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..  click here for 1 page pdf ... see also consular advice
    www.smartraveller.gov.au/zw-cgi/view/Advice/Indonesia  & www.bali.indonesia.embassy.gov.au/

BALI RESORTS 

Bali is probably the most popular overseas travel destination for Australians of all ages. Studies have shown that illness occurs in between 15 - 55% of all travellers with 11% requiring to see a doctor whilst away.

The phrase “Travel broadens the mind and loosens the bowels.” is apt but it should also be remembered that less common serious diseases do occur, which can completely ruin ones holiday and even be life threatening.   Remember that ultimately your health is your responsibility.

Many coastal resorts such as Kutu and large hotels have a high standard of sanitation and safe water supply but remember most people working in them and handling the food do not.

Travellers Diarrhoea

Most episodes of diarrhoea are short-lived and require no particular treatment The need to treat diarrhoea depends on either its severity or persistence. Transmission is mostly via contaminated food or water. Interestingly the use of oral cholera vaccine (Dukoral) will reduce the incidence of common travellers diarrhoea by 60-70%. The WHO have a good pamphlet  copy

  • Choose food which is freshly and thoroughly cooked and served stemming hot

  • Eat fruit or vegetables that you can peel or cut open yourself, eg. banana, citrus fruits, papaya.

  • Dry foods and Breads are generally safe.

  • Canned and bottled drinks are safe.

Dangers

  • Avoid milk, ice cream and other milk products unless made with pasteurised (or boiled) milk.

  • Avoid sauces, mousses, mayonnaise.

  • Avoid smorgasbord even in 5 star restaurants (reheated foods & food sitting at room temperature)

  • Avoid prawns, oysters, fish, unless thoroughly cooked.

  • Avoid uncooked leafy vegetables, eg. in salads.

  • Ice is only as safe as the water it is made from.

Treatment
Because diarrhoea is so common it is important to be aware of how to manage it if prevention fails.

Fluids
Most travellers do not develop dehydrating diarrhoea; almost any beverage coupled with a source of salt (eg., salted crackers) suffices for hydrating most ill travellers Bottled or canned beverages, tea, broth, foods such as rice, bananas, papaya (papaw), potatoes and dry biscuits are tolerated best.

Management of Diarrhoea

  •  Antimotility drugs (‘stoppers’).  Since most diarrhoeal illnesses last only a few days, these drugs may be very helpful in relieving diarrhoea and cramps. Do not use if high fever or blood in motions. Do not use in children under 6, and be cautious in children under 12.  Adult Dosage: loperamide (Imodium) -2 capsules (each 2 mg) followed by 1 cap after each unformed stool. (maximum 8 caps per day.)

  • Antibiotics. Diarrhoea with high fever, distressing symptoms or blood in motions; A single dose of two tablets of any of the following drugs should be effective.    If response is not dramatic after 12 hours continue 1 tab twice a day for a further 3 days. (Ciprofloxacin 500mg, norfloxacin 400mg, doxycycline 100mg, Co-trimoxazole.)

  • Prolonged diarrhoea without fever . A bowel parasite “giardiasis” is the commonest cause. The best treatment is tinidasole (Fasigyn) - 4 x 500mg tablets (2g) in a single dose.

  • Prolonged diarrhoea with fever .Seek medical help.

Children with diarrhoea are of special concern. The younger the child, the more rapidly dehydration can occur. A child’s fluid loss is best replaced with an oral rehydration solution (ORS) such as Gastrolyte.  Adults travelling with young children should carry ORS sachets with them. If ORS is not available, use one of the following:

  • Lemonade (not low calorie) - 1 part lemonade to 4 parts of boiled water.

  • Fruit juices (not concentrated) - 1 part fruit juice to 4 parts of boiled water.

Malaria

Resort, Urban Areas & Day trips Minimal risk and antimalarial drugs not recommended. The use of insect repellents is recommended, as this will also minimise the risk of other diseases from bites such as Dengue.

Inland Forested areas  The benign vivax form of malaria exists and is sensitive to Chloroquine.

Dengue is a viral disease producing Severe headache, bone & muscle pain, high fever and rash usually occur 4-6 days after an infected bite.

Rabies: Bali was Rabies up until August 2008
(illness is 100% fatal to humans) mostly acquired from dogs, cats & monkeys (even minor scratch, graze or lick). Incubation period 10 days to 10 years
Rabies risk management:
You should wash the wound immediately with soap and water and disinfect with iodine (betadine). Seek medical
attention if risk seems high. (unprovoked attack, irritable animal) and have post-exposure vaccine as soon as
possible (preferably within 48 hours). Otherwise at least seek medical advice on return. see Vic gov reference

Other Considerations

Medical Kit: Panadol, sunscreens, sunburn cream, antihistamines, antiseptic (Betadine), antifungal (tinea and thrush), diarrhoea medications (antibiotic, gastrolyte if taking children), bandages and dressings, condoms.

Heat and Humidity: Plenty of drinks rich in mineral salts (fruit and vegetable juices, clear soups and even a little table salt) are recommended. Daily showering, loose cotton clothing and talcum powder will reduce heat rash. Risk of severe sunburn needs consideration.

Shoewear: Shoes should be examined before use - as snakes tend to rest in them. ... Leather goods made from inadequately treated skins may contain anthrax spores causing life threatening skin sores.

Accident Prevention: Traffic accidents are a leading cause of accidents among travellers. Vehicles are often unroadworthy. Unfamiliarity with roads, poor condition of roads and drunk drivers add to the dangers. Kuta beach in Bali is considered a dangerous beach for swimming and on average 6 tourists drown each year.

Travel Insurance: Travel insurance should cover not only medical & hospital expenses but also costs due to general accidents, medical evacuation, loss of luggage & money, as well as delays due to strikes.

Medical Examination after travel: It is advisable (if not essential) to visit your local doctor promptly if you

  • suffer from a chronic disease, such as cardiovascular disease, diabetes mellitus, chronic respiratory disease;
  • experience illness in the weeks following their return home, particularly if fever, persistent diarrhoea, vomiting, jaundice, urinary disorders, skin disease or genital infection occurs;
  • consider that you may have been exposed to a serious infectious disease while travelling;
  • have spent more than 3 months in a developing country.

Source: WHO - http://whqlibdoc.who.int/publications/2005/9241580364_chap1.pdf  (page 8)

Information mostly taken from: "International Travel and Health" (WHO year book - internet only)
Australian Immunisation Handbook, 8th Edition - 9/2003 - Part1 - Part 2 & Part 3 (large pdf files)
Centre for Disease Control, USA -  www.cdc.gov/travel Travel Health Seminar Oct 96, June 97,Feb 98, March 99, May 2000, August 2002 & March 2005 - Victorian Medical Postgraduate Foundation.
Manual of Travel Medicine, Melbourne, Oct 2004. Updated 3rd edition 2011.  Additional references & disclaimer.

 

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North East Valley Division General Practice, Victoria, Australia, Disclaimer 
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