Truk Lagoon: Dive Trips

Medical

Simon Mitchel has very kindly written this brief for me to recommend to everyone coming on our trips. This is based on our experience with people coming with us in the past. I hope that this is helpfull.

Medical Briefing

I thought it might be valuable to have some prior communication on medical matters before your trip to Truk Lagoon with Pete.

Truk has very limited medical resources. For that reason, Pete has asked me to come on the last 3 trips. The fact that I am still enthusiastically packing my bags each year should give you some sense of the diving treat you are in for!! This document contains some commentary on important medical matters. Some of this is “for information”, but there is also some advice. For perspective, my presence as “the doctor” is largely to ensure we have on site expert advice for medical emergencies, and particularly diving emergencies. It is important that everyone understand we cannot provide a mobile pharmacy. Whilst I will always be available to discuss any medical (diving or non-diving) issue arising during the trip, I cannot carry enough supplies to be certain of adequately covering the group for common problems. It follows that this document contains some important advice about things each individual should bring to meet predictable needs.

Decompression illness

Pete insists on having a diving medicine specialist on his trips because although there is a capable chamber on Truk (only a 10 minute drive from where we stay) there are no doctors who are expert in the field. Moreover, since the hospital facilities at Truk are very limited, to the point where we might not be able to rely on the presence of basic supplies to give intravenous fluids, or manage a patient’s airway, we take our own equipment for such purposes. For perspective, I think it is important that everyone understands that despite this precaution, the management of a very sick patient in Truk remains a major challenge. It is impossible to provide proper high level care out of a suitcase, and we all must accept that we are travelling to an environment where major illness cannot be managed as well as it would be in our home town. With this in mind, it is absolutely vital that we all have current insurance that would cover both treatment in a hyperbaric chamber and evacuation if it were necessary. I personally recommend having a high level DAN policy, plus a more general travel insurance policy. DAN will cover treatment in the Truk chamber if I am supervising it.

Usual medications

If you have a medical condition requiring medication (such as high blood pressure) please ensure you bring enough of your medication to cover the entire trip. You should not rely on being able to obtain a particular drug at Truk.

Ears

Because the water at Truk is so warm, and because we spend so many hours a day immersed in it, there is ample opportunity for the protective layer of wax to be “washed out” of the external ear canal, and for pathogens to enter it. We invariably have problems with external ear infections which can become quite troublesome. We cannot bring supplies to provide treatment for an entire party with ear infections. I strongly recommend that everybody brings (and routinely uses) an ear drying solution which are usually combinations of alcohol and ascetic acid. There are many of these available commercially, and some pharmacies make their own. I have no particular preference. Also everybody should come equipped with antibiotic drops suitable as a first line agent for treating an external ear infection under my supervision if necessary. These will not be used routinely, but it is important you have them in case of an infection. Again I have no particular preference. You will probably need to see your GP / family practitioner to get a prescription for these.

Coughs and colds

We all have to travel some distance and on multiple flights to get to Truk. Unfortunately this provides ample opportunity to be exposed to others with viral upper respiratory tract infections (URTIs). Moreover, the stay at Truk is long enough to exceed the incubation period for such infections. The first year I went virtually everybody suffered an URTI. Last year there were hardly any problems. Let’s hope this year will be the same as 2010. However, when something like that “goes around” it puts very heavy pressure on limited medication supplies. So, I strongly recommend that everybody brings their own supply of a simple analgesic / antipyretic such as aspirin or paracetamol (called acetaminophen in North America I think), some analgesic throat lozenges, and a decongestant nasal spray which might speed your return to diving if you get upper airway congestion. Some cough and cold preparations contain oral decongestant medication such as pseudo-ephedrine or phenylephrine, and these might be very useful too.

Immunizations and other prophylactic measures

Truk is free from malaria. Some travel advisory documents recommend immunization against typhoid. I would not actively discourage you from doing this, but I have never bothered myself because the hygiene standard at Blue Lagoon appears to be very high. The food is good, and I cannot recall a single case of gastroenteritis (let alone typhoid) arising on any of the trips in people staying there. It would be a good idea to make sure your tetanus immunization is up to date.

Infections

Diving around coral reefs and shipwrecks always raises the possibility of infected cuts and scratches. These can become troublesome and may even progress to cellulitis or more serious soft tissue infections. I strongly recommend that everybody brings a single course of a broad spectrum antibiotic (such as amoxicillin + clavulanic acid) for use under my supervision should such a problem arise. You will need to see your GP / family practitioner for a prescription.

Sprains and strains

Lifting diving equipment and clambering around boats carries the risk of causing musculoskeletal sprains and strains. It is useful to have a course of a non-steroidal anti-inflammatory drugs (such as diclofenac, ibuprofen or similar) provided you have no contra-indications to taking such drugs. These are also useful in treating the symptoms of URTIs.

Sunscreen and insect repellent

The boats do have limited cover, but use of sunscreen for some of the longer transits is very important. Although there is no malaria at Truk, it is still useful to have insect repellent to prevent annoying bites.

Thromboprophylaxis

As previously discussed, we are all flying long distances to get to Truk, which is NOT the place where you would want to suffer a pulmonary embolism after arrival. It follows that I strongly recommend that everyone uses calf compression stockings during their travel to and from Truk. Get good quality stockings that are readily available from pharmacies.

Fitness for diving issues

Obviously I am happy to advise on fitness for diving in relation to any medical issues that arise during the trip, but please have any current concerns about fitness for diving addressed before you leave home, or contact me about them before you leave.

If anyone has any specific questions about medical matters please free to contact me at dr.m@xtra.co.nz

Associate Professor Simon Mitchell

MB ChB, PhD, DipDHM, CertDHM (ANZCA), FANZCA

Consultant Anaesthesiologist and Diving Physician