NEDLANDS: 2/141 Stirling Highway

FREMANTLE: 85 South St, Beaconsfield

November 14, 2018

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 reco

October 22, 2018

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

September 27, 2018

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 t

September 19, 2018

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 ea

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 Otovango 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.

Meet the Team – Dr Perse reflects on China

Many years ago, I went travelling with my wife Sally. We spent nearly a year backpacking through Asia, and towards the end of our trip spent a month travelling independently through China.

Our trip started with a flight from Hanoi to Hong Kong. The old Hong Kong airport wasn’t far from the CBD, which meant skimming across the rooftops of the city skyscrapers on the way in to landing – quite an exciting arrival in a very exciting city. We’d arranged our arrival to coincide with the handover of Hong Kong from Great Britain to China. This also meant that the accommodation reservation we had made disappeared, presumably as the room could be let for more than we’d booked it for. A stressful several hours of searching ended up with us finding a room in a very dodgy part of town, ChungKing Mansions – but we were grateful to have somewhere to sleep for a few nights no matter how basic.

The next few days were preoccupied with the handover, the British putting on an extravagant ceremony. Not to be outdone,the day after possession the Chinese put on an even better one. It rained a lot. We took a fast ferry across to Macau not far away, and spent a few days there. At the time a Portuguese colony, Macau has also since been handed back to China. Lots of casinos, very popular with the Chinese, and paving very reminiscent of Lisbon!

We left Hong Kong by ferry, heading north up the Pearl River, past Guangzhou (colonial Canton in British days) on our way to Guilin. With all the rain and the swollen flow of the river downstream, our boat broke down and we were offloaded in a town on the bank of the river that seemed as though it had never seen a Westerner before. Certainly there was nothing written in English, and no one spoke it either. Fortunately for us there was an American anthropologist on the ferry who was fluent in Chinese and who, together with his Chinese wife, took us under his wing and helped us find a room for the night and a ‘sleeper bus’ to Guilin the next day. I somehow remember very clearly a sachet of soap like liquid left in the bathroom that night, labelled in English ‘Shower Poo’.

After our horizontal bus journey, we spent a few days in a small town, Yangshuo, near Guilin in Guangxi province, and marvelled at the stunning scenery, with vertical limestone cliffs arising out of verdant rice fields. We spent a pleasant few days riding bikes around.

We next travelled to Szechuan province, and the City of Chengdu. Our main memories are of fabulous food (notwithstanding the amazing heat of Szechuan peppercorns), a beautiful teahouse on the edge of a lake, entertaining baby panda twins, an enormous Buddha carved from a cliff face on the banks of a swift river, and a serene Buddhist monastery.

Travelling independently was a challenge. Every train station had a foreigner’s ticket counter, at which no foreigner could purchase a ticket. Tickets were solely reserved for native Chinese, to buy at something above the standard ticket price. In every destination our first job was to find a local to buy us train tickets to our next destination, on the black market. This usually took two to three days, which fortunately was about how long we wanted to stay anyway before moving on. It didn’t always go well. On one occasion we found ourselves on the way to Xian, with a couple of Chinese locals demanding we give up our seats. We stuck to our guns, saying we had purchased our seats to Xian, only to discover our black market tickets only got us a bit more than half way. We couldn’t read Chinese! We were threatened with being thrown off only part way to our destination (again!) but managed to stay on the train- standing til we reached Xian.

Xian was amazing. It is now famous for the discovery of the terracotta warriors. This is an army of life-sized terracotta figures, buried with China’s first emperor around 200 BC. They were only discovered in 1974 when farmers were making excavations for a well. At last count, there were over 8000 soldiers, 500 horses and 130 chariots. The adult figures vary in height, the generals being tallest, as well as in uniform and hairstyle, according to rank. All have a unique face. It was a sight worth travelling to see.

Beijing was our last destination in China, and 20 years ago it was an enormous, bustling city. The palaces, gardens and temples oozed with history. The Great Wall of China was only a day trip away, and a bottle of Tsing Tao beer was cheaper than a bottle of water!

We left China on the trans-Mongolian train, to join the trans-Siberian railway in Irkutsk. China had been the most challenging country in which to communicate in all of our Asian travels – we got by using a phrase book, finding the question we wanted to ask in English, and pointing to the relevant Mandarin translation. Locals would then take our phrase book, point to the answer in Mandarin, and we would trace across the page to the English translation. We tried to speak some Chinese, but with the variations in meaning according to inflection and tone, we usually got nowhere. We did manage to order 2 beers in Mandarin eventually though, and recognize the difference in Chinese characters between man and woman – essential for deciding which toilet to enter.

Over 20 years later, our month in China remains a very fond and vivid memory. We’d love to go back again, see more, and how much its changed.

Dr Aidan Perse

Hear from our patients – on the Kokoda Trail

This week we got an email from patients Peter and Damian who are off on a father/son trip to PNG. Peter told me before he left that he would only be able to send an email at the start of the trek because there’s no power or internet after that for around 9 days.

Hi Travel Health Plus Team – Waiting to board a flight to Popondetta to start our adventure, then its a 5 hour truck ride to Kokoda – at which point we have to walk. We are a small team of 8 so should be a tight crew. No mosquitos last night but malaria is definitely a concern so glad I have my tablets. Port Moresby isn’t safe but there aren’t any tablets you can take to protect against that. A couple went to the local supermarket and ended up running there and taxiing back. Let the adventure begin….. Peter & Damian.

For those who plan to visit PNG for any reason, a trip for travel health advice is a must!

Minaret

Hajj & Umrah Health Requirements

Australians heading to Saudi Arabia for the Hajj & Umrah pilgrimages need to ensure that they are vaccinated prior to departure, to meet the requirements of the Saudi government. These requirements can change from year to year and are aimed at disease prevention, not just in Saudi Arabia but also within countries pilgrims will be returning to. With massive numbers of people coming together from all over the world, the potential for disease spread is great.

In 2018 the requirements for those travelling directly from Australia to Saudi Arabia are:

  • Proof of vaccination against Meningococcal ACWY within the last 3-5 years (depending on which type of vaccine was last given), and no less than 10 days prior to arrival

Of note:

  • Yellow Fever vaccination – this is not required if travelling directly from Australia to Saudi Arabia
  • Yellow Fever vaccination – an international certificate is required if arriving from one of the  Yellow Fever risk countries in Africa or South America (discuss with your doctor if you have a complex itinerary and are not taking a direct flight)
  • Polio vaccination – proof of vaccination required if coming from a country where polio remains a risk (Australia is not one of them)
  • Influenza vaccination is recommended by the Saudi Health authorities for everyone

 

Nedlands Appointments Now Available

We have listened to the requests of our patients and are very excited this week to announce the much anticipated commencement of clinic sessions in Nedlands.

Located at 2 / 141 Stirling Highway (on the Weld Street corner), appointments are currently available on Tuesday and Thursday afternoons between 2 – 5 pm for travel advice, health student and general vaccination visits. Just like in our Beaconsfield clinic, all vaccines, products, kits and medications are onsite. Appointments are necessary.

Unfortunately Nedlands does not offer medicals or Q fever testing but we continue to offer  our full range of services at our main site.

Bookings for either Nedlands or Beaconsfield can be made either online via our website or by phoning us on 9336 6630. We look forward to seeing you soon.

Paula Johnstone 

Clinic Manager