Bhutan - Lindsay Brown [226]
The most effective treatment for severe AMS is to get down to a lower altitude as quickly as possible. In less severe cases the victim will be able to stagger down with some support; in other cases they may need to be carried down. Whatever the case, do not delay, as any delay could be fatal.
AMS victims may need to be flown out of Bhutan as quickly as possible – make sure you have adequate travel insurance.
The drugs acetazolamide (Diamox) and dexamethasone are recommended by some doctors for the prevention of AMS. However, you should be aware that their use is controversial. They can reduce the symptoms, but they may also mask warning signs; severe and fatal AMS has occurred in people taking these drugs. Drug treatments should never be used to avoid descent or to enable further ascent.
Insect Bites & Stings
Bedbugs don’t carry disease but their bites are very itchy. They live in the cracks of furniture and walls and then migrate to the bed at night to feed on you. You can treat the itch with an antihistamine. Lice inhabit various parts of your body but most commonly your head and pubic area. Transmission is via close contact with an infected person. They can be difficult to treat and you may need numerous applications of an antilice shampoo such as Permethrin. Pubic lice are usually contracted from sexual contact.
Ticks are contracted after walking in rural areas. Ticks are commonly found behind the ears, on the belly and in armpits. If you have had a tick bite and experience symptoms such as a rash at the site of the bite or elsewhere, fever, or muscle aches you should see a doctor. Doxycycline prevents tick-borne diseases.
Leeches are found in humid rainforest areas. They do not transmit any disease but their bites are often intensely itchy for weeks afterwards and can easily become infected. Apply an iodine-based antiseptic to any leech bite to help prevent infection.
Bee and wasp stings mainly cause problems for people who are allergic to them. Anyone with a serious bee or wasp allergy should carry an injection of adrenaline (eg an Epipen) for emergency treatment. For others pain is the main problem – apply ice to the sting and take painkillers.
Skin Problems
Fungal rashes are common in humid climates. There are two common fungal rashes that affect travellers. The first occurs in moist areas that get less air such as the groin, armpits and between the toes. It starts as a red patch that slowly spreads and is usually itchy. Treatment involves keeping the skin dry, avoiding chafing and using an antifungal cream such as Clotrimazole or Lamisil. Tinea versicolor is also common – this fungus causes small, light-coloured patches, most commonly on the back, chest and shoulders. Consult a doctor.
Cuts and scratches become easily infected in humid climates. Take meticulous care of any cuts and scratches to prevent complications such as abscesses. Immediately wash all wounds in clean water and apply antiseptic. If you develop signs of infection (increasing pain and redness), see a doctor.
Sunburn
Even on a cloudy day sunburn can occur rapidly. Always use a strong sunscreen (at least factor 30), and always wear a wide-brimmed hat and sunglasses outdoors. Avoid lying in the sun during the hottest part of the day (10am to 2pm). If you become sunburnt stay out of the sun until you have recovered, apply cool compresses and take painkillers for the discomfort. One per cent hydrocortisone cream applied twice daily is also helpful.
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WOMEN’S HEALTH
Pregnant women should receive specialised advice before travelling. The ideal time to travel is in the second trimester (between 16 and 28 weeks), when the risk of pregnancy-related problems are at their lowest and pregnant women generally feel at their best. During the first trimester there is a risk of miscarriage and in the third trimester complications such as premature labour and high blood pressure are possible. It’s wise to travel with a companion.