Holidays. We research them, save money for them and look forward to them, and for many of people the prospect of a summer break keeps them going during the long winter months. So the last thing customers need is to be struck down by illness or suffer from sunburn instead of relaxing, having fun and enjoying their holiday.
While it’s difficult to prevent some health problems while away from home, thinking ahead and being prepared for common travel-related ailments is essential. Pharmacy teams are ideally placed to advise travellers on what to pack in a travel health kit, as well as providing tips on reducing their risk of common health complaints and how to manage these if they do succumb to them.
Most common in children, travel sickness is caused by repeated movements during travel which confuse the balance sensors in the brain. Common symptoms include feeling or being sick, sweating, increased saliva, headache and feeling cold.
Any long journey over four hours on a plane, train, car or bus can increase risk of DVT
Melanoma is the fifth most common cancer in the UK, with around 15,900 cases a year, according to Cancer Research UK. The good news is that according to a recent British Skin Foundation (BSF) survey into sun cream usage, of those who use sun cream, three in five used SPF30 or higher, while seven in 10 parents use SPF30+.
There is however a long way to go to educate customers about sun safety, as one in three people still get sunburnt every year, with 28 per cent getting burnt three or more times.
This year’s Sun Awareness Week takes place from 6-12 May and is a great opportunity to talk about sun protection with customers. Karis Betts, Cancer Research UK health information manager, says: “The most important message for you to get across to your customers is for them to keep covered up with clothing, hats and sunglasses and to spend time in the shade or indoors during the hottest part of the day. Sunscreen should be the last line of defence, never the first. Reapply sunscreen on exposed skin frequently and always use more than you think you need.”
Sun cream should be applied generously, with about six teaspoons needed to cover an adult’s body. It should be applied 20-30 minutes before going into the sun and moisturiser should be applied first, if using one, followed by sun cream, insect repellent and then any makeup.
Mistakes customers are likely to make include only applying sun cream once a day, missing areas of skin and thinking they can spend longer in the sun when they’ve applied sun cream, says Karis, who adds that a sun cream with a minimum of SPF15 and with a four or five UVA star rating should be used on each application.
When it comes to babies and small children, Dr Anjali Mahto, consultant dermatologist and BSF spokesperson says they should never be left in direct sunlight. “It’s essential to use a high SPF, such as SPF50, combined with hats and clothing to protect their delicate skin,” she says. “Educate children about the importance of sun protection from an early age to get them into the habit of looking after their skin. Data suggests five or more sunburns in youth can increase lifetime melanoma risk by up to 80 per cent.”
This is a parasitic infection caused by the bite of female mosquitoes. Symptoms include fever, chills, sweating, muscle pain, headache and vomiting. Infection can be severe and fatal if not treated quickly.
The preventative A, B, C, D approach should be recommended to customers:
This is one of the most common holiday illnesses and most cases occur during the first week of travel. As well as loose and watery bowel motions, customers may experience fever, cramps, nausea or vomiting.
Travellers’ diarrhoea can be caused by bacteria, such as E. coli or salmonella; parasites; or viruses, such as norovirus. These can all be spread by eating or drinking contaminated food and water, or contact with contaminated cutlery and crockery. If it’s just loose bowel movements without other symptoms, it can be caused by a change in diet.
Advise customers ensure they do following:
In most cases, diarrhoea will clear up without specific treatment. The most important thing is to avoid dehydration, especially in children. Advise drinking around 200ml fluid after each bout of diarrhoea.
Advise customers to seek help if: there is blood or mucus on stools; they are having six or more bouts of diarrhoea in 24 hours; they are vomiting, in pain or have a fever. In some cases, antibiotics and/or intravenous fluids may be needed to prevent dehydration.
Sunscreen should be the last line of defence, never the first
The insects customers are likely to come across will depend on the country they are visiting. Diseases transmitted by insects are most common in tropical and subtropical countries. For specific information visit Fit For Travel NHS.
Insect bites can cause itching, discomfort and skin can become infected through scratching.
With insect bites, prevention is key. The best way to avoid getting bitten by mosquitoes is to cover up exposed skin with loose clothing, use insecticide mosquito nets for sleeping in and apply an insect repellent containing DEET, picaridin or p-Menthane-3,8-diol (PMD) on any exposed skin.
All travellers should check if there are any restrictions on the medicines they plan to take with them, including OTC medicines. Some countries have extensive lists of medicines that are not allowed. Customers can check with individual country embassies.
In addition, customers should be advised to:
Any long journey over four hours on a plane, train, car or bus can increase risk of deep vein thrombosis (DVT). Blood flows more slowly and pools in the legs when sitting for long periods, increasing the risk of a blood clot.
Those at increased risk of DVT after a long journey include: anyone having an operation in the last two months, pregnant women, those with a history of DVT or pulmonary embolism, women taking the contraceptive pill or hormone replacement therapy, people who are overweight and anyone with a blood clotting disorder.
Advise customers to try the following:
Symptoms of heat exhaustion include a temperature of 38°C or above, feeling faint and/or dizzy, headache, tiredness, sweating, urinating less, nausea and vomiting. It is not usually serious if the person cools down within 30 minutes.
Heat stroke may occur if heat exhaustion is not treated properly. Signs include headache; feeling restless and confused; hot flushed and dry skin; fast pulse; a temperature of over 40°C and dizziness.
Remind customers that getting acclimatised to hot weather takes around 10 days. During that time they should limit physical exertion and keep well hydrated. Carrying a small fan helps cool the body when unable escape the heat. Customers should be advised to avoid being outside between 11am and 3pm, where possible.
Anyone affected by heat exhaustion should lie down in a cool place with their legs raised. They need plenty of water to drink, but also a rehydration solution to replace salts lost through sweating. Spraying their face and body with water and using a fan can help the body cool down quicker.
Heat stroke is a medical emergency and help should be called for immediately. While waiting, advice is to remove outer clothing, wrap in a cold wet sheet or sponge with cool water and use a fan. This should be continued until their temperature falls to below 38°C. If they lose consciousness, they should be put in the recovery position.
Pharmacist Shaheen Bhatia set up a travel clinic at P&S Chemist in Ilford, London, after requests from locals. Eight years on, she explains how its gone from strength to strength.
“I was being asked if I could provide the meningitis ACWY vaccine for customers who were travelling to Mecca, as they found it difficult to get a GP appointment and also the doctors were charging high prices for these vaccines. I looked into it and got myself trained. I was lucky that the demand for the travel service was already there.
“It’s been so popular right from the outset. Once I started giving the meningitis ACWY vaccine, customers soon asked if I could provide other travel vaccines, so
I got trained to administer these too. Our popularity has spread through word of mouth, but we’ve also been very proactive with our advertising. We have in store leaflets for customers who want to find out more about what we offer. We also get referrals from local GPs too, who are very supportive of our service.
“We have a lot of ethnic minorities in our area – from India, Pakistan and Africa – and they travel home to visit family so they welcome our advice on how to protect children when they are abroad. But we also get backpackers asking for advice on anti-malarials, about diarrhoea prevention or sun protection. They like the fact that we’re a one-stop travel shop and they can get both the advice and all the remedies they need in one place. Our most popular travel vaccines are hepatitis A and typhoid, tetanus and menACWY.
“The travel clinic has boosted our income, but it’s also given us a more clinical image. Lots [of customers] have commented ‘I never realised that pharmacists could do things like vaccinations.’ Our customers often comment that they really appreciate the time we take going through everything with them, especially regarding taking their medication abroad.”