The time has come to start getting serious about the packing and today is medical.
First Aid Kit
After a bit of reading and trawling trough discussion forums I have decided to go for a safe, comprehensive, but not silly complement of stuff.
I started with getting the very conveniently priced (£19.99 on eBay) CarePlus® First Aid Kit Waterproof.
What got me interested in it, other than the price, was the waterproofing. Reading about cycling trough equatorial countries it turns out that panniers, even when waterproof, will be tested to their limit by roads with knee deep puddles. The medical kit is perhaps one that might benefit from double protection.
Second thing is that it’s small (10x6x17 cm) and light (217 gr).
Additionally I thought that the generous complement of stuff provided in it might be split in two parts and used in successive stages of the trip while at the same time leaving space for additional components that I feel I ought to add.
Finally it included an emergency foil blanket and, much to my surprise, it appears from reports of many that have done long distance cycling before, that is a sign of a good kit. Anyway the content of the kit is as follow:
Care Plus first aid guide card 5 x sterile gauze swabs (5×5 cm) [will take 3], 4 x low adherent pad (10×10 cm) [will take 2], Support bandage (7.5cm x 4.5m), 2 x conforming bandage (7.5cm x 4m) [1 will do], 10 x adhesive wound dressing (25x72mm) [will take 3], 10 x adhesive wound dressing (60×110 mm) [will take 3], Finger plaster, Knuckle plaster, Surgical tape, Wound closure strips (5), 2 x pair vinyl gloves [1 will do], 10 x alcohol wipes [will take 5], Emergency shears, Tweezers, 6 x safety pins, Triangular bandage, CPR shield [now this is what I call an excellent idea, would you give CPR to anybody with a light hart in an Ebola infested area?], Emergency blanket [turns out it’s a must have], Shatterproof thermometer, Burn gel dressing (10×10 cm), 4 x finger condoms [I wonder ?:-]
I quite cannot see myself in any situation that will require finger condoms, but I’m prepared to be surprised and, in the end, they do not take a lot of space. In addition to this I’m planning to add:
Paracetamol [a fair bit of it], Aspirin [some], Antiseptic cream, Anti fungal cream, Suncream, Malaria pills, Broad spectrum antibiotic [to be advised by GP], Mosquito repellant [will get a DEET and a non DEET based one, will need both anyway, and see who’s right] Bite relief [either pen or spray to avoid scratching myself to death], Eye wash, Eye drops, Antihistamine [Flixonase (Flonase) Spray, just because I suffer from hay fever]
Ok round about now I’m starting to feel like I might become a travelling pharmacy, I’m sure there’s not much more. In any event it will be beck to revisit this post in a couple of years and see what was actually used. Moving on…
Superglue [now this is a bit out there but I figure that it might have a multiple purpose for fixing stuff too, anyway it apparently is excellent at closing wounds], Dysentery treatment [sooner or later it will happen, GP will advise on what is best to carry], Toilet paper and Wet wipes
The other area to be considered is immunisation. The NHS is one of the best things the UK has to show for and the Fit For Travel site is the natural starting point, traveling to Africa to start with I’ll probably encounter the bulk of the hazards I’m likely to face in the whole trip. Looking through the advice by country and distilling the list gets me with a pretty comprehensive menu to take to the GP for further advice.
Cholera; [A vaccine called Dukoral is available to protect against cholera. Adults and children over 6 years require 2 doses. The vaccine is administered at intervals of at least one week and immunisation should be completed at least 1 week prior to potential exposure. For those at ongoing risk a booster dose is required at 2 years.]
Diphtheria, Poliomyelitis, Tetanus ; [A combination vaccine called Revaxis is available to protect adults against diphtheria, tetanus and polio. Children normally receive these vaccinations as part of the national schedule. Travellers should ensure that they have had a primary course of vaccine and receive a booster every 10 years if they are travelling to an area where diphtheria, tetanus or polio are considered high risk.]
Hepatitis A-B; [Vaccination is recommended if you are visiting areas where drinking water may be unsafe and where hygiene and sanitation is poor. There are various brands of hepatitis A vaccine available: Avaxim, Epaxal, Havrix Monodose, Havrix Junior Monodose and Vaqta Paediatric. Hepatitis A vaccine is also available in a preparation that combines it with hepatitis B vaccine: Ambirix, Twinrix and Twinrix Paediatric and a preparation that combines it with typhoid vaccine: Hepatyrix and ViATIM.]
Meningococcal Meningitis; [Vaccines to protect against multiple strains of Meningococcal Meningitis for travellers are available: ACWY VAX vaccine, Menveo and Nimenrix. These are different vaccines to that included in the UK childhood vaccination programme which only protect against type C. Individuals should consider being vaccinated if they are travelling to a country where Meningococcal Meningitis is present and where their stay maybe prolonged or they are involved in activities which may increase the risk of exposure to the disease, for example, working and living closely with the local population.]
Rabies; [Vaccination is recommended for all travellers who will be living or travelling in endemic areas and who maybe exposed to rabies because of their travel activities i.e. trekking, working or living in rural areas. Two vaccines may be used in the UK to protect against rabies: Rabies Vaccine BP and Rabipur. It is imperative to seek medical attention within 24 hours if a bite or scratch is sustained in any rabies endemic area even if pre-travel vaccination has been given. Saliva should be thoroughly washed off with soap and water and the wound irrigated with iodine solution or alcohol. This is very effective in removing virus from the bite site, providing it is prompt and thorough. Suturing of the wound site should be avoided and tetanus vaccination should be considered.]
Typhoid; [Various vaccines that protect against typhoid are available: Typherix, Typhim Vi and and an oral preparation (3 capsules) called Vivotif. A single dose of injectable vaccine protects for three years, but will not protect against para-typhoid fever. There are two vaccines that combine typhoid with hepatitis A for convenience: Hepatyrix and ViATIM. Individuals should consider being vaccinated if they are travelling to a country where typhoid fever is more common and where they will be unable to take sufficient care with food and drink.]
Yellow Fever; [Travellers should be advised to use personal protective measures when entering areas where yellow fever is present. This includes using insect repellents and wearing appropriate clothing. A vaccine called Stamaril is available for travellers to protect against yellow fever visiting risk areas. In addition, certain countries have yellow fever certificate requirements. To obtain a valid vaccination certificate against yellow fever it is necessary to be vaccinated in an approved vaccination centre so that an International Certificate of Vaccination can be issued. This certificate is valid from 10 days until 10 years after the first dose of vaccine.]
And then there is Malaria. Looks like to me this is the one that will keep me busier during the traveling. As I’m going to spend quite some time in most of the world infested areas it stands to reason that I might not get out of this without getting it. That said there is no hurry and all I can do to delay this “inevitable” is going to be a plus.
Looks like covering up is de-rigour from dusk to dawn, this in itself will also help with not conflicting with the local customs in most places, it might however fly in the face of cooling down after a day’s ride [tricky]. Rubbing insect repellant on both body and cloths will have to become second nature too.
Fascinating as most health and travel logs go to pain to tell readers that neither electronic devices or garlic are effective against mosquitoes, somehow I thought that was obvious, garlic is for vampires. On a serious note here is what I’m going to have:
Mosquito net is essential and I’m going to tackle with both a standalone and built into the Hammock. Hammock sleeping is less fussy and preferable but you cannot always guarantee to find anchorage and therefore it pays to be prepared.
Which brings us to the most interesting part of the topic: profilassi and medication. There are various options but, reading around the two that look more promising are Mefluoquine and Doxycycline
- Preparations available: Lariam® (Roche). Adult dose is 250mg week.
- One dose should be taken a week before departure and it should be continued throughout exposure and for 4 weeks afterwards, however three (3) doses at weekly intervals prior to departure are advised if the drug has not been used before – this can detect in advance those likely to get side effects so that an alternative can be prescribed.
- Take your tablets with food and plenty of water at the same time on the same day each week. It is very important to complete the course.
- Licensed for one year’s continuous use in the UK but there is no evidence that use for periods of up to 3 years carries any greater risk of side effects.
- Mefloquine is unsuitable for those who have a history of severe liver disease, depression, generalized anxiety disorder, psychosis, schizophrenia, suicide attempts, suicidal thoughts, self-endangering behaviour or any other psychiatric disorder, epilepsy or convulsions.
- Those with kidney disease or a heart condition should be assessed carefully before taking this medication.
- Side effects may include: nausea, diarrhoea, dizziness, abdominal pain, rashes, pruritus, headache, dizziness, convulsions, sleep disturbances (insomnia, vivid dreams) and psychotic reactions such as depression.
- Although there is no evidence to suggest that mefloquine has caused harm to the foetus it should normally be avoided during the first trimester of pregnancy or if pregnancy is considered possible within 3 months of stopping prophylaxis.
- Preparations available: Doxycycline (non-proprietary), Vibramycin® (Invicta).
- Adult dose is 100mg daily. One or two doses should be taken before departure. It should be continued throughout exposure and for 4 weeks afterwards. It is very important to complete the course.
- Take your tablets with food and at the same time each day. If you miss a dose, take one as soon as you remember then carry on as before (you may have to get more tablets). Never take two doses at the same time. Heartburn is common if capsules release their contents into the gullet so they should be taken with a full glass of water and preferably while standing upright and not just before going to lie down in bed.
- No guidance is given by the manufacturers on prolonged usage for malaria prevention but has been used for periods of up to 2 years for acne without an increased risk of side effects.
- Interactions with other drugs: check with your doctor if you are taking regular indigestion remedies, iron or zinc tablets, retinoids (for psoriasis) or cyclosporine. It must be remembered that anti-epileptic drugs (phenytoin, barbiturates and carbamazapine) may reduce the efficacy of the doxycycline.
- Side effects may include: anorexia, nausea, diarrhoea, thrush, sore tongue (glossitis), headaches, blurred vision or tinnitus. Erythema (sun burn) due to sunlight photosensitivity; sunscreens are important and if severe alternative antimalarials should be used.
- Pregnancy: Contraindicated in pregnancy (including for one week after completing the course), breast feeding, in those with systemic lupus erythematosus, porphyria and children under 12 years because permanent tooth discolouration and/or delayed bone development can occur.
Based on other long distance cyclist experience [to be validated by a conversation with the GP] I lean towards the Doxycycline. While not as practical I’d rather not end up in an asylum and, given the antibiotic nature, it might give some additional protection against the abundant bacterial ensemble I will undoubtedly come in contact with.
Finally, as already mentioned in the first aid kit section there will be the need for a whole lot of bite alleviation tools as it will be impossible not to be bitten at all.
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