This post written with the consultation of Dr Felicity Nicholson

People new to exotic travel often worry about tropical diseases, but it is accidents that are most likely to carry you off. Road accidents are very common in Bangladesh so be aware and do what you can to reduce risks: try to travel during daylight hours, always wear a seatbelt and refuse to be driven by anyone who has been drinking. Listen to local advice about areas where violent crime is rife. Traveling around the major cities after 22.00, especially Dhaka and Chittagong, is best done in private transport. Noise pollution is another major problem in Dhaka and Chittagong, so if you have sensitive ears bring a pair of earplugs. Sound-blocking earphones and a music device are even smarter for when you’re stuck in traffic.

Preparations

This post written with the consultation of Dr Felicity Nicholson

Malaria

Along with road accidents, malaria poses another threat to the health of travellers in south Asia. It is unwise to travel in malarial parts of Bangladesh whilst pregnant or with children: the risk of malaria in many parts is considerable and these travellers are likely to succumb rapidly to the disease.

Malaria in Bangladesh

The Anopheles mosquito that transmits the parasite is most commonly found in the Chittagong Hill Tracts region of Bangladesh. All other regions of the country are considered low-risk malaria areas, and there is no malaria in Dhaka. When visiting the CHT outside the main towns (Khagrachari, Bandarban or Rangamati), antimalarial drugs are definitely advised. If at all uncertain, however, visitors should err on the side of caution and take prophylaxis medication well before their visit to the CHT. Doxycycline is widely available and inexpensive as well.

Content in this post provided free courtesy The Bangladesh Traveller website.

Medical Facilities in Bangladesh

Dhaka is the only place where somewhat decent medical facilities exist, but major procedures such as childbirth or surgery should definitely be undertaken abroad. Many expatriates head to Thailand for their regular medical treatments and more intensive diagnostic procedures. For less serious travel-related illnesses, International Centre for Cholera and Diarrhoea Research, Bangladesh (ICCDR,B) has a travellers’ clinic which charges US$50 per visit for insured patients and US$15 otherwise. The clinic can also provide vaccinations as well. Appointments are recommended.

Emergencies are probably best handled at one of the major hospitals.

• Apollo Hospital Hse 81, Blk E, Bashundhara; tel : 02989 1661/2; mob: 01713 046684, 01713 046685; emergency tel : 02 989 6623; emergency mob: 01911555555; emergency ambulance tel : 01714 090000; e-mail : info@apollodhaka.com; www.apollodhaka.com
• British High Commission Clinic Elizabeth House, Hse 23, Park Rd (cnr of Rd 6), Baridhara; tel : 02 882 4345. Generally for high commission staff & British aid workers, but will likely point you in the right direction in the case of emergencies.
• Dr Wahab’s Medical Centre Hse 3, Rd 12, Baridhara; tel : 02 882 1454. Can consult for acute but not life-threatening illnesses; also handles medical checkups for many international visa applications.
• ICCDR,B 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali; tel : 02 886 0523–32; e-mail : info@icddrb.org; www.icddrb.org; time : 09.00–12.00 &14.00–17.00 Sun–Thu.
• Square Hospital 18/F West Panthapath, near Dhanmondi; tel : 02 815 9457, 814 2431, 814 1522, 814 4400, 814 2333, emergency m 01713
  377773–5; www.squarehospital.com.
• United Hospital Hse 15, Rd 71, Gulshan 2; tel : 02 883 6000, 883 6444; mob: 01914 001234.

Travel Clinics and Health Information

A full list of current travel clinic websites worldwide is available on www.istm.org/. For other journey preparation information, consult www.nathnac.org/ds/map_world.aspx. Information about various medications may be found on www.netdoctor.co.uk/travel.

UK

• Berkeley Travel Clinic 32 Berkeley St, London W1J 8EL (near Green Park tube station); tel: 020 7629
  6233; time: 10.00–18.00 Mon–Fri, 10.00–15.00 Sat.
• Cambridge Travel Clinic 41 Hills Rd, Cambridge, CB2 1NT; tel: 01223 367362; fax: 01223 368021; e-mail: enquiries@travelcliniccambridge.co.uk; www.travelcliniccambridge.co.uk; time: 10.00–16.00
  Mon, Tue & Sat, 12.00–19.00 Wed/Thu, 11.00–18.00 Fri.
• Edinburgh Travel Health Clinic 14 East Preston St, Newington, Edinburgh EH8 9QA; tel: 0131 667 1030; www.edinburghtravelhealthclinic.co.uk; time: 09.00–19.00 Mon–Wed, 09.00–18.00 Thu/Fri. Travel
  vaccinations & advice on all aspects of malaria prevention. All current UK prescribed anti-malaria
  tablets in stock.
• Fleet Street Travel Clinic 29 Fleet St, London EC4Y 1AA; tel: 020 7353 5678; www.fleetstreetclinic.com;
  time: 08.45–17.30 Mon–Fri. Injections, travel products & latest advice.
• Hospital for Tropical Diseases Travel Clinic Mortimer Market Centre, 2nd Fl, Capper St (off Tottenham Ct Rd), London WC1E 6AU; tel : 020 7388 9600; www.thehtd.org; time: 09.00–16.00 weekdays; 24hr emergency available. Offers consultations & advice, & is able to provide all necessary drugs & vaccines for travellers. Runs a healthline (tel : 020 7950 7799) for country-specific information & health hazards. Also stocks nets, water purification equipment & personal protection measures. Travellers who have returned from the tropics & are unwell, with fever or bloody diarrhoea, can attend the walk-in emergency clinic at the hospital without an appointment.
• MASTA (Medical Advisory Service for Travellers Abroad), London School of Hygiene & Tropical Medicine, Keppel St, London WC1 7HT; tel : 09068
  224100; email: enquiries@masta.org; www.masta-travelhealth.com. This is a premium-line number, charged at 60p per min. For a fee, they will provide an individually tailored health brief, with up-to-date information on how to stay healthy, inoculations &
  what to take.
• MASTA pre-travel clinics tel : 01276 685040. Call or check www.masta-travel-health.com/travel- clinic.aspx for the nearest; there are currently 30 in Britain. They also sell malaria prophylaxis, memory cards, treatment kits, bed-nets, net treatment kits, etc. NHS travel website www.fitfortravel.nhs.uk. Provides country-by-country advice on immunisation & malaria prevention, plus details of recent development, & a list of relevant health organisations.
• Nomad Travel Stores Flagship store: 3–4 Wellington Terrace, Turnpike Lane, London N8 0PX; tel: 020 8889 7014; fax 020 8889 9528; e-mail: turnpike@nomadtravel.co.uk; www.nomadtravel.co.uk; walk in or appointments tel : 09.15–17.00 daily, with late night Thu. 6 stores in total countrywide: 3 in London, also in Bristol, Southampton & Manchester. As well as dispensing health advice, Nomad stocks mosquito nets & other anti-bug devices, & an excellent range of adventure travel gear.
• InterHealth Travel Clinic 111 Westminster Bridge Rd,
  London, SE1 7HR; tel : 020 7902 9000; e-mail : info@interhealth.org.uk; ww.interhealth.org.uk; time :
  08.30–17.30 Mon–Fri. Competitively priced, one-stop
  travel health service by appointment only.
• Trailfinders Immunisation Centre 194 Kensington High
  St, London W8 7RG; tel : 020 7938 3999; www.trailfinders.com/travelessentials/travelclinic.htm; time: 09.00–17.00 Mon–Wed & Fri, 09.00–18.00 Thu, 10.00–17.15 Sat. No appointment necessary.
• Travelpharm The Travelpharm website (www.travelpharm.com) offers up-to-date guidance on travel-related health & has a range of medications available through their online mini-pharmacy.

Irish Republic

• Tropical Medical Bureau Grafton St Medical Centre, Grafton Bldgs, 34 Grafton St, Dublin 2; tel : 1 671 9200. Has a useful website specific to tropical destinations (www.tmb.ie).

USA

• Centers for Disease Control 1600 Clifton Rd, Atlanta,
  GA 30333; tel : 800 232 4636, 800 232 6348; e-mail : cdcinfo@cdc.gov; www.cdc.gov/travel. The central source of travel information in the USA. Each summer they publish the invaluable Health Information for International Travel.
• IAMAT (International Association for Medical
  Assistance to Travelers) 1623 Military Rd, #279
  Niagara Falls, NY 14304-1745; tel : 716 754 4883; e-mail : info@iamat.org; www.iamat.org. A non-profit
  organisation with free membership that provides lists
  of English-speaking doctors abroad.

Canada

• IAMAT (International Association for Medical Assistance to Travelers) Suite 1, 1287 St Clair Av W, Toronto, ON, M6E 1B8;time : 416 652 0137;
  www.iamat.org
• TMVC Suite 314, 1030 W Georgia St, Vancouver, BC, V6E 2Y3;time : 905 648 1112; e-mail : info@tmvc.com; www.tmvc.com. One-stop medical clinic for all your international travel medicine & vaccination needs.

Australia, New Zealand, Thailand

• TMVC (Travel Doctors Group) time : 1300 65 88 44; www.tmvc.com.au. 22 clinics in Australia, New Zealand & Thailand, including: Auckland anterbury Arcade, 170 Queen St, Auckland; time : 09 373 3531; Brisbane 75a Astor Terrace, Spring Hill, Brisbane, QLD 4000; time : 07 3815 6900; e-mail : brisbane@traveldoctor.com.au; Melbourne Dr Sonny Lau, 393 Little Bourke St, 2nd Fl, Melbourne, VIC 3000; time : 03 9935 8100; e-mail :

  melbourne@traveldoctor.com.au; Sydney Dr Mandy Hu, Dymocks Bldg, 7th Fl, 428 George St, Sydney, NSW 2000; time : 02 9221 7133; fax : 02 9221 8401

• IAMAT PO Box 5049, Christchurch 5, New Zealand; www.iamat.org

South Africa

• SAA-Netcare Travel Clinics e-mail : travelinfo@netcare.co.za; www.travelclinic.co.za. 12 clinics throughout South Africa.
• TMVC NHC Health Centre, cnr Beyers Naude & Waugh Northcliff; tel : 011 214 9030; e-mail : traveldoctor@wtmconline.com; www.traveldoctor.co.za.
  Consult the website for details of clinics.

Switzerland

• IAMAT 57 Chemin des Voirets, 1212 Grand-Lancy, Geneva; e-mail : info@iamat.org; www.iamat.org

Travellers’ diarrhoea

Travelling in Bangladesh carries a fairly high risk of getting a dose of travellers’ diarrhoea, or the ‘chitta shittas’ as its sometimes referred to; perhaps half of all visitors will suffer and the newer you are to exotic travel, the more likely you will be to suffer. By taking precautions against travellers’ diarrhoea you will also avoid typhoid, paratyphoid, cholera, hepatitis, dysentery, worms, etc. Travellers’ diarrhoea and the other faecal-oral diseases come from getting other people’s faeces in your mouth. This most often happens from cooks not washing their hands after a trip to the toilet, but even if the restaurant cook does not understand basic hygiene you will be safe if your food has been properly cooked and arrives piping hot. The most important prevention strategy is to wash your hands before eating anything. You can pick up salmonella and shigella from toilet door handles and possibly banknotes. The maxim to remind you what you can safely eat is:

PEEL IT, BOIL IT, COOK IT OR FORGET IT.

This means that fruit you have washed and peeled yourself, and hot foods, should be safe but raw foods, cold cooked foods, salads, fruit salads which have been prepared by others, ice cream and ice are all risky, and foods kept lukewarm in hotel buffets are often dangerous. That said, plenty of travellers and expatriates enjoy fruit and vegetables, so do keep a sense of perspective: food served in a fairly decent hotel in a large town or a place regularly frequented by expatriates is likely to be safe. If you are struck, see box for treatment.

Treating Travellers’ Diarrhoea

Dr Jane Wilson-Howarth

It is dehydration that makes you feel awful during a bout of diarrhoea and the most important part of treatment is drinking lots of clear fluids. Sachets of oral rehydration salts give the perfect biochemical mix to replace all that is pouring out of your bottom but other recipes taste nicer. Any dilute mixture of sugar and salt in water will do you good: try Coke or orange squash with a three-finger pinch of salt added to each glass (if you are salt-depleted you won’t taste the salt). Otherwise make a solution of a four-finger scoop of sugar with a three-finger pinch of salt in a 500ml glass. Or add eight level teaspoons of sugar (18g) and one level teaspoon of salt (3g) to one litre (five cups) of safe water. A squeeze of lemon or orange juice improves the taste and adds potassium, which is also lost in diarrhoea. Drink two large glasses after every bowel action, and more if you are thirsty. These solutions are still absorbed well if you are vomiting, but you will need to take sips at a time. If you are not eating you need to drink three litres a day plus whatever is pouring into the toilet. If you feel like eating, take a bland, high carbohydrate diet. Heavy greasy foods will probably give you cramps.

If the diarrhoea is bad, or you are passing blood or slime, or you have a fever, you will probably need antibiotics in addition to fluid replacement. A dose of norfloxacin or ciprofloxacin repeated twice a day until better may be appropriate (if you are planning to take an antibiotic with you, note that both norfloxacin and ciprofloxacin are available only on prescription in the UK). Ciprofloxacin is considered to be less effective in Bangladesh. If the diarrhoea is greasy and bulky and is accompanied by sulphurous (eggy) burps, one likely cause is giardia. This is best treated with tinidazole (four x 500mg in one dose, repeated seven days later if symptoms persist).

Eye problems

Bacterial conjunctivitis (pink eye) is a common infection in south Asia; people who wear contact lenses are most open to this irritating problem. The eyes feel sore and gritty and they will often be stuck together in the mornings. They will need treatment with antibiotic drops or ointment. Lesser eye irritation should settle with bathing in salt water and keeping the eyes shaded. If an insect flies into your eye, extract it with great care, ensuring you do not crush or damage it otherwise you may get a nastily inflamed eye from toxins secreted by the creature. Small, elongated red-and-black blister beetles carry warning colouration to tell you not to crush them anywhere against your skin.

Prickly heat

This ailment is definitely a common problem in Bangladesh, especially during the hottest months of April–June. A fine pimply rash on the trunk is likely to be heat rash; cool showers, dabbing dry, and talc will help. Treat the problem by slowing down to a relaxed schedule, wearing only loose, baggy,100% cotton clothes and sleeping naked under a fan; if it’s bad you may need to check into an air-conditioned hotel room for a while.

Skin infections

Any mosquito bite or small nick in the skin gives an opportunity for bacteria to foil the body’s usually excellent defences; it will surprise many travellers how quickly skin infections start in warm humid climates and it isessential to clean and cover even the slightest wound. Creams are not as effective as a good drying antiseptic such as dilute iodine, potassium permanganate (a few crystals in half a cup of water) or crystal (or gentian) violet. One of these should be available in most towns. If the wound starts to throb, or becomes red and the redness starts to spread, or the wound oozes, and especially if you develop a fever, antibiotics will probably be needed: flucloxacillin (250mg four times a day) or cloxacillin (500mg four times a day). For those allergic to penicillin, erythromycin (500mg twice a day) for five days should help. See a doctor if the symptoms do not start to improve within 48 hours.

Fungal infections also get a hold easily in hot, moist climates so wear 100% cotton socks and underwear and shower frequently. An itchy rash in the groin or flaking between the toes is likely to be a fungal infection. This needs treatment with an antifungal cream such as Canesten (clotrimazole); if this is not available try Whitfield’s ointment (compound benzoic acid ointment) or crystal violet (although this will turn you purple!).

Other insect-borne diseases

Malaria is by no means the only insect-borne disease to which the traveller may succumb. Others include sleeping sickness and river blindness (see box Avoiding insect bites, page 000). Dengue fever is common in Bangladesh and there are many other similar arboviruses. These mosquito-borne diseases may mimic malaria but there is no prophylactic medication against them. The Aedes mosquitoes that carry dengue fever viruses bite during the daytime, so it is worth applying repellent if you see any of these mosquitoes around. After killing it, you can identify such a mosquito by the presence of white bands on its legs. These mosquitoes generally acquire the dengue virus after feeding on the blood of an infected person, and after an incubation period of eight to ten days the mosquito is capable of transmitting the disease for the rest of its life. Infected people are the main carriers and multipliers of this virus, generally circulating in the blood of the infected person at the same time that they have their fever.

Symptoms of dengue include strong headaches, rashes and excruciating joint and muscle pains and high fever. Viral fevers usually last about a week or so and are not usually fatal. Complete rest and paracetamol are the usual treatment; plenty of fluids also help. Some patients are given an intravenous drip to keep them from dehydrating. It is especially important to protect yourself if you have had dengue fever before, since a second infection with a different strain can result in the potentially fatal dengue haemorrhagic fever.

Avoiding Insect Bites

As the sun is going down, don long clothes and apply repellent on any exposed flesh. Pack a DEET-based insect repellent (roll-ons or stick are the least messy preparations for travelling). You also need either a permethrin-impregnated bed-net or a permethrin spray so that you can ‘treat’ bed-nets in hotels. Permethrin treatment makes even very tatty nets protective and prevents mosquitoes from biting through the impregnated net when you roll against it; it also deters other biters. Otherwise retire to an air-conditioned room or burn mosquito coils (which are widely available and cheap in Bangladesh) or sleep under a fan. Coils and fans reduce rather than eliminate bites. Travel clinics usually sell a good range of nets,
treatment kits and repellents.

Mosquitoes and many other insects are attracted to light. If you are camping, never put a lamp near the opening of your tent, or you will have a swarm of biters waiting to join you when you retire. In hotel rooms, be aware that the longer your light is on, the greater the number of insects will be sharing your accommodation.

Aside from avoiding mosquito bites between dusk and dawn, which will protect you from elephantiasis and a range of nasty insect-borne viruses, as well as malaria (see page 000), it is important to take precautions against other insect bites. During the day it is wise to wear long, loose (preferably 100% cotton) clothes; this will keep off ticks and day-biting Aedes mosquitoes which may spread viral fevers, including yellow fever.

Bilharzia or schistosomiasis

with thanks to Dr Vaughan Southgate of the Natural History Museum, London, and Dr Dick Stockley, The Surgery, Kampala

Bilharzia or schistosomiasis is a disease that commonly afflicts the rural poor of the tropics. It is an unpleasant problem that is worth avoiding, though can be treated if you do get it. This parasite is common in almost all water sources in Bangladesh. The most risky places are where infected people use water, wash clothes or bathe, etc.

It is easier to understand how to diagnose it, treat it and prevent it if you know a little about the life cycle. Contaminated faeces are washed into the lake, the eggs hatch and the larva infects certain species of snail. The snails then produce about 10,000 cercariae a day for the rest of their lives. The parasites can digest their way through your skin when you wade, or bathe in infested fresh water.

Winds disperse the snails and cercariae. The snails in particular can drift a long way, especially on windblown weed, so nowhere is really safe. However, deep water and running water are safer, while shallow water presents the greatest risk. The cercariae penetrate intact skin, and find their way to the liver. There male and female meet and spend the rest of their lives in permanent copulation. No wonder you feel tired! Most finish up in the wall of the lower bowel, but others can get lost and can cause damage to many different organs. Schistosoma haematobium goes mostly to the bladder.

Although the adults do not cause any harm in themselves, after about four to six weeks they start to lay eggs, which cause an intense but usually ineffective immune reaction, including fever, cough, abdominal pain, and a fleeting, itching rash called ‘safari itch’. The absence of early symptoms does not necessarily mean there is no infection. Later symptoms can be more localised and more severe, but the general symptoms settle down fairly quickly and eventually you are just tired. ‘Tired all the time’ is one of the most common symptoms among expats in south Asia, and bilharzia, giardia, amoeba and intestinal yeast are the most common culprits.

Although bilharzia is difficult to diagnose, it can be tested at specialist travel clinics. Ideally tests need to be done at least six weeks after likely exposure and will determine whether you need treatment. Fortunately it is easy to treat at present.

Avoiding bilharzia

If you are bathing, swimming, paddling or wading in fresh water which you think may carry a bilharzia risk, try to get out of the water within ten
minutes.

• Avoid bathing or paddling on shores within 200m of villages or places where people use the water a great deal, especially reedy shores or where there is lots of water weed.
• Dry off thoroughly with a towel; rub vigorously.
• If your bathing water comes from a risky source try to ensure that the water is taken from the lake in the early morning and stored snail-free, otherwise it should be filtered or Dettol or Cresol added.
• Bathing early in the morning is safer than bathing in the last half of the day.
• Cover yourself with DEET insect repellent before swimming: it may offer some protection.

HIV/AIDS

The risks of sexually transmitted infection are extremely high in Bangladesh, whether you sleep with fellow travellers or locals. About 80% of HIV
infections in British heterosexuals are acquired abroad. If you must indulge, use condoms or femidoms, which help reduce the risk of transmission. If you notice any genital ulcers or discharge, get treatment promptly since these increase the risk of acquiring HIV. If you do have unprotected sex, visit a clinic as soon as possible; this should be within 24 hours, or no later than 72 hours, for post-exposure prophylaxis.

In Bangladesh, HIV/AIDS prevalence remains extremely low, probably a result of the conservative culture of the country, although the incidence of more minor sexually transmitted diseases is high. For HIV/AIDS, occurrence rates are quite high amongst intravenous drug users and there is little knowledge or prevention action taken in the country. Therefore, it could become a high-prevalence area a few years down the track.

Meningitis

This is a particularly nasty disease as it can kill within hours of the first symptoms appearing. The telltale symptoms are a combination of a blinding
headache (light sensitivity), a blotchy rash and a high fever. Immunisation protects against the most serious bacterial form of meningitis and the tetravalent vaccine ACWY is recommended for Bangladesh by British travel clinics, but if this is not available then A+C vaccine is better than nothing.

Although other forms of meningitis exist (usually viral), there are no vaccines for these. Local papers normally report localised outbreaks. A severe headache and fever should make you run to a doctor immediately. There are also other causes of headache and fever, one of which is typhoid, which occurs in travellers to Bangladesh. Seek medical help if you are ill for more than a few days.

Rabies

Rabies is carried by all mammals (beware the village dogs and small monkeys that are used to being fed in the parks) and is passed on to man through a bite, scratch or a lick of an open wound. You must always assume any animal is rabid, and seek medical help as soon as possible. Meanwhile scrub the wound with soap under a running tap or while pouring water from a jug. Find a reasonably clear-looking source of water (but at this stage the quality of the water is not important), then pour on a strong iodine or alcohol solution of gin, whisky or rum. This helps stop the rabies virus entering the body and will guard against wound infections, including tetanus.

Pre-exposure vaccinations for rabies are ideally advised for everyone, but is particularly important if you intend to have contact with animals and/or are likely to be more than 24 hours away from medical help. Ideally three doses should be taken over a minimum of 21 days, though even taking one or two doses of vaccine is better than none at all. Contrary to popular belief these vaccinations are relatively painless

If you are bitten, scratched or licked over an open wound by a sick animal, then post-exposure prophylaxis should be given as soon as possible, though it is never too late to seek help, as the incubation period for rabies can be very long. Those who have not been immunised will need a full course of injections. The vast majority of travel health advisers including the WHO recommend rabies immunoglobulin (RIG), but this product is expensive (around US$800) and may be hard to come by – another reason why pre-exposure vaccination should be encouraged.

Tell the doctor if you have had pre-exposure vaccine, as this should change the treatment you receive. And remember that, if you do contract rabies, mortality is 100% and death from rabies is probably one of the worst ways to go.

Tickbite fever

South Asian ticks are not the rampant disease transmitters they are in the Americas, but they may spread tickbite fever and a few dangerous rarities in Bangladesh. Tickbite fever is a flu-like illness that can easily be treated with doxycycline, but as there can be some serious complications it is important to visit a doctor.

Ticks should ideally be removed as soon as possible as leaving them on the body increases the chance of infection. They should be removed with special tick tweezers that can be bought in good travel shops. Failing that you can use your fingernails: grasp the tick as close to your body as possible and pull steadily and firmly away at right angles to your skin. The tick will then come away complete, as long as you do not jerk or twist. If possible douse the wound with alcohol (any spirit will do) or iodine. Irritants (eg: Olbas oil) or lit cigarettes are to be discouraged since they can cause the ticks to regurgitate and therefore increase the risk of disease. It is best to get a travelling companion to check you for ticks; if you are travelling with small children, remember to check their heads, and particularly behind the ears.

Spreading redness around the bite and/or fever and/or aching joints after a tick bite imply that you have an infection that requires antibiotic treatment, so seek advice.

Snake bite

Snakes rarely attack unless provoked, and bites in travellers are unusual. You are less likely to get bitten if you wear stout shoes and long trousers when in the forests of Bangladesh, plus these will help ward off leeches. The only other time where there is a risk of snake bite is during the flood seasons in Bangladesh, when the snakes, like people, attempt to move to higher ground. Most snakes are harmless and even venomous species will dispense venom in only about half of their bites. If bitten, then, you are unlikely to have received venom; keeping this fact in mind may help you to stay calm. Many so-called first-aid techniques do more harm than good: cutting into the wound is harmful; tourniquets are dangerous; suction and electrical inactivation devices do not work. The only treatment is antivenom. In case of a bite that you fear may have been from a venomous snake:

• Try to keep calm – it is likely that no venom has been dispensed.
• Prevent movement of the bitten limb by applying a splint.
• Keep the bitten limb BELOW heart height to slow the spread of any venom.
• If you have a crêpe bandage, wrap it around the whole limb (eg: all the way from the toes to the thigh), as tight as you would for a sprained ankle or a muscle pull.

Evacuate to a hospital that has antivenom. At the time of writing this is only known to be available in Dhaka. Many centres have an Indian antivenom but unfortunately this isn’t effective against the most common biting snakes in Bangladesh. Antivenom that includes all the common biters is held by ICCDR Travellers Clinic (68 Shaheed Tajuddin Ahmed Sharani, Mohakhali;
tel: 02 8860523–32; e-mail : info@icddrb.org; www.icddrb.org; time : 09.00–12.00 & 14.00–17.00
Sun–Thu).

And remember:

• NEVER give aspirin; you may take paracetamol, which is safe.
• NEVER cut or suck the wound.
• DO NOT apply ice packs.
• DO NOT apply potassium permanganate.

~story by Mikey Leung~

Are you down with a terrible case of the “Chitta Shittas?” Then you might want to consider a visit to the new ICDDRB Travellers’ Clinic.

The ground reality is that only the hardiest of tummies manage to escape Bangladesh without experiencing a bout of travellers’ diarrheoa, and for those who live in Bangladesh for long periods, it is a right of passage.

Prevention is of course the best medicine. Try to choose food that is hot and fresh, and never feel ashamed to ask restaurant waiters to re-heat food. Choose well-frequented restaurants by eating at regular meal times (people in Bangladesh tend to take lunch between 1 and 2pm, and dinner from 8 to 10pm). If a restaurant looks busy, you can bet that they’re turning over food quickly, which is always a good sign. Best of all, in Bangladesh you will receive frequent invitations to join for dinner at people’s homes—take advantage of this hospitality and enjoy home-cooked meals which is typically the best food you can eat in Bangladesh.

Nonetheless, travellers should expect to experience some digestive discomfort upon arrival. This could be due to any number of reasons: a change in diet could cause it, as well as exposure to a whole new set of bacteria that your digestive system may not be accustomed to. Some expatriates have complained of persistent digestive problems, resolved only by a hydration, a steady diet and inclusion of more raw ingredients than is typically served at a Bangladeshi meal.

And when you get the bug that just won’t go away, head to the clinic and take their advice.

The clinic also offers a range of other non-poo related services like blood testing, kidney testing, travel vaccinations, cervical smears (ladies, there are expatriate doctors here) and a whole bunch of other stuff that should address all the weird and wonderful tropical diseases you manage to acquire while living in Bangladesh.

The cost is extremely reasonable: US$15 per consultation ($50 for insured people).

If you need to come just ask for “the cholera hospital” to any CNG or taxi driver. ICDDR,B stands for the International Centre for Diarrhoeal Disease Research, Bangladesh. Suffice to say that these guys know their shit.

The clinic’s brochure is available at this link. (PDF, 200 KB).