Author: Kristin Gagnon, RN

by Kristin Gagnon, RN Kristin Gagnon, RN No Comments

Destination Kilimanjaro: Does It ‘Peak’ Your Interest?

One step in front of the other. After 7 days of hiking through jungle, hot sun, arid desert, rain, fog, hail, wind and snow we are almost at the summit. And finally, after hiking all night, we make it to the summit just as the sun is rising. And here we stand at 5,895m on Uhuru Peak, the roof of Africa, on the top of Mt. Kilimanjaro (with a bonus surprise at the top!)

Mt. Kilimanjaro is one of the world’s seven summits, representing the highest peak on Africa’s continent. Located in Northern Tanzania it attracts an estimated 25,000 climbers per year but for those attempting the 4-5 day routes only 10% will reach the summit. As Kilimanjaro does not require any technical climbing skills many people underestimate its seriousness. At TravelSafe Clinic we’d like to prepare you for a successful climb. Keep on reading for tips about choosing your route, tour company, packing, and high altitude.

Choose your route

The Marangu route is the classic route up Kilimanjaro and is usually sold as a “5 day, 4 night” trip. This route is often named the “Coca-Cola” route as accommodation is in bunkhouses rather than camping. Many people who attempt this route do not successfully summit as there is little time to acclimatize to the high altitude. There are at least 9 other routes which involve camping and are usually sold as 6-9 day packages. Choosing a longer route will provide more opportunity to acclimatize to the high altitude. We chose the 8 day Lemosho route, which has a high success rate and provided us with sufficient time for acclimatization. This route begins in rainforest and travels upwards through moorlands, arid desert, and glacial zones. It is considered one of the most scenic routes on Kilimanjaro!

Choose your tour company

Trekkers must book through a licensed agency and be accompanied with a guide. Do your research as your success greatly depends on the support of your tour company. TripAdvisor is a great place to look for climber’s reviews. The cost of a trek can range from USD $1,000 to USD 5,000+. You can find a great company for less than USD $5,000 but don’t cheap out as you may be sacrificing gear and guide experience. You may find some discounted packages by booking your trek and safari with the same tour company. Some important considerations when choosing your tour company:

  • How many people in a group? Your experience will vary greatly if you are a group of 25 versus a group of 2-6 people
  • Ask about gear and ensure it’s high quality (you don’t want to wake up in a puddle if it rains!)
  • Ask about the guide’s experience and ensure that medical checks are included and oxygen is provided (our guide carried oxygen throughout the entire trek and checked our blood pressure, pulse, oxygen saturation and breath sounds twice per day)
  • Is the company a member of KPAP (The Kilimanjaro Porter’s Assistance Project)? The KPAP’s website isn’t lying when it says that “the porters are the heart and soul of your trek.” The porters carry the heavy gear, cook and serve food, and ensure you are well looked after. KPAP ensures that partner companies are in compliance with guidelines for the proper treatment of porters, to ensure that they are paid fairly and do not carry more than the maximum allowable weight.

 

What to pack?

From hot humid jungle, to dry desert and glaciers. Be prepared for sun, rain, cold and snow. Layers are key!

  • Hiking boots (well worn in!)
  • Camp shoes (it feels so good to get your feet out of your boots after a day of trekking)
  • Headlamp and extra batteries
  • Hiking poles
  • Breathable, waterproof shell jacket
  • Breathable, waterproof pants
  • Down jacket
  • Fleece jacket
  • Fleece pants
  • Moisture-wicking long sleeve shirts and t-shirts
  • One to two base layers (tops and bottoms)
  • Hiking socks (with a variety of cushioning)
  • Sock liners (for summit night and to prevent blistering)
  • Sun hat
  • Warm hat
  • Glove liners
  • Warm, waterproof gloves for summit night
  • Sunglasses
  • Gaiters (we didn’t use these but many people swear by them to keep the dust off)
  • Day pack (large enough to carry your water, camera, lunch and layers)
  • Waterproof duffel bag (the porters will carry this)
  • Water bladder (3 L) or water bottles
  • Warm sleeping bag
  • Sun screen
  • Lip balm
  • Wet wipes
  • Electrolytes (i.e. hydralyte)
  • Snacks (although we didn’t end up eating most of our snacks as we were extremely well fed on our trek)
  • Blister bandaids
  • Camera and extra batters (Our iphones and gopro didn’t work at summit due to the cold)
  • Medications: ciprofloxacin, diamox, immodium, ibuprofen, antiemetic, antimalarials (if needed)
  • Cash for tipping guides and porters
  • Cards or book for down time

Much of this gear can be rented in town before starting the climb. We rented waterproof duffel bags, waterproof pants, and a warm jacket for summit night. I wouldn’t recommend renting boots as these should be well broken in and moulded to YOUR feet to prevent blisters.

 

The highs of Kilimanjaro – coping with altitude

After months of preparation and years of dreaming everyone climbing Kilimanjaro has the same goal – reaching the summit. Unfortunately many travellers arrive under-prepared, ascend too quickly, and fail to reach the summit. Proper acclimatization is not possible for many trekkers and so most people suffer to some degree of acute mountain sickness (AMS).

AMS is a genetic trait that varies from person to person. It is not dependent on the degree of physical fitness and it is not possible to predict the risk of AMS. The only predictor of AMS is how you reacted on a previous trip to high altitude – if there were previous problems at high altitude then these are likely to return on Kilimanjaro.

Symptoms of AMS may be mild and include headache, fatigue, lack of appetite, nausea, insomnia, dizziness, and general malaise. A small number of people can develop more severe symptoms of High Altitude Pulmonary Edema (HAPE) or High Altitude Cerebral Edema (HACE). Symptoms of HAPE include a dry cough and shortness of breath at rest, when “it becomes impossible to finish a sentence without gasping for breath.” In addition to AMS symptoms, HACE causes profound lethargy, drowsiness, confusion, slurring of speech, and difficulty walking in a straight line. If symptoms of HACE or HAPE appear a person requires immediate descent and medical attention. Both HACE and HAPE can be fatal if a person does not descend to a lower altitude.

Keep in mind the following tips about high altitude to help you prepare for a successful climb:

 

Pole pole

  • You will hear the phrase “pole pole” countless times on the mountain. This is the Swahili word for slowly and your guides will say it to you over again. Heed this expression and make sure you walk “pole pole!”
  • Allowing more time to acclimatize will help for a successful summit. Consider choosing a longer route instead of a 4-6 day route or add an extra day or 2 to your ascent.
  • If possible, hike nearby Mt Meru (4,565m) or Mt Kenya (4,895m) before your climb up Kilimanjaro.
  • If you plan on visiting Ngorongoro Crater (2,286m) do so before Kilimanjaro. Sleeping here for the last few nights of your safari will help to acclimatize for Kilimanjaro (especially for those living at sea level in Vancouver!)
  • Don’t try keep up with the porters! Most of the porters have spent a considerable amount of time on the mountain. Even when you feel like you are keeping a good pace your porters will fly by you. Remember to walk pole pole!

 

Climb high, sleep low

During the day climb higher than your sleeping altitude to encourage acclimatization. Follow your guide’s advice if an acclimatization walk is recommended after you’ve reached camp.

 

Consider your meds!

  • Consider taking diamox (acetazolamide) to speed acclimatization, starting two days before ascending and continuing until reaching the summit.
  • Bring ibuprofen or acetaminophen to treat headache caused by AMS
  • Bring an antiemetic to treat nausea/vomiting caused by AMS. Ginger is a natural alternative to anti-nausea medications that may cause drowsiness.
  • Avoid alcohol and sleeping pills

Stay hydrated!

Drink 2-3 L of water per day (more on summit day). Urine should remain clear and hydration is absolutely necessary even if you do not feel thirsty (fluid loss from breathing greatly increases at high altitude).

 

Recognize the symptoms AMS and know your limits!

People with mild symptoms of AMS can safely remain at high altitude and treat headache and nausea. If symptoms continue to worsen while resting at the same altitude then you must descend at least 300m. Listen to your guides if they advise you to turn around. Your guides want nothing more for you to summit so recognize the seriousness of your symptoms if they are telling you to turn around. Reaching the summit of Kilimanjaro is not worth your life! And remember that the journey doesn’t end at the top. You also need the strength to get back down

 

Recommended reading: “Kilimanjaro: The Trekking Guide to Africa’s Highest Mountain” by Henry Stedman

 

by Kristin Gagnon, RN Kristin Gagnon, RN No Comments

Is the Yellow Fever Vaccine Shortage Really ‘Bugging’ You?

Travelling to Africa or South America? You may be at risk for Yellow Fever.

If you are travelling to Africa or South America, you may be at risk for yellow fever. Yellow fever is a potentially serious and life threatening disease caused by a virus spread by an infected mosquito. The best way to prevent yellow fever is to get vaccinated!

There is currently a shortage of the yellow fever vaccine in Canada. A return to normal supply is only expected in late 2018. When travelling to an area with yellow fever risk, especially to areas experiencing an outbreak, the best option is to receive a full dose of the vaccine or to postpone travel.

When this is not possible, the Public Health Agency of Canada has recommended the use of a fractional dose of yellow fever vaccine. Based on existing evidence the World Health Organization (WHO) has determined that a fifth of the standard vaccine dose (0.1mL instead of 0.5mL) will provide protection against yellow fever for at least 12 months.

The WHO states that a fractional dose does not qualify for a yellow fever certificate. Therefore, when receiving a fractional dose travellers are provided with a waiver which is valid for 12 months beginning 10 days after vaccination. An explanation that the traveller received a fractional dose due to a severe vaccine shortage is written on the waiver. This waiver should satisfy border entry requirements.

 

What should you do if you are travelling to Africa or South America?

Book your consultation at TravelSafe Clinic as soon as possible! We will review your itinerary, vaccine history, and medical history to determine if the yellow fever vaccine is recommended for you.

If you need the vaccine you will then need to book a separate appointment to return for a yellow fever fractional dosing clinic. You will be booked with a group of people at the same time to receive a fractional dose since the vaccine must be used within one hour once opening (so please arrive on time for your fractional dose!).

Depending on vaccine availability you will either return to TravelSafe Clinic for the fractional dose or be referred to another travel clinic for vaccination.

 

Is there any option to receive a full dose?

Due to the extreme vaccine shortage TravelSafe Clinic is only able to offer a fractional dose when the vaccine is in stock. You may be able to locate a full dose at other travel clinics in Vancouver that have a greater supply of the vaccine. There are also a number of yellow fever vaccination centres in major airports serving as transit points to Africa and South America.

This may be an option if you will not be at yellow fever risk or required to show the vaccine certificate for at least 10 days following vaccination and if you have no major medical issues. It may be possible to make a vaccine appointment if travelling through airports in Frankfurt, London, Munich, Paris, Johannesburg, and Mexico City. We can review your options during your consultation at TravelSafe Clinic.

 

Yellow fever certificates now valid for life!

As of July 2016 yellow fever certificate validity changed from 10 years to life of the person vaccinated. Therefore a yellow fever booster is no longer needed if it has been longer than 10 years since previous vaccination. The lifetime validity automatically applies to all existing and new certificates, beginning 10 days after vaccination. So hang on to those old yellow fever certificates!

by Kristin Gagnon, RN Kristin Gagnon, RN No Comments

Adults Need Shots, and I Don’t Mean the Alcoholic Kind!

Adults need booster shots at Travel Safe ClinicAdults need boosters too

The need for vaccination does not end after childhood, as many people may think. Some diseases such as measles, mumps and whooping cough are still a risk in BC.

 

Protection from many vaccines received as a child can wear off over time so getting another dose (called a booster) can increase immunity to provide the best and longest lasting protection.

 

Some people cannot get immunized, such as babies that are too young for vaccines, or people with certain medical conditions. Vaccination is the best way to protect you and those around you from vaccine-preventable diseases.

 

 

Vaccine-preventable diseases that adults can get immunized for include:

  • diphtheria
  • hepatitis A
  • hepatitis B
  • herpes zoster (shingles)
  • human papillomavirus (HPV)
  • influenza
  • measles
  • mumps
  • meningococcal
  • pertussis (whooping cough)
  • pneumococcal
  • polio
  • rubella
  • tetanus
  • varicella (chicken pox)

 

Travelling? There might be other vaccines too!

As well as keeping up to date on your routine vaccines, you might need others for travel. Depending on your destination you may also need vaccines for typhoid, Japanese encephalitis, yellow fever, rabies, cholera, or traveller’s diarrhea.

Whethertravelling or not, at TravelSafe clinic we can help you determine what vaccines are needed and how many doses.

 

It’s never too late to finish your vaccine series!

Sometimes life gets in the way and it’s not always possible to come back to the clinic to complete a vaccine series according to the recommended schedule. It’s never too late to finish! Completing your vaccine series ensures long term protection, so when that next vacation presents itself all you’ll need to worry about is what to pack!

For more information see the Public Health Agency of Canada’s guide, Not Just For Kids. An Adult Guide to Vaccination

 

by Kristin Gagnon, RN Kristin Gagnon, RN No Comments

Tuberculosis Skin Testing – What you need to know!

Congratulations! You’ve been accepted to that school program or perhaps you got that new job. But before you can start you’ve been asked to complete a TB skin test by your school or employer. No idea what a TB skin test is? Here’s what you need to know.

What is TB?

TB, or tuberculosis, is a bacteria spread through the air when a contagious person coughs, sneezes, sings or talks. TB usually occurs in the lungs but can affect any organ. Medication is available to treat TB.

What is a TB skin test?

The TB skin test is used to detect infection with TB bacteria. The TB test consists of two appointments:

Appointment #1: A small amount (0.1mL) of test substance is injected under the first layer of skin on your forearm. If you have been exposed to TB bacteria your skin will react to form a firm red bump.

Appointment #2: You must return to the clinic 48 to 72hrs later to have your forearm looked at by the nurse. If it is not looked at within 72 hours the result becomes invalid and the test must be repeated. Make sure to arrive on time for your second appointment!

What is a two-step TB skin test?

If you have been asked for a two-step TB test then you need to repeat the exact same procedure 1-3 weeks after the first test. A two-step TB test is used to establish a baseline for people who need regular TB skin testing.

Is there anything I need to do to get ready for the test?

  • Be sure you don’t receive any live vaccines in the 28 days before your TB test as they can interfere with the test (MMR, chicken pox, oral typhoid, shingles, or yellow fever vaccines). These vaccines can be given on the same day as the TB test or anytime after the test is completed. Td, Tdap, polio, hepatitis A and B are all inactivated vaccines and can be given anytime before or after the TB test.
  • If you need other vaccines please bring your list for the nurse to review and any forms you may need signed.
  • Please bring a list of your current medications.

Is there anything I can’t do after the TB test?

DO everything as you normally would. Eat and drink as normal. Shower and swim as much as you like.

DON’T scratch it or put a bandage on it (in case the bandage irritates your skin). If it becomes itchy you can put a cool cloth on it. Do not put any creams on it.

I’ve had the BCG vaccine – Can I still get a TB test?

Yes you can! The BCG vaccine, or Bacille Calmette Guerin, is routinely given in many countries to protect against TB disease. Although there is a chance the BCG vaccine may cause a false-positive TB skin test, this is not likely if you received the vaccine more than 10 years ago.

My TB skin test is positive – does this mean I have TB?

Not necessarily! The TB test can be positive if you have been infected with TB bacteria, had a previous BCG vaccine, or have had an infection with non-TB bacteria from the same family of bacteria. The test cannot determine how long you may have been infected with TB or whether the bacteria is active or latent (sleeping). The next step is to review your health history with the nurse and complete a chest x-ray to see if TB bacteria are growing in your lungs.

What’s the difference between active and latent TB?

  • Latent TB infection occurs when you have breathed in the TB bacteria but your immune system stops the bacteria from multiplying so you don’t get sick. If you have latent TB you don’t have any symptoms and cannot spread TB to other people.
  • Active TB disease occurs when you have breathed in the TB bacteria but your immune system does not stop the bacteria from multiplying. These multiplying bacteria can make you very sick.

Where can I get the x-ray done?

You can go to any hospital in the Lower Mainland for your x-ray (eg. St Paul’s Hospital, Vancouver General Hospital, Royal Columbian Hospital, Burnaby General Hospital). Take your requisition to the radiology department. The x-ray is free when you have a BC care card.

How do I get the results?

A doctor at TB Control will review your health history and look at your x-ray. An x-ray report will be mailed to your home address if no further follow-up is required. It can take 4-6 weeks to receive your x-ray results in the mail. If you have still not received your results after this time please call TB control (TravelSafe clinic does not receive any x-ray results).

 

TB Control Vancouver Clinic
655 West 12th Avenue
Vancouver, BC V5Z 4R4
Phone: 604-707-2692

TB Control New Westminster Clinic
100-237 Columbia Street E
New Westminster, BC V3L 3W4
Phone: 604-707-2698

 

Please see the following links for further information on Tuberculosis in Chinese, Korean, Punjabi and French.

 

Be sure to get your TB test as soon as you find out you are accepted into your school program or got your new job. Whenever possible don’t leave it to the last minute!

Any other questions you may have can be answered by the nurse at the TravelSafeTM clinic when you come in for your TB test. See you soon!

Before you travel, protect your health.

TravelSafely with TravelSafe Immunization Clinic

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