Kokoda Track Many Australians are drawn to the challenge of this 96 km trail over the Owen Stanly ranges near Port Moresby in Papua New Guinea. It marks the 1942 battleground between the advancing Japanese forces and Australian diggers in WW2. Walking conditions are harsh due to extremely steep terrain, humdidity, rain, mud and remoteness. As a result, the main health issues include dehydration, overhydration, exhaustion (including heat stroke), heart attacks, injuries, tropical ulcers, blisters and fungal skin infections. Malaria carrying mosquitoes are also present. The following information provides some broad and general guidelines about health risks and recommendations for these destinations. This should not be taken as a substitute for personal consultation with a doctor with experience in travel health.
Most Common Health Issues Fitness to trek Thorough preparation is essential in order to prepare for the rigours of trekking in the above conditions. Training should begin at least four months before the trek. Nothing beats climbing stairs and steep hills with a loaded pack, in the boots you plan to trek in - boots should be well worn in and correctly sized. Oversized boots will lead to jamming of the big toe into the boot end on long downhill stretches and undersized boots will cause pressure blisters. In most parts of Australia the combined experience of heat, humidity and mud and tree roots cannot be replicated. Have a medical check-up. Following the deaths of four Australian trekkers in 2009 there were calls for mandatory medical clearance for all trekkers, including cardiac stress testing for those with risk factors, to exclude hidden heart disease. There are many other medical conditions which would make trekking unwise, including obesity or a general lack of aerobic fitness.
Hydration Issues Because of excessive sweating in humid conditions whilst trekking it is important to carry enough water and keep adequately hydrated. However, some of the Australian deaths on the Kokoda track are thought to have been due to over hydration with water only, which, when combined with excess sweating and salt loss, leads to salt depletion and swelling of the brain. The solution is to drink to your thirst - your brain will tell you how much fluid you need. It's not a bad idea to add one rehydration salt sachet to at least one drink per day.
Heat Exhaustion This is a serious condition that can develop into heat stroke- a medical emergency. It occurs when excessive sweating in a hot environment reduces the blood volume. Warning signs may include paleness and sweating, rapid heart rate, muscle cramps (usually in the abdomen, arms or legs), headache, nausea and vomiting, dizziness or fainting. Get the person to a cool area and lay them down. Remove outer clothing. Wet skin with cool water or wet cloths. Increase fluid intake if they are fully conscious. Emergency evacuation may be necessary.
Traveller's Diarrhoea This is the one most travellers to developing countries experience sooner or later, with watery diarrhoea and sometimes vomiting. It is caused by bacteria, such as E.coli, Campylobacter, Salmonella and Shigella, Cholera and sometimes by other bugs such as giardia. Careful food and drink choices (no tap water), as well as hand hygiene, help in prevention. Use water sterilisation tablets in your water bottle or use a water bottle with a built in filter. Diarrhoea is treated with rehydration if mild but if inconvenient, with a ‘bowel stopper’ such as loperamide (Gastrostop or Imodium) and if more severe or persistent with an antibiotic or giardia treatment. These are best obtained prior to travel. We stock gastro kits containing all of these medications.
Malaria This mosquito born parasite is extremely common in PNG. The mosquitoes usually bite between dusk and dawn. Preventive medication should be taken. Mosquito bites should be avoided by covering up exposed skin in the evening and applying DEET containing repellents. Sleeping accommodation should be mosquito proof e.g. in a mosquito proof tent or in a lodge under impregnated mosquito netting. Even if all precautions are taken, any fever even up to a month or two after leaving the area, is malaria until proven otherwise. Since the minimum incubation period for malaria is seven days, symptoms often don't develop until after returning to Australia
Japanese Encephalitis This mosquito born virus occurs mainly in rural areas - the exact rates are unknown because of the lack of reliable data coming out of PNG. Vaccination is available
Evacuation and Travel Insurance Adequate insurance is essential because of the remoteness of the track and the huge costs involved in moving a body (dead or alive). Often the sick or injured will need to be carried out on stretcher over several days because of remoteness, unpredictable weather and poor services.
Medical and First Aid Kit A comprehensive list of recommended supplies is usually provided by trekking companies. Some recommended medications are prescription only, such as malaria tablets and antibiotics to self-treat various infections. It is important to be self-sufficient and not rely on others. Our experienced staff can assist you in making up a kit.
Foot care and Clothing Look after your feet; dry well, use antifungal power or gel and treat blisters and pressure points early. Never walk barefoot. Wear appropriate clothing - be guided by your tour company. Dry your clothes every night.
Other Keep your passport in a waterproof bag or container. Only trek with a reputable company. Register your travel plans with the Australian Government - www.orao.dfat.gov.au/orao. Check the security situation in PNG and on the track. Treat wounds early with irrigation to remove dirt and apply antiseptic, keep dry and use antibiotics at earliest sign of infection.
Vaccinations Routine Vaccinations for all travellers All international travellers should be up to date or immune to the following as these are transmissable diseases which may have serious complications:   
Measles ( recent outbreaks in PNG) Chickenpox Influenza - especially for the elderly or those with underlying medical conditions
In addition a tetanus booster if more than 5 since last vaccinated is advisable to avoid having to get a booster shot in PNG in the event of a tetanus prone wound
Recommended Vaccinations for most travellers to PNG Hepatitis A is a food and water borne virus that infects the liver and causes jaundice. Many people in the developing world have natural immunity, but travellers generally do not. The vaccine is very safe and effective, a single injection providing immediate protection for 6-12 months, after which a booster shot provides long-term immunity. Hepatitis B is a blood borne virus, but may also be sexually transmitted. Accidents, injuries and sometimes even medical treatment in the developing world can expose travellers to this disease. Hepatitis B is highly infectious and can lead to chronic liver disease and liver cancer. All children and young adults born since 1990 in Australia have generally been vaccinated Typhoid fever is a bacterial infection which is caught through ingesting contaminated food and water. Mortality is in the order of 1 in 10 in some settings. Resistance to common antibiotics is also widespread so treatment has become more difficult.
Other vaccinations to consider Japanese Encephalitis- see the section on Japanese Encephalitis. Cholera outbreaks have occurred in several provinces, including Port Moresby, in recent years. The vaccine provides some cross protection against common E Coli diarrhoea. Vaccination may be recommended.