Australia.

Other immunisations that may be considered include typhoid, hepatitis B and rabies, depending on the length and nature of the trip. As well as Yellow Fever, there are a number of other important mosquito borne viruses that are also a risk in Brazil, and South and Central America in general. Dengue fever is the most prevalent of these and will result in at least a week or two of significant illness. Zika is a milder illness, but has the potential for devastating effects on an unborn child. Anyone planning a pregnancy when travelling to South and Central America ought to seek expert travel advice prior to planning and booking their trip. At this point in time there are no readily available vaccines for dengue or Zika, so strict avoidance of particularly day time biting mosquitoes is essential. Malaria is a further consideration for travel to the Amazon, and anti malarial medication will be recommended in many situations.

There are  other health risks associated with Brazil, most of which can be avoided or managed with a little education and common sense. Contaminated food and water can be a problem in some parts of the country, with travellers diarrhoea likely to have an impact on the enjoyment of your trip. The risk can be minimised by following safe eating and drinking practices, and its wise to travel with a medication kit in order to manage illness whilst away.

Travelling to Victoria Falls, Chobe National Park and Okavango Delta with your Travel Doctor.

Victoria Falls is one of the most spectacular sights on planet Earth, with this amazing destination often visited alongside the beautiful Chobe National Park and Okavango Delta. All three locations are close enough to visit in a single multi-day tour, with each place providing numerous sightseeing opportunities for the adventurous traveller. While all three destinations are fairly safe and accessible, it’s important to be aware of relevant health issues, take necessary precautions, and get recommended vaccinations to avoid disease.

Victoria Falls is located at the border of Zambia and Zimbabwe in southern Africa. With a name that literally means “the smoke that thunders”, Mosi-oa-Tunya is an amazing sight and a bucket list destination for many. While it’s neither the highest or widest waterfall in the world, it is classified as the largest due to its sheer size and volume. The entire area surrounding Victoria Falls is a sight to behold, with the volume of the Zambezi River pouring through a number of awe-inspiring gorges. The best time to visit Victoria Falls is from February to May, directly after the impressive summer rains.

Chobe National Park is located in nearby Botswana, with this biologically diverse location known for its ferocious lions which prey on the local elephant population. The entire area is teeming with wildlife and rich vegetation, including lush floodplains and scorched marshes. Game viewing is unparalleled in this area, with Chobe also a bird lovers paradise. The trip from Victoria Falls to Chobe only takes a single day, with a number of tours also including the nearby Okavango Delta.

Also located in Botswana, the Okavango Delta is a large swampy area formed at a trough of the Okavango River. The Delta was recently named one of the Seven Natural Wonders of Africa, making it a must-see destination for many. This entire area is produced by seasonal flooding, draining in the summer months of January and February before the rain falls over the next four months. The flood waters peak between June and August, when the delta swells to three times its permanent size. The best time to visit Botswana is during the dry season from May to September, with Okavango flooded from June to October.

Victoria Falls, Chobe National Park, and the Okavango Delta are three of the most popular natural attractions in Africa. While tourist infrastructure is solid and tours are plentiful, there are some important safety considerations that you need to be aware of. Before embarking on this life changing adventure, it’s important to assess your physical health and fitness and become aware of any diseases and health risks that are relevant to the area. Along with getting fit before you go and packing a medical kit, it’s also important to be aware of various illnesses that may require vaccination.

It’s always important to consult your doctor before travelling overseas, with specific medical advice and vaccinations needing to be tailored to your itinerary. Some childhood vaccines may require boosting, such as measles and tetanus. It’s also a good idea to get influenza vaccine when travelling regardless of the time of year. The risk of influenza due to travel is much greater than when you stay home, and the consequences are greater too – it will ruin your trip.

There are some destination specific vaccines to consider for the trip as well. Everyone travelling in Africa ought to be covered for hepatitis A. Hepatitis B, typhoid and rabies may also be considered for more adventurous or extended travel. Yellow Fever vaccine requirement is a complex subject – definitive advice on the need for this vaccine is very dependent on your itinerary, and advice on the need for it is made on an individual basis.

Once you’re on the ground, problems are generally avoidable with common sense safe practice. Diarrhea is the most common ailment in travellers in the developing world, and safe eating and drinking is essential. It is also wise to take a medical kit that can be used to treat traveller’s diarrhea. As well as measles and influenza, other airborne viruses are a significant issue when travelling, and using alcohol-based hand sanitising gels in busy places like airports is the best protection. Malaria is the most important mosquito borne disease in Africa, and mosquito bite avoidance is the first step in limiting risk, using DEET based repellents, wearing long loose clothes and sleeping under mosquito nets if your accommodation is not air-conditioned . Malaria is vastly more prevalent in Africa than the rest of the world, and is rapidly fatal untreated. Anti-malarial medications are essential in most of Africa, and options are discussed with your doctor depending on your itinerary and circumstances.

Hear from our patients- Peter & Damian reflect on the Kokoda Trail

Damian and I have completed our trek of the Kokoda track-  from North to South in just over nine days. We trekked with Back Track Adventures and were ably led by Sarah and her porter team who were predominately from the Naduri Village.
The track is a single trail with continual ups and downs and many false peaks which can be mentally challenging. Some days we were on the track for up to 10 hours. One positive is that it is one of the few tracks I have been on that is specifically for trekkers; a lot of the places we visited could only be reached by walking.
After rain the track becomes incredibly slippery. Tree roots become slippery slides and boots either disappear in the mud or slip right across. You end up on your backside several times so be prepared for the cuts and abrasions that can accompany these falls.
You will get blisters. There are many techniques for preventing and treating blisters and you need to source the best solution before you go and be ready with the treatments. Having well worn in boots is of course critical. Having a good pair of reef sandals is also important as one day we spent two hours wading through a creek bed. Sandals were also important for around the campsites to help our feet recover at the end of the day.
There is no treated water on the track but plenty of running water available in creeks and rivers. We found the Fill2Pure water bottles very convenient in the camp sites and used water purification tablets in backpack water bladders for daytime trekking to stay hydrated on the trail. We also used tablets to make up hydralyte solutions to replace the salts from the continual sweating.
It is impossible to get dry on the track as during the day it either rains or your clothes become sweaty from the humidity. Overnight when the temperature drops dew forms on anything hanging outside. Each morning meant getting into wet, smelly clothes. We were lucky in that we didn’t get much rain whilst trekking. When it did rain we didn’t bother with rain coats as we were wet from sweat anyway and were warm enough. However, it is worthwhile having a pack rain cover and dry bags in your pack to at least keep one set of clothes dry.
When the sun did come out is was very hot and sunscreen and a hat was a must. I highly recommend having sunscreen readily available as the environment can switch from overcast to clear and jungle to open track very quickly.
We didn’t have any trouble with diarrhoea which I am sure was in part to having hand sanitiser readily available and of course treating the water.
There were mosquitoes on the track, particularly in the low-lying areas at the start and finish. Malaria is a real concern and a trip to a village medical centre confirmed that is was their number one medical issue. Having repellent readily available and applying it religiously was key. Some members of the team had visible mosquito bites so hopefully they weren’t malaria carrying. Of course, taking malaria tablets is a must.
Muscles that you didn’t know existed will hurt so make sure you have a good supply of anti-inflammatories and muscle and joint pain creams. My knees took a particular beating with the downhills. Having trained on similar terrain and being fit will make the trip much more enjoyable.

The trek was an enjoyable experience and for me a great opportunity to walk in the steps of the young, brave Australians who gave their lives to protect our country. We visited many of the key sites in the Kokoda campaign and had a moving ceremony at Brigade Hill to remember the fallen. Peter FitzSimons “Kokoda” is a must read to understand the full context of the Kokoda campaign.

The villagers on the track were shy but friendly and we spent an enjoyable rest day attending church and playing with the children in Naduri village. They have wonderful voices and love to sing and we had a number of ‘sing sings’ during the trek. Audience participation was always encouraged so make sure you learn the words to Advance Australia Fair to avoid embarrassment.

I would like to thank the Fremantle Travel Health Plus team for getting us medically prepared for the trip and contributing to us returning sore but healthy.

Peter and Damian.