The Medical List
(The Medical Kit)

All global travellers or holidaymakers should carry some sort of medical kit when they are travelling abroad, but determining the size and contents of the kit can sometimes be a problem since there are literally dozens of medicines from which to choose.

The choice is further complicated by the destination and type of holiday and/or activity undertaken e.g. people travelling to a European resort will require fewer medicines than those going to a developing country in the tropics and high altitude climbers and trekkers will need different medicines than scuba divers.

Knowing which medicines to include and which to leave out depends on several factors such as; What kind of travel, the destination, the number of people travelling and the sort of activities you will be involved in.

In many instances there will be no difference between the countries in a region due to the similar conditions and climate of those countries. For example; if you were planning a trip to South East Asia and were planning to visit Thailand, Vietnam, Cambodia & Laos on a single trip. The medicines you may require would be the same due to the similarity of the climate but there would be a difference between Thailand and Laos due to the different infrastructures.

The duration of your trip (in days) and the number of males and females travelling in your group would be a factor if you were travelling for an extended period to a remote location.

An important factor is the proposed activity that you will be undertaking during your trip. The list of recommended medicines will vary hugely depending on these activities. As previously mentioned, a group of climbers or trekkers travelling to a mountainous region will require different medicines from a group of scuba divers on a tropical coral reef.

Trying to figure out the quantity of medicines to take with you is not easy and hopefully you will not actually need them during your trip. If you work on a worst scenario basis then this should give you an idea. For example; a group travelling to some remote location and some members of the group come down with a tummy bug and you find yourself running out of anti-diarrhoeal medicine.

Please Note: You can find out which vaccinations and malaria tablets you require
from the "Tabs & Jabs" page on this web site.

Besides the medicines you decide to take, you should always include any recommended anti-malarial tablets plus any prescribed medicines with you.

However, if you take any medicines containing codeine (or other opiates), you should check if it is legal to take them to the destination country. Some codeine containing medicines (Co-Codamol, Solpadeine, etc.) are available over the counter in the UK. However, possession of codeine is illegal in some countries and could lead to problems e.g. Egypt, Turkey, UAE and others. You should check with the relevant Embassy of the destination country to ascertain whether it is legal to take codeine containing medicines with you.

Be aware when purchasing medicines abroad that fake drugs are more common in certain countries and can be a significant health risk.

Carry any medications in your carry-on luggage (except liquids). Keep the medications in their original packaging with labels and information leaflets. If you are taking prescribed medicines, take a copy of any prescriptions you have. This will help with any customs issues and if you need to obtain more while you are away.

Below is a list of the various categories of travellers and examples of the kinds of medicines they could include on their list for travel. This is followed by our FORMULARY which gives in depth information about the various medicines listed (and others) plus more information about the activities they would be useful for.

Holidaying / Business Travel / Skiing

This type of traveller almost always travel to a location with good access to medical facilities such as hotels and resorts. Any medicines required during travel would probably be readily available locally.

Although this category will be usually apply to travel to a European, North American, etc. resort, it is also appropriate for more exotic locations such as Mexico, Kenya or Thailand where the accommodation consists of high class, air conditioned, resort hotels with modern facilities.

The same applies to business travellers who intend confining their travels to cities with modern hotels and conference facilities. However, you should still check the local vaccination and malaria requirements for your destination country since this may not be the same as a European resort.

Since the vast majority of skiiing holidays take place in ski resorts and are a world apart from the traveller who goes trekking in mountanous regions this would be the appropriate category. However, for those more adventurous travellers who intend skiing into remote mountain areas, the mountaineering or trekking option would be more appropriate.

Most hotels and resorts will have access to a doctor and/or a local pharmacy where any medicines needed could be obtained. However, it would still be a good idea to take a basic supply of medicines in case they are needed in a hurry.

These would include:

• Paracetamol tablets - reduces pain and fever.
• Ibuprofen tablets - Anti inlammatory pain killer (works very well when taken together with Paracetamol).
• Loperamide (Imodium) capsules - diarrhoea.
• Dioralyte sachets - Rehydration powder following travellers diarrhoea.
• Cinnarizine (Stugeron) tablets - Travel sickness - especially if travelling with kids.
• Antihistamine tablets (cetirizine, fexofenadine) for mozzy bites.
• Hydrocortisone cream - for mozzy bites.

A few basic first aid items like some sticking plasters and an antiseptic cream would also be useful.

Carry the items in your hand luggage (except for the creams) on the plane in case they are needed during the flight.

Backpacking

Backpackers will be assumed to be travelling through a region using the public transport infrastructure of that region and mainly staying in accommodations in villages, towns and cities with greater interaction with the local population and staying in hostels rather than resort hotels.

Being more self reliant, all the medicines listed in the above option would probably be required but in larger quantities.

However backpackers will be conscious of the need to keep the weight they are carrying to a minimum. They should be selective as to which medicines they carry and they may also be able to get supplies from the towns and cities they visit on their travels.

Other medicines to consider are:

• Antacid tablets - Rennies or Setlers
• Decongestant tablets - Pseudoephedrine (Sudafed)
• Laxative tablets - Dulcolax
• Anti-Nausea tablets - Buccastem
• Antibiotics such as Cirofloxacin for severe bacterial diarrhoea but requires a prescription in the UK.

Whenever you’re passing through a town or city to reach somewhere more remote, its worth topping up any last minute supplies.

Safari / Long Term

These options also assume that you will require a greater degree of self sufficiency during your trip and will therefore require a greater quantity of the medicines which were listed in the first two options. This would also depend on the duration of the trip and number in the group.

The medicines required are pretty much the same as with backpacking but the weight constraints do not apply.

The safari option here is aimed at private safaris organised in the destination country itself rather than the organised safaris run by many of the major tour companies from resort hotels.

Local safari companies may have limited supplies or will be able to recommend any special requirements and where to obtain them.

The long term option is for volunteer workers, missionaries etc. who will have a greater degree of interaction with the local population and will not be using high class hotels etc. exclusively for their accommodation. Recommended vaccines plus extra for long term travel are necessary.

For someone intending to stay for a prolonged period, you should seek out the local medical facilities. You may need to obtain other medicines such as antibiotics whilst you are away. It may be possible to obtain antibiotics before you travel but you would need to get a prescription from your doctor to obtain them in the UK. Some antibiotics can be purchased in pharmacies in other countries.

A good comprehensive first aid kit would be essential. A sterile kit may also be usefiul in this instance.

Trekking/Mountaineering

These are the expedition type holidays where the destinations include the remote regions of the world which are very often mountainous regions. These trips usually involve a relatively high degree of exertion and self sufficiency.

There are several companies that organise group tours to remote locations such as trekking in the Nepal Himalayas, the Inca Trail, ascent of Kilimanjaro etc.

Organised trekking expeditions may have already arranged for your medical requirements. It is always a good idea to check this with the organisation involved before you travel. You could even take some of your own medicines "just in case".

Backpackers travelling to remote regions would be better suited to this option rather than the previous.

Because of the need for greater self sufficiency and not having access to medical facilities in remote locations plus the added danger of physical injury it would be necessary to include extra medications over and above those in the previous groups.

These would include:

• Stronger pain killers - e.g. Tramadol
• Antibiotics - e.g. Amoxycillin (Erthromycin for those with penicillin allergy).
• Altitude acclimatisation - Acetazolamide (Diamox)

These medicines will require you to get prescriptions from your GP or a travel clinic. You should discuss your travel plans and requirements with a doctor before you travel.

The extra physical exertion could also lead to the development of aches and pains or even blisters on your feet. Including creams or ointments for this would be a good idea e.g. Deep Heat, Ibuleve, Voltarol, Movelat etc.

The extra physical exertion especially in a hot climate will result in sweating and a loss of salts from the body. These can be replaced by using oral rehydration powder like Dioralyte which contains sodium and potassium salts. Also staying hydrated at altitude is vitally important for the acclimatisation process.

Professional expeditions will almost certainly have an expedition doctor who will be responsible for the medical requirements of the team.

Cycling / Mountain Biking

This option will be fairly similar to the previous in that it will assume a relatively high degree of exertion and self sufficiency. Although cyclists on the whole tend not to go into such remote locations as mountaineers, they do have the ablity to travel long distances quite quickly and can find themselves far from medical help in a relatively short space of time. Any subsequent injury that required hospitalisation could then become a serious problem if they were unable to return by bike to get to a hospital. The journey back could take far longer than anticipated.

The required medicines would be similar to the Safari/Long Term option plus some of the Trekking option, depending on the remoteness of the intended journey.

Canoeing / Rafting

Again this will be quite similar to the previous option but will also take into account the fact that the travellers will be exposed to local water sources such as rivers & lakes etc.

The kind of rafting here would be the long distance expeditions into remote areas rather than the organised day trips for a few hours white water rafting on local rivers.

Sometimes river expeditions can travel into remote places where it is difficult to get access other than by river. This should be taken into account when deciding how long it would take to get an injured person to hospital. In some instances it may be possible to air lift the casualty out by helicopter although this may not be an option in some countries or locations.

Be aware of any water borne diseases endemic to the area you are travelling in. Biting insects are often plentful around water so make sure you use appropriate repellents. Sunburn can also be a factor since you may be unaware due to the cooling effect of the water. Always cover up in strong sunlight.

Eye infections can be an issue due to getting water into your eyes. Chloramphenicol eye ointment/drops would be a useful addition to your medical list.

Scuba Diving

This option also assumes a relatively high degree of self sufficiency. However, most organised dive tours will have made arrangements for medical facilities and requirements will not be so great on this type of trip as they would if you were organising your own expedition. Again, it is wise to check before travelling.

If you are diving out of a hotel resort with a dive centre then the first option (holidaying etc.) would probably be more appropriate.You can always modify the list of medicines according to the facilities made available by the tour operator.

Problems with ears and sinuses are common amongst scuba divers due the immersion in sea water and the subsequent changes in pressure during diving. The addition of ear drops such as Otomize Ear Drops or similar and a decongestant like pseudoephedrine (Sudafed) should be included ion your list.

Divers and snorkellers should always flush out their ears with fresh water following a dive. This will hopefully prevent any problems developing.

One of the biggest hazards to health whilst scuba diving are decompression accidents such as decompression illness and burst lung. The only treatment for these life threatening conditions is recompression in a hyperbaric facility (known as a pot). Diving in remote locations will mean there is no immediate access to a pot and travelling long distances to reach one by boat may take a long time when immediate treatment is essential.

Therefore, adequate training in scuba diving and carrying out of correct decompression / safety stops following a dive is an absolute must!