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Written by Debbie Boyer
Qualified and Registered Nurse


Should you require further advice please contact your local doctor

Wound Care in a tropical climate

Any wound should be kept as dry as possible and the sooner it is left open to 'air' the better.

If the wound is septic, clean with hydrogen peroxide, applied with a cotton wool ball, then use a saline solution to swab the peroxide off. Then apply an antibiotic cream and close the wound with a gauze dressing.

Keep the wound closed for as long as it is oozing, or looks septic and feels warm to the touch. As soon as the inflammation subsides it can be left open, and cleaned daily with alcohol and Mercurochrome applied.

Cover at night when going to bed.

If a wound is not healing a doctor should be consulted, as an antibiotic may be needed.

Try not to apply powder substances, as they just 'cake' on the wound and it can turn septic underneath.

Elderly people should pay more attention to wounds, cuts or grazes as the skin is more fragile and blood supply to the skin is diminished, so healing can be delayed or complicated.

If you have not had a tetanus injection within the last five years prior to injury, then you should have one.

The most important factor is to keep wounds clean and dry, and to leave them open as soon as possible.

When in doubt, consult your local doctor or nurse for necessary help.

Cuts
Apply pressure to the site for five minutes to stop the bleeding. If it is a deep cut, sutures may be needed, go to the nearest doctor or clinic.

If the cut is not deep then clean it with a Betadine solution and apply a thick gauze dressing. Elevate the limb for 30 minutes to stop the wound from continuously oozing, thereafter apply a plaster, checking that you have not applied it too tight (if it is on a finger).

Keep the cut covered for two days and make sure it is as dry as possible, then open and leave it to heal.

Grazes
Clean with Betadine and not alcohol as the alcohol will burn. Make sure to get as much debris out as possible. Apply an antibiotic cream and cover. Do this for two days, then leave open and clean with alcohol. Apply Mercurochrome daily.

Remember, when in doubt consult your local doctor or nurse.

(Posted October 2010)
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Written by Dr Bernard PIAT
MB, BCh, B.A.O. (Dublin) DRCOG, JCPTGP (UK)

Should you require further advice please contact your local doctor

Vaccination of your children in Mauritius

You are in Mauritius and you are confused as to what immunisations your child is supposed to have next? So is your doctor!!! Well, not quite but…

Different doctors will have slightly different schedules simply because different countries have different recommendations (see table below). What your doctor will recommend for your child depends on where he or she was trained and qualified and also on his or her beliefs in immunisation. Many doctors seem to follow the French schedule probably because the vaccines are made in France.

Look at the table for the most recent recommendations from different countries for immunisation there.

In addition, the recommendations seem to change every two to three years and often lead to an increase in the number of vaccines recommended.

The vaccines that I consider to be essential in Mauritius are:
Tuberculosis, diphtheria, tetanus, accellular pertusis, inactivated polio vaccine and haemophilus influenza type b, measles, mumps, rubella and human palillomavirus.

A little note on some of the vaccines:

BCG for tuberculosis is not being recommended as routine in some countries but it is wise to have it done in Mauritius as we still get occasional cases of tuberculosis. The vaccine does not give full protection but if the vaccinated person caught the disease it would not be so severe and would be more easily treated.

Hepatitis B. This is a form of severe hepatitis transmitted ONLY by blood products, needles and sexual contact.

Rotavirus. This causes a severe form of gastroenteritis and, as it is viral, it does not have any treatment except supportive treatment.

Varicella vaccine. This gives at least a partial protection to catching chicken pox. Wise for adults who have not caught it yet, but is it really necessary for children? Not part of the routine schedule in any country yet.

Pneumococcal conjugated vaccine. This gives protection against a bacteria which is becoming increasingly resistant to antibiotics due to their inappropriate. Becoming part of the routine in many countries but should be used in children who have respiratory problems, recurrent ear infections or recurrent bacterial upper airway infections.

Meningitis C vaccine is done in some countries where there have been occasional outbreaks in schools and universities. It protects only from the meningococcal C strain.

Human palillomavirus. This is the one for young girls and although it will not provide any protection against STDs, it will reduce the risk of developing cervical cancer. It is, however, essential to continue the routine of cervical smears as usual.

Hepatitis A is the hepatitis caught through contaminated food. Not necessary in Mauritius even though it exists and that there have been occasional outbreaks like in many European countries, but wise to do if you are planning to travel to a country with a higher risk.

I hope this will help you understand the vaccination programme and that you will be able to have an informed discussion with your doctor if necessary.

(Posted 16 March 2011)
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Written by Dr Bernard PIAT
MB, BCh, B.A.O. (Dublin) DRCOG, JCPTGP (UK)

Should you require further advice please contact your local doctor

Dehydration and heatstroke

During the hot weather we are now experiencing, you will need to increase your fluid intake, regardless of your activity level. Don't wait until you're thirsty to drink as you will already be significantly behind. On average, when we are thirsty we are around 750 to 1000ml behind!!!

Avoid drinking liquids that contain alcohol or large amounts of sugar such as soft drinks and sugary juices, these actually cause you to lose more body fluid. Also avoid very cold drinks, because you tend to drink only small amounts. As a guideline consider 32ml/kg of body weight per day. Always carry a bottle of water with you and have a sip regularly.

Replace salt and minerals
Heavy sweating removes salt and minerals from the body. These are necessary and must be replaced.

Wear appropriate clothing and sunscreen
Exposure to the sun is vital for our health so that we get sufficient amounts of vitamin D, but getting sunburnt is not a good idea. Wear as little clothing as possible when you are at home. Choose lightweight, light-coloured, loose-fitting clothing. Sunburn affects your body's ability to cool itself and causes additional loss of body fluids. It also causes pain and damages the skin. When you go outdoors, protect yourself from the sun by wearing a hat or a cap and by putting on sunscreen of SPF 15 or higher 30 minutes prior to going out. Continue to reapply it according to the product directions.

Schedule outdoor activities carefully
Try to limit your outdoor activity to morning and evening hours when the heat and sun intensity are milder. Try to rest in shady areas so that your body's thermostat will have a chance to recover.

Pace yourself
If you are not accustomed to exertion in a hot environment, start slowly and pick up the pace gradually. If exertion in the heat makes your heart pound and leaves you gasping for breath then STOP and rest. Get into a cool area or at least into the shade and rest, especially if you become lightheaded, confused, weak or faint. And use a buddy system, so that you always let someone know where you are planning to go and when you hope to be back.

Those at high risk
Although all of us can suffer from heat-related problems, some people are at greater risk than others.

  • Infants and young children are sensitive to the effects of high temperatures and rely on others to regulate their environments and provide adequate liquids.
  • People 65 years of age or older may not compensate for heat stress efficiently and are less likely to sense and respond to change in temperature.
  • People who are overweight may be prone to heat sickness because of their tendency to retain more body heat.
  • People who overexert during work or exercise may become dehydrated and susceptible to heat sickness.
  • People who are ill (fever) or with chronic diseases, especially with heart disease or high blood pressure, or who take certain medications, such as for depression, insomnia or poor circulation, may be affected by extreme heat.
  • Visitors from a cooler climate will need a few days to become acclimated before attempting long walks, trips or outings, so work up to it gradually.

Do not leave children in cars
Even in cool temperatures, cars can heat up to dangerous temperatures very quickly. Even with the windows cracked open, interior temperatures can rise dangerously

Heat stroke
Heat stroke occurs when the body is unable to regulate its temperature. The body's temperature rises rapidly, the sweating mechanism fails, and the body is unable to cool down. Body temperature may rise to 41°C or higher.

Recognizing heat stroke
Warning signs of heat stroke vary but may include the following:

  • an extremely high body temperature (above 40°C)
  • red, hot and dry skin (no sweating)
  • rapid, strong pulse
  • throbbing headache
  • dizziness
  • nausea
  • confusion
  • unconsciousness.

What to do
If you see any of these signs, beware. Have someone call for immediate medical assistance while you begin cooling the victim. Do the following:

  • Get the victim to a shady area.
  • Cool the victim rapidly using whatever methods you can. For example: spray the victim with cool water from a garden hose, sponge the person with cool water and fan him or her vigorously.
  • If the victim is able, give them water to drink.
  • Get medical assistance as soon as possible.

Recognizing sunburn
Symptoms of sunburn are well known: the skin becomes red, painful and abnormally warm after sun exposure. When sunburnt you are at more risk of getting heat stroke.

What to do
Consult a doctor if the sunburn affects an infant younger than one year of age or if these symptoms are present: fever, fluid-filled blisters or severe pain.

Also, remember these tips when treating sunburn:

  • avoid repeated sun exposure
  • apply cold compresses or immerse the burnt area in cool water
  • apply moisturizing lotion to affected areas and do not use butter or ointment (oil-based skin preparations)
  • do not break blisters, if blisters do break leave the skin where it is, it is the best dressing you could have.

So, enjoy the summer, drink water regularly and do not get sunburnt.

(Posted 12 November 2010)
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