Let’s Talk with Dr Faraaz
This edition let’s talk about something that affects many of us – travelling. And specifically to South East Asia. This article, as with all of the ones that have gone by are designed to get you thinking, and not a replacement for good medical advice. If you do have any concerns of that nature then you should, as always speak to your doc!
Let’s take Pakistan for example. The sixth most populous country in the world with an estimated population of almost 200 million. It is a destination of choice for thousands of travellers from the United Kingdom each year with over 270, 000 visits annually. From all of those going to the country to visit family or friends, how many take the appropriate precautions? Do you?
The generic advice is that all people wishing to visit Pakistan should see their doctor up to 6 weeks prior to travel. This is because they may well need some injections, and some general advice on how to stay health-safe. Other than advising adequate health insurance, in Pakistan if medical assistance is needed, the advice is to dial 15 asking for an ambulance.
So before going to Pakistan, simple things need to be reviewed for example, are you immune to measles? It occurs worldwide, and it is common in countries such as Pakistan. Again, you might need a few injections before travel and these are designed to protect you. They aren’t an optional extra, just in case, but strongly advised so that you don’t fall ill. These may include diphtheria, hepatitis A, poliomyelitis, tetanus and typhoid. Do you ensure that you are up-to-date before travelling?
Now we come to the all-important anti-malarials. This is an interesting one. Some people I have spoken to say, ‘oh we don’t need anti-malarials. We have been in and out of Pakistan our entire lives.’ Does that constitute life-long immunity to malaria? Read on and find out. Just because one has been bitten 999 times and not got malaria, doesn’t mean that the hundredth bite will not be the one that harms.
So what is malaria? It is caused by a protozoa called Plasmodium. People get malaria when a female anopheline mosquito bites them. Plasmodium develops within the gut of the insect after the mosquito becomes infected following a blood meal. It develops inside its gut for 7-20 days, which then infect its salivary glands. The next time the mosquito takes a bite into human skin, your skin, they are ejected into the human and taken up by the liver. Here, they will multiply, and within days liver cells burst releasing them into the blood stream. They then enter red blood cells and multiply once more leading to red cells bursting.
Quite a dramatic process wouldn’t you say? Well malaria can cause anything from anaemia through to multi-organ dysfunction as it impairs micro-circulation. Cell rupture, toxin release and inflammatory reactions cause widespread problems and can be fatal. The next part is important and tackles what I mentioned earlier. People who for example grow up in Pakistan, may have developed partial immunity to malaria. That is not to say that they don’t get it, but that they can tolerate the parasite better than for example we can. However, if they leave that environment that immunity is lost. So to those who say they lived in Pakistan and they are immune to malaria is strictly untrue, and it could affect them just as it could affect someone who has lived in a non-malaria area all their life.
If you have been to Pakistan, or another area with high rates of malaria and feel unwell on your return, for example a have a high temperature, feel tired, vomit or have diarrhoea – then seek advice from your doctor. And most importantly, to try to avoid all these problems altogether, it is worth discussing taking an anti-malarial prior, during and after your travels with your doctor. These medicines can potentially reduce your risk by 90%!
Remember your other simple precautions as well. Things like covering up well, wearing sleeves and trousers, especially following sunset. And of course insect repellents and mosquito nets. All of these will reduce your risks further.
The bottom line is that malaria is a killer. It puts at risk almost half of the world’s population and kills around 438, 000 people every year. It can cause anaemia, diarrhoea, jaundice, low blood sugar, respiratory distress, multi-organ failure, seizures, coma and death. It is something to take seriously and hopefully before you book your next flight to Pakistan (or elsewhere) – this article helps you consider how you could reduce your risk of malaria.
One size does not fit all and if you are uncertain about anything you have read, speak to your practice nurse or doctor.
I hope this article leaves you with some searching questions, some of which only you have the answers to. Reflect and enjoy the journey! You can follow my Twitter feed on @Faraaz_Bhatti and let’s talk about important health issues. If you would like me to discuss any specific issue or get a conversation going then feel free to let me know.
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