Health

Once one of our friends came to us on a boat to Indonesia, on an island in the Komodo archipelago. Local attraction - monitor lizards, carnivorous lizards, up to three meters long, which also run faster than humans. Usually they don’t attack people, but tourist guides say that you need to be careful with them and not be distracted in their presence. After a long walk on the island, our friend remained unscathed after many close encounters with the monitor lizards, and when she tried to jump into the tender, she fell from a wooden pier, unsuccessfully landing on a colony of sea acorns, also called “dog teeth”, earning three deep cuts on her hips.

The place is uninhabited, the nearest hospital, if you can call it a building with three rooms, five dirty beds and some kind of medicine, was three hours on a motorboat, which we also did not have. Fortunately, our friend, her husband is a surgeon, and he made her twenty-three stitches right on the boat. As always, fortunately, we had needles, threads, clips, needle holders, surgical gloves, sterile bandages, syringes, disinfectants and anesthetics on board. All this has been on board for many years since leaving Italy, and every time when all these things caught my eye, I wondered if we were too overzealous or too pessimistic.

It was the most serious injury in many years, but we have had others.

Once in the Caribbean, we caught a barracuda, she fought hard and the entire cockpit was covered with slime. Trying to put the fish in the bucket, Carlo slipped and broke his foot.

This time, in order to fix the fracture, I used a wooden kitchen spatula, wrapping the spatula and foot in a thick layer of porous rubber and securing everything with packing adhesive tape. Three weeks later, when there was an opportunity to do an x-ray, the foot was fine.

There were a lot of different smaller problems, burns, ulcers, renal colic, colds, which we always resolved with the means available on board.

In addition to accidents and incidents, during long boating on the boat various health problems may arise and you must be ready to resolve them or at least give first aid before the doctor thinks you can.

Various diseases

On the boat, the first of all diseases, although rarely reaching dangerous levels, is seasickness. Anyone who suffers from it, knows that she always lies in wait, ready to return as soon as the boat leaves the sea, making the first days of sailing awful.

If the voyage is long and the crew is small, you need to try to block it in the bud, and even better to warn. But the most important thing is to overcome it.

Means are different: from patches that emit scopolamine to bracelets that create pressure on the corresponding point, special chewing gums and tablets or homeopathic remedies, bread crust with anchovy pate or just drink a glass of salted water.

Motion sickness comes from the inner ear, where the organ is located responsible for balance, but it manifests itself in the stomach. There is only light food, do not drink alcohol, be on deck, dress well, lie down or do work, all these measures are effective and help to overcome the crisis. The only thing you can be sure of is that this in a couple of days the body will get used to the new situation and seasickness will begin to recede until it passes completely. At least in most cases.

In addition to conventional means, we always keep antiemetic drugs in pills and ampoules on the boat, in case of emergency, if suddenly someone has a seasickness crisis stronger and longer than normal in order to save a person from dehydration.

Another problem that appears more often than usual on the boat is the problem of digestion. Usually, it’s not the permanent crew members who are accustomed to life on the water, but friends and guests arriving on vacation or for charter, who suffer. Apparently this is a problem of our time, judging by the television advertising, every third video recommends the means of regulation and stimulants for digestion. And people bring them with them: this and some mucous pods that need to be filled with water the day before use, and bran, and capsules with linseed oil, and tablets of activated charcoal and glycerin in various forms. And there are no problems. People know about their frustrations and take what helps them from home.

Difficulties arise when someone appears who has not had these problems before. The man arrives on the boat after hours of flight, changing the time zone, climate, lifestyle and food. If we add to this that you are moving a little while sailing and in ninety-nine percent the toilet on board does not provide sufficient privacy, being separated from the rest of the boat by thin partitions, and the skylight suddenly begins to seem like a panoramic wind, summing up all this, do not be surprised that many begin to suffer from constipation. Usually everything is resolved within a few days with the understanding and assistance of the rest of the crew, but if a person comes across too suspicious, who has never encountered this problem before, you should have the means on board to unlock the situation, because when there is at least one on board, tormented by the inability to go to the toilet, it can poison the cruise with everything else. To establish peace and quiet aboard, I had to steal glycerin miniclism in a tourist center in the Maldives, exchange coal tablets for flour on a Swiss yacht and smuggle bran to Australia. Do not wait until happen to believe!

Otherwise, on the boat you need to be prepared for any cases, from the most serious: a blow with a geek on the head or an attack of appendicitis, to a cold and cough, not excluding tooth decay. And the first-aid kit should be chosen so that the best way to resist the worst misfortunes.

It must be remembered that the boat during a long transition is immersed almost in a sterile environment, where infections usually do not occur, but the protective functions of immunity, which are not in demand for a long time, gradually weaken.

An example of what happened to Mauro Mancini and Ambrogio Fogar, who drifted on a raft for sixty days after their Surprise yacht sank. While they were on the raft, although they were very weak, they were not ill with anything. After two of them on board the ship that saved them, they both got pneumonia. Probably the infection was present on board in a non-aggressive form, but they no longer had a protective immunity. They were treated with antibiotics, but Mancini’s body, weakened by a long stay on the raft, was unable to survive the disease due to lack of food and age.

This is of course an extreme case, but when preparing it is better to bear in mind the worst options and then state that they were in vain worried.

The first-aid kit must take into account the age of the crew members, the state of health of each individual, the presence of children on board, and whether the diving with scuba diving is foreseen.

In the annex to this book, we have compiled a list of medicines and medical materials that must be kept on board. Naturally it needs to be adapted to the number of crew members and the type of navigation. There are a lot of medicines and materials, they are decent and take up a lot of space and, in addition, have a shelf life. Unfortunately, when they are needed, they must be available and you need to have them on board.

Treat others

Even if the first-aid kit was chosen in such a way as to counter all possible problems of the crew, it always happens that a good part of the drugs is used to treat other people you meet along the way. If swimming takes place in undeveloped countries or in places far from large centers, it often happens that you respond to requests for help.

It is not an easy task to treat residents of remote places suffering from diseases, possibly different from ours, with difficulties in communicating the lack of knowledge of the language. In such cases, you should try to do your best, remembering that you are dealing with people who have never taken drugs and therefore have a faster and more powerful effect on them than on us.

On an atoll in Melanesia, I cut an abscess on a fisherman's finger and treated it with an antibiotic ointment. The next day, the opening of the abscess was absolutely clean and the wound began to tighten. Naturally, from that day on, bananas and fresh fish were guaranteed to us, as well as a queue of patients who went for treatment to the boat.

Once on the Red Sea coast, old men with cataract-covered eyes came to us, and in order not to disappoint them, I gave them eye drops, it was a pity to look at them. Another time a Muslim fisherman wanted me to heal his wife in the distance. He uttered inhuman screams and spat on the ground to show me how it breaks!

At Lamaler in Indonesia, I even made a compliment to myself. The villagers are nice, polite people, except for one annoying person who constantly asked for something from us. And not that he asked for something valuable, just to give it all the time meant to cheat others. One day he asked us to come home to heal his wife. He poured us huge cups of coffee and then began to explain that a woman has a heartbeat. I was very scared and asked the woman what exactly she felt.

- Sometimes it suddenly starts to beat strongly, even when I sleep.

- Good. Do not drink more coffee. If you want to drink, drink only warm water!

A week later, a contented husband brought us eggs and assured us that his wife had recovered! However, I advised him to continue treatment.

Remember that the side effects on these people are also more damaging than on us. Therefore, it is better to give them to take medicines in much smaller than the recommended doses. Of course, there are diseases or wounds before which you feel powerless and you can only thank heaven for being lucky to be born in a country with a developed and affordable medicine, I hope for a long time.

Vaccination

There is a medical publication, which you can ask your doctor or medical institution, which lists all vaccines that are mandatory and recommended for different countries of the world. Although traveling by boat, the risk of infection is less than by land, you should still follow the standards recommended by sanitary institutions and prompted by common sense. In third world countries, you need to be careful with water, dairy products and raw vegetables, which are usually watered with sewage. It makes sense to vaccinate against viral hepatitis, they are for type A and type B. However, you must first do a blood test to find out if there are antibodies to the disease in the blood. In this case, vaccination is not necessary, because you already have immunity, possibly due to infection with hepatitis that did not lead to jaundice and that passed unnoticed.

The same with malaria. Traveling and living on a boat is a risk of being bitten by an infectious mosquito less than on land. Mosquito anopheles, which carries malaria, is active for only a couple of hours at sunset. They do not fly anchored at anchor a hundred meters from the coast and with the wind, and if it happens, it is enough to wear a long-sleeved T-shirt and long pants at dusk hours. In order to infect, the mosquito that bit you should have bitten a sick person shortly before. Therefore, in the low-populated areas, the risk of infection is very low. Although there is always minimal risk. Unfortunately, there are no vaccinations against malaria.

When crossing the Pacific, the danger of malaria exists from New Caledonia to the islands of Salomon and Papua New Guinea, and then reappears in Indonesia after passing through the Torres Strait. And after crossing the Indian Ocean, here it is again, on the entire coast of East Africa, from Kenya to Tanzania and Mozambique and further to the Comoros and Madagascar.

This means that those who decide to resort to prevention must take large doses of strong medicines for months, which can also have serious consequences for the liver and eyesight.

Given the low risk of infection, living on a boat, it is better not to resort to any prevention, avoid going ashore during dangerous hours, dress accordingly at this time and use the repellents bought on site, as they are more oily and do not evaporate immediately with sweat. like the ones that are available from us.

And yet you must have everything you need to treat malaria on your boat: Lariam, Malarone or Fansidar, depending on the part of the world where you are. Malaria is manifested in a series of symptoms, such as fever, chills, pain in the bones and joints. To make sure the diagnosis is necessary to make a quick and painless blood test, it is done in any hospital in the Third World. In countries with an increased risk of malaria, you can always find commercially specific drugs for the local type of disease. In some countries, there is already a kit on the market that contains the test necessary to diagnose malaria and tablets for its treatment.


Tropics

Most of the boats going on a long voyage are aimed at the southern seas, that is, the tropical belt. The water of these seas can create problems. The Mediterranean is now considered polluted, but I remember when I was small and someone was injured on the beach, the usual phrase was:

- Go wash in the sea. The sea will cure you.

This practice is not at all suitable in tropical seas. Although not polluted or poisoned, ... no, that is precisely why tropical seas boil with life. The high temperature of the water promotes the reproduction of microorganisms, which sometimes even make it turbid and that can penetrate even the smallest wound, infecting it. And these infections can have very long recovery periods.

My advice is to apply an antibiotic ointment to any wound in a tropical climate and try not to wet it for several days. After each bath, the wound must be disinfected and the ointment applied again. The likelihood of infection increases if a cut occurs on the coral. There are also many microorganisms on the corals, and a simple scratch can turn into a purulent abscess.

Every time we have friends aboard, I repeat what I just explained. Often, they consider me a reinsurer and a person who has only fifteen days of vacation at their disposal will never give up bathing for two days because of a small cut. And it was not rare that these people waited for months until the wound healed, and the scar remained for several more years.

We happened in Indonesia to change the course in order to deliver our friend to Timor and there to land him on the first plane to Bali to cure a neglected wound, which developed into phlebitis!


Dangerous animals

In the tropical seas, a huge number of animals. Some of them, very few, are dangerous, and you need to be able to recognize them. Do not immediately think about sharks. In my entire life, I only once met a man with a shark bite scar. It happened on Salomon, in the muddy water of a closed lagoon, and the man we were talking about was hunting for American tourists. He only transferred the fish to the boat and was even up to a belt in the water when a shark attacked by the beating of an agonizing fish attacked him. She attacked a man without having distinguished his size in muddy water.

Usually sharks keep their distance. They are also afraid of larger animals. A man in the water with arms extended forward, with flippers and possibly a gun, longer than three meters, and a reef shark, which reaches a maximum of one and a half meters, will not dare to attack him. Otherwise, you need to observe the usual precautions, avoid muddy water, do not swim under the water with the harpooned fish, be careful when you enter and when you leave the water.

The really dangerous animals are much smaller and less visible: the jellyfish called Box Jelly Fish (Chironexfleckeri) appears in the rainy season, that is, from November to March, in Australian waters. It is several centimeters in size and hardly noticeable, but its tentacles can be several meters long and covered with microscopic stings, which cause very painful burns. The poison that they inject, neurotoxin, can be deadly, but now there is an antidote against it. Also in the Australian waters, there lives an otsminozhek Hapalochlaena maculosa, a few centimeters long but with a deadly bite, against which the antidote does not yet exist.

Between the coral boulders, throughout the Indian and Pacific oceans, you can find the Conusgeographus, a conidi mollusk that, if disturbed, shoots a dart, microscopic but deadly. Fortunately, the shot takes place a few minutes after the cone was moved from its usual place. It is important to be able to recognize it, and if you really really want to catch it, immediately close it in a glass jar.

Further, if we want to continue, there is still a stone fish, a scorpion fish, a butterfly fish, but let's not poison the journey that has not yet begun! After all, it is enough just to take precautions, for example, never walk barefoot on coral or sandy bottom near corals, where exactly all these poisonous fish are hiding.

Near villages it is also better not to go barefoot. The beach is usually a public toilet, and there are intestinal parasites that enter the body through the feet. Here, too, it is better not to wait until you happen to believe! On an Australian boat we met in Vanuatu, one of the children had just gotten rid of these parasites. Parents said that they had watched him weaken and pale for several months for no apparent reason for several months. They decided to take him to Australia for treatment, when a nurse from a local village, worried about the child’s thinness, checked his feet and discovered the place of parasite infestation that had already occurred several months ago.

“She treated him with strange broths,” they said. They dared to entrust her treatment to the boy and he soon recovered.

Remember that knowing everything before going on a trip is impossible. But on sale there are illustrated identifiers of dangerous fish and marine animals and during the transitions there will be as long as you want to read and study.

And finally, paraphrasing the Polynesian proverb, usually the external beauty of a fish is inversely proportional to its edibility. And indeed, the more bright and elegant the fish, the less edible it is.


Chiguatera

In the entire Pacific and parts of the Carib there is the danger of a chiguatera. We are talking about a disease that occurs when eating toxic fish.

The primary cause of the disease is ciguatoxin, a particular toxin found in algae, which usually grows on coral reefs but begins to thrive in special conditions, in places where coral dies. This happens as a result of human activity that explodes corals with dynamite, creating ports and channels, or under the influence of natural forces, cyclones and waves. Algae-eating fish accumulate toxin in their body without any harm to themselves. Then predatory fish eat herbivores and big fish eat smaller ones in the food chain, as a result of which an increasing amount of toxin accumulates in large fish. And when a person eats one of them, the amount of toxin in which has reached a significant level, the nervous system is affected.

The risk comes only from reef fish, while pelagic fish, such as tuna, dorado, king fish, are safe. But on the reefs, the phenomenon varies from island to island, from place to place, from one type of fish to another. There is no method to determine whether healthy fish is infected, and since the toxin is resistant to high temperatures and acids, cooking, frying, drying, freezing or pickling will not help. Having eaten infected fish, cooked in any way, a person is doomed to suffering. The best way out would be not to eat fish caught on reefs in risky areas. But the mollusks and crustaceans are safe.

If you still want to eat fish, the risk increases with the size of the specimen and decreases if you remove the liver, insides, eggs and head, because in these parts the toxin accumulates in greater concentration than in the muscles.

In all books they write that it is a good precaution to show suspicious fish to local residents, also indicating the place where they were caught. So we did on the island of Makatea, located in the half-day voyage from Tahiti. We caught a large grouper, showed it to a fisherman, and indicated in which part of the reef they caught it.

- No problem, you can eat it. “And we believed, forgetting that it was on Makatea that dynamite was used to blow up a large section of the barrier, in order to allow ships coming in for phosphates to land at the island.

The symptoms appeared a couple of hours after dinner, when we had already chosen the anchor and were walking towards Tahiti. At first, it was just a heaviness in the stomach and dizziness, then gradually the limbs became harder and harder to move. We still successfully reached Papeete and did not move for two weeks, completely incapacitated by poisoning. Hands and legs seemed to be filled with lead, any movement was worth the inhuman efforts, and besides, when in contact with water electric shocks were felt.

It was June, it was hot and we were sweating. Unexpected downpours constantly drenched us from head to toe. To go ashore, we had to wet at least the feet. If we add to this that there is no cure except to drink more to dilute the toxin, and as a result often to write, there was practically no moment all day when we would not contact with water and feel electric discharges.

Poisoning went away by itself, gradually, gradually, in about a month. A whole year after this incident, we did not eat fish!

I was very late to remember that when I cleaned the fish, it seemed to me that its consistency seemed strange, it was like rubber, I had never seen such a thing in fresh fish before. But who knows! ..

Fortunately, this poisoning, although very unpleasant, is almost never fatal. However, the poison partially remains in the body, even after the disappearance of the symptoms and comes into effect again when the next dose of the same toxin arrives.

Therefore, among the natives, often dealing with these poisonings, there are deaths due to lung blockage.

For tourists, a chiguatera is just a nuisance, no worse than malaria or money; it may be that it takes longer to recover. But if you have the strength to abandon the fish, every time you are on the atolls from the Marquis to the Torres Strait, there should be no risk.

Recently, a kit called Cigua — Check has been developed, which can be used to determine the presence of toxin in fish.

For more information, see www.cigua.com or contact Oceanic Test Systems, tel. (808) 531-3017, fax (808) 531-3177

Insurance and medical care in the world

There are many insurance packages that guarantee medical care in any part of the world and evacuation to their homeland within 48 hours by a special plane, if there is no possibility to provide the necessary treatment on the spot. Typically, these insurance are very expensive, have a very high franchise and are completely unable to guarantee you help in most places where you go on a yacht, if only because in most cases even contacting the insurance company is not easy.

On the contrary, in almost all hospitals in the world, you will be given cheaply or even free of charge. Because now many countries in the world have agreements on health care with Italy or with Europe, or simply because in a country where the cost of living is low and private medical services are not expensive.

When we were in Thailand. Carlo suffered an attack of renal colic. At the medical center, where he was hospitalized in a day hospital, a full examination was done, including radiography using a contrast method, a diagnosis was made and all the necessary medicines were given for a fee of thirty euros.

In Papeete, I received an echography for free, because I am a citizen of a European state, for it was worth two hundred thousand liras in Italy at that time. In Australia, thanks to an agreement between the local government and ours, Italian citizens can be treated for free at state-of-the-art hospitals at a fairly high level; they only need to get something like a local health card. And in places where there are no hospitals, and your insurance company is unlikely to be able to provide you with the promised medical care.

The exception to all this is the United States and the few other countries where medical services are very expensive, even emergency ambulance. There, any victim, before they begin to heal, must confirm his solvency. If among your goals are American shores, you may want to think about health insurance.

On the American boat, which we met on Chagos (Indian Ocean) with two young men on board, one of the two severely injured his knee, falling on a sharp coral. They notified the family in the States on the radio and I don’t know, by acting on what levers, they managed to make it so that one of the warships from the base on Diego Garcia came for the wounded. The boy was first treated on a ship, then taken to a military base for X-rays, and his friend got permission to go on a boat to a military base in three days to pick him up.

The cost of a medical operation is $ 16.000 (it is not known what the cost of its delivery is) and two teenagers who are used to the standards of their country said that it was not much at all! And did not even have to worry about the method of payment. Military doctors simply sent an insurance company account.

We asked ourselves the question many times what we would do if it happened to us!

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