Travel Reference
In-Depth Information
be associated with passing blood or slime, it is important to seek medical advice as soon as
possible as this is likely to be a form of dysentery which will need antibiotics to treat it.
Holidayschedulesoftenmakeitimpossibletofollowthe'sititout'advice.Whenalong
bus journey or flight is anticipated you may wish to take a blocker such as Imodium, but if
you are tempted to do that it is better to take an antibiotic with it. 'Blockers' are dangerous
if you have dysentery and work best if combined with an antibiotic such as Ciprofloxacin
(500mgtwicedailyforatleastthreedays).Thethree-daycourseusedtobehighlyeffective
but resistance is developing. It is probably best, therefore, to take local advice and try to
find a clinic rather than treating yourself. Drink lots whatever treatment you are taking and
ifyouareworriedorfeelveryill,findalocalmedic.Keepwellhydratedandthesymptoms
will usually settle.
CHOLERA
Although it has a fearsome reputation, cholera doesn't usually make healthy
people ill. It takes the debilitated, poor and half-starved of famine or conflict zones, or it
is present along with other gastro-intestinal infections. Cholera is avoided in the same way
as other 'filth-to-mouth' diseases and - if there are symptoms - it can be treated with the
usual oral rehydration fluids that all wise travellers know about (see above). However, for
those who prefer to prevent the disease in the first place, an oral cholera vaccine, Dukoral,
can be taken. This vaccine is suitable from two years and older but the doses vary so allow
at least three to four weeks before travel.
OTHER HITCHHIKERS
There is a high prevalence of tapeworm in zebu, so eat your
steaks well done. If you do pass a worm, this is alarming but treatment can wait.
BILHARZIA (SCHISTOSOMIASIS)
This is a nasty, debilitating disease which is a
problem in much of lowland Madagascar. The parasite is carried by pond snails and is
caughtbypeoplewhoswimorpaddleinclean,stillorslow-movingwater(notfast-flowing
rivers)whereaninfectedpersonhasdefecatedorurinated.Theparasitecauses'swimmer's
itch' when it penetrates the skin. Since it takes at least ten minutes for the tiny worm to
work its way through your skin, a quick wade across a river, preferably followed by vigor-
ous towelling off, should not put you at risk. Bilharzia is cured with a single dose of Prazi-
quantel. If you think you may have been exposed to the disease, ask your doctor to arrange
a blood test when you get home. This should be done more than six weeks after the last
exposure.
SEXUALLY TRANSMITTED INFECTIONS
These are common in Madagascar and
AIDSisontheincrease.Ifyouenjoynightlife,maleorfemalecondomswillmakeencoun-
ters less risky.
