Disaster in the Indian Ocean

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The earthquake off the island of Sumatra in December 2004 left its mark on 2005. The earthquake did its own damage, but the tsunami it generated did far worse, devastating lives and land for a thousand miles around. The wave continues to ripple in other ways, in terms of damaged health and lost tourism.

For those traveling to give help to the victims, or for travelers who may fall victim themselves, a little education is vital to prevent and treat disaster-related health issues now and in the future. Moreover, knowing about health and disasters removes fear and anxiety so we can all get right back to traveling.

Controlling outbreaks of disease

Those who live in the region suffered far more than tourists who could pack up and come home to advanced medical care. There have been plenty of news stories about the impending health crises that would follow, but many of the media reports gave a wrong impression of the diseases that occur with disasters. Corpses are not a major source of disease, and the hysteria of having to bury bodies immediately slowed down the primary issue of obtaining and distributing clean, safe water to everyone.

Furthermore, malaria was not the primary, immediate worry after this tragedy; diarrheal disease was. Typically after a disaster, people suffer from dysentery, typhoid, cholera and malnourishment as the sources of clean water disappear from the tremendous physical damage of a disaster. But relief efforts bringing in fresh water have blunted outbreaks of these ailments.

Malaria, in contrast, depends upon mosquitoes for transmission. They need fresh water (sometimes brackish, depending upon the species) for the larval stage of their development, and this takes several weeks. With malaria, mosquito abatement efforts went into overdrive in January when rains began, in order to prevent large-scale outbreaks of this dangerous disease. Malaria typically peaks during and just after monsoon season when there is standing water for the mosquitoes to lay their eggs.

Phuket, incidentally, is a malaria-free area. Sumatra, Sri Lanka and India suffer much more than Thailand from this all-important disease. But since Phuket is a tourist destination for Westerners, it got an unbalanced, biased coverage.

Malaria can be viewed as perhaps the single most important disease on this planet, but in the West it is ignored. Seven to eight times the number of those with HIV suffer from malaria, but you never hear of this, for political and economic reasons. Still, clean water, not mosquitoes, is the key to keeping disease at bay right after most disasters.

The World Health Organization and relief groups often do a great job after disasters. For example, there was an outbreak of measles after the tsunami: health care workers swarmed the area, vaccinating communities, and the potential epidemic was aborted.

It is wise to leave such relief efforts in the hands of those trained and prepared for this difficult task and not travel into the disaster area to help if you are not part of such a team. People with good intentions can drain critical local resources, get in the way and cause more harm than good. For those travelers who are on scene when the crisis occurs, however, much help can be provided until the relief organizations arrive.

Fending off infection

Whenever there is a disaster, simple measures significantly reduce the risk of taking ill. This applies just as well for those in California, where the threat of a large earthquake looms large.

The crux of good health is clean, safe water — for both drinking and washing. You should always wash your hands with soap and water that has been boiled or disinfected before preparing or eating food as well as after toilet use, not to mention after participating in disaster cleanup activities and after handling articles contaminated with flood water or sewage.

Soap and water are highly effective in reducing the risk of infection. If soap and water are not available, you can use alcohol-based products, like hand gels, as a substitute. Beware: overuse of these products can paradoxically remove the protective oils from your skin and make you more vulnerable. To reduce this risk, use a moisturizer or hand cream after rubbing your skin with these alcohol-based disinfectants.

Taking care of injuries and wounds is another important priority. All travelers should know basic first-aid principles for managing these problems, not only for themselves but for others as well.

Wounds must be cleaned and dressed promptly. You must remove any debris or particles in cuts, gashes or abrasions, wash thoroughly with soap and clean water and then place a clean and dry dressing over it. You don’t necessarily need to put antibiotic ointment in the wound and you don’t need to take antibiotic pills unless an infection develops.

Wounds also pose a risk for tetanus, which occurs when dirt or debris enters through the broken skin. There was an increase in the number of people infected with, and dying from, this infection in the tsunami-devastated part of Sumatra. There were also outbreaks of other infections, some rather unique, acquired from wounds and contact with soil.

A tetanus booster is essential if more than five to 10 years have passed since your last booster dose and you plan to travel abroad.

Procuring safe water

Assume water is contaminated, treat it with respect and do the right things to make it safe. Until your supply is tested and found safe, you should use boiled, bottled or treated water.

The most reliable and effective way to sterilize water is to boil it. The moment water comes to a roiling boil it is safe to drink. If you have iodine tablets, make sure they have a full 20 minutes to dissolve; if the water is cold, you must double that time. Do not use iodine for more than a week or so, as it can affect your thyroid gland. It also can pose a danger to developing babies in pregnant women.

Chlorine tablets are not as reliable, but in a pinch you can use household bleach (5.25% sodium hypochlorite): add 1/8 teaspoon (~0.75 ml) of bleach per gallon of water if the water is clear. For cloudy water, add 1/4 teaspoon (~1.50 ml) of bleach per gallon. Mix the solution thoroughly and let it stand for about 30 minutes before using it.

Only use safe water to brush your teeth and to wash and prepare food, wash your hands, make ice (or make baby formula) and wash dishes. Use the bleach solution to rinse water and food containers before reusing them.

If any refrigerated or frozen food sat at room temperature for more than a couple of hours, throw it out. Don’t eat any food that has any unusual odor, color or texture. If the power is out, leave the fridge closed: the temperature can stay cold enough to maintain safe food for a whole day if the refrigerator is not opened.

Taking precautions

Disasters don’t just affect people. Animals are also disturbed. Domestic animals may behave uncharacteristically, especially if their owners or homes are lost, and wild animals may enter human habitats. Treat them with care and keep your distance. Animals can transmit many diseases to people, and the worst of these is rabies.

Whether dealing with a disaster here at home or traveling to aid those suffering abroad, take precautions. Get appropriate vaccines in advance, carry a first-aid kit (and know how to use it!), learn how to avoid and manage travel-related illness and take essential gear.

Clothing for such work should include watertight boots (with steel toe and insole), protective heavy work gloves, goggles, earplugs and perhaps a hard hat. Wearing face masks will help keep dust and many germs from getting into your lungs. If you wear a filter mask, it should meet the minimum N-95 OSHA standard; these can be purchased at many pharmacies and hardware stores.

This tragedy hurt the local travel industry, even when it was already down. Thailand, whose two top income earners are tourism and poultry, may suffer the most, after having just gone through the bird flu outbreak. The domino effect of this earthquake may potentially lead to increased cases of avian influenza as the infrastructure to monitor and control disease weakens under the pressure of coping with the tsunami.

Travel is vital to help these people get back on their feet. The money tourists spend will help rehabilitate the region. If a traveler takes simple preparations, gets properly vaccinated and does not drain the local resources, then there is no reason not to travel to the Indian Ocean region. The consequences of a disaster are often unforeseen, but preparation beforehand can make a great difference in dealing with it when it comes. Unfortunately, people typically don’t think about this until it is too late. It could happen to us.

Healthy travels.

Dr. Spira is medical director of the Travel Medicine Center (131 N. Robertson Blvd., Beverly Hills, CA 90211; visit www.healthytravel.com).

Next month in this column — a discussion of Acute Mountain Sickness by Dr. Larry G. Baratta.

Please login or subscribe to ITN to read the entire post.

The earthquake off the island of Sumatra in December 2004 left its mark on 2005. The earthquake did its own damage, but the tsunami it generated did far worse, devastating lives and land for a thousand miles around. The wave continues to ripple in other ways, in terms of damaged health and lost tourism.

For those traveling to give help to the victims, or for travelers who may fall victim themselves, a little education is vital to prevent and treat disaster-related health issues now and in the future. Moreover, knowing about health and disasters removes fear and anxiety so we can all get right back to traveling.

Controlling outbreaks of disease

Those who live in the region suffered far more than tourists who could pack up and come home to advanced medical care. There have been plenty of news stories about the impending health crises that would follow, but many of the media reports gave a wrong impression of the diseases that occur with disasters. Corpses are not a major source of disease, and the hysteria of having to bury bodies immediately slowed down the primary issue of obtaining and distributing clean, safe water to everyone.

Furthermore, malaria was not the primary, immediate worry after this tragedy; diarrheal disease was. Typically after a disaster, people suffer from dysentery, typhoid, cholera and malnourishment as the sources of clean water disappear from the tremendous physical damage of a disaster. But relief efforts bringing in fresh water have blunted outbreaks of these ailments.

Malaria, in contrast, depends upon mosquitoes for transmission. They need fresh water (sometimes brackish, depending upon the species) for the larval stage of their development, and this takes several weeks. With malaria, mosquito abatement efforts went into overdrive in January when rains began, in order to prevent large-scale outbreaks of this dangerous disease. Malaria typically peaks during and just after monsoon season when there is standing water for the mosquitoes to lay their eggs.

Phuket, incidentally, is a malaria-free area. Sumatra, Sri Lanka and India suffer much more than Thailand from this all-important disease. But since Phuket is a tourist destination for Westerners, it got an unbalanced, biased coverage.

Malaria can be viewed as perhaps the single most important disease on this planet, but in the West it is ignored. Seven to eight times the number of those with HIV suffer from malaria, but you never hear of this, for political and economic reasons. Still, clean water, not mosquitoes, is the key to keeping disease at bay right after most disasters.

The World Health Organization and relief groups often do a great job after disasters. For example, there was an outbreak of measles after the tsunami: health care workers swarmed the area, vaccinating communities, and the potential epidemic was aborted.

It is wise to leave such relief efforts in the hands of those trained and prepared for this difficult task and not travel into the disaster area to help if you are not part of such a team. People with good intentions can drain critical local resources, get in the way and cause more harm than good. For those travelers who are on scene when the crisis occurs, however, much help can be provided until the relief organizations arrive.

Fending off infection

Whenever there is a disaster, simple measures significantly reduce the risk of taking ill. This applies just as well for those in California, where the threat of a large earthquake looms large.

The crux of good health is clean, safe water — for both drinking and washing. You should always wash your hands with soap and water that has been boiled or disinfected before preparing or eating food as well as after toilet use, not to mention after participating in disaster cleanup activities and after handling articles contaminated with flood water or sewage.

Soap and water are highly effective in reducing the risk of infection. If soap and water are not available, you can use alcohol-based products, like hand gels, as a substitute. Beware: overuse of these products can paradoxically remove the protective oils from your skin and make you more vulnerable. To reduce this risk, use a moisturizer or hand cream after rubbing your skin with these alcohol-based disinfectants.

Taking care of injuries and wounds is another important priority. All travelers should know basic first-aid principles for managing these problems, not only for themselves but for others as well.

Wounds must be cleaned and dressed promptly. You must remove any debris or particles in cuts, gashes or abrasions, wash thoroughly with soap and clean water and then place a clean and dry dressing over it. You don’t necessarily need to put antibiotic ointment in the wound and you don’t need to take antibiotic pills unless an infection develops.

Wounds also pose a risk for tetanus, which occurs when dirt or debris enters through the broken skin. There was an increase in the number of people infected with, and dying from, this infection in the tsunami-devastated part of Sumatra. There were also outbreaks of other infections, some rather unique, acquired from wounds and contact with soil.

A tetanus booster is essential if more than five to 10 years have passed since your last booster dose and you plan to travel abroad.

Procuring safe water

Assume water is contaminated, treat it with respect and do the right things to make it safe. Until your supply is tested and found safe, you should use boiled, bottled or treated water.

The most reliable and effective way to sterilize water is to boil it. The moment water comes to a roiling boil it is safe to drink. If you have iodine tablets, make sure they have a full 20 minutes to dissolve; if the water is cold, you must double that time. Do not use iodine for more than a week or so, as it can affect your thyroid gland. It also can pose a danger to developing babies in pregnant women.

Chlorine tablets are not as reliable, but in a pinch you can use household bleach (5.25% sodium hypochlorite): add 1/8 teaspoon (~0.75 ml) of bleach per gallon of water if the water is clear. For cloudy water, add 1/4 teaspoon (~1.50 ml) of bleach per gallon. Mix the solution thoroughly and let it stand for about 30 minutes before using it.

Only use safe water to brush your teeth and to wash and prepare food, wash your hands, make ice (or make baby formula) and wash dishes. Use the bleach solution to rinse water and food containers before reusing them.

If any refrigerated or frozen food sat at room temperature for more than a couple of hours, throw it out. Don’t eat any food that has any unusual odor, color or texture. If the power is out, leave the fridge closed: the temperature can stay cold enough to maintain safe food for a whole day if the refrigerator is not opened.

Taking precautions

Disasters don’t just affect people. Animals are also disturbed. Domestic animals may behave uncharacteristically, especially if their owners or homes are lost, and wild animals may enter human habitats. Treat them with care and keep your distance. Animals can transmit many diseases to people, and the worst of these is rabies.

Whether dealing with a disaster here at home or traveling to aid those suffering abroad, take precautions. Get appropriate vaccines in advance, carry a first-aid kit (and know how to use it!), learn how to avoid and manage travel-related illness and take essential gear.

Clothing for such work should include watertight boots (with steel toe and insole), protective heavy work gloves, goggles, earplugs and perhaps a hard hat. Wearing face masks will help keep dust and many germs from getting into your lungs. If you wear a filter mask, it should meet the minimum N-95 OSHA standard; these can be purchased at many pharmacies and hardware stores.

This tragedy hurt the local travel industry, even when it was already down. Thailand, whose two top income earners are tourism and poultry, may suffer the most, after having just gone through the bird flu outbreak. The domino effect of this earthquake may potentially lead to increased cases of avian influenza as the infrastructure to monitor and control disease weakens under the pressure of coping with the tsunami.

Travel is vital to help these people get back on their feet. The money tourists spend will help rehabilitate the region. If a traveler takes simple preparations, gets properly vaccinated and does not drain the local resources, then there is no reason not to travel to the Indian Ocean region. The consequences of a disaster are often unforeseen, but preparation beforehand can make a great difference in dealing with it when it comes. Unfortunately, people typically don’t think about this until it is too late. It could happen to us.

Healthy travels.

Dr. Spira is medical director of the Travel Medicine Center (131 N. Robertson Blvd., Beverly Hills, CA 90211; visit www.healthytravel.com).

Next month in this column — a discussion of Acute Mountain Sickness by Dr. Larry G. Baratta.