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TRAVEL HEALTH

 

Because we travel extensively in the developing world, we've read a lot about travel health, talked with medical friends and visit a travel doctor before leaving on a trip. Here's what we've learned - some of it the hard way.

NOTE: WE'RE NOT MEDICALLY TRAINED, SO CHECK OUT THIS INFORMATION WITH A PHYSICIAN - PREFERABLY ONE TRAINED IN TRAVEL MEDICINE.

You'll want to tailor the information to fit your own needs. For example, if you're visiting Western Europe you won't need anti-malarial medications, syringes or other exotic medical aids. You probably won't need many (if any) shots. For extended trips through Third World countries, give priority to immunizations, clean food and water, and anti-malarial precautions.

IMMUNIZATIONS

Several weeks before leaving on a foreign trip, we visit a doctor who specializes in travel medicine. It's important not to put this off until the last minute, as some immunizations require a series of shots. (For our ten-month journey through remote areas of Southeast and Central Asia in 2000, we had a total of 12 shots - including: tetanus, polio, hepatitis A, rabies, typhoid, meningitis, diphtheria and Japanese encephalitis. Another year, we had some booster shots and added a yellow fever inoculation for South America. There have been no adverse effects to these immunizations.

TRAVELERS' TUMMY

Travel = Travelers' Tummy to many people. However, we've found that it's possible to travel for many months in developing countries with few or no intestinal problems. To defend our stomachs against travelers’ tummy, we don’t use ice, drink or brush our teeth in tap water in Second or Third World countries. For a short trip (under a month), we buy bottled water - making sure it is properly sealed. For longer trips, we carry a water filter to avoid leaving a pile of un-recycled plastic behind us; we add a viral solution for particularly suspect water.

Street vendors’ food is usually a no-no (it often sits all day without refrigeration), as is ice cream (it may have melted and been re-frozen.) In the early weeks of travel in developing countries, we avoid fresh salads unless we know that the restaurant washes the veggies in treated water. Until our stomachs have adjusted to new bacteria, we eat only well-cooked food and fruit we can peel. Slowly, we add local dishes - eating in busy restaurants where the food hasn’t been sitting around for long periods. We did eat at the Peruvian market shown below, because we'd been in Peru for several weeks at this point (i.e., we were used to the local bacteria) and the food was freshly-barbecued beef and potatoes. We had no ill effects.

 

 

(Having said all this about developing countries, we should say that the worst case of traveler's tummy we ever had was in 1965 in England!)

BASIC MEDICAL KIT

These are the medical supplies we take on long trips, along with the directions we use. Brand names are in quotation marks; generic names are in parentheses.

PRESCRIPTION MEDICATIONS: Take enough prescription medications to last the trip. If necessary, these can be puchased without a prescription in many developing countries; to minimize the chance of counterfeit or inert drugs, use the best pharmacy available and check expiration dates.

VITAMINS: A travel diet may not be sufficiently balanced; take a multi-vitamin tablet at least every other day.

SKIN:  Sunscreen SPF 30 - for an explanation of how sun-blocks work and to order excellent sun-block products:  www.chinookmed.com/detail.php?product_id=000783&limit_start=0   Use mosquito repellant with at least 25-30% DEET - for an explanation of how repellants work and to order excellent controlled release and broad spectrum repellants: http://www.chinookmed.com/detail.php?product_id=000739&limit_start=0

Also: long-sleeved shirts for sun and bug protection; lip balm SPF 30; antihistamine (can cause drowsiness) for itchy skin due to insect bites, rashes, hives, allergies; anti-fungal cream for athlete's foot; baby wipes to prevent diaper rash; 1% hydrocortisone ointment to control itching

PAIN:  "Extra-strength Tylenol" (acetaminophen) 2 tablets of 500 mg (max 4000 mg/day); also good for reducing fever

STRONGER PAIN: "Tylenol #3" (acetaminophen with codeine) 30 mg 1 tablet every 3 hours (or) "Vicodin" 500 mg 2x/day

INFLAMMATION:  "Advil" or "Motrin" (ibuprofen) 400 to 600 mg for mild pain - every 6 hrs with food; for more significant pain, especially with signs of inflammation, use 600-800 mgs. If used several days, can elevate blood pressure.

NAUSEA, UPSET STOMACH:  "Maxaran" (metoclopromide)* 10 mg every 6 hours; peppermint and crystallized ginger are good for mild nausea

DIARRHEA: This is nature's way of expelling unwanted bacteria. The best prevention of diarrhea while traveling is to drink boiled, filtered or bottled water, eat only cooked or peeled fruit and vegetables, and wash hands well before eating. Mild diarrhea should be treated with rest, lots of water. Eat bland foods such as rice, bananas, weak tea. Avoid using anti-diarrheal medications, which can lead to constipation and make you feel sick longer because the bacteria remains in your body.) But if you need to travel that day, take "Immodium" (loperamide) 2 mg - one tablet is often enough to stop diarrhea.

SEVERE DIARRHEA   Ciprofloxacin (fluoroquinolone) 500 mg.  2 tablets morning and evening for three days. Take 2 hours before or 6 hours after taking magnesium, aluminum or calcium, which prevent full absorption.  Severe diarrhea can lead to dangerous dehydration. "Gastrolyte" (re-hydration salts) re-hydrate faster than plain water. Homemade re-hydration solution: 1 liter of boiled or bottled water plus 6 tsp. sugar or honey and 1/2 tsp. table salt. (For better taste, use this formula: 1 liter of water, 3/4 cup orange juice, 2 Tbl. sugar; and 1/2 tsp. salt.)  If diarrhea persists, see a doctor.

SEVERE VOMITING:  Like diarrhea, vomiting is nature's way of expelling unwanted bacteria. However, extreme vomiting can lead to dehydration. Anti-emetic suppository: "Compazine" (prochlorprazine) 25 mg 

URI (UPPER RESPIRATORY INFECTION - COMMON COLD):  "Sudafed, etc." (pseudophedrine) 30 mg (if used for several days, beware of urinary blockage); an antihistamine can also be used as a mild sedative; cough drops (if persistent coughing prevents sleep, take one tablet of "Tylenol #3"; a digital thermometer (fever is a temperature of over 101 degrees for three or more days. If 103 degrees or above, see doctor immediately.)

ANTIBIOTICS:  (Always complete the full course of antibiotics)  1. Chest, skin, sinus infections: "Zithromax" (azithromycin) 250 mg. Full course is 6 tablets: 2 tablets 1st day; 1 each for remaining 4 days;  2. Colon infection - amoebic: (blood in stools): "Flagyl" (metronidazole) One dose is often enough. More than one occurrence of blood in stools, seek medical help immediately; 3. Colon infection - bacterial: use Ciprofloxacin (see above)

MOTION SICKNESS:  Dramamine" (dimenhydrinate) 50 mg tablets (or) "Transderm Scop" (scopamine) behind-the-ear patches. Sold by prescription only in the U.S., patches are good for three days; apply four hours before needed & wash hands well afterward. (Try a patch before leaving on trip; some people experience side effects.) For mild nausea, crystallized ginger or peppermint candy may be helpful.

HIGH ALTITUDE SICKNESS  "Diamox" (acetazolamide)  If you are travelling above 8,000 feet, get educated on high altitude sickness (also called acute mountain sickness - AMS); it can be a killer.

CUTS AND WOUNDS:  Thoroughly clean cuts with soap and water - cuts and scratches can be serious in the tropic; apply "Betadine" or other NON-ointment anti-bacterial. Ointments (esp. in hot and humid areas) can prevent wounds from healing and lead to infections. Lightly cover wounds, and keep clean and dry. Carry "Band-Aids" (or generic) in several sizes. A new second-skin Band-Aid called "Advanced Healing" is expensive, but breathes, speeds healing. Good for blisters.  (Some hikers use "Moleskin" to protect feet from blisters, but it tends to pull Joan's skin off)

SPRAINS:  4-5" roll of elastic or cloth tape to wrap and support sprained area. Re-wrap at least twice a day. For strains & sprains, the key is "RICE": Rest, Ice, Compression, and Elevation.

SYRINGES:  If you are in a remote area and need a syringe, you'll want one that is unused. You need a prescription to buy them; take a copy of the prescription with you to avoid border hassles. (If possible, avoid getting a blood transfusion in a developing country; instead, try to get air-lifted to a First World or Westernized country. You might want to buy evacuation insurance for remote or dangerous areas.)

MISCELLANEOUS:  small scissors, nail clippers, nail file, tweezers and lots of Zip-lock baggies. Although this practice is discouraged by some, to save weight and bulk we take medications out of original packaging and put them into baggies - carefully labeling each (with a permanent marking pen) with the generic name, strength, dosage and expiration date.

WATER PURIFICATION 

Clean water is critical to health. When in doubt, drink well-sealed bottled water. However, this results in lots of plastic refuse that isn't recycled in developing countries. "Puritabs" (chlorine tablets) provide basic protection. "Aqua Plus" iodine tablets provide more, but could affect the liver if used for longer than a month. Best choice in developing countries is a lightweight water filter.  Level 1 filters protect against both bacteria and viruses and are especially good when backpacking or in very polluted areas. Levels 2 and 3 are probably enough for most travel needs. We carry a $52. Sweet Water model (Levels 2 & 3), plus Viral Stop (this brings our filter to Level 1) for extreme situations. Below Joan is using a Platypus water bottle, which folds flat for packing. All are available at: www.rei.com

 

 

MALARIA PRECAUTIONS 

Malaria can be deadly. Because it continually mutates to become resistant to anti-malarial medications, check with a travel doctor for the most effective anti-malarial for the particular area you plan to visit. Anti-malarials won't prevent malaria, but will lessen its effects if you get it (i.e., you won't die).

The main prevention is do everything you can to avoid mosquito bites. In malarial areas, use mosquito repellent containing DEET (N,N-diethyl-3-methylbenzamide.) Research reported in the New England Journal of Medicine - one of America's top medical journals - shows that only DEET is effective enough to use in malarial areas. Do NOT rely on "Skin So Soft" by Avon, garlic, B-12 or homeopathic remedies!

Wear pants and long-sleeved shirts; spray or soak clothing & netting in advance with permethrin; and sleep under the netting. Permethrin is an insecticide that kills mosquitoes, ticks, etc. on contact; it is often unavailable outside the U.S. Permethrin and top quality repellants (controlled release DEET and broad spectrum spray that kills mosquitoes, ticks and sand-flies) are available through:  www.chinookmed.com  If you don't want to treat your clothing yourself, buy Buzz Off! clothing that already has been treated with permethrin:  www.exofficio.com

In the photo below, we're in a schoolhouse deep in the jungles of Irian Jaya - one of the worst malarial areas on earth. We are wearing DEET repellant, permethrin-treated slacks and long-sleeved shirts and have permethrin-soaked mosquito netting ready to drop over our "beds" (beach mats on the floor.) Once inside the netting, we didn't leave it during the night because malarial mosquitoes are most active at dusk and dawn. The following information gets personal, but we're strongly committed to helping others avoid malaria. Being old geezers, we had to figure out how to pee during the night without getting out from under the netting. Lou used a wide-mouth plastic Platypus bottle (slightly embarrassed when buying it, he told the female clerk he needed a bottle with a mouth big enough to put ice cubes in; who knows what she thought of someone taking ice cubes on a backpacking trip!) Joan had a Freshette - a feminine urinary device created by female pilots during World War II that allowed her to use a bottle. Available from: www.campmor.com  We made a lot of commotion using the bottles at 3 a.m. - but got NO mosquito bites during three weeks in Irian Jaya - or during later trips through the hills of northern Thailand and the Amazonian jungles of South America.

 

 

PRESCRIPTION ANTI-MALARIALS:  Be sure to get the right anti-malarial for the region you're visiting. Get it before leaving home as it may not be available in remote areas, may be counterfeit, or past its expiration date. Three of the most widely-used anti-malarial medications are: 1. (doxycycline) 100 mg once a day. Begin one day in advance. Must be taken daily and for four weeks after leaving a malarial zone. (Note: women taking "doxy" are prone to urinary tract infections. Take suppositories and anti-fungal cream to treat.)  2. "Larium" (mefloquine) One tablet taken once a week. We remembered by saying "Mondays for malaria!" Begin Larium TWO WEEKS in advance. If side effects occur (excessive dizziness, depression, nightmares), switch to another anti-malarial. Take for four weeks after leaving a malarial zone. 3. "Malarone" (atovaquone and proguanil hydrochloride) is the newest and most expensive of the three. We have used the first two without problems, but haven't tried Malarone.

(Take a digital thermometer into malarial zones to help in diagnosing malaria. If you will be trekking through jungles or away from reliable medical centers, consider taking a malarial test kit. If you test positive for malaria, get medical help fast. )

BACK AT HOME:  If you feel ill for some time after returning home from a trip to a remote area: 1) get checked for malaria or other diseases; 2) get a stool and blood check-up for parasites.

***

Yes, this is a long list of medical supplies and health precautions, but you probably won't need most of them and the fun and excitement of travel are definitely worth it!

 

DETAILS, DETAILS, DETAILS

LOW-RISK AREAS

For those who’d like to travel beyond mainstream Western Europe while avoiding areas with major health risks, we suggest the following are good choices (as of early 2005 when this was written) in no particular order: Portugal, Hungary, Czech Republic, Greece, New Zealand, Australia, Galapagos Islands, Argentina, Chile, Antarctica.

BOOKS 

Guide to Healthy Travel written by travel specialist Elaine Jong, M.D. & published by Eagle Creek ($5); Lonely Planet's Healthy Travel series (India & Asia; Latin America; Africa); Comprehensive Guide to Wilderness & Travel Medicine by Eric Weiss, M.D.; How to Shit in the Woods by Kathleen Meyer. (We're checking to see if you've read this far!)

HEALTH CARE ABROAD

The U.S. Center for Disease Control provides travelers’ health information, list of inoculations needed:  www.cdc.gov/travel/

International Association for Medical Assistance to Travelers (IAMAT) lists qualified, English-speaking doctors and clinics throughout the world; also lists malarial areas. Membership is free, but a donation is appreciated:  www.iamat.org

International Society of Travel Medicine:  List of travel clinics in foreign countries   www.istm.org/

Bangkok travel medicine clinic: Travmin TMVC is located a block from Skytrain's Chitlom Station, in the Alma Link Building, 25 Soi Chidlom, Bangkok. Phone: (662) 655-1024. FAX: (662) 655-1026. Bangkok hospital:  Bumrungrad Hospital is a top-level private hospital that even has a Starbucks! English-speaking staff, quick service, reasonable fees.  33 Sukhumvit 3 (Soi Nana)   Emergency: (662) 667-2999   www.bumrungrad.com

MEDICAL SUPPLIES 

Chinook Medical Gear sells medical kits, water treatment tablets and filters, all-spectrum insect repellent, controlled release mosquito repellent, permethrin spray or liquid, permethrin-soaked mosquito netting, high altitude and marine medical supplies and survival gear. Note that permethrin soaking lasts six weeks or six washings, while spray lasts two weeks or two washings. (To increase longevity, use the soak method, let dry and soak again. Each separate soaking will provide six more weeks of longevity.)   www.chinookmed.com  

INSURANCE  

Check with your medical insurance before leaving home to be sure you are covered abroad and to obtain its list of approved foreign health providers. (Note that Medicare is not valid in foreign countries.) For travel in remote areas, consider buying evacuation insurance that will pay for being flown to the nearest good medical clinic or even all the way home.

 

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Joan and Lou Rose     joanandlou@ramblingroses.net