Health & Medical
Malaria
Malaria is the most serious health hazard you will face in PNG. It is a potentially fatal disease and is becoming more common and more difficult to treat because of drug resistance. Most cases of malaria occur with people who did not take their anti-malarial medication or who did not take it as prescribed. Most malarial deaths occur because the diagnosis is delayed or missed.
Malarial mosquitos are night-biters (unlike day-biting dengue mosquitoes) so you need to take particular care to cover up at dusk and night-time. It is best to wear long sleeve shirts and long pants during these periods and to cover any exposed skin with tropical strength mosquito repellant.
The most important preventative measure is to sleep in a mosquito proof tent (Adventure Kokoda provides one for each trekker for this reason). If you elect to sleep in huts or guesthouses along the trail you will increase your chances of contracting malaria substantially because many villagers carry the malarial parasite. If a malarial mosquito bites one of them in their hut - then bites you in the next hut or guesthouse - bingo!
Malarial risks and antimalarial drug resistance patterns are constantly changing, so its important to get the most up-to-date information before you trek. The following webistes provide the latest information on malaria and the most appropriate prevention measures:
. www.malaria.org
. www.tvmc.com.au
Tell your Doctor you are going to PNG for 10 days and will be spending eight of those on the Kokoda Trail in the Owen Stanley Range. He or she will then prescribe the appropriate anti-malarial medication for you.
Heat and Humidity
You need to give your body the best possible chance to acclimatise to the heat and humidity you will experience along the Kokoda Trail.
More trekkers are evacuated from the trail from the effects of heat (dehydration) than any other cause. It is therefore vital to ensure you are physically prepared for your trek and to understand the need for fluid replacement.
The most importand change that occurs with acclimatisation is that you sweat more readily and in larger quantities. Sweating helps cool you down, as heat is lost when sweat evaporates off your skin.
Heat and dehydration can affect your physical performance and mental judgement, even when you're not ill as such. This is especially important in an environment such as the Kokoda Trail.
You can lose more than two litres of fluid an hour in sweat on the trail. If you don't balance this by drinking more, you will be in serious danger of dehydration or heatstroke.
You should not rely on thirst to prompt you to dring - by the time your thirst mechanism kicks in you will already be dehydrated. How much urine you are passing is a much better indicator of how dry you are. If you're only passing a small amount of concetrated (dark yellow) urine, you need to drink more. Cool fluids are absorbed more rapidly than warm ones.
As a rough guide you will need to drink between three and five litres of water each day during your trek.
Sweat contains water and salts. As you acclimatise, your body learns to conserve salt better, and less is lost in sweat. You generally lose more water than salt in sweat, and your main requirement is to replace water. At first you can lose more salt than normal, but so long as you're not on a salt reduced diet, you should still be able to make it up from your diet without needing to add extra salt. The current thinking is that you don't need to actively replace salt unless you experience symptoms, usually muscle cramps, or are doing strenuous exercise. As a rule, salt tablets are best avoided - our diets tend to be relatively high in salt anyway, and too much salt can cause kidney and heart problems in the long term.
It is a good idea to carry some electrolyte replacement powder (staminade or gatorade) to mix with your water. You should mix the powder in strict accordance with the directions supplied because if you 'overdose' it can have the opposite effect.
Signs of Dehydration
Any condition that leads to an excessive loss of body fluids can cause dehydration, including heat, fever, diarrhoea, vomiting and strenuous physical activity. Signs of dehydration are:
. nausea and dizziness
. headaches, and dry eyes and mouth
.weakness and muscle cramps
. passing small quantities of dark urine
. raised tempreture
The best treatment if you experience any of these symptoms on the trail is to dring lots of fluids. Oral rehydration salts (ORS) are best at replacing lost salts as well as fluid, but any (nonalcoholic) fluid will do.
Fainting
This is quite common when you first arrive in a hot climate, and its more likely to affect older travellers. It occurs because heat causes the blood to pool in your legs when you're standing, meaning that less blood reaches your brain, causing you to feel dizzy and faint.
If you begin to feel dizzy you should lie down and raise your legs
to a higher level than your head, spray some cool water over your face and sip some fluid.
Heat Stress
Heat can cause a range of symptoms, from relatively mild discomfort to more serious heat exhaustion and potentially fatal heatstroke. Although these condidtions are usually described as seperate entities, in practice they overlap to a certain extent, so its best to treat any heat illness as heatstroke. Mild heat illness can progress to a more severe one if you don't take actioin to prevent it.
Some of the indicators of heat stress are:
. heavy sweating; your skin fells moist and cool
. tiredness and ittitability
. nausea and loss of appetite
. prickly heat rash
. muscle spasms or twitching
. muscle cramps - painful, occurs in your limbs and abdomen
If you experience any of these symptoms, take this as a sign to take a break from the trek. Rest in a cool envirionment or take a cool bath if there is a stream nearby, and drink lots of water. If you have muscle cramps, drink oral rehydration salts (ORS), gastrolyte and plain water. You can also add a little extra salt to your food and massage your muscles to ease the spasms.
Heat Exhaustion & Heatstroke
Both conditions are more likely to occur if you've experienced heavy and prolonged sweating, without adequate fluid replacement or sufficient time for acclimatisation. The two conditions overlap to a degree, so if you're not sure of the diagnosis, always treat for heatstroke. You are unlikely to be capable of recognising or treating severe symptoms of heat exhaustion or heatstroke in yourself - so keep a lookout for signs of these disorders amongst your fellow trekkers.
Some of the indicators of heat exhaustion or heatstroke are:
. heavy sweating, with cold clammy skin
. headache, dizziness and nausea or vomiting
. tiredness, weakness and restlessness
. muscle cramps
If you take the trekker's tempreture and pulse, you'll find their tempreture is normal and the pulse is fast. The aim of treatment is to cool the trekker down to encourage them to drink plenty of fluids. You should:
. lie the trekker down in the shade, apply wet cloths to their head and body and fan them
. as soon as you can, move them to a cooler place
. encourage them to take sips of water
. arrange for medical help if they continue to vomit or show no signs of improvement
If untreated, heat exhaustion can progress to heatstroke. In heatstroke, sweating stops and you get a dangerous rise in body tempreture. Heatstroke can be fatal. Signs include:
. confusion, headache
. lack of sweating; skin feels hot and dry and looks flushed
. incoordination, confusion, fits and unconsciousness
. raised body tempretures
Heatstroke can be rapidly fatal, so you need to take immediate action to lower the person's tempreture while you get medical help:
. arrange for emergency medical evacuation as a matter of urgency
. move the trekker into the shade or a cooler environment
. if they're conscious, give them cool water to sip.
. apply wet cloths and fan them - sponging or spraying them with cold water can also help
Some Words of Caution!
Two trekkers have died on the Kokoda Trail over the past couple of years. In both cases the trek operator did not have a satellite phone to call for emergency assistance. More than a hundred trekkers have been evacuated - most from heat related illness caused by a lack of physical fitness and dehydration. It is therefore VITAL that the trek operator you choose has a satellite phone and a VHF radio in your group to ensure you can communicate from along the Kokoda Trail. You are taking an unnecessary risk with your own life if your trek operator is not equipped with both of these important items.
You should also ensure you trek with a company that provides an experienced Australian trek guide as they are qualifed to recognise the symptoms of heat stress and begin immediate treatment. They are also the most qualified to take control and execute the necessary actions required for an emergency evacuation.
Emergency evacuation from along the Kokoda Trail will invariably involve the carriage of the patient by stretcher to the nearest village or to a suitable place for a helicopter to land. This takes a fair bit of time and a fair bit of manpower to arrange. Very small groups do not have capacity to arrange for this and usually have to wait for a larger group to come along to render assistance.
Larger trek operators such as
Adventure Kokoda and Executive Excellence have had to render assistance to such groups on many occassions over the past couple of years.
Medical Clearance
The trek is tough and physically demanding. The Owen Stanley ranges are rugged and remote. It is therefore important that you be physically fit.
You must have a thorough medical examination prior to departure as you will be required to obtain a medical clearance as directed.
You should ask your doctor for two prescriptions during your check-up:
- Anti-malarial medication - for Papua New Guinea;
- Anti-inflammatory medication. Have your doctor prescribe anti-inflammatory tablets in case of extreme muscle soreness; and
- Antibiotics for treatment of infections
Click here to download the Medical Certificate required by Adventure Kokoda
Personal Travel Insurance
It is mandatory for you to have a suitable Personal Travel Insurance Policy prior to your departure from Australia. The policy must cover the cost of emergency evacuation by air from any point along the Kokoda Trail, and medical/hospital treatment within PNG and/or Australia.
A Travel Insurance Application Form will be sent to you by Travelscene, Twin Towns, on receipt of your booking.
Public Liability Insurance
It is your responsibility to ensure the trek operator you choose has a current Public Liability Insurance policy to protect you from permanent disability caused by an accident during the trek. It would be an irresponsible risk to trek across the Kokoda track without this type of protection.
Personal Travel Insurance Claims Process
Airlines in PNG require prior payment before they will dispatch a plane or a helicopter for an emergency evacuation. It is therefore important for you to have an international credit card with you on the trek so that prior payment can be authorised in the event of an emergency.
Immunisations
Whilst no vaccinations are required for entry to PNG you should seek advice from your Doctor in regard to the need for cholera, typhoid and hepatitis vaccinations and to esure your tetanus cover is up to date.
Plan ahead for getting your vaccinations. Some of them require an initial shot followed by a booster, while some vaccinations should not be given together. This also applies to some malaria prophylactics, which have to be begun at least a week before you leave home.