The term “backpacking” has changed over the last several years as travel has become more accessible to a greater number of people. It refers to travellers who organize their own trips and usually stay in cheap accommodation. This type of traveller can be exposed to additional health risks.

Vaccinations
“It is now generally accepted that no other measure taken by man, apart from the provision of clean water, has ever saved more lives than immunization against infectious diseases.” (G Kassianos)

It is recommended that a traveller seek the advice from their travel health adviser or doctor at least 6 weeks prior to travel to obtain all the recommended vaccinations. Although vaccinations are extremely important in preventing disease, they are not 100 percent effective and additional travel advice is necessary.

Insurance
Ensure you have full travel and health insurance to cover illness, accidents and emergency repatriation expenses.

Malaria
Ensure the areas you are visiting are not malaria risk areas. Consult with your travel health adviser.
Prevention: The ABCD of Malaria

Awareness. The risk and type of malaria at the destination. Also an understanding of how the disease is spread. Some natural immunity is gained if you are born and live in a malaria endemic country. However, natural immunity can be lost as quickly as up to one year after living/traveling abroad. Important to remember if you are planning to visit relatives in the country where you were born.

Bite Avoidance. Consider the following points:
• Sleep in well maintained hotels with fully air-conditioned or screened accommodation. Use the air-conditioning or ceiling fan during the night as air flow deters biting.
• Permethrin-impregnated mosquito nets should be used whilst sleeping if there is no air conditioning.
• Use a safe and effective repellent, preferably Diethyltoluamise (DEET), on exposed skin. DEET in lotions, sprays or roll-on formulations is safe and effective when applied to the skin but the protective effect only lasts for a few hours. DEET based repellents can be used on cotton clothing, wrist and ankle bands but should be applied with care to the face as they can irritate sensitive mucosa such as the eyes.
• In cabins, huts or tents use insecticides in form of aerosols, vaporizers, candles, smoke spirals or others in living and, most of all, in sleeping areas.
• Cover up with long sleeves, trousers and socks between dusk and dawn.
• Wear light colours as less attractive to mosquitoes.
• If undertaking ‘remote overnight’ activities ensure sites for sleep and rest are at a distance from stale water, ditches and water barrels.
• Avoid such activities in high risk areas during the rainy season.

Chemoprophylaxis. Appropriate prescribed oral anti malarial medication.

Diagnosis. For most people symptoms can present from 7 days up to 4 weeks after being bitten by an infected mosquito but can present for any time up to one year later. Any traveler who becomes ill with fever or a flu-like illness while traveling and up to a year after returning home should immediately seek medical advice.

Malaria is a serious and sometimes fatal disease if not promptly diagnosed and treated.

Travellers Diarrhea
WHO Recommendations: Prevention of Travellers’ Diarrhea

Travellers should
• Avoid consumption of potentially contaminated food or drink.
• Avoid contact with potentially contaminated recreational waters.
• Know how to treat diarrhea. If unsure, speak to a doctor or nurse.
• Carry oral rehydration salts and water-disinfecting agents.

Precautions for avoiding unsafe food and water:
• Avoid cooked food that has been kept at room temperature for several hours.
• Eat only food that has been cooked thoroughly and is still hot.
• Avoid uncooked food, apart from fruit and vegetables that can be peeled or shelled, and avoid fruits with damaged skins.
• Avoid dished containing raw or uncooked eggs.
• Avoid food bought from street vendors.
• Avoid ice cream from unreliable sources, including street vendors.
• In countries where biotoxins may be present in fish and shell fish, obtain advice locally.
• Boil unpasteurized (raw) milk before consumption.
• Boil drinking water if its safety is doubtful.
• Avoid ice unless it has been made from safe water.
• Avoid brushing the teeth with unsafe water.
• Bottled or packaged cold drinks are usually safe provided that they are sealed; hot beverages are usually safe.

Road Accidents
Road accidents cause more deaths amongst travellers than any other cause. Follow the basic advice:
• Remember traffic may come from the opposite direction.
• In many countries many drivers do not observe pedestrian crossings or traffic signals.
• Hired vehicles are often poorly maintained so check carefully.
• Always wear a seat belt.
• Observe speed limits and traffic signs.
• Lock doors at stopping points especially at isolated places.
• Never drink and drive.
• Try to avoid hiring scooters and motorcycles as there is little protection in the event of and accident but if you do, wear a helmet.

Unsafe sex
Unprotected sex will put travellers at risk of sexually transmitted infections including HIV.

Culture Shock
Culture shock is the term used for the “lost” feeling some travellers may experience when they arrive at a new or unfamiliar destination.
• Expect culture shock and be aware of the feelings you may experience. The initial feelings normally diminish after the first few days.
• Be open minded.
• Limit your expectations.
• Make sure you research your destination prior to travel – use websites, books and ask other travellers. From this knowledge at least you know what to expect.
• Avoid travelling when you are already tired and take rest before departure. Avoid heavy commitments on the first day.
• Talk with other travellers and try to join group activities. Fellow travellers may be from a similar background to you and may be experiencing the same feelings. Talking may help.
• Make an effort to talk to other expatriates and locals. Try not to create a mini “England” or “Australia”. Working and living abroad is about meeting different people.
• Try not to withdraw, even if you feel like it.
• Take care of your physical health – try to take regular exercise and get adequate sleep.
• Try to avoid excessive alcohol as this can make your feelings worse.
• Keep in touch with family and friends back home so you can discuss new experiences but do not contact them excessively.
• Try to interact with locals and respect their culture.
• Try to learn a few words of the local language.
• Expect times when you are feeling “down” or home sick, this is completely normal – try to something that makes you feel good e.g. massage, a workout or a chat with a new friend.
• Keep a sense of humour!!

First Aid Kit
You should consider including medication/ equipment for simple first aid, travellers diarrhoea, sufficient anti-malarial tablets, any regular medication you require and possibly an antibiotic.

Photo by Lhoon and licensed under the Creative Commons Attribution ShareAlike 2.5