 Executive Summary · Be self-sufficient in health matters, to avoid adding to the problem. Access to local medical supplies and hospital care will be limited. · The most immediate disease risks are from contaminated food and water · The risks from diseases spread by insects including malaria and dengue fever will grow · A massive public health effort is being mobilised, but the above disease risks are present anyway in the region, even under ideal conditions · Do not be distracted from basic precautions, such as road safety and the need to avoid unnecessary risks
Preparation and self-sufficiency
Medical resources in the affected regions are already overwhelmed. It is vital to be well-prepared and fully supplied with basic medicines and personal protective measures, to avoid diverting essential local services from the enormous task in hand.
VACCINATION – nobody should travel to the region unless they’ve already been well protected, but any missing vaccines would be worthwhile having right up to the last moment – especially against hepatitis A, typhoid, tetanus, diphtheria and polio. Cholera, rabies, hepatitis B, flu and possibly meningitis might also be worthwhile.
MEDICAL SUPPLIES – should include as a minimum: first aid supplies for minor injuries, a sterile needle kit, insect repellents, mosquito nets, antimalarials where appropriate (see below), water purification supplies, alcohol handwash gel or antiseptic handwipes, oral rehydration solution, antidiarrhoeal medication, antibiotics, painkillers, facemasks, and sunscreen. Ensure personal medicines are taken in adequate quantities (at least half as much again as you think you need).
OTHER SUPPLIES – for travel to the worst affected locations, carry your own canned or packaged food and bring your own supply of water. Also consider carrying your own cutlery, pocket knife, disposable chopsticks, and drinking straws.
TRAUMA PACKS – for travel to Aceh, Northern Sri Lanka, and any other trouble spots past or present, there may be a risk from landmines, and a real possibility that these have shifted in the floods. Carry individual or group trauma packs including field dressings and QuickClot.
Food & water-borne infection
Local fresh water supplies and reserves are now heavily contaminated with salt water, sewage or both. Water for drinking, washing and safe food preparation is scarce, and an increase in diarrhoeal diseases has already been reported. Possible disease risks include diarrhoea, dysentery, cholera, giardia and parasitic infestations.
All drinking water should come from a safe bottled source, or should be boiled or treated with iodine. Carbonated bottled water is safest. Ice should be considered extremely risky (if present at all) and should not be consumed. Coconut water is a reliable and widely available safe source.
Hands should be cleansed carefully before handling food. All food should come from packages or cans, or should be freshly and thoroughly cooked and served piping hot.
Since disaster zones are not known for their gastronomy, maximum food hygiene precautions should be observed at all times.
Under extreme conditions (and if there is a very high rate of diarrhoeal illness among those around you) it may become advisable to use antibiotics on a prophylactic basis to avoid infection. Certain individuals with gastro-intestinal problems (e.g. patients on acid suppressants and those with Crohns disease) should be prepared to take prophylactic antibiotics earlier.
Insect-borne disease
Countries in the region with a risk of malaria include: Indonesia, Sri Lanka, India, Myanmar. There is not normally a risk of malaria in southern Thailand though the situation there will need to be carefully monitored.
There is a risk of dengue and other mosquito-borne viruses throughout the region.The risk of dengue fever may increase considerably if rain falls on the accumulated debris.
Careful anti-mosquito measures should be observed at all times, including: mosquito repellents both in daytime and night-time; mosquito nets at night; covering up; using mosquito coils when sitting outdoors; using an insecticide room spray or an electric mosquito-killer in your room at night.
Malaria medication may be appropriate; remember that visitors are at greater risk of severe illness than local people who may have some previous partial immunity. Suitable drugs for the entire region would be doxycycline, Malarone or Lariam; for India, Sri Lanka, and possibly Indonesia, chloroquine + Paludrine could be considered.
General safety
Access to good medical care in an emergency is likely to be much reduced, so be on maximum alert regarding every aspect of your own safety. This is especially important on the roads, when entering damaged buildings. If visiting trouble spots, do not allow scenes of devastation to lower your guard.
Psychological aspects
Do not underestimate the psychological impact of providing news coverage of a natural disaster. Our brains are simply not programmed to cope human tragedy at close up range and on such a scale. Do not be reluctant to seek help on return home, or to leave early if you are finding things difficult. Help is widely available, and experience with coverage of other disasters shows that many people need it and can benefit from it.
Support
The Fleet Street Clinic will do all it can to support journalists travelling to the region. We will respond to requests for medical advice by telephone or email. We have discounted arrangements for freelancers working independently, who need vaccines or supplies. We have ready-made medical packs and a good supply of vaccines available for any journalists who wish to come and see us before deployment, which is the most sensible option. We can also help anyone returning to the UK who is suffering from symptoms; we can carry out post-tropical checks, and offer or arrange psychological support. More resources can be found on the Fleet Street Clinic website : |