Health Tips for my Daughters in College

Warning: This paper was written for the benefit of my two daughters who started their college life last year. It is a dadly advice for his kids. It is not meant to put down any establishments or vested interests. I am not a doctor, an epidemiologist, a health officer, ministry spokesman or any such certified expert who themselves will not and cannot guarantee our safety. It is me, the father of my kids speaking up for them.

INTRODUCTION

The student population of universities and colleges are increasingly more cosmopolitan then ever before. It is therefore, important that the students be informed on the relevant health issues that this new living conditions give rise to. While diseases are not entirely avoided, all necessary and reasonable precautions must be taken to live a healthy life on campus.

IN CASE OF EMERGENCIES, MEDICAL PRACTITIONERS WILL NEED TO KNOW THE FOLLOWING:

Imagine yourself in a situation where you are not able to make a decision about your health, and the next-of-kin are not nearby to be reached. The people around you have to make some sort of decision, what sort of information will help them?

·    The person to contact in case of emergency. Keep an ICE card on you at all times.

·    Blood group.

·    Food allergy such as gluten (i.e. wheat protein), certain oils and seeds (such as groundnut and sesame), and certain proteins (such as molluscs, etc.).

·    Systemic allergy to any drugs, whether prescriptive (e.g. diclofenac related brands such as Voltaren) or over-the-counter (OTC) types (e.g. mefenemic acid related brands much as Ponstan) – Malaysian students should get their “red-card” from the Government Hospitals; others may have to wear other related sort of warning on their persons (such as tag–chain, tattoo, etc.)

·    Asthmatic allergy to any environmental factors.

·    Relevant medical history – (i) previous serious illnesses or accidents that required hospitalization; (ii) the nature and location of any implants in the body; (iii) diabetes and or abnormal blood pressure; (iv) weakened condition of heart, lungs, liver, etc); and (v) in the case of females, whether they are pregnant.

·    Status of any current treatment for major illnesses such as (i) cancer; (b) stroke; (c) AIDS; (d) kidney failure; etc.

·    Any sort self-medication (either OTC drugs, improperly acquired medication, or non-medical “traditional” products).

COMMUNITY LIVING

Community living poses a certain degree of health risk due to the greater ease of contact, hence a need to be aware of vaccination and hygiene.

·    Most illnesses preventable by vaccines must be vaccine against. This is the responsibility of parents and students, and not of the Government.

·    On the other hand, reviewing your vaccination is an opportunity to consult a physician to check your immunization record, and your own Government’s policy and health recommendations.

·    Vaccination is never a substitute for observing good personal hygiene and hygienic handling of food and water.

·    Students engaging in extreme sports (such as scuba–diving, para–sailing, etc.), or risky lifestyle but nevertheless the coming into contact with remote communities (e.g. native villages in Perak, Pahang or Sarawak), and poorly designed housing settlements (e.g. squatters, workers’ quarters, migrant, refugee and guest–worker enclaves) in Malaysia do pose health concerns. Students need to be aware.

HEALTH CONCERNS IN MALAYSIA

All students need to keep in mind that each country has its own health concerns and recommendations for travellers. Being informed about it is just as important for your well–being during the duration of your studies. Students come to Malaysia with preventable illnesses from their home country; or they come here and are exposed to illness that are prevalent in Malaysia. When students from different parts of the world gather here, there is an increased risk to the student’s health.

VACCINATIONS

Malaysians are generally vaccinated against the following diseases:

·    Tuberclosis (BCG Vaccination)
·    Diphtheria, Tetanus, Pertussis ("whooping cough"), Polio, Haemophilus Influenza
      Type b (HiB) - each of these used to be a separate immunization exercise

·    Measles, Mumps, Rubella – also used to be separate immunization. (MMR

      Vaccination)

·    Human papillomavirus (HPV Vaccination) – for girls 13 years of age in 2010 and                thereafter.

These are diseases that the Malaysian Government is most concerned about:

·    Cholera – Cholera used to be a scourge in the annual flood zones of Malaysia. Students should avoid travelling into these areas during the floods. However, students who need to be in these areas should consider having a cholera vaccination. Considering the changing weather in Malaysia, people living in areas unaccustomed to floods or in such vicinity should be careful. While Cholera may be a serious illness, it can also be easily prevented.
·    Meningococcal disease – Malaysia does not require vaccination against meningococcal disease but it is fast becoming a global concern. Getting this MCV4 should be compulsory for dormitory students since community living is part of our lifestyle. All students should also consider such a vaccination.

·    Yellow fever – The need to immunize against yellow fever depends on the students exposure to countries where this disease is a concern – South America and Africa. Any student from these regions must carry a certification of vaccination against Yellow fever.

·    H1N1 & H151 – These two types of influenza are also called the “swine flu” and the “avian flu” respectively. It is most likely to affect those working in the farms but can break out into an endemic. If there is a health alert raised by the Government, students should keep abreast on the latest development. Nevertheless, if you have influenza, use wet–tissues, wear a surgical mask, dispose tissues carefully, drink plenty of water and see your physician. If you are worried, you may get a flu vaccination.

·    Malaria – There is no long–term effective vaccination available in Malaysia. Students travelling into a locality where Malaria is endemic are required to take prophylactics that provide temporary protection, several days prior to their trip. Students who take field–trips as part of their course requirement; or visiting friends in smaller towns and villages must see the physician for advise before prescription. Since Malaria is a mosquito–borne disease, protective measures against bites are essential.

·    Dengue – Any sort of unremitting fever for two days with spots appearing on the palms, are routinely tested for dengue. If your physician do not have the necessary facility for the test, please go the Emergency Ward of any General Hospital. It is easily spotted and treated but there is no vaccine available. Not treating dengue can lead to fatal complications in the liver, the brain and other organs; and the student becomes the carrier for an endemic spread of the disease.

·    Bacille Calmette–Guérin (BCG) – Malaysians are generally administered BCG as a preventive against tuberculosis (TB) so successfully the disease had become rare until the 1990s. The influx of guest–workers from South Asian countries have reintroduced this disease together with a more virulent and highly contagious type. Tuberculosis is a serious national concern, and a contagion in the student population may lead to serious consequences. Students exhibiting thick coloured phlegm that does not clear with normal antibiotics should be referred to the GH for suspected TB. There is a strain of TB from Bangladesh that requires quarantine and a wide range of antibiotics.

·    Hepatitis – Hepatitis A is a disease of the liver that is a lot more prevalent in Southeast Asia then anywhere else in the world. Hepatitis A is found primarily in feces; and can be prevented from reaching your table by good hygiene, avoiding seafood (such as “bottom feeders” – crabs, cockles; and dishes with these animals. ) Vaccination is available. HeHHH(Note: Hepatitis B & C are technically sexually transmitted diseases, and is of a more serious nature. Barring immoral activities, it can be accidentally transmitted to the healthy community via carelessness of health workers etc. We do not expect students with Hepatitis B or C to be on campus but then.)

·    Japanese encephalitis – Japanese encephalitis was a leading cause of viral encephalitis in Asia, and remains a concern in Malaysia since the 1990s. Students should consider vaccination. Since it is a mosquito borne disease preventive measures against mosquito bites should be taken seriously.

·    Rotavirus – Rotavirus comes in many strains and are natural inhabitants of gastro–intestinal tracts of humans and animals. Symptoms of rotavirus infection is severe diarrhea leading to dehydration and other complications. While children are most affected, it is not uncommon among adults. Good hygiene is the best prevention but vaccination is available.

RESTAURANTS

Restaurants are a health concern in Malaysia. Due to poor management of food handling and storage, restaurants pose a threat to the health of the nation. Here why I think so:

·    Toilets - There should be a 30 feet minimum distance from toilet to kitchen but no restaurant in Malaysia observes it. And toilets should be dry and cleaned on a regular basis. This makes almost every restaurant I have visited in Malaysia unfit. (Go figure!) A nice shop frontage is no guarantee of a well managed establishment.

OTHER HEALTH CONCERNS LIVING IN THE TROPICS

There are a host of minor health concerns that a student may face living in the humid tropical climate of Malaysia. Students should not feel ashamed of it and must seek medical attention.

·    Ringworms – this is neither a ring nor a worm, it is a fungal infection affecting the region between the toes. Once infected, it can spread and may prove difficult to be rid of. See your physician and follow their instruction carefully. See a physician who can cauterize it with laser.

·    Fungal infection of nails – the best preventive of this common ailment is to apply nail varnish to your toes and fingers. The infection will slowly thicken the nail and becomes unsightly. Do not use OCT remedies without consulting your physician.

·    Hair Lice – This can be treated in style with styling-gel (really!) and leaving it on for 12 hours.

·    Body Odour – “BO” is a common problem in dormitory living and can lead to social issues. A simple whole body application of selenium compound shampoo (e.g. Selsun) will solve the problem. See your physician to eliminate other underlying causes.

A NOTE ABOUT NON-MEDICAL REMEDIES:

·    It is common for Malaysians to self-remedy their illness using products termed such as “siddha”, “traditional”, “herbal”, “homeopathy”, “ayurvedic” or “Chinese” medicine. They may or may not consult even a “medical practitioner” or a “sinseh”. Students who do so are considered self medicating and do so at their own risk. The Malaysian Ministry of Health has routinely warned against such treatment.

·    If you self-medicate, please show the physician any left over “medications” if you are seeking medical help at a hospital or clinic.

BROWNING OUT

·    Self-regulated common sense in physical exercise, rest, good nutrition, vitamin supplements, personal hygiene and grooming should be normative for all students.

·    If you are constantly tired, losing your sense of humour, quick to temper, losing your weight for no reasons, experiencing poor control of your bowels, having difficulty getting up in the morning, or stiffening of muscles, you may be experiencing any one of the following: (i) physical exhaustion (due to unaccustomed weather or overexertion in games); (ii) developing an illness (diabetes, or other medical problems); (iii) emotionally or mentally burning out. In any case, see your physician for proper care and treatment. Discuss with your parents if you were prescribed.

MOSQUITOES

·    Avoid mosquito bites using sensible methods: (i) Do not use “mosquito-coils” – it is a fire hazard in the dormitories. (ii) Avoid aerosol based repellants. (iii) Use electrical device repellants. (iv) Use a mosquito-net. (v) Use repellant-gels and creams sparingly.

·    Mosquitoes have complex behaviours each depending on its sub-species. Devote time to keep your room bright, airy and free of mosquitoes.

·    If you are having mosquito problems in your dorms, there is a breeding ground 200m from the vicinity.

RATS

·    Rats are a national problem that no one like to admit because we have not been humiliated by a plague. But then we have leptospirosis. Malaysians feed our rats by a chain of (i) ad-hoc waste disposal centres; (ii) subsidized canteens in factories, schools, and even some government facilities; (iii) poorly managed warehouses; kiosks and outlets selling food; (iv) poorly serviced sewerage and drainage; and (v) unclean restaurants.

·    The best way to avoid coming into contact with rats, rat urine or their droppings is to not to walk about in bazaar or pasar malam on wet days.

·    Learn to recognize the smell of rat urine and avoid such premises like the plague.

·    Always wash the outside of a bottle or can drink before opening them.
·    If you see a specimen in your college or dorm ... you are in serious trouble. Report.

OTHER STUDENTS
·    All hygiene rules at home must prevail. 
·    Do not share medications. 

SOME HEALTH TIPS (adapted from the http://wwwnc.cdc.gov/travel)

Drink and use clean water

·    Buy bottled water with unbroken seals.

·    Use boiled water. Bring your water to a complete boil for 1 minute.

·    Water purification tablets do not always guarantee safety.

·    Use safe water to brush your teeth, wash and prepare food, and make ice.

·    Clean food preparation areas and kitchenware with soap and safe water and let dry completely before reuse.

·    Store water in a clean, covered container.

·    Do not use piped water for cooking or drinking without first boiling it.

·    Do not drink beverages sold in plastic containers or use ice if you are not sure the ice was made with safe water.

·    Do not swim in untreated fresh water pools, rivers or ponds.

·    Do not re-cycle plastic water bottles for drinking water.

Eat safe food

·    Cook all meat to 72^oC (160^oF). No exceptions. Sometimes restaurants serve meat that are purposefully not entirely cooked, such as steamed chicken in Hainan Chicken or cockles in Chow Koay Teow – avoid it.

·    Eating food prepared before your eyes is safer than those prepared out of sight.

·    Do not eat half–cooked or uncooked foods, except for fruits and vegetables you can wash and peel yourself.

·    Do not eat in places where there are flies, do not smell right, appears unclean or the people preparing or serving food does not appear clean or healthy.

·    If there is a blue glowing fly-repellent device in a restaurant, that is a good sign to avoid the establishment.

Keep your hands clean

·    Wash your hands with soap and safe water. If you do not have soap, use hand-sanitizers. Carry them with you.

·    There is a particular way to wash your hands – learn it.

·    Wash your hands before you eat or prepare food, and before feeding your children.

·    Wash your hands after using the toilet, after cleaning your child’s bottom, and after taking care of someone ill.

·    Keep your nails trimmed.

Use of toilets

·    Clean toilets and surfaces contaminated with faeces using water and soap; or you may use a sanitation aerosol purchased at the local pharmacy.

·    Do not throw sanitation pads into the toilet (for women).

·    Flush the toilet after use. If you are not sure how, it is NOT embarrassing to ask someone.

Practice hygiene

·    Clean up the areas you cook and eat. If there are flies in the vicinity you should be concerned. Cover your food.

·    Wash yourself, your children, diapers, and clothes at least 30 meters away from drinking water sources. In the same vein, do not use the water in the dorm toilet for preparing food or drinks.