Diarrhoea during travel is thought to affect 10 million travelers each year. The most common cause is a bacteria called E. coli. Traveller's diarrhoea is characterized by frequent loose bowel motions, abdominal cramps, nausea and vomiting. On the Kokoda Trail, it can complicate an already grueling exercise with severe dehydration and fatigue.
The bacteria that cause traveller's diarrhoea are sensitive to some antibiotics, including ciprofloxacin, norfloxacin and azithromycin. Prophylactic antibiotic treatment is not recommended for healthy adults.
This risk of contracting traveller's diarrhoea can be substantially decreased by strict adherence to simple hygiene precautions. Wash hands before eating and after going to the toilet, purify all water, ensure food is freshly cooked and fruit (and nuts) are peeled.
For those who get traveller's diarrhoea while on the Trail, a single large dose of antibiotic is usually all that is required
Ciprofloxacin – 1.5g
Norfloxacin – 800mg
Azithromycin – 1g
Chafing and foot care
Chafing is a potentially serious problem in the moist jungle environment of the Kokoda Trail, leading to bleeding, skin infections and extreme discomfort. It can be prevented by the wearing of bike-pants-style elastic undergarments such as Skins. Careful, early attention should be given to any areas that appear to be chafing with liberal use of barrier ointments like Bepanthen. Infected chafing areas may require antibiotic therapy.
Foot care is vital on the Kokoda Trail. Worn-in, supportive waterproof boots are a necessity. We recommend inner and outer hiking socks to minimise shearing, with at least a new set every second day. Ensure toenails are trimmed throughout the trek. Where possible, allow your feet to dry (eg. lunchbreaks, during the evening). When crossing creeks without your boots on, be sure to wear reef sandals or Croc-style shoes to avoid cuts and scratches from submerged rocks. Take similar care while bathing in the creeks and streams. Fungal infections can be prevented by the application of antifungal powder or cream in the evenings.
Prevention of blisters can be achieved applying hydrocolloid pad dressings (eg Dr Scholl, Spenco) to pressure areas. These often come off in extreme moisture and require an elastoplast dressing over the top to remain in place. The common pressure areas are the side of the big toe and the ball of the foot, but obviously this varies and individuals should become familiar with their particular pressure areas during training.
Treatment of blisters consists of keeping them clean and avoiding further abrasion. Commercial blister pads (Dr Scholl, Spenco, Band-Aid) are useful for this purpose. Antibiotics may be required if the blisters become infected with bacteria.
A common overuse injury on the trail is known as patellofemoral pain syndrome (runner's knee). This condition has a variety of causes, but on the Trail is due to repetitive knee flexion with extra weight loading the joint. Pain is usually felt behind the kneecap, especially when going downhill.
It may not be possible to totally prevent this condition but there are some measures which can be taken to reduce your risk.
- Proper warming up and stretching before each day
- Good footwear
- Quadricep strengthening during training
- Some people may benefit from taping or bracing the knee joint to ensure proper tracking of their kneecap - see your physiotherapist if you are experiencing these symptoms in your training
- Trekking poles to decrease the load on the knee joint
Treatment of the condition begins with rest (which may not be possible!). Anti-inflammatory tablets can aid in pain reduction and decrease the inflammation.
The Kokoda Trail traverses slippery, steep, uneven slopes and sometimes treacherous river crossings. Almost any injury is possible. Those suffering serious injuries will require evacuation, usually by a combination of jungle stretcher and helicopter.
Injury prevention measures include:
- Boots with good ankle support and grip
- Trekking poles - one or two, depending on personal preference. Trekking poles decrease the amount of force going through your knee and ankle joints and also provide stability on slippery downhills
- Personal carrier. Decreasing the load on your back will improve your balance and decrease back strain injuries. A personal carrier will also assist you across log bridges and in slippery areas of the track.
Your body's fluid balance will be placed under considerable stress while hiking in the humid mountain jungle of Papua New Guinea.
Risks of dehydration include strenuous exercise, hot climate and illnesses such as diarrhoea. Some blood pressure medications called diuretics can also increase your risk of dehydration. Symptoms include increased thirst, dry mouth, decreaed urine output, weakness, fatigue and confusion. Severe dehydration can lead to seizures, coma and death.
Too much fluid can be equally dangerous. The practice of "drinking as much as possible" has lead to a condition called exercise associated hyponatraemia (EAH). A near-fatal case occurred on the Kokoda Trail in 2006 with the trekker requiring helicopter evacuation to Intensive Care in Port Moresby Hospital. Symptoms of EAH include lightheadedness, confusion, weakness, seizures and even death.
Just how much should you drink? The best guide is your body's thirst requirement. Only drink fluids when you are thirsty. A rough guide is a maximum volume of 750ml/hour, with 1000ml/hour the absolute limit.