Kokoda Trail
The
Kokoda Trail has gained increasing popularity for Australian travelers
over the last decade. Traversing the Owen Stanley Range in the
Southern Highlands of Papua New Guinea, the Kokoda Trail was the site
of a heroic rearguard action of Australian soldiers against the
invading Japanese army in 1942. The physical challenge and the
tangible history of the trail attract more and more trekkers of all
ages each year, particularly from Australia. Walking the track
typically consists of hiking up to 10 hours a day with a backpack
weighing up to 20kg for 7 to 10 days.
The remote jungle location of the trek means that transport to medical care can be slow and difficult. Careful preparation is vital to ensure the wellbeing of each trekker on the Trail.
Preparation
Physicial Fitness
Trekking the Kokoda Trail is physically demanding. The 96km track is a narrow, uneven, muddy path with numerous steep inclines and declines.
Training is essential. Any training programme should consist of aerobic exercise, strength building and hiking up and down hills with a backpack.
We recommend that all trekkers over the age of 40 have an exercise stress test pior to commencement of training. Those with risk factors such as obesity, smoking, diabetes, high blood pressure, high cholesterol or strong family history of cardiac disease should consider an exercise stress test even if under the age of 40. Trekkers with known cardiac disease should have a stress echocardiogram or myocardial perfusion study prior to commencement of training.
Immunisations
Current recommendations are for immunisation against
- Typhoid
- Hepatitis A
A combination Typhoid/Hepatitis A vaccine (Vivaxim) is available. This should be given at least 14 days (preferably one month) prior to risk of exposure.
We also recommend ensuring Hepatitis B and Tetanus immunisations are current.
Malaria prophylaxis
There are three medications available for malaria prophylaxis
Doxycycline. One tablet each day for one week prior to departure until four weeks after returning home. The most common side effects are heartburn/reflux and exaggerated sunburn response. Be sure to apply adequate sunscreen if using doxycycline. This medication is also an antibiotic and theoretically provides protection against wound infections and possibly even against diarrhoeal illness (although the diarrhoea bacteria are mostly resistant).
Mefloquine (Lariam). One tablet each week starting 1 - 2 weeks prior to departure until four weeks after returning home. Mefloquine's main advantage is its once-weekly dosing. Side effects include nightmares, insomnia and nausea. It can rarely lead to psychiatric disturbances and seizures. Trekkers taking beta-blocking cardiac medication, those allergic to quinine or with a history of seizures should not use mefloquine.
Atovaquone/proguanil (Malarone). Malarone is a newer combination tablet taken once daily for two days prior to departure until one week after returning home. Malarone can occasionally cause nausea, vomiting, diarrhoea, abdominal pain and headaches, although side effects are usually mild.
The most effective method of malaria prevention is to avoid mosquito bites. Liberal use of insect repellant and tents with mosquito netting are essential.
Personal medical kit
Malaria prophylaxis
Ibuprofen or similar anti-inflammatories
Antibiotics – We recommend cephalexin (for wound infections, urinary tract infections) and ciprofloxacin (for diarrhoea)
Antihistamine – for allergies, insect bites/stings
Antifungal ointment or powder
Bepanthen or similar barrier ointment
Mosquito repellent
Sunscreen
Disinfectant gel for handwashing
Waterproof elastoplast – two rolls
Strapping tape – two rolls
Blister dressings – prevention and treatment
Band-Aids (waterproof)
Pocketknife – with scissors, tweezers, etc
Sports drink powder – useful for masking taste of purified water.
On the trail
Diarrhoea
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.
Patellofemoral syndrome
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.
Injuries
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.
Fluids
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.
Afterwards
Fevers
Some illness may present after returning home.
- Malaria. The usual incubation period is 7 - 30 days, but this can be delayed by months if the trekker has taken antimalarial tablets for prophylaxis. The symptoms of malaria are fevers, chills, headaches, vomiting and generalised aches and pains. Trekkers should seek medical attention if any of these symptoms develop in the 12 months subsequent to returning home.
- Dengue Fever. Another mosquito-borne illness with an incubation of 3 - 14 days, most often less than 7 days. It is characterised by fever, joint pains, headache and rash. A small proportion of people progress to the more serious form of the illness, Dengue Haemorrhagic Fever.
- Typhoid Fever. Typical incubation is 5 - 21 days. Presents with fever, nausea, abdominal discomfort, diarrhoea (or constipation). The disease may still occur in those who have been immunised.
All the possible rare illnesses are too numerous to mention here. Remember to inform your doctor about your recent travel to Papua New Guinea if you become unwell after the trip.
