Health Considerations for Backpackers & DXPeditioners

To be clear, I am not a Medical Doctor, so the following is an account of my personal experiences, the health situation in Cambodia, and precautions I’ll be taking in the future.

Background

Whilst operating in Cambodia, especially when operating from Koh Rong Island (IOTA AS-133) I was frequently bitten by all kinds of insects, namely:

  • Bed Bugs
  • Sand flies
  • Mosquitos

While Dengue Fever has been present in Cambodia, it was not endemic while I was there, so I (nor anyone else) placed too much emphasis on protection from insect bites.  Most of the time, I wore a singlet top, shorts and flip flops.  I was bitten all over the place, and as it turned out, the local insects produced greater allergic reactions than whenever I suffer insect bites back home in Australia.

Scratching produced wounds, and the wounds became infected with various results.  Read more for the whole story and advice to prevent experiencing the same issues I did, but warned medical issues are discussed. 🙂

The Result of My First Visit to Koh Rong

Each bite became significantly itchy, and I couldn’t resist the urge to scratch.  This was my greatest mistake. Within 1 week of living on Koh Rong Island, I had developed in excess of 20 lesions on my legs and feet, all of which were infected with some form of opportunistic bacterium (most likely of the Staphylococcus variety).  Primarily, this is one of the reasons I only activated Koh Rong later in my stay for a short period of time, as after my first trip there I had to spend time recovering back on the mainland.

The health system of Cambodia is extremely basic (more than likely a result of the tragic Pol Pot / Khmer Rouge Regime). For most locals and foreigners, the first point of contact is the ‘pharmacy’ or drug store, which resembles western drug stores of the early 20th century (in so much as everything is over the counter).  You can always tell a drug store, as it will feature a green cross sign out the front.

As insect bites and subsequent infections are one of the most common medical issues, the drug stores are often quite adept at ‘prescribing’ (selling) the correct antibiotic for the infection. As a result of consulting the drug stores and acquiring antibiotics, combined with a bit of ‘bed rest’ back on the main land, the majority of my wounds healed successfully. Certainly, this was the case the first time I had infected wounds.

One thing to note is that often Westerners will be offered the ‘premium’ imported antibiotics; one pharmacy attempted to sell me a product consisting of Amoxicillin & Clavulanic acid for $5 USD per strip.  

I opted instead for a local Amoxicillin only product at $0.75 per strip, which worked just fine. Please bear in mind that the Amoxicillin & Clavulanic Acid combination is generally a superior product, but the price was ‘unreasonable’, and ‘Amoxicillin Duo’ as it is often called in Australia tends to tear my stomach apart (it is very good at killing off all the natural ‘gut fauna’). Already suffering stomach issues in Cambodia, I was hardly about to volunteer to pay $5 for even more.

At any rate, after about a week and a half of recuperation in my main land apartment, I was good to go again to Koh Rong.

More Mistakes, Mixed Results

The second time I visited Koh Rong, it was clear that I had not significantly learnt from the experience.  At the suggestion of other travelers, I had started taking a second generation antihistamine (fexofenadine) to keep the urge to itch at bay, and for the most part avoided scratching and the subsequent infections.

However, I still continued to wear a singlet top, shorts and flip flops.

This time, I managed to avoid a bunch of obvious infections, however I did develop a few less obvious infections.  Namely:

  • My left foot became significantly swollen unless kept raised.
  • I developed a Carbuncle on my left thigh (no idea how).
  • I developed several lumps under my armpits.

Carbuncles are not especially life threatening, essentially being a staphylococcus infected hair follicle that develops a large bump due to pus. The common treatment in Cambodia is to seek out a ‘clinic’, denoted by a blue cross, who will often lance the wound for you and release the pus. From my reading of Carbuncle treatments on the internet, this seems to be in line with Western medical practice, although you’re likely to be afforded the luxury of a local anesthetic at a Western Clinic / Surgery.  

A lot of Westerners make use of the Cambodian ‘blue cross’ clinics, but be advised that it can be painful as local aesthetics are not used. This is probably a very good thing, as Cambodia has one of the highest rates of HIV & AIDS in South East Asia, and the qualifications and/or hygiene practices vary between clinics.  

Some Cambodian ‘blue cross’ clinics will have a local doctor*, some may have been setup by a foreign trained Doctor, and others rely on individuals who have been trained by one of the former.  The point to take away from all of this is that the clinics mainly offer a service equivalent to that of a trained ‘first aid respondent’ or ‘trainee nurse’.

Knowing the above, and being naturally the curious type, I decided to take care of the Carbuncle on my left thigh myself. I did this for a few reasons, primarily because I had a slight fever, was travelling home soon, and was concerned that the infection could get worse and was possibly contributing to my swollen foot.  The lumps in my armpits were not ‘leaky’, there was no obvious point of infection, and I didn’t at the time know exactly what they were so I left them alone.

I won’t go into details regarding how I took care of the Carbuncle on my left thigh, other than to say that I continued to take antibiotics, and lanced it myself. In my case, it was relatively pain free, and I was able to release a significant degree of pus and possibly even remove some necrotic tissue (I’m no doctor, so I can’t be certain it was necrotic). I am glad I did it, as by the very next day the 3 inch / 70mm diameter red spot around the Carbuncle had abated.  I used sterile equipment where possible, but was unable to acquire a scalpel anywhere.  As such, I had to rely on my Victorinox ‘credit card’ knife set, which I sterilized with a combination of heat, iodine & isopropyl alcohol.  

Return to Australia, and Western Medical Followup.

Two days after I returned to Australia, my right foot suddenly became swollen, hot to touch, red and extremely painful, even though I was still taking Amoxicillin Antibiotics. With no obvious site of infection, no obvious pus, I believed it to be Cellulitis and immediately booked a visit to my family Doctor.  Cellulitis, especially if left untreated or inappropriately treated, can rarely progress to a limb (or life) threatening issue.

My Doctor independently diagnosed it as Cellulitis. When I had my consultation with him, I simply described my symptoms, showed him my previously healed wounds, and told him where I had been and that I was taking Amoxicillin antibiotics.  

Whilst talking to my Doctor, I specifically didn’t mention my suspicion of Cellulitis, as I am not a trained medical professional. I didn’t want to influence his diagnosis of my medical problem in any way, as the correct diagnosis of a medical issue is always more important than boosting your ‘self-diagnosis’ ego.

I was prescribed a two week course of ‘stronger’ antibiotics, and am currently monitoring the situation.  So far, the pain level in my foot has decreased, although I still find it beneficial to keep it elevated.  It is my belief that this aids circulation, and as such, both reduces pain levels and helps ensure the antibiotics reach their target.

Lessons Learnt & General Advice For Backpack DXPeditioners

The following is a brief summary of what I have learnt, and what I will be putting into practice next time I go on a DX Adventure:

  • Minimize you chances of infection: If you are operating near a body of water and sand, wear pants, socks and shoes.  It may be hot, and it may be less comfortable, but there is a good chance it could prevent a life threatening medical condition.
  • Take a basic first aid kit. Ham Radio and (most) DXPeditions aren’t known for being particularly risky activities in general, but why not discuss what you will be up to with your doctor while getting your immunizations? If I had done this, and told my doctor that I would be operating from the beach, I am sure he would have recommended I take with me a supply of antihistamines, a decent quantity of band aids (plaster strips), and basic wound cleansing products (iodine swabs, alcohol swaps, saline solution). He may have even prescribed some antibiotics so I could have access to Western Quality medication if needed.
  • If you feel the need to scratch, do not under any circumstances. If you’re finding this to be really hard, it is possibly worth a trip to the drug store to obtain some antihistamines. Even better would be to discuss the potential need for antihistamines with your regular / family doctor before you depart.
  • Don’t be afraid of local consultations and treatment, but exercise caution. The Amoxicillin I obtained from the drug store took care of the majority of my infections, and that ultimately allowed me to activate Koh Rong IOTA AS-133. However, be mindful of the training / qualifications of the people you are getting advice from, and the hygiene practices of the drug store or clinic. If your condition is not life threatening, don’t opt for surgery / lancing if it can be safely postponed till you get back home.
  • If you still have any medical issues when you get back home, such as infections, lumps, swollen or red skin etc, seek medical advice. Whilst it is unlikely you’ve got any life threatening issues, prevention is always better than cure, and you can’t put a price on your health. Even if you think the antibiotics you got from the overseas clinic are ‘doing the job’, a second opinion certainly wont hurt.  
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s