By Dr Eddy Bajrovic*
For much of the last fortnight, India has baked in temperatures of up to 48oC (118oF). The national death toll from heat since mid-April has now topped 2200 people - 1636 in southern Andhra Pradesh state alone.
The first hint of relief for India’s 1.3 billion people came last weekend with the arrival of the first rains of the Indian Ocean monsoon in the south. However, it will take weeks before they fall in northern India, where intense heat and dry winds have caused severe dehydration on a massive scale.
Scientists warn we can expect more heatwaves and other weather extremes in decades to come.
So, if you’re travelling abroad in summer, what should you do if your holiday is hit by a heatwave?
Food choices become critical
Coping with the high temperatures far from home involves more than wearing light, loose clothing, staying out of the sun, avoiding exertion during the hottest hours, and maintaining hydration.
Travellers also need to take extra care over food and beverage choices, especially in a developing country. Developing countries like India typically see a spike in food poisoning during and just after heatwaves.
Why? Because the power supply is often an early - and regular - casualty in a prolonged heatwave, as air-conditioners are cranked up to the max day after day.
Street food is problematic
Heat coupled with a power outage means food spoils quickly. Drinking water can’t be treated either, making the golden rules of avoiding ice and drinking only sealed bottled water even more critical.
Major hotels and larger restaurants may have back-up generators, but many smaller ones don’t.
Street food can be particularly problematic in a heatwave. Stalls, carts, and equipment are often old and virtually impossible to keep clean, while operators have little or no knowledge of sanitation. With no access to refrigeration or safe water for cooking, dishwashing or hand washing, dining al fresco can become a lottery for visitors and locals alike.
Opt for safer selections
Here are our tips for choosing no-regrets food:
Choose piping hot food – It might sound counter-intuitive, but in a heatwave it’s especially important to pick menu items that have been cooked thoroughly from fresh ingredients and arrive too hot to eat immediately. Nearly all food poisoning is due to microorganisms (and their toxins) found in food: high heat kills the organisms and neutralises the toxins.
Avoid warm food – While organisms are killed by high heat, the opposite happens in warm food – between 5 and 60ºC they multiply rapidly.
Be cautious about dessert – Desserts are often eaten many hours after they are prepared. Organisms multiply rapidly in creamy products – especially at room temperature or when fridge temperatures fluctuate due to a power outage. Even if dairy-based products reach you properly chilled, they may have undergone thawing, allowing bacteria to multiply. Subsequent refrigeration slows bacterial growth but preserves organisms already present.
Tips for staying cool
Heat generated by our muscles must be shed to maintain our core temperature of about 36.7°C. As humidity rises, perspiration becomes less effective and the human body retains more heat, raising our core temperature to dangerous levels.
To counter this:
Dress for the heat – Dress for heatwave conditions in lightweight, light-coloured, loose-fitting clothes. Cotton ‘breathes’ and absorbs perspiration, helping to cool your body.
Stay indoors or in shade – Avoid direct sunlight during the hottest hours from mid-morning to mid-afternoon.
Drink up – Most heat-related problems result from dehydration. Drink non-alcoholic fluids even before you feel thirsty (which occurs when you are approximately one litre dehydrated). Maintain a constant intake – up to 1 litre an hour if exercising or walking. Passing light yellow urine several times a day is the best indicator of adequate hydration.
Take time to acclimatise – It can take time to adjust to the higher temperatures in a hot, humid country – especially for kids and elderly or overweight people. Take it easy for a day or 2 until all members of your group are ready to tackle the holiday schedule.
Recognise the warning signs – Heat can cause a range of symptoms – muscle cramps, tiredness, nausea, vomiting - even an altered mental state. Kids are more susceptible.
Never leave kids alone in a car – Everyone has heard the tragic stories of children being left in a car. A car can heat up from 27oC to 49°C in just 15 minutes!
Treating heat stress
There are two stages to heat stress - heat exhaustion and heat stroke. The first step in treatment is to lower the person’s temperature as quickly as possible by getting them to a cool space, such as an air-conditioned room or car.
Heat exhaustion: The key to treating heat exhaustion is rehydration and rest. Start with sips of cool to cold water and gradually increase intake to 250mls every 15 minutes. Between 2 and 3 litres of fluid over 2-3 hours may be required for complete rehydration.
Heat stroke: The next stage of heat exhaustion is heat stroke. The signs are changes in the level of consciousness, irritability, hallucinations, and unsteadiness in walking.
Heat stroke can be fatal and should be regarded as a medical emergency requiring urgent medical intervention.
* Dr Bajrovic is the Medical Director of Travelvax Australia.
For more expert advice about coping with the heat, possible vaccinations and other travel health-related issues for your next overseas trip, please call Travelvax Australia’s advisory service on 1300 360 164 (toll-free from landlines). You can also book a medical appointment at one of our 58 clinics around Australia.