Medical Issues for Cruisers Part One
The constant fresh air, lack of stress, frequent exercise from swimming and walking ashore, coupled with infrequent exposure to germ-ridden recycled air of office buildings, and rare contact with potential disease makes cruising an incredibly healthy lifestyle. Long-term cruisers seldom get sick, but it is important to be organized in advance, be aware of medical hazards, have the required immunizations for travel, and be prepared for emergencies with a well-stocked medical chest and on-board resources for diagnoses and treatment.
To properly prepare for medical emergencies in advance of an extended cruise, sailors should consider taking a basic first aid course. Programs typically cover the symptoms and treatment of allergic shock, animal bites, bleeding, burns, concussion, drowning, sprains and fractures, choking, heart attack and cardiopulmonary resuscitation, poisoning and overdose, seizures and shock. Most courses available come with well-illustrated texts that can be kept aboard as valuable resources later on.Of course it’s not possible to give the proper care to someone that’s injured if you don’t have the right supplies on board, and that’s where a proper medicine chest comes into play. On board Bagheera, we prefer segmenting our medical supplies in several plastic airtight containers. And like most cruisers, we carry supplies for a full spectrum of health hazards including dressings, ointments, lotions, powders and medications for every aspect and function of the body, including antibiotics and even morphine. Every sailing family or couple should consult their family physician before leaving, but they should certainly keep the basic supplies on board. Having sailed together for over 100,000 nautical miles in most climates, our basic supplies include are pretty extensive (see sidebar).
Medications Every cruising couple or family setting out on an extended voyage should first analyse their medical history and anticipate the demands on their medical chest so they’ll know to stock up on the necessary items wherever they’re available. You can also consult your local travel clinic as well as physician before leaving to obtain prescription medication, but don't go overboard in stocking up for every conceivable eventuality. Not only are medications expensive, they generally have an expiration date. Although it is wise to carry antihistamines and antibiotics, specific medications can be purchased locally when needed and often cost considerably less in developing countries.
Exceptions are medications for pre-existing conditions where ample supplies should always be carried, remembering that cruisers' plans often change. Also make sure prescription drugs are officially labeled. We never had any problems with our medical supplies on board, but regulations regarding drugs vary from country to country. While we were in Greece, for example, an Australian girl was arrested because she had codeine in her bag without a prescription. Back home, she was used to buying it over the counter.
We recommend that you carry a variety of medical books, oriented both for general family health and travel. It is in the tropics that you will most likely have problems. It's worth taking time when choosing these resources to ensure that they address your particular destination and lifestyle. Also find out about any radio resources that offer emergency medical advice.
Immunizations When you travel outside Western and Central Europe, the US, Canada, Australia, New Zealand, and Japan, certain immunizations may be needed. As several diseases are on the rise it is important to have current information. Obtaining this and the necessary vaccinations can require careful advance planning. Fortunately, due to the dramatic increase in travel, especially adventure holidays, travel clinics are now common in the major cities in most first world countries. Visit a clinic at least six weeks before you leave for infected areas. Updates and advice on immunizations and high-risk areas for malaria are provided by organizations such as the World Health Organization and IAMAT (International Association for Medical Assistance to Travellers 716 754-4883). In addition IAMAT has listings of English-speaking doctors and health institutions worldwide.
Several national departments also provide information. On my recent visit to a Department of Health Travel Clinic in Vancouver I was not only given informative literature on specific diseases, but there was also a general travel booklet put out by the government. This included a number to call in the Quarantine Health Services of Health Canada in Ottawa (613/957-8739) for medical updates as well as a list of names, addresses, and phone numbers of all the Canadian Missions around the world. But don't be in too much of a rush to go cruising after you have immunizations in case you have an allergic or adverse reaction.
|"Don't be in too much of a rush to go cruising after you have immunizations in case you have an allergic or adverse reaction."|
For worldwide cruising, you’ll also want to make sure you have prepared for diseases transmitted through food and water such as:
Hepatitis A (also called infectious Hepatitis)—This is a viral infection of the liver which is found worldwide, and it can be transmitted in food and drink or by ingesting contaminated water during swimming. Vaccines come in a two-dose series, 100 percent one-year coverage with the first. A second, one year later, boosts protection for 20 years. (See note after Hepatitis B for vaccination for both A and B.)Typhoid Fever—Known as a bacterial infection transmitted through food or water, this can produce life-threatening diarrheah. One injection gives immunity for three years or three oral doses gives seven-year protection.
Cholera—This is an acute intestinal infection caused by bacterium transported in contaminated food or water. Although the risk is low, check where cases have been reported (e.g. Africa, Central and South America, SE Asia and India). Vaccine now gives good immunity for six months, injection or oral capsule. Also be cautious about swimming in freshwater. In most tropical regions there is a risk of Bilharzia (schistosomiasis), with an estimated 80 percent of cases in Africa. This infection is acquired through a parasite that may enter the skin during contact in slow-moving freshwater.
Of course there are some insect-borne diseases that sailors need to be wary of. Avoiding insect bites by wearing long-sleeved clothing, staying inside when mosquitoes are biting (generally dawn, dusk or evening), and using repellent are the best initial defences. Also, having screens fitted on all ports and hatches works.
Yellow fever—This is viral infection of the liver and other tissues transmitted by mosquitoes in the tropical areas of Africa and South America. One injection protects you almost 100 percent for 10 years.
Malaria—Malaria is found in virtually all tropical countries. No vaccine is available to prevent it. Avoid the disease by protecting against mosquito bites and taking anti-malarial drugs (such as chloroquine and Larium (Mefloquin) which kill the malaria parasite. Generally prophylactic drugs are taken one or two weeks before travelling and continue for four weeks after. It is important to access current information and be advised which drug to take and side effects of the medication. If visiting isolated high-risk areas, enquire about a 'standby' treatment dose of Fansidar. You’ll also want to be aware of Dengue Fever, and Japanese Encephalitis.
|"Malaria is found in virtually all tropical countries. Unfortunately, there's no vaccine is available to prevent it."|
Of course there are other diseases that cruising sailors need to be aware of. These include:
Hepatitis B—An infection of the liver caused by a virus, which ranges from mild to life threatening. It is spread through poor personal hygiene and exposure to contaminated blood, through poorly sterilized medical equipment, sharing needles including tattoo, ear piercing or acupuncture needles, having a blood transfusion (particularly in a tropical country) and sexual activity. The vaccine gives 90% protection and is generally given in three injections over 6 months. Immunity lasts from three to five years. (In many places it is now cheaper to have the Twinrix vaccine for both Hepatitis A and B than either of the vaccines for A or B on their own. Requires a three-series injection over 12 months)
Rabies—This is an acute viral infection of the nervous system spread through the bite of an infected animal and it is usually fatal if not treated promptly. It is more common in tropical countries. Avoid contact with animals and do not feed or pet cats, dogs or monkeys. Given as a course, protection lasts for tow to three years.
As we travelled the world, it was rare that there weren't adequate medical facilities in the most populated centers we visited. The buildings may not have been in good repair, with paint peeling off the walls, but the medical care was generally excellent. Many developing countries have good medical schools. They also send students for training overseas and receive supplies and personnel from Europe and North America.Although we, and many fellow cruisers, circumnavigated without medical insurance and found local costs minimal, times have changed and today visitors are likely to be charged the real cost of health care. Fortunately, with so many people cruising and living overseas, medical insurance has become competitive and can be tailored further to one's individual needs. As benefits vary widely it is important to read the fine print carefully before choosing. One company we contacted excluded coverage for scuba diving or participation in a rally or race.
You’ll also want to know the following things about your policy:Does your policy pay foreign hospital and related medical costs and if so does it pay up front or do you pay first and get reimbursed later? Does your policy allow for cash advances for medical costs? Does it cover continuing treatment and living expenses after discharge from hospital if you are not fit enough to return home? Will it provide for your medical evacuation to the closest country with appropriate facilities and for someone to accompany you? Does it cover pre-existing medical conditions? Will it pay for the preparation and return to your country of your remains should you die while in a foreign land? Does it have a high deductible and annual maximum? Does the policy have an offshore residency requirement? Will it cover you on visits back home?
For those sailors cruising for shorter periods, cheaper rates may be obtained buying regular travel insurance sold at travel agencies, automobile associations, or through the bank or your credit card company. Be aware that when using regular travel insurance that there is often a strict vacation time limit and that the company's policy is generally to ship people home as quickly as possible, so that they will be covered by their home-based plan.
Besides having details of your insurance on the boat, give copies to your business manager or family member back home. And always get a detailed invoice from the doctor or hospital. Trying to get copies of the paperwork after you have left, particularly if in a different language, can be frustrating.
In all of our travels we have not found taking medical precautions a burden, but we do have some interesting anecdotes to tell. We first took malaria pills in Venezuela. While Andy and I took our quinine in sundowner gin and tonics, I gave the quinine to the children in strawberry jam. They have never eaten strawberry jam again! It wasn't until the Indian Ocean that we had to have immunizations against yellow fever, Hepatitis A, typhoid, and cholera. Those of you who have read Still Cruising may remember our son Colin's reticence about having his shots after watching 30 boat loads of adults coming out of a clinic in Darwin moaning in pain!
Just the BasicsAntibiotic ointment such as Bactroban and Neosporin to prevent infection Antifungal cream such as Tinactin for Athlete's Foot etc: also relieves burning and itching Syrup of ipecac which induces vomiting, and you might consider activated charcoal which absorbs poisons, preventing them from entering the bloodstream Aspirin or acetaminophen (Tylenol) for pain or fever (Children and teenagers should not have Aspirin.) and a powerful painkiller such as morphine. Ibuprofen (Advil), an anti-inflammatory for minor aches and pains in muscles, bones and joints, menstrual pain and toothache (also relieves sunburn), Epsom Salts, ice pack Antihistamine (such as Benadryl, Claritin) for allergies and hayfever, also eases the itch from insect bites and stings and helps with motion sickness. Watch for drowsiness and reactions with alcohol. Epi-pen kit (adrenalin syringe) Loperamide (e.g. Imodium) or Lomotil for diarrheah, Bismuth subsalicylate (e.g. Pepto- Bismol) for diarrheah, heartburn, indigestion and nausea. (Antibiotics for diarrhea include Norfloxacin and Ciprofloxacin. A laxative for constipation Seasick medication (see my previous and next article for a variety of remedies). Stugeron (Cinnarizine) is one of the most popular, available in most English speaking countries except USA and Canada, also Mexico. We also always carry ginger. Calamine lotion or hydrocortisone cream for bites and stings White vinegar for jellyfish stings Antibiotics (two courses) particularly when visiting remote places (carry prescriptions) Cold and flu tablets, throat lozenges Eye wash and ear medication for 'swimmer's ear' Orajel or oil of cloves for toothache and zinc oxide to set up and seal a cavity Insect repellent (with DEET for mosquitoes), Chapstick, sunscreen, vitamin E replenishing cream for chapped hands and feet Cotton balls, antiseptic wipes, gauze, adhesive bandages, gauze and tensor bandages, tape, tweezers, scissors, thermometer and a flashlight Spare syringes and needles in case injections are required where there are medical hygiene problems
Here's a list of the basics that we carry aboard Bagheera for medical emergencies:
Here are three examples of insurance companies that offer overseas medical coverage:
PPP at www.healthcare.co.uk
Blue Water Insurance at www.bluewaterins.com
Healthcare Global at www.wallach.com