Here at the University of Maryland Travel Clinic in College Park, we see many faculty, staff and students who are traveling around the world, either as part of their research and study programs, or just backpacking for enjoyment. People are increasingly traveling into developing countries, where conditions can be unfamiliar to most Americans.
This information was put together to assist travelers in avoiding some of the pitfalls so they can have a healthy, enjoyable experience. However, after reading all this you may wonder if you really want to go! Please do! Traveling is a great experience and not to be missed. It's also more fun without diarrhea, sunburn, malaria, etc.
Our clinic is open to all university students, faculty and staff. There are charges for immunizations. The total cost will depend on what an individual needs. Please schedule appointments 4-6 weeks in advance of your trip if possible. For people going on longer, more involved trips, 8-12 weeks in advance is advisable. Please bring records of prior immunizations with you to your appointment if possible.
Guide to the Adventurous Traveller
BUT I HAVE TO EAT!
Food and water are two of the most important considerations while traveling. The problem is that most water and much of the food is contaminated with various parasites, bacteria, and viruses. What to do!
Avoid raw, uncooked foods-salads, salsa, fruit, raw shellfish, dairy products, and foods off the vendor stands. Eat only foods that are hot and cooked, dry foods like bread or food you can peel like bananas, oranges, etc. Do not drink the water; instead drink sodas, bottled water (particularly carbonated), (make sure bottle is uncapped in front of you and drink it with a straw), hot tea, coffee, beer, wine. Get your bottled water from a reliable source since ambitious entrepreneurs now have recapping devices so they can fill a bottle with tap water and reseal it to look like new. Also, avoid ice cubes and use bottled water to brush your teeth or dentures. Use only your own cleaning solutions to clean contact lenses.
It is possible to purify water. You can boil it for 3 minutes at a rolling boil or add iodine based purification tablets (Potable Aqua or Polar Pure). Also, in combination with tablets you can filter the water. The filter used with tablets gives you excellent protection. There are also new filters that have an iodine resin filter. With these filters you do not need to do anything else to the water. Various filters are available at the Health Center Travel Clinic, REI, Sports Authority, or Hudson Trail Outfitters. Also, you can boil water with an immersion coil provided you have an electric outlet (you may need an electrical converter in many countries).
Sometimes you will hear people discuss taking prophylactic antibiotics (Doxycline, Bactrim, Cipro, or Noroxin) to prevent traveler's diarrhea. This is generally not recommended because of possible development of resistant bacteria, increased sensitivity to the sun (you could get a horrible sunburn), intestinal side effects, allergies, or vaginal yeast infections in women. It is better to be meticulous with the food and water, and wash your hands. You can take along some Pepto Bismol or Immodium AD for relief of diarrhea if needed. It is important to replace fluids lost through diarrhea. Oral rehydration salts (ORT) are good for this. You mix the salts with one quart of clean water. ORT salts are available at the University Health Center Travel Clinic or pharmacy. However, if you should develop bloody diarrhea and fever, don't take anything except fluids and see a doctor. Some people, if they are going to be traveling off the beaten path, get a prescription for Bactrim DS or Cipro to take twice a day, for 3 days, which will help severe diarrhea.
Do not think that because you have received all your immunizations that you are fully protected against diseases transmitted by contaminated food and water. There are many infections for which there are no vaccines available at present. So it is important to follow these guidelines. back to top
THOSE GOLDEN DAYS
Sun can be a killer. Most people tend to travel in hot, humid, tropical, or dry desert climates, and have a tendency to underestimate the power of the sun, subsequent dehydration and sun stroke.
Do wear a hat! Wear sunscreen. Most importantly-drink a lot of safe liquids like bottled or boiled water. Don't wait until you get thirsty; by that time you are already dehydrated. back to top
SHOTS!
Yes, indeed! Start 8 to 12 weeks ahead of time depending on your itinerary. Everyone should have had a diphtheria tetanus booster in the last ten years and two doses of measles vaccine. Polio vaccine (injectable or oral) is recommended for people traveling in areas outside of the western hemisphere, western Europe, Australia, New Zealand, and Japan. Travelers to any third world country-this includes the former Soviet States and eastern block countries-should get a typhoid vaccine (injectable or oral) and hepatitis A vaccine. Travelers to Greece should also get a hepatitis A vaccine. For some individuals, flu vaccine and pneumovax (against pneumococcal pneumonia) are also helpful.
Other vaccines depend on your itinerary. Yellow fever is present in Africa and South America, and will be needed for travel there. Meningococcal meningitis is a problem in large parts of Africa, Nepal and parts of India; a vaccine is available. Japanese encephalitis is present throughout most of Asia and anyone going on a prolonged trip (over 3 weeks in rural areas) is advised to get vaccinated (this is a series of three shots over a one month period). Cholera is a problem in most developing countries and although the vaccine is not the most effective, it is helpful for some people with specific health problems and is often required for political reasons at border crossings. Hopefully a new oral vaccine against cholera will be available in the not too distant future.
People who are doing field research or staying in a country for many months, are advised to get hepatitis B vaccine and rabies vaccine (to help protect against animal bites). Both of these vaccines are a series of three shots. In rare instances, plague vaccine may also be needed.
Remember, it's better to get your injections here; once overseas, needles may not be clean. Also, keep your immunization records with you. back to top
BUGS! YUCK!
Mosquitoes and other insects carry a variety of diseases like malaria, dengue fever, Japanese encephalitis, Chagas disease, sleeping sickness, etc. So, it's important to avoid them. Take mosquito repellent with you and use it. The active ingredient in repellents is DEET. You do not need a 100% concentration to be effective; 30% is just fine. There are a few non DEET repellents now. Mosi-guard Natural is available overseas. Another new non DEET product is Bite Blocker which is available in the US. It is also possible now to get a combination repellent and sun block. It is marketed by Repel, Avon, and several other companies. A good mosquito repellent for children is Skedaddle which you can get in a drug store. You might need repeat applications. Don't wear perfume, after-shaves, etc. Wear light colored clothing with long sleeves and long pants, particularly in the evening. Avon Skin-So-Soft is particularly good for those no-see-ums. Get permethrin sprays (permanone) to spray on clothes, beds, walls, windows, and mosquito nets. Lighting mosquito coils also helps ward off insects. Sleep in screened rooms or under mosquito nets (if you use a mosquito net, drop it and tuck around the bed, so when you get ready to sleep, you won't have mosquitoes inside the net). For travelers to South America who will be staying in rustic accommodations, it is very important to use mosquito nets at night to prevent Chagas disease. It is possible to buy a portable mosquito net called La Mosquette for $75.00 plus shipping and handling (weight 5 lbs., fits single or double beds) from IAMAT, 417 Center St., Lewiston, NY 14092, telephone number 716-754-4883. Another source for mosquito nets is Travel Medicine, Inc., 351 Pleasant St., Suite 312, Northhampton, MA 01060, telephone number 800-872-8633. Also check camping stores like Sports Authority, REI, etc.
Almost everyone has heard about malaria pills. (there are actually several) The main one has always been chloroquine, taken once a week. In some parts of the world, particularly in Central America, the Middle East, and some parts of China, this is still effective. However, much of the malaria in the world has become increasingly resistant to chloroquine and also to fansidar, which was a mainstay back-up drug for a while. Now the recommendations are to use a new drug, mefloquine (Lariam). If that's not possible, use daily doxycline (a derivative of tetracycline). Hopefully there will be a new anti-malarial drug on the market in the not too distant future. Like all medications, there can be side effects and reasons why someone should or should not take a particular medicine; i.e., allergies, pregnancy, other medications a person is on, some chronic health condition. Discuss this clearly with your doctor. Remember-it is important to continue these medications after you return home for a period of four weeks. back to top
WHAT YOU CAN'T SEE
Schistosomiasis is a disease caused by a parasite that lives in tiny snails in fresh water streams and lakes throughout much of Africa, South America, Asia, the Caribbean and the Middle East -the whole Nile River is infected for instance. The problem is that when you come in contact with the water, the parasite enters through your skin and can cause severe problems in the lungs, liver, intestines, bladder and so on. This tends to be a chronic disease, and although there is a reasonably good treatment, it's best to avoid it in the first place. Don't go swimming or wading in any fresh water streams or lakes (sea water is okay). If you have to deal with such water, wear boots, gloves, etc. If you need to use the water for bathing or cooking, either boil it or chemically treat it first. Should you happen to come in contact with the water by accident, vigorously rub your skin with a towel as soon as you get out and if you have rubbing alcohol, apply it to your skin. It will reduce the risk of infection considerably. back to top
OH - MY ACHING FEET
As for shoes, take comfortable broken-in walking shoes (and wear them). Do not go barefoot. Many worms, leeches, parasites, and bacteria live in the soil. You can pick them up by walking barefoot. Also, take some sandals or sneakers that you don't mind getting wet so you can wear them walking on the beaches. Many beaches, particularly in Asia and South Pacific, have problems with jelly fish, stinging coral, poisonous rock fish, sea nettles, etc., on the shore; getting stung by them is an exceedingly unpleasant and painful experience. back to top
AH, SWEET LOVE!
Romance is just not what it used to be. In fact, it can be down right dangerous to your health these days. Herpes, Chlamydia, Hepatitis B, AIDS, drug resistant gonorrhea, etc., exist in every country. If you're going to have sex, you should use condoms every time-or don't have sex. Don't even think of having sex with prostitutes; the rate of HIV infection in that group is astronomical! back to top
DOGS, CATS, ETC.
Because animals are not normally kept as pets in developing countries, they are usually running around wild and are not vaccinated against rabies. So, do not pet or play with the animals. If you get bitten, you're in for a lot of shots. Individuals who are going to be living in these areas for long periods of time, would be well advised to get pre-rabies exposure vaccinations (a series of three). Also if you do get bitten, wash the wound with soap and water-it will markedly reduce your risk of infection. back to top
HIGH ALTITUDES
Traveling in mountain areas is becoming quite popular. Ideally, you should ascend to high altitudes slowly and acclimate to the height first. However, many people will fly into mountainous areas and start trekking or skiing immediately. People can develop acute mountain sickness, resulting in headache, nausea, vomiting, insomnia, fatigue, and increased respiration and heart rate. These symptoms will usually go away with rest, lots of fluids (not alcohol), and a high carbohydrate diet. Diamox is a medication that can be useful in treating these symptoms, and can, in fact, be helpful in their prevention if started 2-3 days before going to higher altitudes.
If the situation gets worse, people can also get fluid in their lungs or swelling in the brain. The best treatment is to get to a lower altitude as quickly as possible. back to top
BELIEVE IT OR NOT!
The most common health problem while traveling is not malaria, etc-it's accidents! Accidents involving motor vehicles are the most frequent, followed by water sports, climbing, and assaults. So please, wear your seat belts and helmets, and watch where you're going and what you're doing. back to top
WHEN IN DOUBT, ASK!
When you are going into a remote area, ask the locals about any problems- snakes, scorpions, sharks , water conditions, etc. It's better to be forewarned. back to top
HEALTH CARE ABROAD
Hopefully you won't need any. However, make sure your health insurance will cover you overseas and carry your card with you. You may want to purchase some additional travel insurance which will cover medical evacuation to the U.S. if needed. Remember to read all insurance contracts carefully so you are aware and clear about what the policy covers and does not cover. Some plans are:
Health Care Abroad
107 W. Federal St., PO Box 480
Middleburg, VA 20118
540-687-3166 or 800-237-6615
International SOS Assistance
8 Neshaminy Interplex, Suite 207
Trevose, PA 19053
800-523-8930
Travel Med
1765 Business Center Dr., Suite 100
Reston, VA 20190
800-732-5309
Travel Assistance International
1133 15th St., NW, Suite 400
Washington, DC 20009
800-821-2828 or 202-828-5894
If you do get sick, a good source of help is the American Embassy or British Embassy. Also,well before you leave, contact the International Association For Medical Assistance to Travelers (IAMAT), 417 Center St., Lewiston, NY 10492 ( 716-754-4883). They can give you a list of English speaking doctors all over the world and where to go for emergencies. Another possible resource to contact before you leave is Access America, 6000 Broad St., Box 11188, Richmond, VA 23230 (806-955-4002) which has a 24-hour hot line for subscribers.
If possible, avoid getting injections overseas in developing countries. Sometimes you can get clean, disposable needless and sometimes you can't. There is a considerable risk of AIDS, hepatitis B, etc. People who are traveling extensively may want to take a kit of syringes and needles with them. Sources of first aid kits with syringes and needles are:
Travel Medicine, Inc., 351 Pleasant St., Suite 312, Northhampton, MA 01060, Chinook Medical Gear, Inc.: 120 Rock Point Drive, Unit C, Durango, CO 81301, phone: 970.375.1241 or 800.766.1365 (toll-free), fax: 970.375.6343 www.chinookmed.com email: admin@chinookmed.com; the Travel Clinic here at the University Health Center; or ask your own physician. back to top
SPECIAL PROBLEMS
If you are pregnant, have any heart, lung or intestinal problems, are diabetic, have epilepsy or have any condition that affects your immune system, make sure you discuss this with your doctor and travel clinic ahead of time. You may need to make some special provisions before you travel. And remember, always wear your medic alert bracelet. back to top
WHAT TO TAKE WITH YOU
If you wear glasses or contact lenses, consider bringing an extra pair, and bring all contact lens solutions. Bring all prescription medicines with you in original labeled containers and have copies of your prescriptions. Useful items to take are: sunscreen, mosquito repellent, Advil or Tylenol, cold tablets, cortisone cream, anti-fungal cream like lotrimin for tropics, antihistamine for allergies, Pepto Bismol or Imodium AD for diarrhea.
Other useful items to consider are: Q tips, band-aids, safety pins, and a Swiss army knife if you have one. Everyday products that you can get easily in any drug store here may not be available abroad particularly in former Soviet states, China and many parts of Africa. So, take those items with you-particularly things like tampons, disposable diapers, etc. If appropriate for your trip, remember to pack malaria tablets, water purification tablets, diamox for mountain sickness, motion sickness tablets, or special Trans Derm Scop ear patches, and antibiotics. Also, remember medical kits with sterile needles if you need them. back to top
WHEN IN ROME...
One of the most important and rewarding parts of travel is meeting new people and learning about new cultures. It helps to be sensitive to the ways of the culture you're going to be in. Certainly reading ahead of time will help. Insight guide books and Lonely Planets Press guide books are two of the best for cultures outside of Europe. Be aware of dress codes. In many cultures, particularly Islamic countries, dress is very modest for both men and women. Shorts, tank tops, bare shoulders and tight clothes would be considered offensive. Women traveling alone or with other women in Africa and the Middle East, in particular, should be well advised to use discretion and discrimination. American friendliness, bright smiles, and openness are often misunderstood. In many of these countries, there is separation of sexes on a daily basis, and local women would not be expected to have male friends or converse with unknown men.
The political situations in developing countries often change by the week. If you are going into any problematic area, check with your travel clinic on the situation or call the State Dept. Overseas Travel Advisories number (202) 647-5225, to get the latest information.
Everybody travels with a camera. In some countries it is not allowed to photograph any military facility. This often includes the airport, bridges, rail stations, military personnel, and industrial sites. Check first before you click the camera.
Do not agree to carry any letters, packages, radios, etc. for people or drive vehicles across borders. Such is the state of the world today, that unsuspecting travelers are often used to take drugs, bombs, or other contraband on airplanes or across borders. Also, do not use or deal drugs. If you're caught, the penalties are severe including prison or death. When traveling, do not leave your luggage unattended-not only because of theft but also because again explosive devices can be planted in them.
Take a money belt with you to carry your passport, travelers checks, credit cards, etc. Avoid wearing lots of jewelry, purses on long straps, etc. back to top
HOME AGAIN
If you're home, and you develop any problem-fever, diarrhea, rash, etc., remember to tell the doctor you've been traveling and where.
While it's important to keep these warnings and do's and don'ts in mind, do remember to have fun and enjoy. You'll have a great time.
Bon Voyage and good health!
