By Dr Eddy Bajrovic*
Smoke has been making headlines in Indonesia.
A 24-year-old Queensland man recently received a one-year jail sentence for smoking cannabis on a Bali beach – yet another reminder of Indonesia’s well-documented hard line on drug taking and trafficking by foreigners.
But, international visitors have been far more concerned about the ‘smoke’ rising from East Java’s Mount Raung volcano in recent weeks.
The resulting clouds of volcanic ash have meant costly delays in leaving Bali and other Indonesian destinations as airports were closed and flights cancelled. Many visitors found themselves out of pocket when their travel insurance did not cover costs associated with cancellations once the possibility of delayed departures was made known.
However, some Aussie travellers were worried about the possible impact on their health. (So far, Travelvax Australia has received no reports of respiratory conditions and we’re not anticipating any: Bali’s popular tourist enclaves are 140km from the still-smouldering volcano.)
Should travellers be at all concerned about Mount Raung, or other destinations with active volcanoes nearby? After all, Hawaii’s volcanoes are a tourist attraction, with visitors able to take helicopter flights over them, right?
Volcanoes are not just ‘nature’s fireworks’
Active volcanoes need to be treated with respect. Tourists usually get into trouble when they ignore warning signs and hike too close to lava flows.
For so-called ‘volcano tourists’ and volcano tourism workers, the main risks consist of cuts and grazes from falls on the sharp volcanic rocks, and respiratory and eye irritation from the crater gases that escape from vents or ‘fumaroles’.
Of course, volcanoes can erupt without warning. The ash clouds they produce – and the toxic gases that erupt with the ash – can be transported hundreds of kilometres in the atmosphere to descend on communities.
A handful of tourists have died in volcanic areas from exposure to poisonous gases such as sulphur dioxide and hydrogen sulphide.
The spectacular clouds produced when hot lava enters the sea are not simply steam: they’re actually a dense mist of hydrochloric acid. People viewing the phenomenon from boats offshore have also received second degree burns from waves created by the lava-heated water.
And, as the world learned from the cataclysmic event on another Indonesian island, Krakatoa in 1883, volcanic eruptions can kill tens of thousands and affect the Earth’s climate for many years.
Air quality now a global health issue
But, it’s man-made air pollution that’s become a major environmental concern and a potential health threat for travellers.
According to new research, polluted air causes around 3.2 million premature deaths annually from heart attack, stroke, lung cancer and other illnesses – more than the annual global toll from HIV-AIDS and malaria combined.
The study, published in the journal Environmental Science and Technology, is the first detailed analysis of how reductions in particulate air pollution worldwide would yield improvements in global health.
The researchers looked at outdoor air pollution from particulate matter (PM) smaller than 2.5 microns. It can enter deep into the lungs and is linked to increased risk of heart attack, stroke and other cardiovascular disease, as well as respiratory illnesses such as emphysema, and cancer.
Off-the-scale pollution levels
PM pollution comes from fires, coal power plants, cars and trucks, plus agricultural and industrial emissions. In developing countries – including many popular travel destinations – this deadly pollution also comes from burning coal, wood, crop waste and animal dung for cooking and heating, and from burning rubbish in the open.
Most people live in regions with PM concentrations far above the WHO's air quality guidelinesof 10 micrograms per cubic metre. In some parts of India and China levels exceed 100.
Typically, the health risks of smog and haze increase in winter when temperature inversion (a layer of warm air over cooler air) occurs, trapping the smog in the moist, cold air close to the Earth’s surface.
Not surprisingly, older people are more susceptible to the effects of air pollution and subsequently are at higher risk of heart attacks and strokes than younger people.
Take steps to counter poor air quality
For most healthy adult travellers, the effects of heavy smog and haze are unpleasant, but short-lived. Usually eye and nasal irritation, and a cough; at worst a headache, nausea, and vomiting.
However, air pollution can have more serious effects on young children, the elderly and anyone (of any age) with chronic heart disease or a lung condition, such as asthma or emphysema.
If you fall into a high-risk category, seek pre-departure advice from an experienced travel medicine doctor or your GP about how travelling to a smog- or haze-affected region might affect your particular condition.
If you’re concerned that air pollution may impact your health overseas:
CHECK BEFORE YOU GO – Just like the weather forecast, check the current and predicted air pollution indexonline in real time.
MINIMISE TIME OUTDOORS – If air pollution levels suddenly worsen, stay indoors until the air clears. Keep your hotel room’s windows and doors closed and turn the air conditioner to ‘recirculate’ mode.
REDUCE PHYSICAL OUTDOORS – Physical activity outdoors increases the risk of airborne particles going deep into the lungs. Don’t cycle, play tennis, or jog – especially near heavy traffic or during the afternoon, when ground-level ozone reaches its peak.
WEAR A MASK – If medium-high air pollution is forecast, consider wearing a mask when outdoors – especially if you’re in the high-risk category. Quality masks, such as N95 respirators, are far more effective than cloth or gauze masks at filtering small particles, although they don’t protect against noxious gases. Consult your doctor before using a mask if you have an underlying medical problem, especially a heart or lung condition.
KEEP MEDICATION HANDY – If you use an inhaler or carry medication for a chronic condition, carry them in your hand luggage so they are handy on arrival. Your inhaler and medication should go everywhere with you.
REMEMBER TO PACK – Add over-the-counter saline solution or eye drops to your traveller’s first-aid kit to relieve irritated eyes.
For most travellers, air pollution is a minor irritation.
But, if respiratory symptoms persist after you return home, consult your doctor.
* Dr Bajrovic is the Medical Director of Travelvax Australia.
For more information on all of the health risks for your overseas journey or to book a pre-departure medical consultation, contact Travelvax Australia’s travel health advisory service on 1300 360 164 (toll-free from landlines).