Staying Healthy on Outreach

Staying Healthy on Outreach: From culture shock to stomach illness to AIDS, this is a quick reference guide put together by Counselling and Health Care to help our teams stay healthy on the field.

Immunizations
Your school staff will tell you what immunizations are recommended for the countries to be visited. For travelling in most countries, the following are recommended:
 * Routine childhood immunizations:
 * DPT - Diphtheria, Pertussis (whooping cough), & Tetanus (lock jaw).
 * MMR - Measles (7-day measles), Mumps, & Rubella (3-day measles).
 * Polio -- Sabin (oral) or Salk (injectable)
 * Note: If working with babies, do NOT use oral (Sabin) polio immunization if you need a polio booster or are being immunized for the first time.
 * Hepatitis A
 * Typhoid

General Guidelines
When getting established in an area, look for a referring M.D. to have available! Every YWAM base should visit some hospitals in their area and choose one for their use - before an emergency arises!

Questions to Consider When Evaluating a Hospital (Especially Developing World)

 * How is the medical care? Medical supplies?  Nursing care (personnel)?
 * What are the daily costs?
 * Does the hospital enhance healing or induce depression?
 * Missionary hospitals: often reasonable costs, personal, helpful

Traveler's Diarrhea
Food and waterborne diseases are the number one cause of illness in travelers. Traveler's diarrhea can be caused by viruses, bacteria, or parasites, which can contaminate food or water. Infections may cause diarrhea and vomiting. Make sure your food and drinking water are safe; this includes all beverages! (See "Water Treatment," below.)

Food Guidelines
Your outreach cook's food is probably safe, but if you are at the market or in someone's home:
 * Piping hot is best
 * Peeled fruits and vegetables are safe (if YOU peel them).
 * Purchased packaged drinks are safer than open containers, especially soft drinks.
 * Don't eat dairy products unless you know they have been pasteurized.
 * Do not eat food prepared by street vendors.
 * If food is offered, pray and eat it. Eating smaller amounts will decrease risk.
 * The Center for Disease Control (CDC) in Atlanta says: "Boil it! Cook it! Peel it! Or... Forget it!!!"

Water and Beverage Guidelines
According to seasoned flight attendants, drinking one 8-ounce glass of water or juice every hour in flight, has proven to prevent jet lag, or at the very least, reduce it significantly.
 * Drink plenty of fluids. Keep hydrated.  Take a water bottle.
 * Avoid tap water.
 * Consider water contaminated unless told otherwise.
 * Avoid fountain drinks, and ice cubes (often they are contaminated.)
 * Drink less sugared soft drinks, especially in hot weather. (They can increase the chance of bladder infection, and they actually dehydrate you.)

Water Treatment Recommended by Cdc
Filter water through an "absolute 1--micron or less" filter AND add iodine tablets to the filtered water. ("Absolute 1-micron filters" are found in camping/outdoor supply stores.)

Other methods of water treatment (any of these techniques are acceptable):
 * Filter all drinking water (Katedine Filter are best, if available).
 * Boil water for 5 minutes. (problem: time and use of host's fuel resources)
 * Add water purification tablets or drops to water. (Halazone tablets, Potable Agua, Coghlan's)  Use supplied directions, usually allowing to stand for 30 minutes.
 * Add 2 drops 4% laundry bleach per quart or liter of water. If water is cloudy add 4 drops.  Let water stand for 30 minutes.
 * Add 5 drops 2% tincture of Iodine per quart of liter of water. If water is cloudy add 10 drops.  Let water stand for 30 minutes.

Hygiene

 * Bathe daily, if possible.
 * Check yourself regularly for small cuts or blisters. Treat them early and cover with a bandage.
 * Change and wash your clothes frequently.
 * Avoid going barefoot (hookworm). Use flip-fops in showers (fungus).
 * Wash hands frequently: especially after using the bathroom, before preparing food or beverages, before eating, after handling money and/or shaking hands, and as often as they become soiled. (Waterless hand sanitizers such as Purell or antibacterial baby wipes work well when soap and water are not available.)
 * Keep your hands away from your face unless it is necessary to wash etc.

Hand Washing Instructions

 * 1) Use soap and running water. Rub hands vigorously for 15 - 20 seconds. (If no soap is available, at least use water; the friction and water will remove much of the bacteria, etc.)
 * 2) Wash all surfaces, including backs of hands, wrists, between fingers, and under fingernails.
 * 3) Rinse well for 15 -- 20 seconds
 * 4) Dry hands on paper towel if possible.  Turn off the water using paper towel as well.

Treatment of Traveler's Diarrhea
Traveler's diarrhea is common during the first few days in a new country. Usually the body will heal itself in 3-4 days, so give it a little time. In cases of mild diarrhea: Suggested Dosage: For diarrhea without other problems, drink as much as desired without causing vomiting. General amounts are listed below. If there is vomiting or the person resists taking fluids the solution should be given in small quantities (1 sip every 5 min. day and night, unless sleeping) until normal urination occurs. If unable to continue fluids, seek medical help. Adding a little orange juice or mashed banana will improve flavor and add potassium, an important micronutrient that the body loses during diarrhea.
 * Hydration (replacing fluids) is most important; drink plenty of liquids, and Oral Rehydration Solution (ORS) is best.
 * Adults- 3 liters or more per day, 1 large cup after each watery stool
 * Children over 2 years- 1 to 2 liters per day, 1/2 to 1 large cup after each watery stool
 * Babies under 2 years- up to 1 liter per day, 1/4 to1/2 of a large cup after each watery stool

Note: Gatorade is also good, but cut it to 1\2 strength with water. Can also drink weak tea, clear soups, or coconut water.


 * Pepto Bismol tablets may help.
 * While traveling, Imodium or Lomotil tablets may help, but not recommended otherwise. Do not take if fever and/or bloody diarrhea are present, or for more than 2-3 days. Most diarrhea stops by itself after 3-4 days.  Trying to stop it early with medication could hide the need for medical help.
 * If diarrhea persists for longer than 3-4 days, see your Outreach Leader.

Prevention of Insect-Borne Diseases
Prevention of Insect-borne Diseases (Malaria, Dengue Fever, etc)
 * Best protection: don't get bitten!!! Use skin repellant, mosquito nets, and cover up!
 * See Malaria and Dengue Fever sections for more specific information.

Swimming

 * Do not swim in fresh water; rivers, lakes (standing water), unless known to be safe from bacteria, pollution, snakes, alligators, crocodiles.
 * Salt water is usually safer than fresh water.
 * Well-chlorinated swimming pools are safe.

Animals
Do not handle them! (especially monkeys, dogs and cats), to avoid bites and serious diseases, including rabies and plague.

Safety
Motor vehicle-related death is generally very high in developing countries. The following steps can minimize this risk:
 * Ride in the back seat as much as possible.
 * When driving, drive defensively.
 * Avoid night driving.
 * Wear safety belts where available!
 * Bring a child safety seat if you are bringing a child.
 * Be an alert pedestrian.

Culture Shock
Culture shock can be defined as feeling unable to cope in another cultural environment, although at least some culture shock is to be expected and should be enjoyed as an opportunity for growth.

Suggestions: How do you greet people? How much "personal space" is acceptable? Which gestures are good or bad? Is it possible to politely refuse invitations or food and if so, how? What clothes or styles could be offensive?
 * Look for what God is telling you in this time.
 * Put rest days, quiet times in weekly outreach schedule
 * Talk, share and pray with one another over struggles - Don't be a "lone ranger," have a servant's heart and work as a team. Phil 2:3-8, 14-16
 * Continue to take walks out in the community - don't isolate yourself at home for too long.
 * Learn about the culture before you get there.
 * Get into the culture through language. Learn simple phrases and use them.  Visit local markets, stores, and churches.  Accept invitations to people's homes... ask your school leader first!
 * Keep perspective! This is a temporary exposure, don't waste your opportunities, and remember that you are the guest.

What You Need to Bring With You!
Note: Pack prescriptions in your carry-on luggage.
 * Prescription medications: Plan ahead, make sure you have enough to last during your entire time on outreach, as well as a copy of the prescription(s).
 * Glasses / contact lenses: Carry an extra pair of glasses, as well as your prescription.  Take contact supplies and your prescription with you.
 * Small First Aid Kit:
 * Bandages
 * Cleaning agent (bactine, betadine, iodine solution)
 * Triple antibiotic ointment
 * Pepto Bismol
 * Dramamine or bracelets for travel sickness
 * Aspirin or pain reliever. Warning! Do not give aspirin to children with cold symptoms, as this could cause Reyes Syndrome.
 * Sunscreen, sunglasses, hat.
 * Insect repellent with 30-35% strength DEET for adults, 6-10% for children.
 * Long-sleeved shirt and long pants to wear outside whenever possible.
 * Over-the-counter antidiarrheal medicine to take if you have diarrhea but must travel. Immodium/Lomotil tablets. (NOT recommended for treatment.  See "Treatment of Traveler's Diarrhea.)  These drugs only treat symptoms, they don't cure the illness!

After You Return Home

 * If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (chloroquine, Lariam, doxycycliine) or seven days (Malarone) after leaving the risk area.
 * If you become ill with a fever or flu-like illness while traveling in a malaria-risk area, and up to 1 year after returning home, seek prompt medical attention and tell the doctor your travel history
 * If you have reason to visit a physician, be sure to tell your them your travel history.

HIV/AIDS
What is HIV? HIV stands for Human Immunodeficiency Virus. This virus attacks and destroys the immune system, and causes AIDS (Acquired Immune Deficiency Syndrome).

Viruses usually run their course and the body's immune system overcomes them. In the case of HIV, the virus destroys the immune system. The person becomes ill with diseases such as TB, certain cancers, exotic pneumonias, skin problems, etc., and has no immune system left to fight them. This stage is called AIDS, and at this point the person is usually close to death.

What is AIDS?
It is the advanced stage of HIV infection. It leaves the body defenseless against illness.

A = Acquired: Not inherited.

I = Immune: The system that defends the body against infection and disease.

D = Deficiency: Inadequate immune system, as a result of HIV infection.

S = Syndrome: A term for a group of symptoms.

How is HIV spread? It's not who you ARE, it is what you DO!
 * 1) Sex with an HIV+ person -- vaginal, oral, or anal sex.
 * 2) Blood -- contaminated needles or sharp objects, as in IV drug use, tattooing, body piercing, razors, scissors, and blood transfusions; however, blood supplies in the U.S., Australia, New Zealand, Canada, Japan, and western European countries are now considered safe.
 * 3) HIV+ mother to child -- before, during, or after birth (breastfeeding).

Who is at Risk?
Any one who has ever engaged in risky behavior, such as:
 * Unsafe sexual practices that result in tissue tearing; anal, oral or vaginal
 * Homosexuals
 * Sex with multiple partners
 * Sharing needles to inject drugs
 * Body piercing
 * Tattooing
 * Sharing razors, toothbrushes, scissors
 * Blood transfusions in countries other than the United States, Australia, New Zealand, Canada, Japan, and western European countries.

How is HIV Not Spread?
Note: If there is no exchange of body fluids through sexual contact, if there is no exposure to blood, HIV will not be spread in activities of daily living.
 * Normal, everyday casual contact.
 * Airborne -- such as coughing, sneezing, laughing, talking, singing, casual kissing.
 * Simple skin contact -- shaking hands, hugging, touching.
 * Through simple food or water -- on plates, cups, spoons; or toilets, in baths, pools, hot tubs, showers, etc.
 * Bed linens, towels, clothes, etc
 * Through insects, such as mosquitoes.

Is There a Cure?
No! Only medications that prolong life, and no vaccine has been developed to prevent it.

Prevention:

 * Sexual abstinence till marriage to a person testing HIV negative for 6 months, and both partners remaining true to each other.
 * Don't use alcohol or illegal drugs. Alcohol and drugs impair judgment.
 * Illegal intravenous (IV) drugs impair judgment and equipment is often shared and unsafe.
 * Make sure any needle, syringe, or sharp object used, is sterilized.
 * Don't share razors, scissors, and toothbrushes.
 * If a blood transfusion is necessary, try to have an HIV negative family member or friend donate blood or give your own blood ahead of time (for scheduled surgery etc).

How do I Know if Someone is HIV+?
You don't! It is impossible to know, since often the infected person doesn't even know. During the early weeks or months of infection the virus is not detectable through ordinary tests, but can be spread to others.

Signs and Symptoms:
Note: Many other illnesses can give similar symptoms, and not be AIDS.
 * Swollen lymph glands
 * Unexplained loss of 10% or more of body weight
 * Fever for more than one month
 * Night sweats
 * Persistent, abundant diarrhea
 * Tuberculosis, pneumocystis carinii pneumonia, certain cancers,

How Can I Find Out if I Have HIV?
There are simple tests that can be done, FREE! Just call:
 * Salvation Army, 326-5629;
 * West Hawaii AIDS Foundation, 331-8177;
 * American Red Cross,
 * National AIDS HOTLINE (free 24 hours), 1-800-342-2437.

For more on AIDS and YWAM's policies see: Category:HIV/AIDS

Hepatitis a, B, and C
What is Hepatitis? Hepatitis is inflammation of the liver from any cause. ("Hepatic" refers to liver, "itis" means "inflamation of".) Hepatitis commonly results from a virus, particularly one of five hepatitis viruses-A,B,C,D,or E, which attack the liver. We will address A, B, & C.

Hepatitis a Virus (Hep A)
Hepatitis A is a short-term infection. There is no chronic infection or carrier state as with Hepatitis C and B.

How is Hepatitis Spread?

 * 1) It is found in stool of persons with Hepatitis A.
 * 2) Usually spread from the stool of one person to the mouth of another, due to poor hygiene.
 * 3) Water or food contaminated by sewage.
 * 4) Contaminated raw shellfish..
 * 5) Blood and body secretions may also be infectious.

Treatment

 * After the first several days usually appetite returns, and the person doesn't need to stay in bed.
 * Severe restrictions of diet or activity are unnecessary and vitamin supplements are not required.
 * Empty bedpans directly into toilet, and sterilize after each use by washing the bedpan with a mixture of 10 parts water to 1 part regular bleach.
 * Toilets and floors should be cleaned thoroughly and often with hot water and a disinfectant.
 * Soiled clothing or bed-linen should be laundered in hot water with a detergent and bleach.
 * Scrupulous hand washing of patient and caregivers.

Prevention

 * Hepatitis A vaccine (Havrix) is the best protection, recommended for persons 2 years of age and older traveling to areas where there is increased risk.
 * Havrix is administered in 2 doses, and the second is received 6-12 months after the first. It is recommended that teams receive this prior to going on outreach.
 * Short term protection against Hepatitis A is available from immune globulin. It can be given before, and within 2 weeks after coming in contact with Hepatitis A.
 * Always wash hands with soap and water after using the bathroom, changing a diaper, and before preparing and eating food.

Hepatitis B Virus (Hep B)
Hepatitis B is a hardy virus: easier to "catch" than most people realize. It is 100 times more contagious than HIV, the virus that causes AIDS, and can survive for up to 1 month. HBV attacks the liver and can make a person extremely ill.

How is Hep B spread?
 * 1) Blood:  Contact with infected blood, or blood products; such as sharing needles in IV drug use; blood transfusions, (especially outside of the USA), body piercing, sharing razors, scissors, tooth brushes etc; much the same as for HIV/AIDS.
 * 2) Sex with an infected person for vaginal, anal, or oral sex

Incubation Period
6 -- 12 weeks, sometimes much longer. (The incubation period is the time between the time the virus enters the body, and the time symptoms occur.)

Signs and Symptoms
Similar to Hepatitis A, but the onset tends to be more insidious (more dangerous than seems evident).

Important: A blood test is needed to determine which hepatitis is present. Until the results of the blood test are known, you will not know which hepatitis virus is responsible, and should assume that stools and all body fluids are infectious.

Prevention:

 * There is a vaccine available for Hepatitis B; Just three shots of vaccine provide protection. The Centers for Disease Control and Prevention (CDC) recommends:
 * Universal vaccination of all infants
 * Vaccination of all persons from birth to age 18
 * Vaccination for at-risk adults. Hepatitis B vaccine is strongly advised for anyone traveling to developing countries, or remote areas
 * Don't use alcohol or illegal drugs. Alcohol and drugs impair judgment.
 * Sexual abstinence until marriage to a person testing negative.
 * Make sure any needle, syringe, or sharp object used is sterilized.
 * Don't share razors, scissors, tooth brushes.
 * If a blood transfusion is necessary, try to have the donor be a family member, or friend, who is known to be disease-free; or give your own blood ahead of time for scheduled surgery etc.

Hepatitis C Virus (Hep C)
Hepatitis C is a blood-borne virus. It enters the body through direct blood exposure and attacks and kills liver cells.

How is Hepatitis C Spread?
Much the same as Hepatitis B and HIV. (See Hep B & HIV)
 * 1) Contact with infected blood, or blood products; such as sharing needles in IV drug use; blood transfusions before 1992 or outside of the USA, body piercing, sharing razors, scissors, tooth brushes etc (much the same as for HIV/AIDS.)
 * 2) Sex with an infected person for vaginal, anal, or oral sex.

Incubation Period
2--26 weeks.

Signs and Symptoms
Similar to Hepatitis A and B symptoms

Treatment
There are modern drugs available, however, there are side effects. Since the liver has been compromised. During treatment it is important to maintain a well balanced diet. Avoid the following:
 * Alcohol, as it is very toxic to the liver
 * Smoking
 * Caffeine; chocolate and coffee
 * Foods with high fat/salt/sugar content: processed foods -- canned or frozen, chips, fast food, bacon, sausage, cold cuts, cheeses, Chinese food, and pickles.
 * Tylenol
 * Many herbs and supplements

Prevention

 * Be vaccinated against Hepatitis A and B
 * Don't use alcohol or illegal drugs. Alcohol and drugs impair judgment.
 * Sexual abstinence till marriage to a person testing negative.
 * Make sure any needle, syringe, or sharp object used is sterilized.
 * Don't share razors, scissors, tooth brushes.
 * If a blood transfusion is necessary, try to have the donor be a family member, or friend, who is known to be disease-free; or give your own blood ahead of time for scheduled surgery etc.

Tuberculosis
Tuberculosis (TB) is a disease caused by tiny germs (bacteria) that are breathed into the lungs and start to multiply. Some TB germs may travel to other parts of the body, such as the kidneys, bones, and brain. The person then has TB infection.

How is Tuberculosis Spread?
TB germs get into the air when someone who has TB: The most common way is by spending a lot of time indoors with someone who has TB disease. It generally requires long-term (months or years), prolonged exposure for a person to become infected, unless they have a problem with their immune system, like AIDS.
 * Sneezes
 * Coughs
 * Speaks/sings/laughs

Note: TB germs are not spread on dishes, drinking glasses or other objects.

Why Should I Care About It?
Because you could have TB germs in your body and not even know it. Millions of people have TB germs and don't feel sick. Many need treatment to keep from getting sick---or even dying.

Testing
A simple skin test can help show if there are TB germs in your body. TB skin tests can be gotten FREE at your local Health Department. If the skin test is positive, a chest X-ray and possibly other tests will be done to determine if you actually have TB disease.

Treatment
TB can be cured IF it is diagnosed early enough. Most people do not have to stay in the hospital, but can be treated with medication.

IMPORTANT! Any time you visit another country, be sure to let your health care provider (doctor, etc) know; especially if that country had an outbreak of disease while you visited.

Malaria
What is Malaria and how do you get it?

Malaria is a serious but preventable disease, spread by the bite of an infected female Anopheles mosquito.

Incubation Period
Malaria symptoms will occur at least 7-9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malarial- risk area is unlikely to be malaria: however, any fever should be promptly evaluated.

Note: Travelers who become ill with a fever or flu like illness, while traveling in a malaria-risk area, and up to one year after returning home, should seek prompt medical attention and should tell their physician their travel history.

Signs and Symptoms:

 * Flu-like illness, including:
 * Fever
 * Shaking Chills
 * Headache
 * Muscle aches
 * Fatigue (tiredness)
 * Nausea, vomiting, and diarrhea may occur.
 * Anemia and jaundice may also occur.
 * The type of malaria called P. falciparum may cause kidney failure, coma and death if not treated quickly. (See "Biggest insect-Borne challenge")

Prevention

 * Keep the living quarters picked up and clean.
 * Cover all garbage and dispose of as soon as possible.
 * Keep water containers covered.
 * Rinse food containers before throwing in the garbage.
 * Remain in well screened areas as much as possible
 * Use bed nets treated with permetherine, which kills mosquitoes and other insects. These are usually less expensive and easier to get in countries with malaria.
 * Use permetherine spray on clothing (Available in the camping department at Wal-Mart, for about $5.00, called REPEL permanone)
 * Avoid strong perfumes, colognes, after-shaves, hairsprays.
 * Cover as much skin as possible; wear a long sleeved shirt, long pants, socks, etc., especially at dusk and dawn. Light colors are better, mosquitoes are attracted to dark colors.
 * Adults, wear insect repellant with at least 30 -- 35% DEET. (Available in Wal-Mart Sport's Department.)   Apply lightly every 4 hours.
 * Children need insect repellant with 6 -- 10% DEET, depending on their age and size. Apply lightly every 4 hours.
 * Best protection: don't get bitten!!! Use skin repellant, mosquito nets, etc.

Biggest challenge: Chloroquine-resistant P. falciparium malaria (life threatening)
 * Symptoms - cyclic fever every 12-30 hours, headaches, severe chills/rigor (diarrhea sometimes)
 * Medication - There are medications (called anti-malarials) that can be taken, starting before you even begin your travel. They must be prescribed by a health care provider, and will be based on your travel itinerary and medical history. Some anti-malarial drugs are more effective in some parts of the world than others. Some current treatments include:
 * Chloroquine, "Aralen", "Nivaquine" (as prescribed) - still okay in Central America, Middle East, safe for pregnancy
 * Mefloquine Hydrochloride,"Lariam" (as prescribed)
 * Doxycycline, "Vibramycin" (as prescribed)- for short term, 1 - 3 week's exposure time only.
 * The Center for Disease Control (CDC) website has recommended medications for different countries. Go to   http://www.cdc.gov   then click on Travel Health.  This site also offers toll-free travelers health Information Service phone numbers

Dengue Fever
Dengue fever is caused by a virus, carried by specific mosquitoes that spread it to humans. The possibility of catching dengue fever here in Hawaii is low, but does exist.

There are 2 major varieties of dengue fever: Dengue Fever Variety 1 (DF1) and Dengue Hemorrhagic Fever (DHF).

Dengue Fever Variety 1
Dengue Fever Variety 1(DF1) is the most common type and is fairly harmless, but can debilitate a person for up to one year.

How is Df1 Spread?
By a specific mosquito (Aedes Aegypti) to a human. No human can infect another human with this virus.

Incubation Period
2 1/2 -15 days.

Signs and Symptoms

 * Sudden onset of fever (up to 104F) for 5-6 days, subsides for 3-4 days, and returns for 5-6 days.
 * Horrible headaches (intense pain in the forehead and behind eyes).
 * Swelling and achiness in all joints. Muscles will be extremely sore.
 * Sudden onset of extreme exhaustion/fatigue.
 * Red rash may break out over body 6-12 hours prior to onset of fever (rarely).
 * Enlarged lymph glands.
 * Skin: rash may appear between day 3 and 5.
 * Diarrhea.
 * Even without treatment, the person will recover, and death from this variety is very uncommon.

Treatment

 * Bed-rest, fluids, and medication to reduce fever.
 * Avoid aspirin.
 * It is also recommended to:
 * Treat symptoms early on, to decrease the risk of complications.
 * Find a qualified physician in the area, should complications occur.

Dengue Fever Variety 2
Dengue hemorrhagic fever or "DHF" is a virus spread by a specific mosquito. DHF is life-threatening, requiring hospitalization as soon as possible. This type of dengue causes bleeding beneath the skin and in other parts of the body, leading to shock. Blood transfusion is often required

How is Dhf Spread?

 * By the Aedes Albopticus mosquito.
 * This type of mosquitoes like to bite in the morning and late afternoon, and can be found breeding in containers carrying water, especially after a rainstorm.

Signs and Symptoms

 * Initial 3-4 days are the same as DF1.
 * Fever suddenly skyrockets after the first 3-4 days, without warning, and can reach 107 degrees F.
 * Physical shock and collapse.
 * Hemorrhage under the skin (bruises and bleeding) everywhere. Bleeding from the nose and gums, blood in urine, vomit, and stool.
 * Skin is clammy, extremities cold. Red and blue spots appear on skin (petichiae).
 * Cyanotic (lips etc. grayish blue).
 * Blood pressure drops rapidly and may not be detectable.
 * Mortality: 6-30% die from DHF (or DH2).

What is the Treatment of Dhf?

 * No drug is available for this viral infection. Take to Emergency Room as soon as possible.  The mortality rate for infants under 1 year old is high.
 * Treat the symptoms; rehydration (plenty of fluids) for diarrhea, vomiting, etc.

Prevention is the Key!
Prevention is the most sensible and only real option. The Aedes mosquito is a "day biter" and precautions need to be especially taken during the mornings and afternoons, even indoors and in the shade.

Protect yourself by:
 * Repellents such as those containing DEET (30 -- 35% for adults is best, and 6 -- 10% for children, depending on age and size. Wal-Mart's Sports Department has a repellant called REPEL, which contains 29% deet.)
 * Permethrin sprayed on clothing, bed nets etc. (Available in the camping department at Wal-Mart, for about $5.00, called REPEL Permanone)
 * Alternatives include Neem oil from India, which can be drunk as a tea or worn as a lotion.
 * Avon's Skin-So-Soft is good but does not last long enough to be practical.
 * Mosquito coils in rooms
 * Vitamin B and garlic are not proven to be effective
 * Wear clothing with long sleeves, and long pants or skirts. Make sure they are loose fitting to not get over-heated.
 * Dump any standing stagnant water where they may breed, especially after rains.

Hansen's Disease (Leprosy)
This is a bacterial disease that causes permanent damage to the skin and nerves, but is not very contagious. It is not considered a high-risk disease for short-term outreach teams with limited contact with those with leprosy. But it is good to know the facts.

Hansen's Disease Has Two Forms:

 * 1) Tuberculoid
 * 2) Lepromatous
 * Both forms produce lesions on the skin
 * Lepromatous is more severe with disfiguring nodules
 * Both cause peripheral neurological damage causing sensory loss (loss of feeling in the skin) and weakness.

How is Hansen's Disease Spread?

 * Hansen's travels person to person, most likely through respiratory droplets
 * Exposure to people with active, untreated Hansen's or family members with the disease
 * Living or visiting areas of the world where leprosy is endemic (cases are known to occur in that area)

Leprosy
This is common in countries that are temperate, tropical and subtropical. Approximately 100 cases are diagnosed in the United States each year. Most are limited to the south, California, Hawaii and U.S. island possessions.

Signs and Symptoms

 * One or more hypopigmented skin lesions (areas of skin that have lost color) that have decreased sensation to touch, heat or pain
 * Skin lesions that do not heal after several weeks to months
 * Numbness or absent sensation in the hands and arms or feet and legs
 * Muscle weakness resulting in signs such as foot drop (the toe drags when the foot is lifted to take a step)
 * Definitive diagnosis is done through a skin scraping examination for the bacteria that causes leprosy.

Treatment
Treatment is available through a combination of medications that must be closely monitored. However, new drug resistant forms have led to global concern about this disease.

Information compiled by CCHC-Kona Campus Staff:

Connie Dunbar, RN, BSN

Jeannie Lee, RN, MSN

Naomi Tomko, RN, MSN, CSN

Heidi Wills, RN, BSN