Advice for Travellers

Health risks from the sun

Sun damage to the skin

Although sunbathing may be enjoyable and a suntan a status symbol, it must be remembered that excessive sun exposure is a health hazard due to the effect of ultraviolet (UV) radiation on the skin.

UVB causes sunburn which can range from intense redness to blistering and 'burnt skin' similar to a burn from hot water or fire. Sunburn is more likely when, in addition to direct exposure from the sun, UV is also 'reflected' from water (swimming pools or the sea), white sand or snow. The risk is greater at higher altitudes when there is less protection from the earth's atmosphere. 

Both ultraviolet A (UVA) and ultraviolet B (UVB) radiation are known to cause pre-mature cancers. Drying of skin can result in exacerbation of facial seborrhoeic dermatitis.

Especially vulnerable groups

• Babies and children.
• Fair skinned people who often also have red hair or blue eyes.
• Those with certain medical conditions such as albinism or previous skin cancer.
• Those medications such as tetracyclines including doxycycline, oral hypoglycaemic drugs and diuretics.

Precautions

• Babies under 9 months should be kept out of direct sunlight.
• Children should wear long sleeved, loose fitting shirts, hats and high-factor sunscreen.
• The greatest risk is from the midday sun, usually from noon until 14.00 hours (15.00 in tropical regions) when precautions are especially important.
• Adults should wear a broad brimmed hat, long sleeved shirts and sunglasses.
• Sunscreens.
• Sunscreens do not replace the precautions described above but they can help absorb UVB and to a lesser extent UVA.
• Waterproof sunscreens can prevent their removal by sweat or water although they should always be reapplied after swimming.
• There is a voluntary star system for sunscreens grading UVA protection; more stars indicating greater protection.
• The Sun Protection Factor (SPF) refers to the protection against UVB (e.g. 'SPF 8' allows approximately 8 times longer sun exposure without burning than with no protection).
• To gain effective protection a cream with an SPF value of 15 or above should be used.
• Sunscreens are expensive - be wary of cheap sunscreens bought abroad which may not give adequate protection.
• Check expiry dates.

Heat Exhaustion and Heat Stroke

Prevention is very important.  This is particularly important during the early stages of acclimatization in hot climates when every opportunity should be taken to keep cool, drink extra fluids and add salt to meals.

Heat exhaustion occurs following heavy sweating and excessive fluid loss with inadequate replacement.  This occurs particularly in hot climates when unaccustomed exercise is taken during acclimatization.

Symptoms

• Malaise, headache, light-headedness and fatigue.
• Water loss results in thirst and clouding of consciousness.
• Salt loss does not cause so much thirst and the person remains rational but lethargic with muscle cramps. 

Treatment

• The emergency treatment of heat exhaustion with predominantly water loss consists of fluid replacement with water and/or fruit juice, and cooling by cold water and fans.
• The treatment of the salt loss component consists of salty fluids as in soup or Bovril.  A popular and quite refreshing Far Eastern treatment is salt in limejuice with soda.

Travellers' Diarrhoea

Prevention
This depends upon effective drinking water sterilization and ensuring food is uncontaminated or cooked thoroughly. Personal hygiene when eating and drinking is also important including hand washing prior to eating and using sterile plates, cups and utensils.

What to avoid

• Water should only be drunk when you are sure of its purity. Don't drink it without boiling, chemical disinfection or using a reliable filter. This also applies to water used for making ice cubes and cleaning teeth. Bottled water is usually safe, as are hot tea and coffee, beer and wine.
• Milk should be boiled unless you are sure it has been pasteurised.
• Cheeses and ice-cream are often made from unpasteurised milk and when in doubt these should only be bought from larger well established companies when quality can usually be assured.
• Meat should be thoroughly cooked and eaten hot whenever possible. Avoid leftovers.
• Fish and shellfish can be hazardous at certain times of year, even if well cooked. Take local advice about seafood, but when in doubt it is best to avoid them.
• Vegetables should only be eaten when thoroughly cooked.
• Green salads should be avoided.
• Fruit should be peeled, including tomatoes.
• Wash hands thoroughly before eating or handling food and always after using the toilet.

Those going on short package holidays will normally be staying in accommodation that is chosen and 'quality checked' by the tour operators. This does not protect the traveller from unexpected health problems particularly when venturing away from the hotel.

Alcohol
Unaccustomed consumption of alcohol is very common on package holidays and this can lead to illness from intoxication, accidents and the taking of risks with health that would not be entertained at home.

Accidents
Unfamiliar surroundings and alcohol consumption often result in accidents. Beware of sea currents and take especial care crossing roads. Sharp objects and discarded glass on beaches can injure your feet.

Unsafe sex

Unhygienic sex and failure to use a condom with new partners, particularly with professional sex workers, puts you at risk of serious infections including HIV.

Culture shock

This can be very real even for short-term visitors perhaps made worse by family problems at home, illness or unaccustomed alcohol consumption. Problems may include adjusting to a different climate and language, unfamiliar social amenities, coming to terms with poverty, begging, and movement restrictions for safety or political reasons. It is usually helpful to be patient rather than critical when difficulties arise.