The best travel health advice you will ever get....

We are still surprised at the number of travellers we meet who tell us they suffered from severe diarrhoea for days on end without treating it. This is dangerous to your health and can play havoc with your travel plans. Before we took off on our 4 month trip through Nepal, India and Thailand with our 11 and 9 year old children, we sought advice from our local travel health specialist in Australia, the Travellers Medical and Vaccination Centre (TMVC). Apart from their great service, we used their useful flowchart for diagnosing and treating diarrhoea, which came in their little "Travellers Medication Guide" booklet. We used this a few times, and as a result none of us were sick with bacterial diarrhoea for any longer than 24 hours on our trip. It also helped us to avoid taking antibiotics unnecessarily for traveller's diarrhoea. I have included this flow chart here. Remember too that you WILL NEED a thermometer to take your temperature if you use the flow chart. But do NOT get a glass one filled with mercury! You can get flexible ones that you place against your forehead and these are fine (we used one). Important for kids; Norfloxacin is NOT recommended for kids under 12. They should use Co-trimoxazole, 2 X 80/400 mg tablets a day for 3-5 days instead.

Click on the graphic below to go to the flowchart and print it out, then pack it in your trip First Aid kit!  (MORE HEALTH INFORMATION BELOW)

First Aid Kit | Packing it | Medications | Other infections | Water | Malaria | Vaccines

First Aid Kit. You can buy ready-made traveller's first aid kits. But before you buy one, price how much it would cost to buy a ready-made one versus one you stock yourself (including stuff you already have and stuff you can buy in India, Nepal, Thailand or elsewhere). But make sure a ready made one has all or most of the stuff I mention below, and not too much you don't need. Buy a material (woven) one with zips and compartments (not a hard tin, terrible in a pack).

Packing it. You should have: a digital thermometer (not mercury) for diagnosis of illnesses, a pair of scissors, several assorted bandages including triangular bandages, some surgical tape, Band-Aids (sticking plasters) of all sizes, some antiseptic cream or ointment (small squeeze bottle of Betadine is best). Also some "stop-itch", some tweezers, some cotton wool buds, sterile gauze, some blister moleskins and finally the diarrhoea flow chart from above.

Medications. These should include paracetamol, Tinidazole (antibiotic for amoebic dysentery and giardia, not available in USA so buy it in Asia), Norfloxacin (antibiotic for bacterial diarrhoea) and Roxythromycin (antibiotic for chest, throat and skin infections). You might pack Loperamide, the drug, often known by the brand names "Lomotil" or "Immodium". This is a diarrhoea "stopper". NEVER take this to actually treat diarrhoea as it simply paralyses the bowel therefore stopping flushing out of your system, which after all is why you have diarrhoea. Only take it if you HAVE to travel (we never took it) or where diarrhoea is extremely inconvenient. Actifed is also good for coughs. Remember, you can buy the antibiotics very cheaply in India and other places in Asia, plus the others can be bought there too.

Other infections; diagnosis and treatment. The flow chart above lists all the antibiotics you need for diarrhoea, so I'll try to list here all the OTHER antibiotics you could need. You should take antibiotics if you have a respiratory infection (chest, sinus, ear or throat). Chest infection or bronchitis is indicated by a fever (over about 38C or 38.5C) plus excessive coughing and green phlegm. Sinus infection indicated by fever plus headache and copious green mucous from nose and back of throat. Middle ear infection indicated by fever plus earache. Throat infection indicated by fever and sore throat. So, common indicator is FEVER. The medication for these is Roxythromycin (or called Rulide or Biaxsig). Take 300mg a day (usually comes in 150mg tablets) for 5 days. The alternative if you can't find this is Amoxycillin, take one 250mg tablet 3 times a day for 5 days (don't take if allergic to penicillin). This info is not included in the diarrhoea flow chart obviously, so you could print this out too and put it in your first aid kit.

Water. For water, we actually used a filter. A friend lent us their "Pur Scout" water purifier. It has a ceramic microfilter for giardia etc plus an iodine filter for viruses etc. It was great, it purified water as fast as you pumped water through it, it took about 1 minute for a litre. It meant we hardly ever bought bottled water in India and Nepal, but in Thailand we often bought water, it was so hot that we often just bought extra water to refresh us as we were walking around. Otherwise, the filter was best to pump supplies from the tap in our room. We had 3 good quality leak-proof Nalgene 1 litre bottles which we would fill for our daily needs each night, to carry around in our day packs, brush our teeth etc etc. Nice filters, but not cheap at about Aus$160. Each replaceable iodine filter cartridge is said to filter 380L of water before needing replacing, the replacements cost $70. But, it saves you money on bottled water so it's not as costly as it sounds (about B8 or 33c for 750ml in Thailand). Also, there are so many less plastic bottles lying around or in landfills (if they ever get there) if you filter your own water. Otherwise yes, I would buy bottled water. I can't really comment on bottle brands, unfortunately, because we only vary rarely bought any in India and Nepal. We also had a lot of drinks with ice in while in Thailand only due to the heat and this was never a problem (and it isn't it seems).

But don't use a filter unless it has an iodine filter, unless you add iodine yourself, in which case there's no need to take a bulky filter. But we never encountered muddy water, it was always clear. Also on the trek in Nepal we hardly saw anyone using bottled water! This is a good thing, considering the problem these empty bottles cause. Try not to, you'll actually be a bit of an outcast amongst fellow trekkers if you use bottled water. People (in order of observed frequency) bought boiled water from the teahouses, added iodine tablets, or used a filter.

Malaria. Finally to anti-malarials. My wife and I took Doxycycline ("Doryx 100"), 100 mg per day. But we only took this when we got to Thailand plus 2 weeks after, so 6 weeks all up. We were in India and the Nepal (including the lowlands) in the cold season (Dec-Feb), so our Doctor from TMVC said we would be fine without prophylaxis during that stay. Even the precautions of covering up and using DEET in those countries didn't seem to be needed, I don't remember ever seeing a mosquito. Even in a big wetland national park in India (Kaladeo Ghana Bird Park in Bharatpur), we did use DEET (Rid) but still didn't see a mosquito. We were in Rajasthan in January and Feb. Doxycycline is not something you want to take for long periods as it is an antibiotic. I don't think its recommended to take for periods any longer than about 8-10 weeks. But children under 12 cannot take it so our kids took Paladrine 100mg daily and Chloroquin 155mg once a week. For Paladrine, the kids have 4mg per kg body weight daily. As Blake was 32kg and Gemma was 27kg, they were supposed to have 128mg and 108mg respectively. As the tablets were 100mg each, it was simpler to just give them 1 tablet each daily. For Chloroquin, the kids are supposed to have 5mg per kg body weight once per week (must be the same day each week!). So they were supposed to have 160mg and 135mg respectively. But as the tablets were 155mg, it was simpler just to give them 1 tablet each. They also took these for Thailand only.

A local GP (before we ended up going to TMVC) prescribed Maloprim for us which we bought, only to find out that this is no longer recommended due to possible severe side effects. We ended up selling our supply to a pharmacist in Kathmandu! All drugs are freely available over the counter in India and Nepal plus I have also heard from Thailand, at prices a TINY fraction of the price at home in Western countries. We actually bought all our anti-malarials from Australia before we left, but stocked up on other common listed above when we got to Nepal. You could do this in India, Thailand or elsewhere as well.

We also took along with us 4 melfloquine ("Larium") 250 mg tablets in case any of us got malaria. For adults, you take two immediately then two 6 hours later to cure it. For kids they take 1 tablet (10 mg per kg body weight) immediately then one 6 hours later. You can't use Larium as a cure if you use it as a daily prophylaxis. We didn't use it as a daily because it is so damn expensive! We never needed it. Larium is available cheap in India, Nepal and Thailand, but remember that if you are taking it as a daily prophylaxis you need to start taking it a week or so before arrival to a risk area.

Vaccines. As far as vaccines go, there are a few you should get.  First of all, Hepatitis A, meningoccocal meningitis (for Nepal and India), typhoid and tetanus are the must-haves.  You should also consider getting Hep B (this is transferred by bodily fluids, so if you believe you are at risk, have the shots) and rabies, but these are not as essential. We didn't have a Japanese encephalitis shot as our Doc never mentioned it.  Shop around for vaccine prices too.  Talk to your travel health specialist for a customised consultation.

• Another great online service is Travel Health Online, a great resource for up-to-date health (and other travel) info for most countries.

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