The Travelbug’s Medicine Bag

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This post brought to you by wanderlust, a current severe bout of flu-slash-strep-throat-slash-gastro picked up in the Paeds ward (I washed my hands all the time I swear), and a day of reminiscing over Semester at Sea photos. I would say I packed pretty well for my four-month-long around-the-world voyage (and my previous trips abroad too), but there were some things I wished I had packed – or not packed. Here’s my list of medical stuff to consider.

travel health

Disclaimer: I post this from travel experience and not so much from medical experience. You should always seek your doctor’s advice. Also, I will not be naming any trade names of meds as I am not here to promote any pharmaceutical company :)

Before you leave

Vaccines and prevention – I’m not going to post an exhaustive list because that’s what your local travel clinic is for, but the idea is to use common sense paired with current best evidence. You HAVE to get the Yellow Fever vaccine for entrance into certain countries (and to be allowed back into your own country), so don’t skimp on that. I would strongly suggest taking Malaria prophylaxis but remember that you still need to take mosquito prevention measures. Other things are debatable. A lot of people get boosters for their childhood vaccinations, although I didn’t feel the need to do that. People often ask about Hepatitis vaccinations. My opinion is that if you are not planning on sexual or intravenous activities, you don’t need to get the Hep B shot (I have it as it is a prerequisite at my medical school). Hep A is transmitted faeco-orally so it is worth considering for many places. I would suggest a tetanus shot (if you haven’t had a booster recently) because you just don’t know when you’ll get hurt. I didn’t get the Rabies shot because I wasn’t planning on getting in very close contact with animals, but know that if you do get bitten the shots are a SERIES of shots into the wound (ouch). I did get the Meningococcus vaccine because of the tendency for outbreaks among groups of students and I’m pretty scared of it. I didn’t get things like the Japanese Encephalitis vaccine because a) it’s expensive and b) together with my travel doc I decided that the risk was really negligible.

Prescription/chronic meds – if you are going to travel for a while, find out in advance if you need special permission to fill several scripts at once. I needed to get permission from my medical aid to take four months’ worth of thyroxine out of the country. Also be sure of any restrictions on your medication in different countries, whether you need to report it to anyone, and if you will have access to a refrigerator for things like Insulin (the SAS cabins do have small bar fridges but the clinic is also happy to keep your meds safe).

Sex, drugs and rock ‘n roll (k not exactly)

Oral contraceptive – although it is never on my traveling agenda, I know that many travelers do look for hook-ups while they are away. One of the last things you want as a memory of your travels is an unplanned pregnancy. And to that end, the other last thing you want is an STI, so whether you are male or female, if you think you might have fun of the sexual kind on your travels, take condoms. [End of Public Health Announcement]

For me – and this is where the “I am not your doctor” trope comes in – I am especially fond of this pill because of the control it gives me over my cycle. I am not fond of public toilets, and always try to minimise visits to them. (Med school has given me a fantastically strong bladder.) So by scheduling periods to happen while we were on the ship rather than in country made everything tonnes easier. It has great skin benefits too, but again – risk vs benefit and all that.

Tummy Things

Antacids – SAS and its alumni all suggest Bismuth Subsalicylate, because it is a good antacid but also has some proven efficacy against traveler’s diarrhoea. I didn’t take it for a variety of reasons, one being that I believe the ultimate protection against TD is handwashing (and I did never get TD). But many traveler’s swear by it. The other thing is that when you’re experiencing a bunch of new foods, indigestion is a pretty common occurrence. Halfway through the voyage my heartburn got so bad that I ended up buying antacid when we stopped in Cape Town.

Story: one night I absolutely gorged myself on mac ‘n cheese on the ship, and got pretty sick from it. I was pacing around the cabin all night and then my one roomie gave me some of the pink stuff. It worked within minutes. So it is good stuff.

Antibiotics for TD – I didn’t do this myself, but I saw a lot of kids on SAS that took a course of Ciprofloxacin with them.  I think this is pretty clever, IF you are able to tell with reasonable confidence when you have a bacterial gastroenteritis. It could lead to irresponsible AB use so even if you have the meds, you should still get a doctor’s opinion before taking them.

Antidiarrhoeals - most doctors will not actively recommend antidiarrhoeals because they can cause quite a lot of trouble, especially if you have dysentery. One thing I do have good experience is Diosmectite. It tastes awful but has a good record, and is often used for kids with severe diarrhoea in private practice. It is pretty expensive.

Oral Rehydration Solution – I didn’t take this because I was adamant that I would not get TD and therefore would not need it, and also because I can make my own cheap ORS easily: 1 liter of boiled water, 8 teaspoons of sugar, half a teaspoon of salt. It’s what we teach all the mommies in hospital to make. It tastes pretty awful though.

Peace Corps volunteers making an ORT mural in Benin. Image by Kara in Benin. Click image for source.

Motion Sickness tablets – when I went on SAS the front desk actually supplied free motion sickness tablets, so I never used my tablets. I also actually never got sea-sick, but it’s probably best to have some of these. I hear the patch works great too, just don’t accidentally use too much of it, like some people did!

Noses and Lungs

Vitamin C – as a general immune booster, because you will encounter so many new bugs while traveling. I like the chewy ones because they taste good so you won’t forget them (CANDY NAO!).

Getting drenched by the rain at Volcanoes National Park (Hawai'i) gave a lot of us a mean cold. Thank goodness for Vit C. I'm the one in the middle. Photo by Janelle Williams.

Getting drenched by the rain at Volcanoes National Park (Hawai’i) gave a lot of us a mean cold. Thank goodness for Vit C. I’m the one in the middle. Photo by Janelle Williams.

Anti-histamines and anti-dry-eyes – even if your allergies have been under control for years, I would suggest packing these in case. You don’t want to have photos of your runny nose and swollen eyes.

Antibiotic eye drops – (something I will never leave without again) I wear contact lenses and got a bad eye infection after my visit to India. The drops sold by the ship would have cost me $22. That was just ridiculous to me (my first experience with American healthcare costs) so I told the doctor on board that I would monitor myself and buy the drops only if it got worse. I was lucky that it didn’t get worse, but I could have done some serious damage and should have just bought the drops and not been so stubborn. (Eyes are more important than money, y’all.)

Anti-miserable-feeling-stuff - if you are going to spend a lot of time with people in close proximity (e.g. youth hostels or a ship full of students) the sniffles are bound to go around, or you might just get a miserable headache. I like a nice combination of paracetamol, ibuprofen and codeine, but take something you have good experience with OR that your doctor recommends.

One last thing: Should I pack meds or just buy them in-country?

The reason I’m all for packing meds is a) You know what you get and b) MOST of these meds are quite a bit cheaper in South Africa. I always have health insurance when I travel, but I learned on SAS that our insurance covered medical consultation but not the ACTUAL medicine. So… yeah. Also, I really don’t want to be feeling miserable in a foreign country and looking for medicine, although it certainly is an interesting experience and I did visit a lot of chemists for the fun and intrigue of it (can you tell I’m a nerd). If you are one of the few that can truly say that money is not a problem, and you are not going to a very rural place that might not have what you need, then of course you can just buy things as you need them.

Keep well and keep healthy! What are the health-related things you always take when you travel?

Late Presentations: A New Perspective

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When medical students and doctors get bored, they start sharing “late presentation” stories. My first such experience was in third year, when a homeless man presented to us with horribly advanced rectal cancer. I was so disturbed that he had allowed it to progress so far, and I shared the story in a post.

I have lost count of the “late presentation” I have seen since then – one of the joys of working in a tertiary hospital. Women with breast cancers that have basically consumed entire chest walls. A man with testicular cancer the size of a soccer ball (I kid you not). Children with painful impetigo superimposed on severe scabies infestations.

newperspective

And always, my response in my head has been the one that comes most naturally: WHY ON EARTH DID THEY WAIT SO LONG? Although I always tried to figure out in a respectful manner what the hold-up was, I never considered that my internal frustration could be wrong. Continue reading

Reviewing The Oatmeal’s Running Exposition

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I’m a big fan of Matthew Inman (The Oatmeal) – I mean, the guy has a cartoon about the correct use of apostrophes, thank you very much! So I was very excited to review  The Terrible and Wonderful Reasons Why I Run Long Distances, but I can’t explain that without explaining my own running journey.

I was never the kid who ran in school. At athletics days I always came last in my heats and although I had a suspicion that I would do well in long distance, I never got coaching for it, so I never even considered being “one of those” people that do running. I equated runners with super-fit, super-healthy, and super-attractive super-humans who, in addition, actually had time to do something like running. Continue reading

Let’s Talk About Women in Medicine

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A while back, when my post about South African Public Hospitals was popular, someone recommended I write about women in healthcare. I chose not to because at the time I just didn’t feel really strongly about it. I suppose I kind of wanted to believe that there was no sexism in South African medicine, the same way I tried convincing people (when I was twelve, mind you) that there was no more racism in South Africa.

I mean, guys. There are more females than males in most classes at my medical school. Why would there be issues?? Anyway, the #YesAllWomen hashtag from a while ago had me thinking some, and then I tweeted this, and then I realised, “OMG, I have something to say.”

This is real, by the way. My friends and I have grown so tired of being asked how old we are, where we live, and whether we have boyfriends by patients. I have never seen a male colleague being so blatantly hit on by a (non-psychotic) patient. (Not saying it doesn’t happen, but…) And the only time a doctor has taken our concerns seriously was when the perpetrators were psychiatric patients. Because, you know, that means they’re being sexually inappropriate. But when the offending patient is not a psych patient, we are told that it’s “normal”.

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Visiting Haiti through “Because We Are”

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Ten-year-old orphan Libète has been hardened by the daily struggle to survive in Cité Soleil, Haiti’s most infamous slum. But when she and her best friend, Jak, discover a young mother and her baby brutally murdered in a nearby marsh, it’s unlike anything she’s encountered before. Though initially shocked, the adults of Cité Soleil move on quickly from the event; after all, death is commonplace in this community. Undaunted, Libète takes action with Jak in tow, plunging herself into a dangerous, far-reaching plot that will change her irrevocably and threaten everything she holds dear.

It seems I’m on a streak of reading thrillers that don’t entirely conform to the genre – although my ‘fraidy pantsness is not exactly complaining. Continue reading

Tips for New Student Interns: Part 3 – Be Well

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One last weekend before the new class of Student Interns join us, and one last weekend of my tiny little holiday. If you’ve missed it, I’ve written about working with junior/seniors and also about study methods. Today, something I know makes a lot of people roll their eyes: wellness.

I was told I would outgrow the wellness concept. Well, I haven’t. I still believe that students and doctors need to be emotionally healthy in order to perform at the highest level.

Base image by Anton Tang

Base image by Anton Tang

Continue reading