Swine flu (H1N1 virus) overview

What is Swine Flu?

The virus (H1N1) is a combination of several different influenza strains including pig, bird and human virus.  As of April 25th, 2009 there have been an estimated 68 deaths in Mexico and approximately 1,000 cases, thus far. This is roughly a 7% case fatality rate, mainly in the healthy adult group. This is very unusual as influenza typically kills very young, very old and chronically ill persons.

Where is the outbreak?

As H1N1 (Swine Flu) circles the globe, both concern and the number of confirmed cases continues to grow.  Public Health agencies including the World Health Organization are taking this matter seriously and have raised the Pandemic Alert from a 3 to a 4 (on  scale of 1-6).  This upgrade was largely due to the fact that containment is unlikely and focus will likely shift to mitigation.

As the disease outbreaks are changing constantly, it is best to refer to reputable news sources for up to date information about the spread.  Additionally, check out this Google Map.

Tips for avoiding Swine Flu

Swine Flu can be spread from person to person, so travelers are advised to:

• Wash your hands with either soap and water or alcohol based hand sanitizer, often
• Sanitary disposal of dirty tissues
• Avoidance of those with cough, sneeze or flu-like symptoms.
• Also, those who are sick with flu-like symptoms should stay home from work or school.

Prevention and Treatment Medicine:

Two medicines, both anti-virals, are getting a lot of new attention due to their ability to effectively combat H1N1 and likely lessen the severity and duration of illness.

1. Tamiflu (oseltamivir) is available in both a tablet and liquid form and has been approved for use against H1N1 virus by the CDC.
2. Relenza (zanamivir) is marketed in a spray form and is approved for use by the CDC against H1N1.

The following circumstances are advised to use the above medications by the CDC:

• Household close contacts who are at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions, persons 65 or older, children younger than 5 years old, and pregnant women) of a confirmed, probable or suspected case.
• School children who are at high-risk for complications of influenza (children with certain chronic medical conditions) who had close contact (face-to-face) with a confirmed, probable, or suspected case.
• Travelers to Mexico who are at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions, persons 65 or older, children younger than 5 years old, and pregnant women).
• Health care workers or public health workers who were not using appropriate personal protective equipment during close contact with an ill confirmed, probable, or suspect case of swine influenza A (H1N1) virus infection during the case’s infectious period.

The following circumstances should consider use of anti-viral medication, which may be of help:

• Any health care worker who is at high-risk for complications of influenza (e.g., persons with certain chronic medical conditions, persons 65 or older, children younger than 5 years old, and pregnant women) who is working in an area of the healthcare facility that contains patients with confirmed swine influenza A (H1N1) cases, or who is caring for patients with any acute febrile respiratory illness.
• Non-high risk persons who are travelers to Mexico, first responders, or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection.

Use of N-95 respirator masks may also help prevent influenza spread, although they require special fitting to ensure adequate face-mask seal.

A 2007 CDC statement states that there is no clear evidence that using a surgical mask decreases influenza spread and there are no current recommendations to cover up.

Special consideration should be given to using these antiviral drugs as they should be obtained and used with a physicians script and care.  Counterfeit copies of these medications are common and rarely contain actual medicine to combat influenza.  This can lead to not only drug resistant strains but also leave the person with a false sense of protection.   Antiviral medications should only be obtained from licensed and reputable pharmacies.

Supply of these medications is an obvious concern and the manufacturers are releasing stockpiles to help cope with increased need, as are public health agencies.  Areas with known outbreaks and those people with confirmed cases are of highest priority.

Further Information:

• CDC Swine Flu
• World Health Organization
• Follow updates from Centre for Disease Control on Twitter 

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10 Things To Add To Your Hiking Holiday Checklist

Photo from World Nomads

Hiking holidays are a great way to spend your time off. These trips are often done on new trails and areas you’ve never been before and that is part of the excitement.  Often, people do a bit of hiking while they are packing for their trip with other activities and do not specifically plan for their outdoor adventure.  Shore excursions from cruise ships are a prime examples of this.

The factors of an unfamiliar area, being unprepared and often being in a hurry can stack up against someone, quickly.  When adventuring outdoors, you want as many things in your favor as possible.  Here’s what to prepare for your hiking excursion on your trip!

Signaling Device

• Phone/mobile/sat phone
• Mirror
• Whistle

Being able to contact someone for help is probably the most important thing in an outdoor emergency.  Popularity of mobile phones has helped adventurers be rescued in a timely manner.  Make sure your device from home works in your new location and be prepared that you may not have a signal when outdoors.  Consider renting a local phone, for use during your trip.  Satellite phones can also be rented and provide connectivity, even in remote locations.

Mirrors and whistles serve to attract attention and are very reliable.  They do not run out of battery or lose signal.  Mirrors can reflect light to passing planes or other people, and whistles work well to draw attention, too!  Both are very lightweight and portable.

Extra Food

• Enough for 1-2 days
• Energy bars
• Comfort food

Most day hikes are just that, hikes that are over in one day.  Spending the night outside only happens if there is a problem, but you should be prepared for it.  Healthy people can generally go several weeks without food, but why try it!?  Carrying some extra food, in case you have to sleep out, can make a big difference for comfort and morale.  I am not saying to carry a full buffet, but a few energy bars are lightweight and can make you more comfy waiting for help or while your figure your plan out.

Extra Water

• Carry extra supply
• Purification method (potable aqua tablets, filter, boiling)

Humans may be able to go a week or two without food, but drinkable water is needed much more often.  Death from dehydration can occur in several days.  Carrying extra water is a vital survival tool and should not be taken lightly.  Anticipate your water needs, per person, for your adventure and plan ahead.  This can be carrying extra water or carrying a method to purify water found in the area.  Plan to spend a night outside and consider that you’ll need to drink water during this time.

Fire starter

• Lighter
• Flint and striker
• Matches

The ability to make fire is something anybody who leaves a paved road needs to have.  Fire can be a great signal, especially at night.  Smoke from a fire can be a daytime signal, as well.  Not only does fire provide warmth, but it serves as a tremendous moral booster and makes the difference between an uncomfortable night outside and a potentially life threatening event.  Fuel can be found in the area or brought in your pack.  A few cotton balls or some tissue make perfect fuel sources to help get wood burning and take up a minimal amount of space.

Multi-tool / Knife

• Leatherman
• Swiss knife

A good knife is an incredibly valuable tool.  Multi-tools contain screwdrivers, files and many other accessories that can all have application if you find yourself needing to wait for a rescue or have to spend an unexpected night outside.  A good knife can help with first aid, shelter construction, food preparation and countless other chores that help improve your situation.

Itinerary left with responsible person

• Where you are going
• Which route you are planning
• When you will be home
• Who to call if you are not back by a pre-set date/time

Letting somebody you trust know where you are going and when you are due back should be second nature to outdoor adventurers.  The person you discuss your plans with doesn’t even have to be in the same country, as long as they know the details of your trip.  Make sure they know where you are going and when you are due back.  If you have not let them know that you’ve safely made it back, they should begin looking for you or arranging for help to find you.  Hotel employees, local ranger stations or friends/family back home are all good resources.  Ensure they have some contact information for your area and police stations are often good places to start.  Finally, when you do get back form your adventure, make sure to let them know so they don’t activate a search party!

Extra warmth layer

• Fleece jacket
• Hat
• Gloves

Even in the hottest climates, one should be prepared for a drop in temperature, especially at night.  Changes in weather can come quickly and having an extra layer of warmth can help fight off hypothermia as well as make you a bit more comfortable.  A large amount of body heat is lost through the head and simply wearing a hat can help keep warm.  A fleece jacket and hat take little extra space but can make a night outside a lot more tolerable.

Navigation aid

• Map and compass
• GPS
• Know how to use them

Getting lost is a common occurrence and I am frequently “lost” even at my home trails.  Relying on memory is difficult and next to impossible in an area you’ve never been before.  Carrying a map and compass or GPS is a good idea and may help you find your way back to safety.  However, simply carrying them does no good, unless you know how to use them.  Basic info on how to use a GPS can be found here.  A map and compass do not run out of batteries and never have “no signal”.  A compass requires a different skill than GPS and you can get the basics on compass navigation here.  Practice your navigation skills at home, before you get to the trails!

Basic first aid kit

• Ibuprofen/pain reliever
• Antihistamine
• Antiseptic towlettes
• Bandages/gauze
• Space blanket
• Personal medication

Every person going on an adventure should carry a first aid kit.  What you choose to carry in your kit is another matter, but everybody should carry a first aid kit, of some sort.  A basic kit should include the above items.  Many commercial kits are available, at most outdoor stores.  Also, the kit does no good if you leave it at home!

Portable shelter

• Space blanket
• Tarp
• Plastic trash bag

Carrying some basic equipment that can be fashioned into a shelter is an easy way to minimize discomfort and risk outdoors.  Being prepared to stay overnight, even if you are only being out a few hours is a good way to help survive an emergency on the trails.  Several items, listed above, can be fashioned into an emergency shelter, if the need arises.  Shelter can keep you dry, keep you warm and even help signal for help.  Taking a few extra minutes to drop one of these items in your pack is a great idea.

Even those going off on a “day hike” should be prepared to spend the night outdoors, in the event of an unforeseen emergency.  Carrying a few extra items in your pack can make this night outside more comfortable and lessen the risk of serious injury or death.  These items can help you find your way back home, signal for help and let you take care of yourself and others, should the need arise.  I hope you never have to use any of them, but at least you’ll be prepared if you do have an unplanned emergency outdoors.

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Always Plan Your Fire Escape

Photo from World Nomads

Going on holiday should be a fun and exciting time, filled with meeting new people, new places and new foods.  Nobody wants to think that they might get hurt or sick on their holiday, but the possibility does exist, unfortunately.  A good example of this is the tragic incident of fire, at the Palace Hostel in Childers, Australia.

Our roving medical expert Dr. Erik McLaughlin MD, who is also a qualified fire fighter, shares his tips on safely escaping a hotel fire.

Exit visas

Usually, when I check into a room, I am trying to dump my bags, clean up and get out to the excitement, as quick as possible. 

Taking a few minutes to simply look around can make a world of difference. Look at where the entrances and exits are, especially those close to your room. 

In a real fire, there is a lot of heat, confusion, panic and smoke.  These things all combine to help reduce your vision, impair clear thinking and cause bad judgment.  Knowing where the exits of a building are may seem like an easy thing to do, but could you find your way there, blindfolded and crawling?  This is basically what escaping a fire is like.

Taking a few minutes to think about what you would do if the fire alarm goes off or you are alerted to a fire can make the process of evacuation go much smoother.  I believe that if you have thought and prepared for an event, chances are it will not be as scary as if you are completely unprepared.  Think, where would I go, what would I bring and what can I do to keep my self safe as I am getting out.

Smoke and Heat

Most deaths in fires come from smoke inhalation and not actually burning. 

Should you find yourself in a room and smoke is coming under your door, from a fire in a nearby room or hallway, you need to assess the threat to you.  This is best done by first checking your room door.  Feel the door first, with the back of your hand.  I say back of the hand because if the door has a fire behind it, it will be hot and could burn you.  A burn to the back of the hand may hurt, but still allows you to use that hand for grasping, crawling, etc.  If the door is hot to the touch, don’t open it!  This means fire is likely on the other side of the door and you need to look for another way out.  For that smoke coming in under the door, stop the crack up with a wet towel from the bathtub.

Finding out what is happening is important.  Try calling the front desk and asking what is happening, is that ramen burning on the stove or is the entire top floor on fire?  If there is no answer at the front desk, call the local emergency number and tell them where you are and ask to speak to a firefighter on the scene.

Signaling for help

If you are trapped in a room and are unable to get out, due to the exits being blocked or fire keeping you trapped, you need to get attention from rescuers and let them know where you are. 

Open your window and try to shout for help, even throwing things down to the ground below.  Firefighters are trained to look for clutter on the ground and then look up for open windows and people needing rescue.  Unrolled toilet tissue, sheets and even clothing are all good things to drop down. 

Be cautious that fire on nearby floors can mean smoke funneling into your open window.  Hanging a wet towel or sheet in the window can help decrease the smoke coming into your room and still signal for help.   Larger and well funded fire departments, found in most major cities often have ladder trucks.  These trucks can help rescue people from windows, but they cannot generally reach above the 7th floor of a building.  Remember this when selecting your room.

Time to Go

The goal of a fire is to get out safely.  Obviously, this should be done as quickly as possible but try not to run.  Running can mean tripping and falling.  That is never good.  In the fire department, I was taught to “walk with a purpose“.  This means walking like I have a goal in my walk, not just meandering around. 

Basic physics means that smoke and heat rise and the hotter and smokier parts of the room will be at the top.  You can avoid the problems by staying low and crawling under the heat and smoke, on your hands and knees. 

Also, don’t even think of trying to grab your stuff.  Gear is replaceable, you are not.

During your trip out, you may come in contact with fire and your clothing may catch fire.  Remember that “stop, drop and roll” puts fires out.  If you are on fire, resist the temptation to run as this will only make the fire grow in size.  Instead, drop to the ground and begin to roll, which helps put the fire out. 

If you see somebody else on fire, the goal is to get them to do the same and you can try to smother the fire with a blanket.

Once you’ve made the decision to try and escape the fire, consider jumping in the shower and wetting yourself down, before you leave.  Try to grab a wet towel to wrap around your head and mouth as you are leaving.  Synthetic clothing may melt to your skin in hot temperatures; natural fibers generally do not.  Do not even think about trying to take an elevator, as this might lead to you becoming trapped inside, on the way down.  Instead, look for stairs as your method of escape.

When I travel with others, we usually have a pre-arranged meeting spot, in case of trouble.  This is usually a point near-by the hotel.  We have used light posts, cafes and even bushes as meeting spots.  The point is that when you are safe, go to that point.  Everybody else will meet you there.  This avoids the problem of not knowing where people are.  If they are safe, they should be waiting for you at your meeting spot.  This is especially helpful in talking about fire safety with children and can even be used in running a “fire drill”.

Fire, fire!  Key points to remember

• As you check in, make sure you know the locations of all the exits near your room
• Take a minute to think which way you’d go to escape your room
• Assume all fire alarms are real
• Check your door for heat
• If safe, exit your room through hallway and emergency exit
• Stay low on your way out
• If door is hot, look for another exit
• Block smoke from entering room with wet towels or sheets
• Signal for help by yelling or dropping items below window
• If traveling with others, get out and get to your meeting spot

There are several portable smoke detectors (such as the FlareSafe) that can be carried for extra security in “unimproved” hotels with out such devices.  These take very little room and can offer not only peace of mind but also help protect your life.

Hotel fires are an unfortunate reality of life and travel.  Taking a few minutes to think about what you would do and where you would go can make all the difference, if the time to evacuate a fire comes. 

Calm thinking and a little pre-planning can usually overcome most obstacles and escaping a fire is a great example.

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What Makes A Place ‘Dangerous’ For Travellers?

Photo by World Nomads

I came across a top little article by Brenda Yun at Gadling.com titled, What is a dangerous travel destination? It made me think that many of our World Nomads travel far off the beaten path, in countries that most of us would deem unsafe. I decided to bail up WorldNomads.com Insurance Director, Graham Kingaby and ask him, what makes a place ‘dangerous’ to travel to? And what should you do to stay safe if you need to travel there? Take it away Graham!

After many years in the travel and international personal accident insurance market I have to step back and think.  The answer I give to clients travelling to these regions is a slightly bawdier reworking of the “fail to prepare; prepare to fail” adage. I also try to impart an understanding that walking home from the local bar on an unlit makeshift road where the local drivers don’t have to worry about silly things like speed limits or breath tests may indeed be their passport to paradise, not the sniper in the shadows!

Heading off to a ‘dangerous’ country?

The best thing that you can do before you travel is to research the place that you are going to (you’ll be surprised how many don’t). This is easier now than ever before because of the vast amount of information available for free on the internet. This information is also more up to date and detailed than the printed materiel.

Some helpful tips:

• Use the web and country blog sites to speak to people on the ground if you can.
• Let the people at home know where you are going to be and how to get hold of you.
• Let the nearest Embassy know where you are and how to get hold of you.
• Have a back up plan should thing go wrong – How do I get in touch with people? Who can I call in an emergency? What other routes are there to the airport? Where’s the nearest hospital?

Who can help you?
If you are travelling to a country at the more extreme end of dangerous (and five minutes of research will identify the truly bad places) you really need to take practical advice from a professional security consultant. These people will give you all the training that you need, can hook you up with assistance at your destination, help you plan for all manner of contingencies and keep you up to date with the nuances of the local political climate. Their business is to make sure that you come home safe and sound – A dead or injured client looks very, very bad on their CV!

Do your own homework
Make sure that you know where you are going. Think in your own mind what might go wrong and how you might lessen the risk. Take any training seriously and don’t trust a manager or employer to arrange security on your behalf without knowing who it is providing the security and their credentials. Even when you have that security in place be aware of your surroundings and keep reminding
yourself that you’re not in Kansas anymore, Toto!

Travel for work

Generally people travelling to high risk or post-conflict environments are professionals (Iraq is seldom first choice for a leisurely holiday!), and they therefore approach the trip with a sober mindset. For example if you are travelling to Gaza as part of an NGO team or working on an aid project for a UN agency you probably have had security training before you set foot in-country. You’re also probably familiar with the cultural norms to abide by if you don’t want any static on the streets or to walk into a mob beating or kidnap grab.  Apart from some notable exceptions like the telecom workers who were decapitated by Islamic militants a few days in to their work project in Chechnya a few years back, most western organisations are also very aware of the brand damage and civil or criminal court cases that will follow should they send someone into a dangerous region without all the facts and tools that give them the best chance of coming home when the job is over.  Bearing these facts in mind the number of claims and incidents I have seen relating to simple road traffic accidents and work related risks in third world countries (slipping off a crappy woodworm infested ladder or metal shards in the eye from an unguarded lathe) outnumber those claims for shootings and bombings by a considerable factor.

So, what makes a place ‘Dangerous’ to travel to?

Professional Risk Managers and Insurance Underwriters use a number of different tools to try to assess what makes a country ‘dangerous’.  To get a handle on the combination of factors involved in a person’s risk they use a security matrix updated regularly (daily or hourly in the worst places). These factors can include Crime; Political Stability and Economic Stability. Specialist agencies gather this information from a mix of police and consular services, imbedded agents and indeed the global news media. Organisations like the UN, EU and individual country Foreign Offices also supply detailed security information although access to this may be limited. Most western countries asses risks in broadly the same way although there are some differences. An example might be a US citizen could be more at risk while working in Gaza than a French citizen because of individual diplomatic relationships between countries. Although not politically correct it is true to say that a white worker might be more at risk from kidnap or violence in the Democratic Republic of Congo.

Consider Specialty Risk Insurance

Specialty Risk Insurance helps pay the bills should something go wrong. Kidnap & Ransom insurance services and Political Evacuation cover in particular give additional concierge assistance that can make the difference between life and death. Loss statistics aren’t generally well promulgated for these types of insurance programs but it’s generally understood that 9 out of 10 kidnappings in South America where there’s a K&R policy involved, result in the recovery of a live victim. The success rate for those uninsured is considered to be quite a lot less with an increased time in captivity. As a last comment, a combination of information, preparation, security training and advice combined with good insurance cover can make even the most dangerous places on the planet a reasonably sane travel destination.

Graham Kingaby is the Insurance Director for WorldNomads.com. He has over twenty years experience in the International Personal Accident & Travel Insurance markets and has managed specialist’s personal war and terrorism risks as a broker and underwriter at Lloyd’s of London.  He was also adamant that we use the word ‘promulgated’ and it’s the GM of WorldNomads.com issue if he doesn’t know what it means !!

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Snow safety: frostbite

Photo by World Nomads

Has it been cold enough for you?  For those of us who decided to brave the conditions on days off, and more importantly for those of you who work outside during these cold conditions, do you know how to take care of you skin to ensure that you don’t get frostbite?

What is Frostbite?

Frostbite is damage to the skin and underlying tissues caused by extreme cold. It is distinguishable by the hard, pale, and cold quality of the skin that has been exposed to the cold for a length of time. The area is likely to lack sensitivity to touch, although there may be an aching pain. As the area thaws, the flesh becomes red and very painful.

Any part of the body may be affected by frostbite; but hands, feet, nose and ears are the most vulnerable. If only the skin and underlying tissues are damaged, recovery may be complete. However, if blood vessels are affected, the damage is permanent and gangrene can follow which may require amputation of the affected part.  Upon warming, it is common to experience intense pain and tingling or burning in the affected area.

Symptoms

The first symptoms are a “pins and needles” sensation followed by numbness. There may be an early throbbing or aching, but later on the affected part becomes insensate (feels like a “block of wood”). Frostbitten skin is hard, pale, cold, and has no feeling. When skin has thawed out, it becomes red and painful (early frostbite). With more severe frostbite, the skin may appear white and numb (tissue has started to freeze). Very severe frostbite may cause blisters, gangrene (blackened, dead tissue), and damage to deep structures such as tendons, muscles, nerves, and bone.

First Aid

Get out of the cold and move to a warmer place. Remove any constricting jewelry and wet clothing. Look for signs of hypothermia (lowered body temperature) and treat accordingly.

Try re-warming the affected parts by immersing the affected areas in warm (never HOT) water — or repeatedly apply warm cloths to affected ears, nose, or cheeks — for 20 to 30 minutes. The recommended water temperature is 104 to 108 degrees Fahrenheit (40-42 C). Keep circulating the water to aid the warming process.  Severe burning pain, swelling, and color changes may occur during warming. Warming is complete when the skin is soft and sensation returns.  Afterwards, apply dry, sterile dressing to the frostbitten areas. Put dressings between frostbitten fingers or toes to keep them separated.

Re-freezing of thawed extremities can cause more severe damage. Prevent re-freezing by wrapping the thawed areas and keeping warm. If re-freezing cannot be guaranteed, it may be better to delay the initial re-warming process until a warm, safe location is reached.
If the frostbite is extensive, try drinking warm drinks in order to replace lost fluids.

Do Not…

• DO NOT thaw out a frostbitten area if it cannot be kept thawed. Refreezing may make tissue damage even worse.
• DO NOT use direct dry heat (such as a radiator, campfire, heating pad, or hair dryer) to thaw the frostbitten areas. Direct heat can burn the tissues that are already damaged.
• DO NOT rub or massage the affected area.
• DO NOT disturb blisters on frostbitten skin.
• DO NOT smoke or drink alcoholic beverages during recovery as both can interfere with blood circulation.

Prevention

• Be aware of factors that can contribute to frostbite, such as extreme cold, wet clothes, high winds, and poor circulation. This can be caused by tight clothing or boots, cramped positions, fatigue, certain medications, smoking, alcohol use, or diseases that affect the blood vessels, such as diabetes.
• Wear suitable clothing in cold temperatures and protect susceptible areas. In cold weather, wear mittens (not gloves); wind-proof, water-resistant, many-layered clothing; two pairs of socks (cotton next to skin, then wool); and a scarf and a hat that cover the ears (to avoid substantial heat loss through the scalp).
• Before anticipated prolonged exposure to cold, don’t drink alcohol or smoke, and get adequate food and rest.
• You can also try using toe and hand warmers will also help to keep your extremities warm.

On the day we’re posting this story, there’s 86 cm of snow base and a 3 cm overnight fall at Whistler/Blackcomb.  Wish I was up to my knees in lovely powder snow!  Check out the webcams for yourself whilst you plan the trip.

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Mosquitoes & Bite Prevention

Photo by World Nomads

I have developed a healthy respect for mosquitoes.  Mosquitoes are basically “flying hypodermic needles”, carrying disease.  In my humble opinion, they are the most dangerous insects on the planet.  Mosquitoes transmit infection to more than 700,000,000 people, worldwide and kill one of every 17 people, currently living.  Malaria alone is believed to kill three million people per year.  Clearly, they are to be feared and respected.

Illnesses

Experienced travelers should already be familiar with some of the disease that mosquitoes carry.  Yellow Fever and Dengue, two viral illnesses, are common maladies travelers need to deal with.  Fortunately, Yellow Fever is vaccine preventable.  Malaria is the other disease that travelers need to know.  This blood borne, parasitic infection is a global killer.  Filiariasis also deserves mention, too.  There are many other infections carried by “mozzies” and they all help make up a list of reasons to not get bit!

Mosquitoes

All two winged insects are in the order of Diptera.  Anopheles, Culex and Aedes are the generas to know, as they are responsible for most human bites and disease transmission.  Interestingly, only female mosquitoes are biters, due to the fact that they require blood to help produce eggs.  They typically require a “blood meal” every 3-4 days.  The males are content with flowers and nectar.  Different species prefer to feed at different times, during the day.  For example, the Culex mosquito prefers to bite from “dusk to dawn”, helping travelers avoid bites by limiting outdoor activity during those times.

What Attracts Mosquitoes

The things that attract mosquitoes to bite are not completely understood and involve all of the mosquitoes senses.  Mosquitoes lock on to their target with the help of visual and thermal clues, plus a very developed sense of smell.  The times of day a mosquito chooses to bite help illustrate what clues it uses to find your body.  Day biters are believed to have a more developed visual sense and are attracted to darker colors, such as your favorite black t-shirt.  Also, lots of movement helps draw attention, as well.  Dusk to dawn biters are known for a more elaborate heat sensing system, being attracted to the heat and moisture of the skin. People who sweat more are also believed to be more attractive, at least to the mosquitoes.  Perfumes, scented soaps and lotions are also likely attractants.  Several good hypotheses exist about the likelihood of mosquito attraction to carbon dioxide, the gas exhaled from breathing.  Certain types of mosquitoes carry a fondness for certain body locations such as ankles, face or hands.  Several well-written studies have shown some statistics:

• Adults are more likely to be bitten than children
• Men are preferred over women
• Larger people are more likely to be bitten than smaller people

Clothing

Travelers need to use all of their savvy to prevent bites and stay healthy on their trip.  The first line in mosquito bite prevention is clothing.  Lighter colors are advised and long sleeves and pants act as a barrier to the attacking mosquito.  Think of the clothing as a suit of armor that is difficult for the insect to penetrate.  Caution must be used as wearing long sleeves and pants in hot, tropical environments can lead to overheating and dehydration.

Bed Nets

Bed nets are another first line of protection, acting as a mechanical barrier to keep mosquitoes away from you while you are lounging in bed.  Travelers who are staying in climate controlled hotels with permanently closed windows are likely able to do without nets.  However, those in more rural areas or hotels with open windows and lots of outside access should be prepared with a bed net.  Bed nets are a major method of disease mosquito spread disease, in developing countries.

Permethrin

Permethrin is an insecticide that kills or stuns bugs.  Developed from the flower Chrysanthemum, permethrin should be applied directly to clothing or fabrics.  Application should be made to tents, bed nets, shirts, pants and curtains.  Studies have shown that permethrin lasts for approximately 2 weeks and is non-staining, almost odorless and can remain through several washings.  Proper application is typically done with a spray, using just enough to moisten the fabric and the allowing 2-4 hours to dry.  Permethrin also provides protection against other disease carrying insects such as mites, fleas, ticks and flies.  Most “mosquito coils”, burned to prevent mosquitoes in a limited area, contain permethrin.  Even though the chemical has a low ability to be absorbed through the skin and has a very low toxicity to mammals, it should not be applied directly to the skin.  There are better measures to be applied, to your skin.

DEET

DEET (N,N-diethyl-meta-toluamide) is the premiere choice for mosquito bite prevention.  DEET is an older compound with it’s safety and efficacy very well studied.  First used by the military in the 1940’s and entering civilian use in the 1950’s, DEET has been the subject of many studies looking at user safety and adverse reactions.  Working by disrupting the mosquito’s sense of smell, it helps to “jam the radar” of the mosquito trying to find a target.  Intensive testing of over 20,000 other compounds has shown DEET to be the best in terms of duration of protection and types of insects it repels.  DEET is effective at repelling fleas, ticks, mosquitoes and chiggers. Typical commercial preparations of DEET include gels, lotions, sprays and it can be found in various concentrations, up to 100%.  Most travel medicine literature agrees that a concentration of 35% DEET is optimum, providing decent protection for several hours and limiting potential skin irritation side effects.  The American Academy of Pediatrics advises use of only a 10% DEET  concentration, in children less than 12 years.  Typically, the higher the concentration of DEET, the longer the protection time afforded.  One study looked at 12.5% DEET offering 6 hours of protection, while 25% compounds only provided 8 hours.

DEET has been used by millions of people, for over 50 years.  Studies conducted by the US EPA looked at chronic and acute exposures, potential to cause cancer and possibility of birth defects.  These studies showed no formulation change was necessary, to improve safety profile.  There are, however, cases in medical literature of DEET toxicity.  Of most interest and concern is the report of 14 cases of encephalopathy (brain disorder), of which 13 cases were in children younger than 8 years of age.  Many of the cases involved long term use of excessive doses and inappropriate use of the products.  Most common calls to poison control centers involves the accidental spraying of DEET in the eyes.  Over the last 50 years of use, DEET has shown a remarkable safety profile.

A few things to remember when applying DEET:

• When using sunscreen and DEET together, the effectiveness of the sunscreen will be reduced, requiring more frequent sunscreen application to prevent sunburns
• DEET should be applied first, with the sunscreen placed on top of the insect repellent after a 10 minute drying period
• Use caution with DEET and plastics as it may damage these items

Natural Repellents

Despite the efficacy and safety profiles of DEET and Permethrin, some travelers may elect to try and protect themselves with “natural mosquito repellents”.  Many natural compounds have been evaluated for anti-mosquito properties.  Some include eucalyptus, garlic, citronella and vitamin B.  Citronella, derived from the grass Cymbopogon, is the most promising.  Studies have shown protection against bites, but for shorter times than DEET.  One study showed  a 10% citronella compound provided 84% protection over 4 minutes, versus a 14% DEET solution that gave 96% protection.  Another study has confirmed that the same 5% citronella offered 88% protection over a 2 hour period.  Generally, citronella will require more frequent applications for decent protection.  Avon skin-so-soft is another consideration for those looking to avoid DEET.  Several studies have shown a mere 30 minute protection time, roughly 10 times less than DEET. Citronella candles and incense have been proven to deter mosquitoes in backyards, porches and rooms.  Investigations have shown a 42% reduction in bites from those nearby candles versus those who had no protection.

Oral mosquito repellents

This has been a “holy grail” for mosquito bite prevention, but no effective data has been shown.  Ingestion of certain foods has long been believed to act as bite deterrents, but has yet to be proven despite many attempts.  Mosquito attraction is a complex system involving multiple methods, other than simply sense of smell.  Garlic, onions bananas and even oral preparations of vitamin B have all been disproved. Mosquitoes carry disease that can, at the least, ruin a trip with unwanted illness.  Sever infections, carried by mosquitoes, can result in death.  Prevention of mosquito bites is a key feature of travel health and needs to be though of, well in advance of a trip.  Considerations in selecting an appropriate mosquito repellent include:

• How long do I need protection?  8 hours per day, for 2 weeks, or simply a few hours touring some archaeology sites?
• Availability of products, locally
• Transportation of your method (suitcase, carry-on, backpack) and the space it will require

Most importantly, the decision to use nothing is foolish.  A combination of 35% DEET skin spray and permethrin treated clothing is considered the most effective method.  People who used this combination method of protection showed a 99.9% protection over 8 hours.  This was in stark contrast to those who were unprotected and received an average of 1,188 bites per hour!  Another thing to remember is that it only takes one infected mosquito bite to make you sick!

Further Information:

• The Adventure Health Clinic

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7 Strategies For Staying In Touch

A lot of people don’t give much forethought to a strategy for ’staying in touch’ on their trip.  Often, all they can think about is leaving it behind! However, this can be a vital component to travelling safely, especially for solo travellers.  Consider what will give you peace of mind? And also what the folks at home expect.  Agree to a ‘keeping in touch’ plan with friends and family so that they know where you are and can raise the alarm if you don’t turn up as expected. (Of course, that then means YOU have to stick to the plan!).

Here’s a few ideas you could try…

1. Leave a paper-trail

   Leave a copy of your itinerary with the folks at home, including details of where and when they can contact you.  This works well if you’re the kind of person to plan out every detail of your holiday in advance or book a package tour.  But if you’re more like me and prefer to just arrive and see what happens next, this isn’t much use.

2. The electronic mail revolution

   On my first big trip to Europe in the early 90’s, I felt like a very dedicated daughter when I bought a postcard once a month and dutifully mailed it back home.  It gave my folks a sense of how much fun I was having and where I was – but unfortunately, it was totally out-of-date by the time it arrived in their Australian letterbox. Nowadays, you’d be mad not to use email for that purpose.  It’s quick to drop someone a short note, it arrives instantly and isn’t very expensive if you’re prudent with your internet access. There are loads of free email services available, all accessed via web browsers.   Try the usual travellers’favourites Hotmail, Yahoo and Google mail.

3. Text messages

   I umm and ahh about taking a mobile phone away on holidays…I don’t really want work-related phone calls waking me at three in the morning because I’m in a totally different time zone, but I do want the security of being able to call someone quickly in an emergency.  I think it’s about finding a balance that works for you…and your budget.  Don’t forget that international roaming charges can be huge!  If you’re a big mobile phone fan, look at buying sim-cards and pre-paid credit from local providers.  Usually texts are cheaper than phone calls.

   On a solo trip to Vietnam, I took my mobile phone ‘just in case’.  I wasn’t sure what ‘just in case’ really meant, but it gave me some peace of mind when I took off on some adventures. One of the best memories from that trip was the day I took my cyclo driver up on his offer to visit his family in the country for a day.  Naturally, this was not part of a scheduled tour and although I had spent time with him driving me around Hanoi for a few days, it was one of those calculated travel-risks that took a bit of guts to commit to.  Before we set off on a motorbike down Highway 1 (which is another story in itself and something I do not recommend at all!), I sent a quick text message to a close friend back home outlining the plan and saying that I’d send another text when I arrived back at the hostel that night.  I arrived slightly shaken from the crazy traffic and horns of the Highway to a peaceful rural village where chickens roamed and pigs lazed in front yards.  I shared a simple meal with his whole family on the floor of his one-room house.  My cyclo-driver could only afford to travel home every fortnight, maybe more often if a foreigner like me paid for the petrol, and I felt very privileged to see a side of Vietnam that was off the tourist trail.  Needless to say, I sent a quick text back home that night to say I was safe and sound.

   I know countless people who send these kinds of messages to contacts at home before they set off trekking, back-country camping or driving through remote areas like the Australian outback.  The important bit is to also send a follow up text at the appointed time so you don’t set alarm bells ringing.

4. Join the blog-o-sphere

   Setting up your own online travel journal has many, many benefits:

   • You can tell everyone about your adventures without sending ‘Look at me now’ mass-emails.
   • You can bring your trip to life through photos, stories, videos and organise the information through tags etc.
   • Its great to have a record of your amazing adventures when you’re finally back home – sadly, those beautiful tiny details do ebb away over time.
   • Importantly from a safety perspective, your folks back home can interact with you through leaving comments on your blog.  Trust me, your Mum will love this feature.
   • On most travel blog services (like ours on WorldNomads.com), you retain control of the copyright of your work…this isn’t always the case on social network sites and is worth checking out before you hand over your precious travel memories.

5. Social Networks

   It’s worth mentioning here just how important the explosion of social networking has been to the Modern Traveller.  A bit like blogging, you can now upload your stories, photos, links and videos.  Your buddies can email you, leave comments or even “poke” you virtually.  But best of all for travelling types is the ability to create and maintain a network of friends.

   Sites like Facebook really excel in this area – I have searched for – and found – several travel-buddies from years gone by. They were the ones I really clicked with, but their email addresses no longer worked and I felt they were lost to the ether forever.  The best thing is that they’re now in my friends list and will undoubtedly keep their own contact details up to date no matter where they are in the world.

   Even if all you can manage regularly is a brief status update (…the kind your desk-bound mates at home will wince at), at least it’s a form of staying in touch instantly.

   “Christy is drinking Daiquiris in Fiji… ”

6. Register with your department of Foreign Affairs

   You may also be able to register with the Department of Foreign Affairs (or equivalent) in your own country of residence.  This shouldn’t usurp your other efforts to stay in touch, but can greatly help with contacting you in an emergency.

   If you’re going to be in the same country for a while, it’s also good idea to register your whereabouts with your country’s consulate or embassy in that country.

7. Be prepared.

   To borrow from the Scouts for a moment, “be prepared”.  At the very least you’ll probably need to take email addresses and phone numbers of your family and close friends – even just so you can brag about your trip.  But importantly from a safety perspective, you should also take these numbers and records;

   • Your passport and visa details – travel with photocopies of the personal information page/s of your passport as well as photo copies of any visas. Take a couple of spare passport photos and an alternative photo ID as well.
   • Contact and policy details of your travel insurance provider.
   • Contact details of your country’s consulate in the countries you are visiting.
   • Contact details for the company that issued your travellers cheques and credit card/debit card (to cancel it if necessary), as well as a record of the cheque number and denomination of all of your travellers cheques.
   • Health care provider details, such as your regular doctor or pharmacist (if you are travelling with medication or required injections for your trip).
   • Details of your next of kin or the persons to contact in an emergency.

   It’s also a good idea to leave a hard copy of these with a friend or relative at home in case of emergency. And finally, email all these contact details and scans of your passport to yourself so you have them electronically too.

Once you’ve agreed with the folks back home on how, where and when you’ll contact them, stick to the plan so they don’t worry or raise the alarm unnecessarily. If you’ve got any other ideas on great ways to stay in touch or emergencies when your strategy has really had to swing into action, we’d love to hear about them below.

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Do I Need Travel Insurance?

Don’t leave home without it! Well, naturally we would say that!  But seriously folks, sitting here at WorldNomads.com we get first hand accounts of all the things that can – and do – go wrong on the road.  You can buffer yourself against the shock (and cost!) by taking out adequate travel insurance cover for your needs.

But don’t just take our word for it

Looking at some statistics for Australia (just because we have these on hand).

“Department of Foreign Affairs and Trade (DFAT) … handles over 16,000 cases each year involving the welfare of Australians who have suffered illness, theft, robbery or assault.”

This is triple the number of 20 years ago.  The Department of Foreign Affairs officially states

“If you can’t afford travel insurance, you can’t afford to travel” (read more…)

What does Travel Insurance cover?

Travel insurance protects you in the case of lost or stolen luggage and personal effects; accident or illness, trip cancellation or personal liability.

Probably the most important reason to take out travel insurance is to ensure you are covered for medical treatment. Although your national health scheme may cover your medical expenses at home, once you head overseas, you are (normally) no longer covered. Medical expenses can run into the hundreds of thousands of dollars and you may be refused treatment if you are not insured.

“Ten days in hospital with specialist care, including surgical clipping of an artery, followed by weeks of bed rest in Zurich. The patient’s parents were flown from Australia to Zurich to help her recover. Ongoing travel plans to the USA had to be cancelled.”
- True Claims Story: One Aneurysm and $73,000 later… !

A good insurance policy will also cover you for emergency evacuation back to your country of residence.

Make sure you take out a policy as soon as you pay for any flights or travel arrangements – that way you will be covered if you have to cancel your trip in an emergency.

“We received terrible news while we were traveling… My wife’s brother had passed away. We needed to return home immediately, to help with funeral arrangements”
- True Claims Story: Funeral

Read the Fine Print!

The best single piece of advice we can give is to READ THE POLICY WORDING CAREFULLY.

Let’s repeat that again: Take your time. Have a cup of tea. Sit down quietly and read the policy fine print. Especially the exclusions.

Not all policies are the same and it is essential you read the fine print to be sure you’re covered for the sort of travel you’ll be doing – and the places you’ll be going. In addition to covering hospital treatment and additional expenses (go for the top level if you’re traveling in North America); emergency medical evacuation; funeral expenses; emergency dental treatment; theft and loss of personal belongings, check the policy covers you for any adventure sports or other activities you might undertake, as well as all your gadgets such as cameras, laptops and ipods.

“The other man pulled out a knife and grabbed my wife, threatening to stab her if I didn’t release my bag Of course, I let go immediately but we were still really distressed to lose our expensive photographic equipment.”
- True Claims Story: He pulled out a knife…

Make sure you keep your policy up to date and that it provides a high enough level of cover. If you travel a lot, it may be worth taking out an annual policy. Check the level of excess you will be required to pay, and be sure to keep receipts (at home) for any gear you’re taking that might get stolen.

Sensible Sanchez’s Top Tip

A good rule to travel by is : Don’t take anything with you that you can’t bear to part with. And remember, it’s ok to be scared of new places and experiences – if you never leave home, you’ll never really live.  Travel Insurance is designed to give you peace of mind.  So, read the fine print, buy the policy that covers your needs and take note of the emergency assistance numbers.  And then, go!