Clinical quiz 3: The boys trip to Bali

A great friend of mine is getting married in Bali this weekend so I’m popping up there for a couple of days to join in the celebrations. For those of us who live over here in the west, it is quicker and often cheaper to fly to Bali than it is to get to the eastern states of Australia. That, combined with a large population of cashed up FIFO workers with regular week-off breaks, means that travel to Bali is extremely common. In fact, Bali is widely considered to be “Perth’s most northern suburb”.

Unfortunately, Indonesia is NOT Australia and does have it’s own unique health risks. Patients aren’t necessarily aware of many of these risks, and in fact often only mention their upcoming travel plans in passing, and not because they are actually seeking medical advice for it.

So here’s a scenario for you:

27 year old man comes in because he’s got a viral URTI and needs a doctor’s certificate for work. He’s otherwise fit and well with no other medical problems. He mentions that he’s hoping he’ll get better by the weekend because he’s going away to Bali for his footy team’s end-of-season Bali trip and wants to be in good form. Oh and “by the way, doc, do I need any needles?”

Questions:

1. What additional questions do you need to ask him?

2. What advice to you give him regarding vaccinations?

3. What other health-related travel advice would you give?

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Comment below with your answers. I’ll put in my two cents worth when I get back next week – hopefully without any travel related health problems to report!

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4 thoughts on “Clinical quiz 3: The boys trip to Bali

  1. 1. Further questions to ask:
    a. Durations of current symptoms.Fevers and chills.
    b. Contacts incl recent travel.
    c. Previous travel vaccinations.
    d. Areas they are planning to visit eg. rural vs tourist
    e. Planned activities during stay incl “after-hours activities”…

    2. Advice regarding vaccinations will depend on previous travel vaccinations and obviously the answers to some on the questions asked in (1). Traveling to rural areas and playing with monkeys will expose him to rabies. Traveling during certain times of the year when JE is more prevalent etc.

    3. This presentations is not as uncommon as we think, especially amongst us blokes, who tend to leave everything for the last minute…..and by the way doc, I’m going to Bali next week, are there any travel vaccinations I need?….This usually does not leave enough time for any immune response to develop. My guidlines are the following:

    -make sure the usual things are up to date: ADT, MMR, Pertussis.
    -influenza is up to date
    -Give first dose of Hep A + Hep B (Twinrix) and advise follow-up in 1 and 6 months
    -give typhoid
    -JE is seasonal
    -malaria prophylaxis if required
    -advice about bottled water only, food from reputable outlets (McDonald’s always safe bet), hand sanitizers, condoms and safe sex.

  2. Where are they going in Bali? Contact with animals etc?

    Advice about avoiding unprotected sex, sharing drug equipment/needles, tattooing. I would also mention rabies. Saw a lady who was bitten by a monkey there last year who had to have some fancy plastic surgery and rabies treatment! Malaria is a problem out of the main cities I guess? Drink bottled water and avoid ice (frozen water that is…)

    Needles:
    – DTP booster
    – Hep A and B
    – Influenza, more for the airline/airport environment

    Im sure there’s more, but its a start??!

  3. Thanks for the comments! Francois and Gerry have it pretty much covered. Interesting that you both suggested Hep B as this isn’t routinely recommended. But given that he’s a young bloke perhaps we can assume he’s more likely to do something stupid and either (a) injure himself or (b) have risky sexual behaviour, therefore putting himself at risk of exposure to BBVs? So it’s probably not a bad idea!

    Anyways you can see my new post on “The Travel Consultation” to see what I normally do for pre-travel advice. I would value your input there too if you have anything to add or if you disagree with anything I’ve said. πŸ™‚

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