Middle East - Anthony Ham [562]
If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution containing salt and sugar. A few loose stools don’t require treatment but, if you start having more than four or five stools a day, you should start taking an antibiotic (usually a quinolone drug) and an antidiarrhoeal agent (such as loperamide). If diarrhoea is bloody, persists for more than 72 hours, is accompanied by fever, shaking chills or severe abdominal pain you should seek medical attention.
ENVIRONMENTaL HAZARDS
Heat Illness
Heat exhaustion occurs after heavy sweating and excessive fluid loss with inadequate replacement of fluids and salt. It is particularly common in hot climates when taking unaccustomed exercise before full acclimatisation. Symptoms include headache, dizziness and tiredness. Dehydration is already happening by the time you feel thirsty – aim to drink sufficient water so that you produce pale, diluted urine. The treatment of heat exhaustion consists of fluid replacement with water or fruit juice or both, and cooling by cold water and fans. The treatment of the salt-loss component consists of taking in salty fluids (such as soup or broth), and adding a little more table salt to foods than usual.
Heat stroke is much more serious. This occurs when the heat-regulating mechanism in the body breaks down. An excessive rise in body temperature leads to sweating ceasing, irrational and hyperactive behaviour, and eventually loss of consciousness and death. Rapid cooling by spraying the body with water and fanning is an ideal treatment. Emergency fluid and electrolyte replacement by intravenous drip is usually also required.
Insect Bites & Stings
Mosquitoes may not carry malaria but can cause irritation and infected bites. Using DEET-based insect repellents will prevent bites. Mosquitoes also spread dengue fever.
Bees and wasps only cause real problems to those with a severe allergy (anaphylaxis). If you have a severe allergy to bee or wasp stings you should carry an adrenaline injection or similar.
Sand flies are located around the Mediterranean beaches. They usually only cause a nasty itchy bite but can carry a rare skin disorder called cutaneous leishmaniasis. Bites may be prevented by using DEET-based repellents.
Scorpions are frequently found in arid or dry climates. They can cause a painful bite, which is rarely life threatening.
Bed bugs are often found in hostels and cheap hotels. They lead to very itchy lumpy bites. Spraying the mattress with an appropriate insect killer will do a good job of getting rid of them.
Scabies are also frequently found in cheap accommodation. These tiny mites live in the skin, particularly between the fingers. They cause an intensely itchy rash. Scabies is easily treated with lotion available from pharmacies; people who you come into contact with also need treating to avoid spreading scabies between asymptomatic carriers.
Snake Bites
Do not walk barefoot or stick your hand into holes or cracks. Half of those bitten by venomous snakes are not actually injected with poison (envenomed). If bitten by a snake, do not panic. Immobilise the bitten limb with a splint (eg a stick) and apply a bandage over the site using firm pressure, similar to a bandage over a sprain. Do not apply a tourniquet, or cut or suck the bite. Get the victim to medical help as soon as possible so that antivenene can be given if necessary.
Water
Tap water is not safe to drink in the Middle East. Stick to bottled water, boil water for 10 minutes, or use water-purification tablets or a filter. Do not drink water from rivers or lakes; this may contain bacteria or viruses that can cause diarrhoea or vomiting.
TRAVELLING WITH CHILDREN
All travellers with children should know how to treat minor ailments and when to seek medical treatment. Make sure the children are up to date with routine vaccinations, and discuss possible travel vaccines well before