Q: My daughter, who is 28, has fainted on the last two occasions when travelling long haul. She has been revived with oxygen by cabin crew. She is travelling in December to South Africa and will be travelling alone. Can you recommend any procedures that would minimise this risk, and also explain why this problem occurs?
Lyn Jones
Dr Jules Eden answers: Your daughter needs to see her GP before she flies again. When a plane cruises at high altitude, there is a lower cabin pressure. Even though this is increased to a pressure well above the outside air at that height, it is never the same as at sea level. Because of this, the oxygen concentration is lower. In most passengers this is fine, but if she has a reduced capacity to carry the oxygen available, this could lead to fainting. She needs a full blood count to look for any anaemia and her haematocrit, too. These are indices of how many red cells (the ones that carry oxygen to the tissues) she has and if low it would explain the faints. If these are normal, then she needs to drink plenty of fluids on the flight. Dehydration can lead to lower blood pressure in some people. Finally, if all is fine with her blood and fluid intake and the problem keeps happening, then it may be worth exploring issues such as claustrophobia or fear of flying.
Q: I am travelling to Puerta Vallarta in Mexico in a few weeks time. I intend to do some inland touring while there. Will I need to take anti-malarial medication and if so what is recommended? Also, am I entitled to get this type of preventative medicine on prescription?
Julie Colclough
A: If visiting the main tourist destinations in Mexico, you do not need any antimalarial medication. However, the latest advice is that if you're going off the beaten track, then a weekly tablet of chloroquine is suggested. This applies more to the verdant, swampy south of the country, such as the Chiapas or Yucatan. Sadly, antimalarial medication ceased to be an NHS prescribable tablet in the early 90s. You can buy chloroquine over the counter cheaply at any pharmacy. It needs to be taken for a week before you go and for four weeks on your return.
Q: I am going to Russia and a friend said to watch out for something called giardia. What is it?
Steve Duggan
A: If you are eating anything right now, then stop. The next bit is fairly unpleasant. Giardia lamblia, to give it its full name, is an intestinal parasite easily contracted from infected foods or water and common in eastern Europe. The first signs are a gastric upset with the usual symptoms: stomach cramps, diarrhoea and wind. But wind of the most noxious variety - loud and with a smell that will knock out a horse at 20 paces. To prevent getting giardia, follow the usual rules: drink bottled water, wash it, peel it and so on. If this bug slips through the net, seek medical help - treatment should start immediately. Take the antibiotic metronidazole for a week. This is the one you really cannot drink alcohol with.
Q: In December, we are flying to Dar es Salaam and crossing immediately to Zanzibar by ferry for a holiday travelling around the island. I read that all travellers flying into Dar must have a yellow fever certificate to enter Zanzibar, even if they have just transferred straight form the airport to the port for onward travel by ferry to Stonetown. Can you confirm if this is correct please? And if it is, provide details of the shots needed and the best time to have them.
Pam Evans & Bernard Hand
A: Even though you have flown in and transferred to a non-yellow fever risk area immediately, you still need the shot and the certificate. It's a good idea to have a yellow fever shot before going to Zanzibar since, in Africa, nothing is guaranteed. I have been holed up in Dar es Salaam for a while before waiting for ferry crossings to Zanzibar, and you are at risk while waiting. Many African border crossings are a law unto themselves. So, to minimise the risk of being sent back to Dar, try to have everything in order. As for the other shots, get Hepatitis A and typhoid immunisations about four weeks before you go.
· Dr Jules Eden created E-med as an online support service for anyone who finds themselves a long way from a doctor's surgery. You can get free pre-travel information on any destination in the world. Log on and click on the Travel Clinic icon.
