“It was just a cruise! I didn’t think it necessary to speak with a doctor before leaving. I wished I had – I think I "flushed my money down the toilet!"
Most people who cruise have no dramas. For others it is a different story. I commonly see the “others” before they head off again. Reassuring travellers that the "holiday from hell" can be avoided is important. The travel industry doesn't like to engage in "negatives" associated with health but a bad experience may, however, put travellers off future trips.
Cruises have many things in common ……… but they can also be very different; Some require a long flight before boarding (European river cruising, Caribbean), some will have plenty of sun, sea activities and mozzies (Pacific, SE Asia) and some will test even the hardiest of sailors (Drake Passage to Antarctica).
Most of the large ships will have a “sick bay” but this will not be the case for the smaller ones around SE Asia or Antarctica. It can be a big decision to visit a “sick bay” and to do so for a minor problem might not only be expensive but may also put you at risk of catching something else!
Many health issues related to cruising are preventable. Many can be sorted out with a little knowledge and the right medications. Packing sensible clothing for the time of year and local conditions sounds like common sense but as the adage goes common sense isn't all that common.
Ten tips on how to stay healthy when cruising
1. Consider travelling with a pre-existing health issue
Cruising has advantages if you have a health issue which limits daily activities such as walking. Poor exercise tolerance may be due to joint problems, cardiovascular or respiratory conditions.
Starting out healthy is just as important as the insurance cover you have arranged. If you are on specific medication, make sure you have enough for the trip and you know the generic name for the medication and the dosing recommended. Understand your medicines and what they do. Always carry details on your condition and any current management plan.
Your condition should be optimal and stable prior to departure. Wishing and hoping "she'll be right" is not much help for loved ones who will have to deal with the "unexpected"!! Take a reality check. You may have to consider postponing the trip until your health is stable.
2. Reduce your exposure to respiratory tract infections. Carry medication in the event of illness.
Outbreaks of respiratory tract illness are common on cruise ships. It usually starts with an infected individual boarding a ship. If this person isn't isolated once symptoms start then it will go quickly from person to person by hand transmission. Airborne exposure through droplets also occurs. Unwell individuals have a responsibility to limit this spread but they rarely make the effort.
Good hand hygiene is the key to reducing risk and this should start from the moment you leave home. In the days before you leave ask any unwell relatives or friends to give you a wide berth. You may regret the farewell embrace! Avoid local public transport just before your holiday. Carry a small bottle of gel and use it frequently during the day. You would be surprised by how many times you touch your face and eyes in an hour. Remember, airports and commuter transport pose as much risk of respiratory tract infections as cruising. It is just more obvious when cruising as the travellers are "captive".
3. Consider vaccinations
Vaccinations should be considered before any overseas trip. Cruising is no different but you won't feel like a pin cushion. Routine immunisations should always be checked and updated where indicated. Influenza vaccine is always recommended. Specific vaccines like Yellow Fever may be required depending on the countries visited. Other vaccines like hepatitis A might be considered depending on the activities of the individual.
4. Avoid tummy bugs
Outbreaks of gastrointestinal disease are well known on cruise ships. A common, highly contagious, gut virus is Norovirus. Just a few particles can cause serious disease. It is also transmitted by hands.
Cruise operators are very aware of the potential for gastrointestinal outbreaks and some provide staff to serve at Smorgasbords for the first few days of a cruise to supervise and educate. Children may not be allowed to self serve at any time.
Hand gel is provided on the entry to the dining room. If possible, use your own toilet rather than a public one. At least you can keep your own bugs to yourself. A walk of 5 to 10 minutes to use your own bathroom may make all the difference, particularly if there is an outbreak of Norovirus. While hand gels with alcohol are useful it must be remembered that soap and water is better.
[Our Travel Medicine experts recommend: Aqium Hand Gel]
5. Consider health concerns related to the sun and water exposure
Cruising is hopefully about good weather and plenty of water activities. You can, however, get too much of a good thing.
At high risk times it may take only 10 minutes to get sunburnt. UV radiation is greatest when the sun is highest in the sky. Reduce sun exposure between 11am and 3pm. Remember the risk is increased by reflected light and clouds and breezes may give a false sense of security. Apply sunscreens at least 20 minutes before exposure to the sun. For good protection you need to use at least 30mls (6-8 teaspoons) of sunscreen for an average build. Even with re-application, eventually sunscreens will let UV rays through. Remember to reapply after swimming or towel drying.
Tropical ear is a very painful condition. It can be prevented. Some people appear more at risk than others. Most infections result from fluid remaining in the outer ear canal after swimming or showering. This residual fluid can become infected in hot, humid conditions.. Those prone to wax requiring ear syringing may be more at risk.
Cold water surfers can have bony external ear "growths" making their ear canals more narrow. Warm water surfing can result in tropical ear. Those at risk should consider the use of acetic acid drops after water activities. The alcohol helps evaporate any residual fluid. While we expect the swimming pools on ships to be well chlorinated, the same can't be expected for the ocean waters around some densely populated Pacific Islands.
Early recognition of the problem can prevent a major health issue. An individual at risk might consider adding antibiotic ear drops to their kit just in case.
6. Skin considerations apart from sunburn
Skin infections are commonly associated with travel to tropical areas. Cruising allows people to explore island groups in the Pacific and the Caribbean. Many take the opportunity to go snorkelling or have a scuba dive. It isn't always appreciated that water may be close to population centres and not pristine. You may find yourself swimming unknowingly in sewage!
It is very important to always wear good footwear on beaches and around coral. Small cuts or scratches need to be treated quickly with irrigation, antiseptic cream and cover.
7. Reduce mosquito bites.
Diseases carried by mosquitoes are common in areas frequented by cruise ships. Dengue fever is probably the greatest concern. More recently we have had major outbreaks of Chikungunya and Zika virus disease in the Caribbean and Pacific.
The Aedes mosquito is responsible for spreading all these viral diseases. Aedes is commonly found around towns, particularly in places where there is rubbish and small amounts of stagnant water. Docks and ports as well as gardens are favourite places. The mosquito is an aggressive biter and is mostly about an hour either side of sun up and sundown. This is just around the time the ship might dock or leave a port! If you are a "mosquito magnet" take special care. The best repellents contain at least 30% DEET or 20% Picaridin.
8. Get fit before leaving. Maintain your fitness on board
Don’t feel guilty about your lack of exercise while on the cruise. The blurr between breakfast, lunch and tea and the snacks in between can be a little daunting. So can a bulging waistline. Lose a few kg before heading off. Consider your current level of physical activity. If it is low then organise a daily walk of at least an hour. Seek out the gym and any instruction while on the cruise. It's all free and it may be the stimulus to continue on return. Use any opportunity in port to get some exercise.
9. Consider motion sickness
Less is said about motion sickness these days as the modern cruise ships have advanced technology to maintain stability even in bad conditions. Despite this, some people still have major issues on a cruise. If you have experienced a bad bout of motion sickness in the past then it is likely the same will happen again.
Consider your cabin location at the time of booking. Make sure it's mid ship and where possible choose one with a balcony to provide fresh air. Eat small snacks and often. It is also a good idea to restrict visual cues to those at a distance and avoid reading or watching moving objects until you have your "sea legs".
There are a number of medications available. If you are prone to motion sickness and you have used a medication successfully in the past then stick with the same medication. If you have had unpleasant side effects such as major sedation or dry mouth, consider trialling a different medication before you leave. Common ones include Dimenhydrinate, Promethazine and Cinnarizine.
10. Put together a medical kit
Medical kits are an essential part of healthy travel. Never rely on the easy accessibility of a pharmacy or a doctor, even on a cruise ship. Pharmaceutical names will often be different and sometimes the cost can be a shock.
Seeing a doctor on a cruise ship can be very expensive and unnecessary if the problem is well known and easily managed. Carrying personal information on when and how to use medication and easy access to generic names for medication gives you some control over the management of common health issues related to travel.
Consider putting together your own travel kit and modify it according to your destination and proposed activities. It can always be updated for future travel.
The Little Book
Travelling soon? A useful resource for any traveller is The Little Book by Dr Maggie Phillips & Dr Bob Kass. The Little Book is a comprehensive 'pocket-sized' resource that aims to give the traveller targeted information about travel health issues. Learn about tropical diseases, travel vaccines, medications, regional health issues and common health problems / risks - all explained in simple terms.
Image Credit: Jared, Flickr