Dr Jane Wilson-Howarth, health expert since issue 1, reveals the most common questions she’s faced, and of course, her expert answers
Q: Is it worth taking antimalarials? Don’t they have nasty side effects? Isn’t it better to get the disease, and then cure it?
A: It’s no fun getting malaria. Any delay in getting treatment will mean you will be (a) recovering for a long time – weeks or months, and (b) risk death: 1% of people infected with malaria and treated for it still die.
Q: Which are the best and cheapest antimalarials?
A: Sorry, but cheapest seldom equals best. The best and most protective antimalarials are the three that are only available on prescription in the UK: Malarone, doxycycline and Lariam. Malarone probably causes the fewest side effects in most people but it is the most expensive.
The best antimalarial is the one that suits you individually and that you are comfortable and committed to taking.
Remember, people who buy antimalarials in Asia and Africa risk taking ineffective counterfeit tablets.
Q: How do I get my travel immunisations cheaply?
A: Do your homework (try www.nathnac.org) – then you can have a proper discussion with your GP or nurse about your needs and risks. Less-experienced immunising nurses may offer less-important vaccines that you may not need.
Hepatitis A, typhoid and tetanus should be available free from your NHS GP but that doesn’t mean these are the only ‘essential’ jabs. Most travel vaccines need to be paid for, and prices are normally posted on clinic websites. If your GP practice offers travel vaccines, they may not be cheaper than a private clinic – practices can charge as much (or as little) as they like. Sometimes you’ll save money by getting expert private advice.
Q: Where can I find the best and cheapest insurance?
A: The best insurance is a policy that covers absolutely everything that you are likely to do, for which you have declared any and all previous illnesses and that is underwritten by a reputable assistance company – who you can phone for advice when things go wrong. Don’t economise on it.
Q: How can I avoid bug bites? I itch so much and for so long after being bitten, that holidays have been ruined. Will Marmite help?
A: Sadly, there is no evidence that vitamin B – in Marmite form or otherwise – protects against being bitten by mosquitoes. However, for some people vitamin B does seem to reduce the itchiness of bites (though I’ve never noticed an anti-itch effect). This might mislead people into thinking that they are not being bitten – which, in malarious regions, might be a dangerous or even deadly assumption.
Apply liberal amounts of an effective insect repellent; a 30-50% DEET-based product would be my choice. It needs to be reapplied several times during the day. Also, impregnate long-sleeved eveningwear with permethrin. Finally, shower often but avoid scented cosmetics – mosquitoes love perfumes, as well as smelly feet (and stinky cheese).
Q: I dread dealing with the monthly ‘curse’ when I’m travelling. Is there a solution?
A: Discuss the problem with a GP or family planning doctor and see if you are suitable for Depo-Provera injections. You have them four times a year and they usually stop menstruation altogether. Likewise, an Implanon implant will often stop periods, but this needs to be sorted several months before travel. Another way of reducing bleeding is to have a progesterone-loaded Mirena intrauterine contraceptive system put in. Mooncups (a reusable menstrual cup) can be liberating, too.
Q: I am so worried about catching dengue fever on my travels that I’m almost put off booking to go to the tropics. Should I be so scared?
A: Dengue breaks out frequently in South and South-East Asia and tropical Latin America but there’s no need to worry about it. I have spent 11 years in regions where dengue is rife and have avoided it by being careful about preventing mosquito bites during daylight hours.
Take most care when sitting out in the gardens of plush hotels. Pack plenty of DEET and insect-proof your clothes with permethrin. There is currently no vaccine for dengue fever.
Q: Do you get ill on your travels?
A: I do, but usually with trivial things: colds and sore throats. I’m rarely ill for long. If I break my own rules of healthy eating abroad then I do get sick, but travel isn’t about hiding inside a bubble; sometimes it’s worth the risks.
Q: What’s the worst health scare you’ve had overseas?
A: I was stung by a scorpion in Madagascar; my fellow expeditionaries’ faces said, “OMG – our doctor is going to die!” I was in a lot of pain but I was coping quite well until I saw their expressions. I needed to remind myself that healthy adults rarely die from scorpion stings and pain relief was all I needed.
On another occasion my toddler slipped and caught his head on a marble edge in our bathroom in Hyderabad. He was knocked out for what seemed like an eternity. The nearest competent neurosurgeon was a three-hour drive away; we fled to Karachi where we discovered he’d fractured his skull but that the nurses didn’t know what basic observations they were supposed to make after a head injury. I’d had the foresight to bring an alarm clock to wake me hourly so that I could check he was rousable and his pulse and breathing rates were steady.
Q: What would you ‘prescribe’ for a safe and inspiring trip?
A: Keep an open mind – don’t judge others. Choose freshly cooked hot food. Be properly insured. Finally, pack condoms: apart from the obvious, they’re also useful as emergency water carriers, can be packed with ice and applied to sprained ankles, and can be used to temporarily replace car fanbelts!
