Diseases can be caught from drinking contaminated water (or swimming in it).  Drinking water is rarely a problem within EU countries as in theory all drinking water supplies should conform to EU standards.  However even within the EU unless you KNOW the water supply is safe where you are staying, only use:

• Boiled water
• Bottled water
• Canned drinks (and drink them from the original container)
• Water treated by a sterilising agent.  You can buy water purification tablets from the pharmacy

This advice also applies to ice cubes in drinks and water for cleaning your teeth.

Some parasitic infections e.g. shistosomiasis, can be caught from swimming in freshwater lakes and streams, particularly in Africa, South America and some parts of the Caribbean.  Other diseases can be caught from sand and soil, particularly wet soil.

• It is safer to swim in water that is well chlorinated.
• Avoid swimming in freshwater, particularly in these areas
• Avoid going barefoot.  Wear protective footwear when out, even on the beach

Contaminated food is a common source of many diseases abroad.

• Only eat well cooked fresh food
• Avoid leftovers and reheated foods
• Ensure meat is thoroughly cooked
• Eat cooked vegetables, avoid salads
• Only eat fruit you can peel
• Never drink unpasteurised milk
• Avoid ice-cream and shellfish
• Avoid buying food from street vendors’ stalls unless it is thoroughly cooked in front of you

Remember if you drink alcohol to excess, you may become carefree and ignore these precautions.

Many diseases are transmitted by what is known as the 'faecal-oral' route.   

These include traveller’s diarrhoea.  To help prevent this and other illnesses, always wash your hands with soap and clean water after going to the toilet, before eating and before handling food.

These diseases can be transmitted by:
 

• Sharing of needles (e.g. tattooing, body piercing, acupuncture and drug misuse)
• Sexual contact
• Medical procedures with non sterile equipment
• Blood transfusion

Consider the following to help prevent these diseases:

• Only accept a blood transfusion when essential
• If travelling to a developing country, take a sterile medical kit
• Avoid procedures e.g. ear, body piercing, tattooing and acupuncture
• Avoid sexual contacts, especially without using a condom.  See below.

Medical students on electives may have many new and sometimes distressing experiences, including helplessness and frustration witnessing preventable deaths.  You may experience significant culture shock and have difficulty adjusting on your return to the UK.  It is important to prepare for this and also to ask for help from peers, colleagues, counselling services or the doctor if needed.

Leading causes of death in travellers are drowning and traffic accidents. 

• Avoid alcohol and food 1 hour before swimming
• Never dive into water where the depth is uncertain
• Only swim in safe water.  Check for currents, sharks, jellyfish etc
  
  
• Avoid alcohol when driving, especially at night
• Avoid hiring motorcycles and mopeds
• If hiring a car, rent a large one if possible.  Ensure the tyres, brakes and seat belts are in good condition
• Use reliable taxi firms
• Know where emergency facilities are

 
To reduce the risk of Deep Vein Thrombosis it is sensible on any long haul flight to:

• Be comfortable in your seat
• Exercise your legs, feet and toes every half an hour or so.  Take short walks whenever feasible.  Upper body and breathing exercises can further improve circulation
• Drink plenty of water
• Be sensible about alcohol intake which in excess leads to dehydration

Having unprotected sex puts you at risk of many different sexually transmitted infections (STIs), including Chlamydia and HIV, regardless of whether or not you are on holiday.  Some infections e.g. HIV are much more common in some parts of the world than they are in the UK, particularly in some groups of the population e.g. sex workers.  Indeed some infections are common in some parts of the world but rarely seen or talked about in the UK.  There have been many examples of outbreaks of STIs both in the UK and abroad which have been due to travellers having unprotected sex.

The best strategy is always avoidance, but if you are considering having sex abroad, it is particularly important to:

• Consider whether you would choose to have sex with this person if you were not on holiday.  How will you feel on your return?
• Remember that it is difficult to be sure of someone’s sexual history, especially if you have just met them
• Bare in mind it is difficult to talk about safer sex and condom use, especially if there is a language barrier
• Remember that the other person’s knowledge and views about sexual relationships, STIs and safer sex may be very different from yours
• Be aware that alcohol clouds your judgement about individuals and about what risk you are prepared to take
• Always use a condom
  
  

 
Be sure to check for the British Kite Mark.

In the UK condoms carry the British Kite Mark to prove they have met strict quality standards but elsewhere there may not be such a requirement, or the standards may not be so high.  It is always best to take some condoms with you, even if you do not plan to have sex with anyone whilst abroad.

Travel Abroad Section continued on Page 2