[ Burns ]   [ Tick Bite Fever ]   [ First Aid Kits ]   [ Fractures ]   [ Heat Exhaustion ]   [ Heat Stroke ]   [ Lacerations ]   [ Malaria ]   [ Skin & our Enviroment ]

Please Note: The below-mentioned, nor the publisher can be held liable for any condition, complication of information stipulated in the article, since the level and experience of the individual is not known. Use thus with caution and always within your level of expertise.
Burns	Severity depends on 3 aspects: Body part affected Thickness of the burn Size of the burn Remove all burned clothing and assess whether smoke inhalation has occured. Treat respiratory distress as for any other condition (CPR) and administer oxygen. Smaller wounds can be treated by applying cold water. Chemical burn wounds (acid or alkaline) require large amounts of flushing with water. All jewelery should be remove from the areas affected, since swelling could take place. Calculation for surface body area burned The rule of nine is used: Adults each arm - 9% each leg - 18% (9% for lower leg, 9% for upper leg) trunk back and front - 18% each head and neck - 9% perinium - 1% Infants each arm - 9% each leg - 14% trunk front and back - 18% head and neck - 18% perinium - 1% A palm covers roughly 1% The following burns should not be treated in the bush and require evacuation to a medical facility: Burns involving more than 15% in 10 - 50 year old patients. Burns involving more than 10% in victims younger or older than the above. Serious burns to the hand, face, foot, perinium or circumferential to extremity. Electrical burns Victims with compromised immunity, the elderly, infants Treatment Superficial Burns No blisters, but fever, weakness, cold shivers and vomiting could occur. Cool the burn with water. Apply "Burnshield" or simular topical gel. Give oral painkillers and anti-inflammatory drugs. Prednisone could also be given by a doctor ( 80mg 1st day, 40mg 2nd day, 20mg 3rd day, 10mg 4th day ) Deep Burns Blisters, skin moist and red, hypersensitive Assess for smoke inhalation and treat accordingly. Irrigate to cool burn and to remove loose dirt. Drain large blisters and leave small blisters. Apply "Burnshield" and dress; change dressing daily. Encourage the intake of an oral electrolyte solution like Energade / Powerade. Ringers Lactate could be given IV ( 4ml / kg / % area burned / 24 hours , 1/2 given over 8 hours and the rest over following 16 hours ) Transport to medical facility Antibiotics only to be used if infection is present - pus, fever, swelling, foul odor. A dry, leathery, firm, charred skin indicate full thickness burn. Immediate evacuation after initial emergency treatment required.
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Bosluisbytkoors ( Tick Bite Fever ) (Dr Neil van Tonder)	Hierdie siekte word veroorsaak deur n organisme bekend as Rickettsiae, n klein stafie-vormige bakteriee. Daar bestaan verskeie tipe Rickettsiae en dit kom in verskillende wereld dele voor. So veroorsaak hulle onder andere siektes soos Rocky Mountain Spotted Fever, Queensland Tick Typhus, Trench Fever, Kenya Tick Typhus, ens. In Suid-Afrika ken ons dit as Bosluisbytkoors, met Rickettsia coroni var. pijperi as organisme. Dit kom reg deur Suid-Afrika voor en word oorgedra deur bosluise. Die inkubasie periode ( die tydperk vanaf die byt totdat simptome verskyn ) is gemiddeld een week. Simptome sluit in; koors, lusteloosheid, fotofobie ( lig sensitiwiteit ) en erge hoofpyn wat al hoe erger raak. Op die 3de tot 4de dag kan die pasient n vel uitslag ontwikkel soortgelyk aan masels. Dit verskyn hoofsaaklik op die voetsole, handpalms en gesig. Dit is gewwoonlik moontlik om die bytplek op te spoor. Dit is meestal rooi en later ontwikkel n area van weefsel afbraak sentraal met die vorming van n ulkus. In die area van die bytplek, is die kliere ook gewoonlik vergroot en pynlik. Die simptome duur selde langer as 7 - 10 dae. Die prognose is baie goed en sterf gevalle is uiters seldsaam. Die diagnose word bevestig deur n bloedmonster na n labrotorium te stuur. Behandeling : Die verkieslike antibiotika is Tetrasiklien, wat gegee word tot ongeveer 2 dae nadat die temperatuur normaal geword het. Punte van belang : Meningitis ( Breinvliesontsteking ) kan met presies dieselfde simptome voordoen en kan noodlottig wees. Kontak dus altyd jou dokter sodat die nodige toetse gedoen kan word en antibiotika voorgeskryf kan word, indien nodig! Dit kan ook maklik met Malaria verwar word.
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First Aid Kits	The choice of a medical kit will depend largely on where you plan to tour and how far away you will be from good medical care. Good basic kits can be purchased from Ysterplaat Medical supplies and more comprehensive kits will be made to order or of course make your own. (This list has been compiled using numerous sources including the Australian "Adventure in Leisure" book and in consultation with a practising doctor.) A basic kit should contain the following: First aid book Various bandages Trangular bandages Crepe Bandages Dressings Cotton Wool Adhesive plaster (roll) "Band Aid" type plasters Scissors Tweezers Eye bath Eye patch Safety pins Wound spray Eye drops Disinfectant Detol or Savlon Antiseptic soap Gill soap Ear drops Spersalerg Panado tablets Sindol tablets Micropore tape Latex gloves Burn ointment Anti Diarrhoea tablets Dehydration mix Antihistamine Water purification tablets Sun tan lotion Lip cream "Lipice" Butterfly closures (field substitute for stitches) Steri strip skin closures (for sealing wounds) Disposable razor (for shaving hairy spots) Splints (optional) Tampons Insect repellant Tongue Depressors (can also be used for splints for fingers) Specialist Information (Prescription required for medicines) Nausia and Vomiting Valoid tablets Take 1 x 50mg tablet evry 6 hours Suggested quantity in medical kit 20 tablets Diarrohea Immodium tablets Take 2 tablets to start and 1 after each loose stool Suggested quantity in medical kit 18 tablets Rehydration fluids (after vomiting and diarrohea) Rehydrat, Electrona, Electropak, Game or Energade Drink as much as possible Suggested quantity in medical kit, enough to make 4 litres Antibiotics (All purpose - for infected wounds or flu) Ranclav Course of 15 tablets Take 1 tablet three times a day for 5 days Travellers Diarrohea Ciprobay Course of 6 tablets Take 1 tablet twice a day for 3 days Bladder Infections Use either Purbac or Ciprobay Dosage as above Tetnus Have injection every 18 months - check prior to departure Cuts, Grazes, Burns or Open Wounds Betadine Ointment Apply with dressing daily Insect Bites Fucidin H Contains: Quarterzone to reduce inflamation This will penetrate through the skin to work locally Take together with Loratadine, Claritine or Polaritine for alergy control Grazes Use Merchurachrome to promote scab formation Stitching large wounds Suturing material can be purchased from one of the medical supply companies, but in emergencies use Fishing line (clean) with a disinfected needle DON’T use sewing cotton Bites and Poisons Snake Bite Immobilize the part of the body that has been bitten and keep the bitten part lower than the heart - be prepared to apply artificial respiration Scorpion Sting Put ice on bite, be prepared to apply artificial respiration General rule small pincers & big tail - poisonous! Spiders Put ice on bite, be prepared to apply artificial respiration In the case of a Button spider a hot bath will also relieve the cramps. If ulcers arrise from the bite keep them clean Ticks Burn the tick off with a cigarette or match Poisonous plants Symptoms may include the following: - Vomiting - Diarrhoea - Skin inflammation at contact area - Dialation of pupils - Delirium or convulsions - Difficulty in breathing - Unconsciousness Remedy: Induce vomiting if plants were swallowed Wash skin with water as soon as possible
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Fractures	Signs and Symptoms History and mechanism of injury Deformity and swelling Loss of function and pain Signs of shock Treatment Immobilize the part affected in functional position Apply traction to femur fractures Apply pressure to open wounds to minimize blood loss Observe and treat shock Administer pain killers Evacuate for X-Rays and further management
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Heat Exhaustion (Dr Neil van Tonder)	Signs and Symptoms Symptoms simular to Flu Nausea, vomiting Rapid pulse Low Blood Pressure Temperature normal to 39 degrees Celsius mental status normal Treatment Move to cooler area and stop all exertion. Give oral rehydration Cold packs or ice to neck, chest wall, axillae and groins ( close to big blood vessels ) Remove clothing
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Heat Stroke (Dr Neil van Tonder)	Medical emergency and carry mortality of 80%. Compensatory mechanisms have failed. Signs and Symptoms Core temperature above 40 Degrees Neurologically abnormal ( confused, seizures, bizarre behaviour, disorientation ) Low blood pressure Rapid pulse and breathing ( Tachycardia / Tachypnea ) Sweating might be absent Treatment Rapid cooling essential. Immerse in cool water; Wet body and run fan on highest setting; Ice packs as above. Maintain airway. IV fluids ( 1 - 2 liters Saline solution ). Treat shock and give Oxygen. Continue cooling victim during transport to nearest medical facility.
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Lacerations (Dr Neil van Tonder)	Lacerations represent injury to the skin, with the surface broken. It can either be superficial, requiring only repair of the skin, or deep with injury to underlying structures such as bones, ligaments or organs. Lacerations itself is hardly ever life threatening. Life threathening situations are more as a result of underlying injury, or loss of blood due to rupture of an artery. In bush-medicine the goals are to reduce the risk of infection, promote healing and to reduce the need for evacuation. Examination Look : Look for foreign debri in the wound. Look for underlying tendon injuries. Move the part the body part distal to the injury as well and try to establish, whether the tendons are intact. The patient could also be asked to move the affected body part, by isolating the joint and asking the victim to flex and extend the digit against resistance. Inability to do so, could signify tendon injury. Some wounds might require repair of the underlying tissue as well. Feel : Check that the distal pulses of the affected limbs are present, in order to exclude vascular injury. The Radial pulse lies just above ( proximal ) to the wrist joint on the side of the thumb. The Dorsal Pedis pulse lies on top of the foot, closer to the side of the big toe. The Posterior Tibialis pulse lies just behind the knob ( medial maleolis ) on the inside of the ankle. Anesthesia Topical Anesthesia : Commercial products like Emla gel could be placed around to wound for 15 -20 minutes. Alternatively a mixture of Lignocaine ( Xylotox ) with Adrenaline, could be placed around and into the wound after having soaked it into sterile gauze ( 5x5 cm ). Do not use more than 4-5 Ampules. Never use Lignocaine containing Adrenaline in the fingers and toes, due to the risk of arterial vasoconstriction and loss of the affected digit!! Ethyl-Chloride can be used as a topical local anesthetic, by spray it onto the area. It comes in 50 ml glass ampule. The effect only lasts a couple of seconds. Ice placed directly over the wound provide a short period of decreased pain sensation. Local Anesthesia : Infiltrate the wound and surrounding area with Lignocaine ( Xylotox ) using a small (25-gauge) needle. Dosage should not exceed 10 Ampules of 1,8 ml. Maximum dosage for children is 3 mg / kg body weight. (20 mg / ml in Lignocaine - 1,8 ml amp) Cleaning and Debridement Use a 20 ml syringe with water (boiled and cooled) as a water pistol to clean the wound. A drip set with Saline solution can also be used as an irrigation set if available. A plastic bag with a small hole cut into the bottom and filled with water can also be used. Remove all foreign material with a tweezer. Wound Closure Wounds should be closed / sutured within 8 hours, due to the risk of infection. The following methods can be used : Suturing Provide that suturing material (Nylon, Vicryl, Silk), tweezers, needle holder (Leatherman with tips disinfected) and sterile gloves, are available, suturing can be performed by starting in the middle of the wound and moving to the side. The technique can be practised by “suturing” a cut in a piece of foam. Sterile dressing packs are available from pharmaceutical wholesalers with sterile gauze and gloves. Zips Surgical zips work well on lacerations of 3 cm and longer provided that the correct length of zip is used and that it applied correctly. The sticky part should be applied 5 mm from the edge of the wound. It also does not require any form of local anesthetic. Glue Cyanoacrylate glue (“super glue”) can be used. This works well on small lacerations. The glue is applied to the skin next to the laceration. The skin is then rolled inwards and kept in this position for a few seconds. Care must be taken not to get this into the wound itself, or on the skin of the person treating the victim. Also wait until active bleeding has stopped. Strips of cloth from cloths and tents could also be used by applying “super glue” to the strip and holding it in place until dry. Use the other end to pull the wound closed and glue it to the skin. The strips will fall off after about 3 days. The procedure can then be repeated. Staples 3M Precise Disposable Skin Stapler comes with 25 staples. The technique requires that the wounds edges be pushed together with the index finger and thumb, whilst stapling with the other hand. Staples should not be used on the hands, feet or face. Steristrips These can be applied by starting in the middle and working towards the edges of the wound, alternating between the two sides. Scalp lacerations Provided enough hair is present, the wound can be closed by tying opposing strands of hair adjacent to the wound. Firstly lay a piece of dental floss in line with the wound. Strands of hair can now be crossed over in order to close the wound. The dental floss can now be used to hold it in place , by tying it down. High Risk Wounds These are the wounds that should not be closed and incude : animal and human bites to the hand, wrist, foot or very deep wounds wounds older than 8 hours wounds with large amounts of crushed tissue Pack the wound with Saline moistened gauze and dress with conforming bandage after cleaning and irrigation. Change the dressing daily. Start the victim on a broad spectrum antibiotic, Eg Augmentin, Ciprobay, Clindamycin (make sure about drug allergies). The wound can now be sutured after 3 - 4 days if no infection is present.
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Malaria (Dr Neil van Tonder)	History : Malaria has been with us since the beginning of time. In Africa, fossils of mosquitoes up to 30 million years old show that the vector for malaria was present Deadly fevers - probably Malaria - have been recorded since the beginning of the written word ( 6000 - 5500 B.C.) References can be found in the Vedic writings of 1600 B.C. in India. Hippocrates described certain aspects of an illness now known as Malaria in the fifth century B.C. In the seventh century, the Italians named the disease mal’ aria , meaning bad air, because of its association with the ill smelling vapors from the swamps near Rome. There no references to Malaria in the “medical bookes” of the Mayans or Aztecs. It is likely that European settlers and slavery brought Malaria to the New World. Malaria existed in parts of the United States from colonial times to the 1940s. One of the first military expenditures of the Continental Congress, around 1775, was for $ 300 to buy Quinine to protect Genl. Washington’s troops. Quinine, a toxic plant alkaloid, made from the bark of the Cinchona tree in South America, was used for treatment more than 350 years ago. Identified by French Army physician, Charles Laveran, in Algeria while viewing blood slides. Quinine has now been completely synthesized. Its synthetic analogue is called mefloquine. Vaccine is still being developed, has not yet proven to reduce deaths. Facts : Malaria is a public health problem in 90 countries affecting at least 300 million people. Tropical Africa accounts for 90% of these cases. Estimates of malaria mortality vary from 1,5 to 3 million deaths a year. The Plasmodium genus of protozoal parasites is the causative agent of malaria. Human malaria is caused by 4 species : P. falciparum, P. malariae, P. vivax, P. ovale. P. falciparum is the predominant species and the one that causes the most serious disease. This is also the species that has given rise to the new drug resistant strains that are emerging. The Plasmodium parasites are highly specific with female Anopheles mosquitoes as the vectors and man as the only vertebrate host. The parasites have a complex life cycle that is split between the host and the vector. The South African Situation Incidence assosiated with climatic conditions and influx of migrants from neighbouring countries. Chloroquine resistance necessitated continuing changes in chemoprophylaxis. 90 - 95 % of the locally contracted cases are due to P. falciparum. Prophylaxis against Malaria Precautionary measures against Malaria Mosquitoes feed between dusk and dawn in doors and outdoors. remain indoors at night, wear long-sleeved clothing, long trousers and socks insect repellent stay in well-constracted, well-maintained buildings in the best developed part of town. ( does this mean rooftop tents are better ?!!! ) close windows and doors mosquito proof net treated with permethrin from time to time and edges tucked in. spray house / tent inside use mosquito mats ect. treat clothes with an insecticide registered for this, permethrin. Taking of anti-malaria drugs Could still contract Malaria in spite of prophylactic medication. Contact doctor if any flu-like symptoms start. Tell the doctor of the possibility of Malaria. He would not look for it if you do not tell him / her !!! Symptoms of infection can occur up to 6 months after leaving a malaria area ! Recommendations for SA : High risk area : Drugs from October to May Intermediate risk area : Drugs from October to May only for high risk people ( Children <5 years, pregnant, Immuno-compromised ) Low risk area : No drugs Factors influencing the selection of drugs Patient factors Children / infants Breast feeding Pregnancy / lactation Porphyria Epilepsy Chronic illness : Liver disease may result in drugs becoming toxic. Patients on cardiac medication can only take certain drugs. Sensitivity to Sulph drugs : Persons sensitive for Sulphas, should not take Fansidar or Maloprim. Exposure to sunlight : Exposure for long periods to sunlight can cause photosensitivity and should use sunscreens. Environmental factors duration of stay : Extended use of chloroquine can cause retinal damage, 6 monthly ophtalmiological check-up recommended Mefloquine ( Larium ) should not be used for longer than a year. Doxycycline should not be used for longer than 3 months. Type of accommodation : greater risk in tent vs. building Time of year : In southern Africa Malaria is seasonal, although in certain areas such as Mozambique and the Zambezi Valley, there is a risk of contracting the disease throughout the year. Comments on drugs used for chemoprophylaxis Seriousness of side-effects should be weighed up against the risk of contracting malaria. Chloroquine ( Daramal ) Cheap, without prescription, safe in pregnancy / lactation, safe in children. Used with caution in patients with epilepsy, cardiac or renal disease. Usually well tolerated. Side-effects : headache, nausea / vomiting, diarrhoea, pruritis ( itch ), skin eruptions and itching of palms, soles, impaired vision Serious side-effects are rare, but periodic eye examinations are necessary if used for long periods. Proguanil ( Paludrine ) Best tolerated, very good safety and can be used in pregnancy and children. Rarely cause side effects. Side-effects : Mild gastric intolerance, vomiting, abdominal discomfort, mouth ulcers, skin reactions, hair loss. Mefloquine ( Larium ) Should not be used for > 1 year. The following people should not take it : Pregnant women or 3 months before conception ( 1/2 life of 42 days ) Children <15 kg Patients with history of epilepsy or psychiatric disorders Cardiac conduction abnormalities Depression People requiring fine motor control such as pilots, scuba divers, mountaineers Patients on Beta Blockers, Ca Channel Blockers, Digitalis or Anti-depressant therapy Side-effects : Dizzyness or disturbance of balance Gastro-intestinal disturbances Less frequent effects are : Headache, myalgia, feeling of weakness, visual disturbance Palpitations, bradycardia, irregular pulse and extrasystoles, AV block Hair loss, rash or pruritis convulsions Psycological changes, eg. depressive mood, confucion, anxiety, hallucinations, paranoid reactions Drop in White blood cells and Platelets If Mefloquine is used for prophylaxis, Halofantrine should not be used for treatment since it may lead to potencially fatal prolongation of the QTC interval ( Heart conduction abnormality ) Doxycycline Well tolerated Side-effects : Nausea and vomiting, Photosensitivity, skin reactions, vaginal candidiasis Contra-indicated in pregnancy, breastfeeding and children <8 years as it can seriously damage tooth development. Should not be used for longer than 3 months. Drugs for Standby Treatment Sulfadoxine-pyrimethamine Taken as a single dose. Cannot be taken by patients allergic to Sulphas Quinine Only if person cannot take Sulfadoxine-pyrimethamine. Should not be used without medical supervision. Side-effects : Mild hearing impairment, tinnitis, headache, nausea, visual disturbances ( up to 70 % of patients ), Arrhythmias, hypoglycemia. Quinine toxicity could be confused with cerebral malaria. Halofantrine Should be taken on an empty stomach. Course could be repeated after 1 week. Not to be taken if mefloquine was used Note to be taken in patients with known family history of QTC prolongation. Important points: Can contract it, in spite of taking prophylactic medication, up to 6 months after visiting an area. Inform your doctor. Symptoms : Fever Rigors Headaches Sweating Tiredness Myalgia Abdominal Pain Diarrhoea Loss of appetite Low blood pressure Nausea Slight jaundice Cough Enlarged liver and Spleen
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Skin and our Environment (Dr Dagmar Whittaker)	All that you ever did (or didn't??) want to know about Skin Cancer. The skin has always been the focus of great interest. This is surely not because it is the largest organ of the body or because it acts as a barrier between the inside organs and the environment. More likely this is due to the cosmetic role it plays. Healthy looking skin, hair and nails signal youth and attractiveness that anybody thrives for. But the environmental assaults on the skin are ever increasing especially to us, a nation of “outdoor enthusiasts”. If one would want to isolate one single factor then it is the UV-radiation that we have to worry about. We all know that the UV light comes from the sun, but there is UVA, UVB and now UVC. UVA has got a long wavelength, a relatively low energy and therefor can penetrate deep into the skin. Maybe we remember from those school days, that the skin consists of various layers. The epidermis has three layers. The outermost layer or corneal layer consisting of dead cells which get shed off constantly. Then the squannous layer which makes the bulk of the living cells and the basal or last layer from which rejuvenation takes place. In-between these basal cells are the Melanocytes or Pigment producing cells. The Epidermis has got the thickness of a piece of paper, so the strength of the skin comes from the dermis which begins just under the basal layer. There we find collagen for stability and elastic fibres for elasticity as well as hair, sweat glands, sebaceous or oil glands, blood vessels and nerves. Now back to the UV-radiation: UVA penetrates right through the epidermis and selectively destroys elastic fibres, we all know what that means: aging and wrinkling! UVB has got a much higher energy, which gets absorbed in the epidermis. If it reaches the skin in high enough concentration this impact of energy changes the genetic information of the cell and can turn it into an abnormal or malignant cell. So UVB plays a major role in the development of skin cancer. And then there is UVC. UVC has the highest energy, infact so high that it used to be fully absorbed by the ozone layer in our atmosphere. With the formation of the ozone hole some ten years ago UVC was registered on the surface of the earth for the first time. UVC is so strong that it causes a blistering sunburn in the unprotected skin and as little as three contacts can cause skin cancer. Presently the southern hemisphere in particular Southern Africa, Australia and New Zealand suffer the full effects of the ozone hole during the entire summer months, where people spend a lot of their time outdoors. So what is happening? Sadly there is a world wide increase in the incidence of non melanoma and melanoma skin-cancers, in particular in the southern hemisphere the incidence of a malignant melanoma rose from 1 in 1000 to 1 in 75 in the last 50 years! Now what exactly is skin cancer? What one has to understand is that the skin unfortunately never forgets or forgives: any "overdose" of UV - contact seen i.e. as a sunburn causes some damage and this accumulates over the years. In fact most of the damage to our skin is done in the first 20 years, where the skin (because it is growing) is particuarly sensitive to any energy impact. But once abnormal skincells begin to grow your own immune system takes care of it and destroys them. Only once your immune system slows down abnormal cells begin to escape and grow. This used to happen at an average of + 60 years. But the more severe the damage the more likely it is that this happens earlier. The first visible change would be a red spot followed by a slight scale, which can be removed at the beginning but promptly comes back within a few weeks. This is superficial sun-damage called a solar kerastosis or sunspot and is basically a pre-cancer. Later there will be places like sores or scales where the skin just does not heal. This could then already be either a basal cell carcinoma (starting at the basal layer) or a squamous cell carcinoma (arising from the squamous upper layers). The basal cell carcinoma (BCC) occurs most commonly on the face and in particular - on the nose - because it is in direct relation to the accumulation of sun exposure. It is relatively benign as it almost never spreads to other parts of the body - so therefor it can't kill you. Left untreated however, it grows relentlessly and it may cause major cosmetic problems due to the scarring resulting from the imperative surgical removal - especially taking into consideration that those lesions are firstly most commonly situated on the face and secondly there will often be multiple lesions. The squamous cell carcinoma is more commonly found on the hands, arms legs and chest. Although it grows relatively slowly if left untreated for long enough it can spread via the blood or lymph system, so it is more dangerous than a BCC. Finally there is the Malignant Melanoma or the so-called black skin cancer. It derives from the Malanocytes and if those cells turn malignant they spread in a matter of months rather than years. This is probably the fastest growing and hence the most malignant cancer we know. It can occur anywhere on the body but statistically the most common site is the back in men and the lower legs in woman. It can start from a mole which is changing or just a new black spot. What might look like a freckle today could be a killer tomorrow. Treated early the prognosis is still excellent, left too late it can spread to all vital organs and ultimately cause death. In addition to that, while skin cancer in general occurs from the 5th decade onwards, Malignant Melanomas are most common in the young. And the previously mentioned incidence of 1:75 will probably mean that all of us will know somebody who will die of Malignant Melanoma! But this of course is only one side of the story. It can't and doesn’t mean that we all now have to wait until the cancer catches up with us, nor does it mean that we from now on all have to live indoors or else pack our bags and live somewhere in the Antarctic. Far from it - education is the first step towards prevention and this is where the secret lies: there are golden rules, which we need to follow to adapt to our changing environment: Always wear a high factor sunscreen which is appropriate for your skin type and outdoor activity. Avoid the midday heat between 11 and 3 - rather wear a hat and shirt when outdoors. Protect our children because they are at greatest risk. There is unfortunately some controversy about sunscreens. Are they really as good as they pretend to be? Aren't the chemicals used dangerous in the long run? Are higher factors better than low factors? Just as we are about to succeed to persuade a generation who believes in a "healthy tan" to put on a sunscreen there would be an overseas researcher who warns about these dangers of sunscreens!! Well to that I have got one answer: Firstly there are thousands of researchers doing exhaustive tests which go over years before a sunscreen can be registered - could it take one to prove all those others wrong? Secondly in England it might well be that the overuse of sunscreens is more dangerous than the sun - one can hardly imagine that those two days of sunshine make any difference! Our African sun plus the ozone hole is an altogether totally different story! So is there one good sunscreen that I recommend? Unfortunately not because the requirements are different. We have so called chemical sunscreens where chemicals enter into the skin, absorb the energy and change them to a less damaging one. Those substances can cause problems in the long term if they accumulate in the skin, or they could cause allergies. However, they are cosmetically quite acceptable and relatively "invisible". Then there are the physical sunscreens; i.e. Titaniumdioxide which form like a shield on the outside of the skin and reflect the damaging rays. Naturally these are preferable from a safety aspect but if used in high concentration they become cosmetically quite unacceptable. Also: what is almost as important as the active ingredient is the base in which it is dissolved. Does one need a waterproof sunscreen i.e. for all those kids who are in and out of the pool or all those surfers, or does one need an oilfree base for problem teenage skin, does one need a cream which doesn't runinto the eyes for all the cyclists and runners who sweat a lot - whatever it takes it is somewhere out there - so there is not one sunscreen for all. Now do we actually know what SPF stands for? Sun protection factor is a time factor and revolves around the “Safe Sun Time”. This is area specific and means the duration that you can stay in the sun unprotected without damaging your skin. Now in Cape Town – or southern Africa for that matter - this SST is a mere 10min……With a SPF of say 20 you can now stay in the sun 20 times longer i.e. 200min (just over 3 hrs…) And just to worsen matters: as we come to terms with those definitions there is the latest research showing that UVA exposure is not as harmless as we thought either….. in fact you need UVA to make the skin more sensitive towards the UVB damage….. So shortly we will have 2 numbers on our sunscreen bottles: the SPF as a indicator for UVB and in addition to that a UVA factor. So whats the bottomline in all this confusion?? Quite frankly : The higher the better is the message! Discard those factors 5 and 10 and go for a minimum of a SPF of 30 and a UVA filter as high as possible (standards are only developed in the following year) It doesn't help to be ignorant and say "I have never burnt before" - rest assured that this has changed and you will burn if you go into the sun unprotected. And one last word to all those men out there who still refuse to use creams - just because it feels sticky or there is this problem with the hairy skin. Even for those special circumstances we have totally oilfree spray on sunscreens with a high factor - so no more excuses please! So what is the message: Yes our environment has changed and the sun is more dangerous and all of us have probably got quite a high chance to get one form of skin cancer. But that's not the end of the world. First we must change our attitude and start using daily sunscreens as a matter of routine - the same way we brush our teeth or wash our face without questioning it! Prevention is better than cure! Secondly if any "spots" start coming out then go for a skin check. Everybody should probably have a checkup every 1-2 years after the age of 30 - 35 of age . And finally:if you have got lots of moles have your risk properly assessed. Early detection of a Malignant Melanoma is of utmost importance. To find out whether your moles are dangerous or not takes a Dermatologist one look and one dermatoscopic examination (A " dermatoscop" is an instrument to magnify a skinlesion by a factor of + 12). Definitely it is not necessary to remove all moles. Even irregular moles - and some people have got hundreds of them - can nowadays be photographed with a digital camera and stored on a computer. Firstly to be analysed and secondly the image can be stored to be compared at a follow up visit. (Molemapping) So - the environment changes but so does our technology - We have got fantastic sunscreens to protect our skin, we have got sophisticated diagnostic tools to help recognise skin cancer early and early skin cancer is very easily treatable - so we don't have to move to the Artic quite yet! And on that note:enjoy the fun in the sun - but be sunwise and protect yourself!
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