Top five things to look for in a travel doctor, and why you should have one

travel doctorsDespite writing about food and adventure travel for a living, I used to be somewhat blasé about the concept of travel medicine. Multiple incidents of Giardia/dysentery/traveler’s diarrhea/full-body outbreaks of mosquito and sand fly bites just taught me to carry a serious stash of antibiotics in my first-aid kit. At least I’ve always been conscientious about travel immunizations and educating myself about the primary diseases indigenous to my destination.

When you’re young and healthy, it seems silly to have a travel medicine specialist. Although this article is primarily directed at adventure travelers, odds are, the worst thing you’ll come home with is a backpack full of crappy souvenirs. But no one’s invincible, and should you require a specialist for something not responding to conventional treatment or with progressive symptoms, time is of the essence. Many “exotic” diseases progress rapidly, and can cause irreversible damage or death if not properly diagnosed and treated. Even with incurable diseases, the earlier you catch them, the easier it will be to manage symptoms and prevent them for worsening.

No, I’m not a doctor, although I come from a medical family. But I got seriously schooled after visiting Ecuador two years ago. After a fantastic month of adventure activities in remote parts of the Andes and Amazon Basin, I fell seriously ill the last day my trip. Two years of at-times crippling symptoms, 10 CT scans, five medical facilities, dozens of specialists, four surgical procedures, two surgeries, one cancer diagnosis, and near-medical bankruptcy later, I’ve become an expert at being my own advocate.

My infectious disease doctor believes that I contracted a form of bartonellosis called Oroya Fever after being bitten by sand flies. The good news: My health is currently stable, but we don’t know if the disease is in remission or not. But I have permanent cognitive damage, scarring or tumors on most of my internal organs, and intermittent arthritis. But believe me, I feel lucky.

I don’t want anyone to go through the health and medical nightmare I’ve endured, so I’ve compiled a list of essentials in a travel medicine doctor. Ergo, number one with a bullet:

1. Is he/she a travel or tropical medicine specialist?
Pre-bartonella, I used an internist as my GP/prescriber of antibiotics. If you can find an internist, gastroenterologist, or infectious disease doctor who is also a specialist in travel medicine, that’s a huge plus.travel doctors 2. Does he/she have personal experience traveling or practicing in developing nations?
There are a lot of practicioners who aren’t globally aware, so to speak. You can’t diagnose what you don’t understand, know about, or have first-hand experience with. Period.

3. Is he/she a good listener and empathetic?
It’s difficult to find these qualities in any doctor, especially in today’s medical climate. But it’s imperative to find someone you can communicate with, and who understands what you’re going through if you’re suffering from a mystery travel ailment. Don’t settle, even if you need to travel to another state or country to seek treatment (what stumps doctors here is often commonplace in the country of origin).

4. Does he/she have a good network of colleagues in multiple specialties (including travel/tropical medicine) to consult for additional opinions?
My current mantra is to seek a third opinion, from at least two different medical facilities. That, and to have a travel physician who actively consults colleagues and does additional research to assist with a diagnosis and/or treatment. My infectious disease doctor talked to specialists at a medical school in Peru on my behalf, and even tracked down a relevant medical paper from 1897 as he honed in on a diagnosis. And while I wouldn’t consider it a deal-breaker if the answer is no, see if your doctor is an active and participating member of the International Society of Travel Medicine.
travel doctors
5. Does he/she return your calls/provide you with email, pager, or office number so you can get in touch directly?
I’ve learned that a good doctor who is invested in your recovery will provide an open line of contact to address questions, concerns, and exchange pertinent information. Tip: Please don’t abuse this privilege. Physicians work insanely long hours, under constant stress. And don’t expect to hear back immediately if you leave a non-urgent message; be realistic. A couple of days, fine (many specialists aren’t in clinic every day). A week? Make a polite follow-up.

Whether or not you end up getting a travel doctor, the International Association for Medical Assistance to Travelers (IAMAT) provides loads of useful information, including a directory of global travel medicine clinics with English-speaking staff, and a destination-specific travel health planner. And depending upon what you plan to do on your trip, where you’re traveling, and your financial situation, you may want to invest in travel insurance.

[Photo credits: blood transfusion, Flickr user CarynNL;patient, Flickr user kk+; legs, Laurel Miller]

The Ultimate Travel First Aid Kit

The Spice Isle: What the Grenada guidebooks might not tell you

Grenada is so off the radar for a lot of Americans that it leaves a lot to be learned about the country. (For one, how it’s pronounced. Answer: “Gren-ay-da.”)

But here are some of the more practical tidbits that I learned while in the island country that might also serve you well on your visit:

Keep your swimsuits to the beach. An indecent exposure law forbids it elsewhere. Cover up, even if it’s just a little bit.

Don’t wear camouflage. It’s illegal to wear it in any color or format.

Ask before taking that photo of someone.
It’s good tact in any situation (although goodbye to spontaneity), but I especially felt the need to in Grenada. In fact, a few people called me on it when I didn’t. My instinct was to snap photos left and right at the market, but I intentionally stopped to talk about and buy produce first.

US money. Yes, you can use it and businesses accept it.

Go SCUBA diving. Grenada has the most wreck dives (sunken boats) in the Caribbean.

%Gallery-77695%Drive on the left. (Also means walking on the left-hand side). But first, you have to get a local driving permit from the traffic department at the Central Police Station on the Carenage. Present your driver’s license and pay a fee of EC$30.

No need to rush the spice-buying. You’ll have plenty of opportunities to buy spice and all of the variations of spice products — for cheap, too. Consider buying it from the shopkeeper that you’ve just enjoyed a great conversation with.

Say yes to insect repellent. Mosquito bites ended up being the majority of my souvenirs.

Keep some cash on hand for your departure tax. The airport doesn’t accept credit cards for the payment. You can use either American or Eastern Caribbean cash. Adults: EC$50 (US$20). Children ages 2-12: EC$25 (US$10).

Stick to one elevation at a time. Grenada is blessed with wonders from the depths of the ocean to the heights of a 2,000-foot-high mountain. But it’s such a distance that you’ll want to avoid going SCUBA diving and seeing Grand Etang in the same day — you’re sure to get decompression sickness (the bends).

Wait to buy chocolate until later. No doubt you’ll want to bring chocolate home (Grenada Chocolate Company makes an especially good kind — plus it’s organic and made small-batch). But if you’re like me you don’t have a refrigerator in your hotel room, the chocolate is sure to melt, so pick it up at the end.

Hydrate. It’s easy to forget that you need to drink more than usual because of the weather — even when you don’t feel thirsty.

Do as the locals do. Go to the beach on Sunday for an authentic Grenadian experience — you’ll find local families lounging on the beach, and kids starting up soccer games.

Keep an ear to the local slang. For one, “bon je” (jai/jay) is used as an exclamation of awe. That said, understanding the local patois can be as difficult as learning any new language.

Alison Brick traveled through Grenada on a trip sponsored by the Grenada Board of Tourism. That said, she could write about anything that struck her fancy. (And it just so happens that these are the things that struck her fancy.) You can read more from her The Spice Isle: Grenada series here.

Wacky sign of the week – what does this mean?

I’m not entirely sure why, but this sign scares the crap out of me. I’ve never been a big fan of insects, but anything warning me about bugs twice my size is something I’ll pay attention to (even though it could be a fake sign).

I’m guessing the sign is a warning about big mosquitoes in a swamp area, but I’m also guessing that you are far more creative than I am – so, what do you think this sign means?

Leave your thoughts in the comments below.

Catching the travel bug: Attack of the killer mosqitoes

Welcome to Catching the Travel Bug, Gadling’s mini-series on getting sick on the road, prevailing and loving travel throughout. Five of our bloggers will be telling their stories from around the globe for the next five weeks. Submit your best story about catching the travel bug in the comments and we’ll publish our favorite few at the end of the series.

The swamp here could be the stuff of nightmares. Because this happens to be the rainy season, which lasts from October to March, the trails are meant to be waded, not walked. Yet I am utterly stuck, knee-deep in pungent red mud with stagnant water up to my waist. Ellen Meulman, a PhD student from the University of Zurich, doubles back to pull me out of the quagmire. It takes a few hard yanks. “Be careful,” she says. “You can disappear in these waters.” Thoughts of leeches and king cobras vanish, replaced by a more immediate fear.

We’ve been slogging and hacking through the Sumatran jungle for nearly three hours, on our way to rendezvous with today’s observation team. The field staff hustles day in and out to arrive at the nest-site before dawn and do not return until after dark. In between, they track the individual behaviors of the orangutan in excruciating detail.

But for now, I’m too busy worrying about myself. Asides from the immediate danger of disappearing into the quicksand-like mud and trying to balance on a crude plank trail that’s submerged in water, I’m being absolutely devoured by mosquitos. Before embarking on this afternoon trek through the jungle, I dumped half a bottle of herbal mosquito repellent all over my body, but that has made no difference. At one point, the constant biting and buzzing and circling drive me nearly to tears. Alas I’m too tired to cry.
That night, after returning to camp and getting deleeched (a complicated process that involved me screeching in a high pitch voice, “get them off; get them off”, to my driver), I noticed a patch of mosquito bites around my ankle. I started scratching them and soon enough, a half dozen bumps turned into a dozen.

My flight back to the states was set to depart in a couple days, and this swamp was something like 1,000 miles away from Jakarta airport. So I had to leave the very next day, up a winding river and then through the heart of Sumatra on a 10-hour overnight drive back to Medan. From there, I flew to Jakarta and left right away for New York.

Here the story stalls for about a week. I kept scratching my bites and they kept festering and oozing and doing all the other nasty stuff that I’ll just leave to your imagination. What was somewhat worrisome at this point was that these bites weren’t getting any less itchy–and keep in mind that a week has passed by now. Even worse, they started melding together into a few superbumps.

Then all of a sudden, I started walking with a limp. I immediately thought of the worst case scenario: I had contracted some type of flesh eating bacteria (and made the mistake of Googling the images … don’t). I ran down to my school’s health services, where something happened that you never, ever want to happen in a doctor’s office, which is to have the doctor say “hmm, that’s interesting.” He subsequently disappeared, and a few minutes later, came back with three or four of his colleagues. They proceeded to collectively give a “hmm, that’s interesting”. I could see the pity in their eyes. The end was going to come in only a matter of days.

And being the unlucky guy I was, this happened on a Friday afternoon. The nurses and doctors had no idea what I had, although they feared it was contagious. So they basically held me prisoner as an inpatient for the entire weekend. The following Monday, a dermatologist came to see me and declared that I had a “hypoallergic” reaction to the mosquitoes, which is to say that my immune system just went berserk from the utter number of bites I received.

Two weeks of heavy-duty antibiotics and a course of cortisteroids later, the scary rash that was climbing up my leg had abated. Looking back, would I have trekked out there if I knew that it would land me in the emergency room for the better part of a week? Probably!

Yo see, the orangutans in this part of Sumatra are pretty damn special. They’ve learned some remarkable tricks, such as how to fashion a seed-extraction stick to crack open the prickly shell of the Neesia fruit. The theory goes that this rather complicated skill developed from simpler abilities to use tools to dig for honey, fish for termites, and scoop for water. Yet primatologists know little more than that these smarter-than-we-thought apes possess culture; the pressing question now is to figure out how it’s acquired and transferred.

Though outsiders often refer to this swamp as “orangutan heaven but human hell,” the staff does not plan to jump ship anytime soon. They want to bring the station back to its old glory by this fall, with an new 6-room dormitory, solar panels for constant electricity, and three boardwalks (getting to the orangutans without them can take several hours). They’re even hiring-the graduate students need at least five more assistants to juggle the array of projects.

Since fieldwork stopped across Aceh, it’s difficult to precisely quantify the impact of the civil war on this biodiversity hotspot, home to elephants, rhinoceroses, leopards, sun bears, tigers, and some 6,500 orangutans. While the primatologists at Suaq lost much more time than their neighbors-eight years of data-the 70 or so test subjects haven’t missed a beat. In fact, the concentration of orangutans here, where fruits rain from the trees year-round, is greater than anywhere else in the world (twice the density of other sites on Sumatra and five times the density on Borneo, the only other island where these apes can be found). The unusually high density has enabled these solitary creatures to “teach” each other skills like tool-use, making Suaq the ideal laboratory for studying the origins of human culture.

But for now, Suaq is still a friendly neighborhood. I still distinctly remember the afternoon that I finally spot two of the residents: the mellow Lisa and her 6-year-old daughter, Lilly. Lisa, ambling in the treetops, much prefered her sour melaka fruits to our company. But for a brief moment, Lilly swung down to investigate these strange-looking two-legged apes, and realizing we would not make suitable playmates, disappeared in a blur of orange.

This brief encounter with one of the world’s most intelligent and beautiful creatures was worth dealing with the travel bug.