It is expected that every cruising boat will carry a comprehensive medical kit to deal with a wide range of accidents and possible illnesses, as help at sea in an emergency is not always immediately available. Fortunately, infectious or contagious diseases are not a risk while at sea, but these become a hazard when ashore in many parts of the world.
The two greatest health hazards are mosquitos and unsafe drinking water or food. These can be guarded against in several ways. Malaria, yellow fever and dengue fever are among the diseases that are mosquito-borne. If cruising for any length of time in the tropics it is wise to have mosquito screens fitted over hatches or mosquito netting that can be rigged over bunks. One should keep as much of the body covered as possible at sunset and use insect repellants, knockdown sprays or burn coils.
Not all vaccinations give total protection against food and water-borne diseases, so one should be scrupulous about checking water supplies, treating the water where necessary or drinking bottled water in dubious areas. Also one should avoid raw vegetables, salads, unpeeled fruit, raw shellfish, ice cream, cream and ice cubes in drinks in risk areas unless these have been thoroughly washed or prepared by oneself.
It is highly recommended that supplies of sterilised and sealed items such as syringes, needles, sutures, dressings and infusion cannulae are carried. These sterile packs are widely available in kits for travellers and can be given to medical staff if seeking treatment abroad where properly sterilised or disposable equipment is not used or available. This is a precaution to be taken for all countries where there is a risk of Hepatitis B or AIDS from contaminated equipment, blood or blood products. If an accident or emergency needs a blood transfusion in countries where donated blood is not screened or checked properly, it is advisable to contact one’s embassy or consulate, as some of them keep a disease-free donor list in certain countries.
Many countries give reciprocal free treatment in an emergency, but this is only on the same terms as that received by nationals of the foreign country concerned. This usually applies to state health-care systems, which leave much to be desired in some countries. For members of the EU, there is a special form (in the UK-Form E111 obtainable from post offices, for more information visit http://www.doh.gov.uk/traveladvice/index.htm [BROKEN LINK] ), which entitles the person to emergency medical care throughout the EU. The procedure varies from country to country and details are given on the form. For anyone cruising extensively, it is highly recommended that a worldwide medical insurance is taken out to cover any treatment required, especially if sailing to countries where medical care is expensive, such as the USA, Canada or Australia. This insurance will also often provide for an ill person to be flown home for treatment, which is a wise option to take if the emergency occurs in a country with poor medical facilities.
Sufficient time before departure should be allowed for any vaccinations, as some cannot be given at the same time as others. Details on vaccinations required and precautions against specific diseases are summarised next.
AIDS
The Acquired Immune Deficiency Syndrome, commonly called AIDS, is caused by a virus called HIV. Not everyone infected with the HIV virus develops the disease, although they are likely to remain infected and infectious for much of their lives. There is no way to tell if a person is infected without taking an HIV positive test. A few countries have started asking for an HIV test certificate for visitors coming from certain countries where it is prevalent such as East Africa.
The disease is present worldwide, but in certain countries such as Haiti and East Africa, the disease is endemic in the general population. The two main ways of catching the AIDS virus is sexual contact or through contaminated blood getting into the body via a transfusion, injection or poorly sterilised medical equipment. The virus cannot be caught by everyday contact, crockery, food, swimming pools or mosquito bites. The obvious precautions are to avoid casual sexual contacts and to use a condom. One should carry sterile medical supplies for emergencies when one may require an injection. One should also avoid medical or dental treatment involving surgery in countries where there is a risk. In many less developed countries, blood for transfusion is not properly screened or treated, but there may be ways of obtaining screened blood if the doctor is asked or diplomatic missions are contacted.
Hepatitis B
This is transmitted in a similar way to AIDS, by contact with an infected person or through infected blood or needles. Hepatitis B is found worldwide. There is a vaccination which gives protection, but the course takes up to six months to come to full protection. Three injections are given at 0,1 and 6 months. The best precautions are as those described above for AIDS.
Hepatitis A
This is sometimes called infectious hepatitis and is caught from contaminated food or water and is prevalent in most parts of the world where there is poor sanitation and hygiene. A vaccine, Havrix, is now available, and although expensive, the full course of two injections at a 6 months interval of gives protection for ten years, ideal for long term cruising worldwide. The immunoglobulin injection (HNIG) containing antibodies to Hepatitis A gives protection for six weeks and is an alternative for short visits to vulnerable areas. Otherwise, the main precaution is to take scrupulous care over what one eats and drinks as outlined above.
Tetanus
This dangerous disease is found everywhere in the world and results from the tetanus spores entering the body via even a slight scratch or wound. This can easily happen on any dockside, so it is essential that everyone cruising keeps their tetanus vaccination up to date. Fortunately, this vaccination is safe and very effective and if one had a full course as a child, as most people have, a booster is only necessary every ten years. If one has failed to keep this up to date and tetanus – commonly called lockjaw – develops, it can be treated if the patient is got to proper medical facilities immediately. These may not be available in more remote areas.
Tuberculosis
This disease is on the increase again in certain areas of Africa, Asia, Central and South America. If one has been vaccinated against tuberculosis in the past, revaccination is not necessary. Vaccination is only necessary if living or working closely with the indigenous population in these areas. It is unlikely that any cruising sailors would need this vaccination.
Smallpox
This disease has been eradicated worldwide and vaccination against it is no longer necessary.
Measles
Persons born after 1957 should consider a second dose of measles vaccine before travelling abroad.
Typhoid
Typhoid is found almost everywhere except Australia, New Zealand, Europe and North America and it is found especially in conditions of poor hygiene and sanitation. It is caught from contaminated food, water or milk. Sensible precautions are to take care over food and drink, but vaccination against typhoid is recommended for all those sailing outside of the above-mentioned areas. There are now two types of typhoid vaccine: Typhoid VI antigen, a single dose vaccine giving protection for two years; and Typhoid TY21A, a live vaccine taken orally as capsules in four doses on alternate days, giving protection for five years.
Poliomyelitis
This disease is found everywhere except Australia, New Zealand, Europe and North America. Anyone cruising outside of these areas should ensure that their vaccination against polio is kept up to date. To commence vaccination, a course of three doses of oral vaccine are given, normally when one is a child. Reinforcing doses should be taken every ten years to continue protection against polio. Polio is transmitted by direct contact with an infected person and sometimes by contaminated water or food.
An extra booster dose of the vaccine should be received by persons over 18 years travelling to Africa, East and SE Asia, the Middle East, the Indian subcontinent and all countries of the former Soviet Union.
Meningococcal Meningitis
This serious disease, which is transmitted by direct contact or droplet infection, has had a rising incidence worldwide. There is a particularly high risk in the meningitis belt, which lies across sub-Saharan Africa and includes Senegal, Gambia and Ivory Coast on the west coast and Sudan, Ethiopia and Kenya on the east coast. There is a season for this disease, from November to May, and pilgrims have taken it to Saudi Arabia during the annual Hadj pilgrimage. Vaccination against meningococcal infection is available for meningitis A and C and this gives protection for three years.
Cholera
Cholera is found in some parts of Africa, Asia, South America and the Middle East and especially in areas of primitive sanitation. The disease is transmitted through contaminated water and food. The cholera vaccine used in the past never worked well and is no longer recommended. For this reason, it is not included in the checklist. Scrupulous hygiene is paramount in endemic areas.
Yellow Fever
This disease is only found in some parts of Africa and South America. It is transmitted by the bite of an infected mosquito. Vaccination against yellow fever gives protection for ten years. Vaccination can only be carried out at designated centres, a list of which can be obtained from health authorities, travel agents or one’s own doctor. Although yellow fever is found mainly in tropical forest areas and sailors are unlikely to encounter it, the vaccination is compulsory for travel to some countries, even if only visiting the coast or main ports. A vaccination certificate may be required also in subsequent ports if arriving from countries where yellow fever is present. If not possessing a certificate, one may have to be vaccinated on the spot, another reason for carrying those sterile needles and syringes.
Malaria
This is one of the biggest health risks that may be encountered by cruising sailors and some forms of malaria are particularly virulent and can even be fatal. Malaria is prevalent in many parts of Africa, Asia, Central and South America and the western Pacific. The disease is transmitted by mosquitos, so the first precaution is to avoid getting bitten, as outlined earlier.
Prophylactic treatment is available and anti-malarial tablets should be taken two weeks before entering a malarial area, throughout one’s stay and for four weeks after departure. The problem has increased because some strains of malaria have become resistant to the drugs in use and therefore different tablets are recommended for particular areas. Although anti-malarial tablets are available over the counter in pharmacies it is wise to check with a doctor or a centre for tropical diseases which are the recommended drugs and doses. The tablets are usually taken once a week and it is essential to take them after food. Children take a dose proportionate to their weight. Advice on malaria prophylaxis changes frequently and no regimen is 100 per cent protective, so it is essential to seek up-to-date advice if cruising in an endemic area. Pregnant women and small children are especially at risk as they have a lower resistance to the disease.
Advice should be sought as some drugs are not suitable for pregnant women, or folic acid supplements should be taken. Those suffering from epilepsy or psoriasis should also seek advice about which prophylactic treatment to take.
Areas particularly important for cruising sailors to take precautions in are Vanuatu, the Solomons and Papua New Guinea in the western Pacific, Guyana, French Guiana in South America, Indonesia, Philippines in South East Asia, and Sri Lanka, Comoros, Mauritius and East Africa in the Indian Ocean.
There is now an immuno-diagnostic kit which can confirm whether or not one has contracted falciparum malaria. The test kit (which needs to be refrigerated) is available from various sources, such as TMVC (Travellers Medical and Vaccination Centre [BROKEN LINK]) in Australia. TMVC has a highly informative website dealing with an entire range of tropical and infectious diseases.
Rabies
Rabies is endemic virtually worldwide and is usually fatal if not treated immediately, hence the precautions against admitting animals exercised by many island nations which are rabies-free. The disease can be caught if one is bitten, scratched or even licked by an infected animal such as a dog, cat or monkey. Therefore one should not approach or touch any unknown animal. If one is bitten or scratched by an animal one should wash and disinfect the wound thoroughly and get to medical attention fast. There is a rabies vaccination, which is a course of quite unpleasant injections, which should be started immediately. It is not normally recommended to be vaccinated beforehand against rabies unless one is travelling across the country in remote parts where treatment is not available. If bitten, one should try and keep the animal under observation or if it is wild or a stray, note the place, description and date of the attack and inform the local police.
Bilharzia
This is also called schistosomiasis and is a deadly disease caught from parasites which have a secondary host in minute snails found in freshwater. Swimming in freshwater lakes or streams should be avoided in much of South America, Africa, Asia and the Caribbean. Bilharzia cannot be caught from swimming in the sea or saltwater estuaries.
Diphtheria
Thought to have been eliminated through an extensive immunisation programme, an upsurge in diphtheria in the countries of the former Soviet Union is giving some cause for concern. Low dose of children?s diphtheria vaccine is recommended for travellers to Romania, Ukraine and Russia (especially St Petersburg and Moscow).
Japanese B Encephalitis
This rare, but often fatal, insect-borne infection is found in Asia from India and Sri Lanka throughout South East Asia as far as Japan and the Philippines, including Indonesia. Vaccination is effective for two years and is available on a named patient basis. It is recommended for stays of more than one month in rural areas during the period June to September.
Ciguatera
This fish poisoning is caught by eating toxic fish from certain reef areas. Local knowledge should be sought whether fish from a certain coral reef area or island are likely to be affected. Fish caught by trolling in the open ocean are not likely to be toxic. One should avoid large fish such as barracuda caught in reef areas and one should avoid repeated meals from such fish as the toxin is cumulative. Fish should always be gutted very carefully and the head, roe or internal organs never eaten.
There is now a test capable of identifying the presence of ciguatoxin in fish flesh. When used properly, Cigua-Check (TM) will test ciguatoxin at levels generally below the level that can cause clinical symptoms in humans. The test kit is available from the Ciguatera Hotline in Hawaii (Tel. 808-539-2345, http://www.cigua.com ).
Reefwalking and Diving Hazards
Many of these hazards can be avoided by wearing footwear when walking on reefs and by looking carefully before touching anything while diving or reefwalking.
The stone fish is an ugly animal looking just like a stone which gives a poisonous sting if stepped on. If stung, one should keep fairly immobile to delay the spread of poison, flush the puncture with vinegar and put the foot in hot water. Wrap a bandage immediately above the wound and seek medical assistance.
Cone shells have a dart which they launch in defence and in a few species this can be deadly. One should avoid picking up live cone shells, but if one is stung, one should treat it like snake venom and seek medical advice.
If stung by the jellyfish called Portuguese Man-of-War, it is important not to rub the sting, but detoxify it with alcohol of some sort? spirits such as rum will do or even perfume. The sting then should be rinsed gently with warm water.
Jellyfish stings should similarly be bathed with vinegar and hot water. If sea urchin spikes are trod on or got into the flesh, one must try to remove all the spikes, sucking them out if necessary. Again soak in hot water and treat with antibiotic cream or powder. If you are unable to pull out the spikes, which is often the case, especially with black urchins, you can dissolve them by putting meat tenderiser on the wound for at least 24 hours, or alternatively, a piece of papaya fruit. For all coral cuts, bites and rashes obtained from marine life, one should wash well with hot water and disinfect to prevent infection.
The Sun
This is one of the most serious dangers encountered by sailors and the power of the sun should never be underestimated. Sunburn should be avoided by using sunscreens on exposed skin, covering the head and body until a tan has been acquired. The eyes are particularly vulnerable and should be protected by good sunglasses. When at anchor it is recommended to rig up some kind of cockpit awning.
Not only can the sunburn one’s skin painfully, but it can cause the body to overheat. When sailing in very hot climates, particularly in equatorial regions or in the Red Sea, one should drink plenty of non-alcoholic fluids and also slightly increase one’s salt intake to counteract salt loss through sweating.
Heat exhaustion
In very hot temperatures, any fatigue, dizziness, headache or muscle cramps should be taken seriously. The person should be cooled by sponging with tepid water or with a fan and given salt and fruit juice or a sugar solution (1 teaspoonful of salt and 4 of sugar to 1 litre of water).
Heat stroke
This is characterised by a sudden dramatic rise in temperature, lack of sweat and odd behaviour. Plenty of water should be given and the skin cooled with water and fans. Medical help will be needed, especially if the person loses consciousness.
Skin cancer
Whilst the above are immediate problems, one of the most serious problems caused by the sun is long term and that is the danger of skin cancer. This is caused by prolonged exposure to the sun and may not show up for many years, but it has afflicted many cruising sailors. The risk of developing skin cancer increases as people grow older, but it is important to prevent overexposure to the sun in children and young people as this is a cumulative risk.
Chronic exposure to the sun is the main cause of skin cancer and the carcinomas usually appear on exposed parts of the body, such as face, scalp, hands, arms and legs. The people at highest risk are those spending long periods outdoors and particularly those with fair skin, light-coloured hair and light coloured eyes, such as blue, green or grey. Also more at risk are those who sunburn easily and tan with difficulty. The geographical location is also a factor and the nearer to the equator, the higher the number of cases reported in fair-skinned people.
Ninety per cent of all skin cancers are curable, especially if detected early. Medical advice should be sought for any unusual or persistent change in the skin, whether growth or discolouration or change in size, colour, shape or thickness of any pre-existing moles. Although the incidence of skin cancer has increased and the death rate in the USA has doubled in the last 35 years, in Queensland in Australia, where a public education programme had been established, the death rate has been decreasing despite an increase in the number of cases reported. The increase in incidence is partly due to people living longer and also pursuing a more active outdoor life into their old age. Prevention is the most important factor and so one should avoid prolonged exposure, use sunscreens and cover exposed areas.
Health on the internet
Health matters are more widely covered on the internet than almost anything else and there are several sites that are worth visiting. Two stand out as they have direct relevance to anyone sailing to out-of-the-way places.
Highly recommended is TMVC (Travellers Medical and Vaccination Centre). TMVC runs a highly informative website dealing with an entire range of tropical and infectious diseases – https://tmvc.com/
Equally informative and regularly updated is the website of the US-based Center for Disease Control and Prevention – www.cdc.gov/travel.
