New Species of Malaria?

by Erik McLaughlin on

Malaria, the ever changing, always-evolving, world-sized killer, is responsible for 350-500-million infections and over 1,000,000 deaths per year. Further, 41% of the world’s population lives in a “malaria-risk zone.” Malaria is an illness that any traveler to the tropics needs to consider, and begin to plan for, months before a trip. And with a newly discovered species of malaria, things could only get worse.

For those of you keeping score, there are currently four types of malaria:

  • Plasmodium Ovale (uncommon outside Western Africa)
  • Plasmodium Malariae (low level infection possible for years)
  • Plasmodium Vivax (can lay dormant in liver)
  • Plasmodium Falciparum (the worst, most drug resistant)

A recent article in the Clinical Infectious Disease journal discussed a newly recognized type of malaria, not previously thought to cause illness in humans, called Plasmodium Knowlesi. The new species is thought to be frequently misdiagnosed as the more-benign form, Plasmodium Malariae. It’s also suggested to be as deadly as Plasmodium Falciparum, the worst, most drug-resistant species known today.

Malaysia suffered several deaths from what was believed to be the usually benign form of Plasmodium Malariae in recent years. Studies have shown that these cases were misdiagnosed and deaths resulted from this new species of malaria. Travelers to SE Asia, especially Malaysia, should ensure that, in the unfortunate event that they contract malaria, their diagnosis of Plasmodium Malariae is not the new, more dangerous Plasmodium Knowlesi. This is especially important if there is a high parasite load, meaning there is a lot of infection.

Always check with your primary health care provider to determine what is right for you!

Where There is No Doctor: a medical handbook for everyone

by Jamie Rhein on

Every Peace Corps volunteer in The Gambia was given a copy of the book Where There is No Doctor: A village health care handbook so we could find the answer to our prayers in its pages. When one lives off in a village without easy access to medical help, one has a lot of prayers. Rashes, infections that won’t go away, stomach ailments, fevers etc., etc. Knowing how to pay attention to one’s body just to see if “this too shall pass” in a day or two and how to treat ailments oneself–or if a visit to the Peace Corps nurse is needed was part of the two year job that was once called, “The toughest job you’ll ever love.”

I poured over that book. Once, just a week after I moved to my post, convinced that I had maleria, I read the book to check my symptoms, began treating myself and took the next possible vehicle to Banjul, the country capital where the Peace Corps office, thus the nurse, was located at the time.

The journey was a combination of a sedan car taxi service from my village to Kerewan, the province capital, a ferry crossing at Kerewan, a pick-up truck style taxi ride (in the back of the truck) to the mouth of The Gambia River and then another long ferry crossing from one side of the river to the other, and then another taxi ride to the Peace Corps office. I can still feel every bump of the road and taste the red dust that dusted me by the end of the ride. I looked and felt like hell.

Another volunteer from my training group was also down for possible treatment. He had been bit by a monkey and wondered if he should get rabies shots. I can’t remember the details about his shots, but I do remember that I did not have maleria. I did have wicked dreams because of the medication I had already taken.

After I lived in the village for awhile, my visits to the Peace Corps nurse were infrequent, mostly just for booster shots. Where There is No Doctor came in handy. I learned that an infected blister will clear right up if you soak the infested area with hot water, for example. Pushing against the wound to get the pus to come out is a real no no.

Besides teaching me about my own body and health in an accessible way, it was a good read for understanding health concerns on a village level. The book was written for health care workers in the field who were in a village to help assist with medical care. If you’re going to be traveling in a remote area or, even if you’re not, Where There is No Doctor is a wonderful resource to have on hand.

Traveler’s Diarrhea: Getting it, fixing it, and preventing it

by Erik McLaughlin on

Traveler’s diarrhea is an unpleasant but common problem for a lot of travelers. No matter who you are or where you’ve been, chances are you’ve already experienced this unfortunate situation. (Notice you never seen Indiana Jones or James Bond suffering on their trips, though.) To keep yourself out of trouble on the road, there are a few simple things to remember to make your bout with the nasty bug a little less rough.

Rehydrate

Probably the most important thing to remember with a diarrheal illness is the need to rehydrate. Your body is losing large amounts of water in the stools. In addition to the water, valuable electrolytes such as salt, sugar, potassium, and bicarbonate are also being passed out. This is where diarrhea becomes a problem; The person becomes dehydrated and gets an imbalance in their electrolytes, sometimes requiring hospitalization for IV (intravenous) fluids.

Replacing lost water is the most important intervention one can make. But how much water should you drink and replace? A good rule of thumb, for healthy people without prior medical problems, is to determine how much water is needed based on weight.

Here’s a quick chart for daily water requirements based on weight:

  • 50 lbs or 22kg 1.5 liters/day
  • 100 lbs or 45 kg 2 liters/day
  • 150 lbs or 68 kg 2.4 liters/day
  • 200lbs or 90 kg 2.9 liters/day
  • 250lbs or 113 kg 3.3 liters.day

Remember, this is just the basic requirement of fluid for an average day; if you’re having some losses, say through several days of diarrhea, you’ll need to drink more than this! Sometimes even double your daily requirements are needed to recover. It is also important to note that some medical conditions could be made worse by aggressive re-hydration, such as heart failure or electrolyte issues. Always check with your primary health care provider to determine what is right for you!

If you are making the effort to rehydrate, make sure you’re getting the most out of your efforts. I always say, “work smarter not harder.” Simple sugar in your water helps re-hydration, which allows the water molecules to pass through the lining of the intestines easier. This means the water goes from the bowels to the bloodstream (where it is needed) faster! Sports drinks take great advantage of this fact and use a lot of tasty sugar in their drinks. Salt and potassium are the other two important things your water should contain. Most sports drinks contain everything you need, for re-hydration.

You can also make your own “sports drink” if you need too. Make sure your water is clean and drinkable first, then add 2 pinches of salt, 2 pinches of sugar and a squirt of fruit juice. Maybe not as tasty as store-bought, but works just as well! Powdered electrolyte packets are also available and I always carry a few when I travel.

Making it stop

My general rule is to let a case of Montezuma revenge, Delhi belly, or what ever you call it, run its course. Let it flow, keep well hydrated and ride it out. Loperamide (Immodium, Diareze) is a medicine that slows peristalsis, the mechanism that moves feces through the intestines. This medicine can generally “plug up” a person with profuse, watery diarrhea. Sometimes, the nature of the trip may prohibit frequent bathroom breaks. (Think bus travel, business meetings, walking tours, etc.) Loperamide is a wonderful medicine for this, but not in all cases, and should be used sparingly.

Blood in the diarrhea means that the bacteria is actually damaging the lining of the intestines. This is a need for antibiotics. This is also not a time to take a medicine that traps this bacteria in the intestines! You want that damaging bacteria out of your body, as quickly as possible.

A bland diet such as a BRAT (bananas, rice, apples, toast) often helps “cool off” an angry belly. A few days of eating this should help alleviate the frequency of stools. Dairy products should also be avoided if possible. The enzymes that digest lactose are destroyed when diarrhea occurs. The lactose ends up sitting in the intestine and osmotically draws more fluid from the body into the bowel, bringing on more diarrhea. After a few days, the enzymes are re-formed and you can go back to that cheese.

Bugs

Escherichia Coli is the bacteria name to know or “E. Coli” to his friends. Studies have shown that the vast majority of traveler’s diarrhea is due to E. Coli. A few other bacteria such as Campylobacter Jejuni, Salmonella and Shigella can also frequently occur, depending on geographic location. Viruses are another common cause of diarrhea, as well. The Norwalk virus seems to get a lot of attention, especially on cruise ships.

Cholera is a world famous bacteria that as caused several global pandemics.

Most of the deaths due to cholera are from profound dehydration and depletion of electrolytes. This is the source of the WHO ORS (Oral Re-hydration Solution) program.

Some adventure travelers may encounter some parasites such as Giardia or E. Histolytica.

Prevention

I always use the term “common sense travel.” This is basically all the things your mother told you to do as a kid, such as:

Wash your hands before you eat! This little habit can reduce chances of diarrheal infection by more than half.

Don’t eat at a place that looks dirty. I know, the road side stands have the best food, and they can often be safer than a normal restaurant. Travel health is all about risk management. You know that eating at this place may make you a little sick, but it is worth the chance? This is an individual choice.

Make sure your food is properly cooked and not raw. Extra caution should be taken with shellfish and sea food.

Lastly, we all know about bottled water. Local water may not be the healthiest stuff. Ice is another thing to think of; chances are it is made with local tap water, too. Fruits and veggies should all be washed, hopefully with clean water or avoided.

The use of antibiotics as prophylaxis (doing something to prevent illness) is a controversial matter. The nature of the trip and medical history are things to be considered when decideing whether or not to use them. Honeymoons, business trips and athletic competitions are instances that can be derailed by a simple case of diarrhea. Also, people who travel with low immune status are candidates for such prophylaxis.

Some studies have shown that bismuth subsalicylate (Pepto Bismol) is effective in prevention of traveler’s diarrhea and is a good option as well. Generally, I avoid recommending prophylactic antibiotics for most travelers.

Antibiotics

Should you take them? This seems to be the main question when it comes to traveler’s diarrhea. I believe that there are certain instances when taking antibiotics for travel-acquired diarrhea makes sense, with the presence of blood in the stool being the most important. Presence of fever is another indication of more severe infection, as is abdominal cramping. Realizing that most people don’t have quick access to health care when they travel, I do think it is wise to carry a dose of antibiotics in case of invasive or severe diarrhea. Speak with your health care provider about this working for you. Some choices include a quinolone such as Cipro or TMP/SMX (Bactrim). There are instances of increasing antibiotic resistance and other options may be needed.

Getting sick while traveling is something everybody wants to avoid. The natural adventurous spirit of travel means that more risks are taken, especially when it comes to eating. Hopefully this will help people feel a little more comfortable if they have to deal with this problem.

Resources:

Always check with your primary health care provider to determine what is right for you!

Travel Safely: Create your own DIY first aid kit for the road

by Erik McLaughlin on

Nobody ever asks where the first aid kit is when something good has happened. In fact, they’re traditionally one of the first things left behind, in the interest of size and weight. This brings me to the most important rule of a kit: “You can’t use it if its not with you.” I like to think of my kit as an insurance policy that I hope to never use.

When somebody begins to make a first aid kit for travel, they often ask a few friends. They may even ask a nurse or doctor. This is when it gets complicated. If I carried everything I was told, “you have to have this,” I would have a steamer trunk full of gear. This is not a real world solution. The key is to recognize a few special needs of the individuals who will be using the kit, and the locations they are traveling in.

Search and Rescue teams have a tendency to compartmentalize their equipment: One bag contains climbing rope, one box contains life vests, and so on. This method is great, especially with health kits. Ideally, a traveler will be armed with a few smaller kits that they have prepared in advance to be ready to use depending on the adventure. Think of it as a carpenter selecting the right tool for the job.

The first kit that should be the basis of all the others is the “Basic Travel Kit” set forth below. It will be highly customizable depending on the health needs of the travelers, length of travel, and destination. This is the kit that is ideal to bring on a trip through larger, developed cities and towns where advanced medical care is easily found and re-supply of medicine is possible.

The center of the kit is the person’s home medications. If somebody is taking regular medication at their house, they should, of course, continue to do so while traveling. An important thing to remember is to bring enough medication for the length of the trip, and spare for those unexpected layovers, cancellations, storms, or finding that perfect spot and staying an extra week. A spare set of eyeglasses and copies of all home medication prescriptions is also a good idea.

This kit is made to be packed into a polycarbonate water bottle, which provides a crush proof and watertight container. You can also drink out of it, too.

  1. Tylenol/Paracetamol (pain and fever reduction)
  2. Ibuprofen (pain and fever reducer, anti-inflammatory)
  3. Antihistamine (allergies, sleep aid)
  4. Pseudoephedrine (nasal decongestant, helps with “ear pop” from planes)
  5. Loperamide (anti-diarrheal)
  6. Multi-tool (Macgyver always had his)
  7. Safety pins (quick fix for clothing, making an arm sling, emergency cloth)
  8. Sun screen (SPF 15 minimum, small bottle)
  9. Bandanna (sling for arm, dust mask,
  10. Antiseptic towelettes (cleaning hands and wounds)
  11. Electrolyte packets (for replacing loss due to vomiting or diarrhea)
  12. Matches (light source, fires)
  13. Tweezers (removing ticks, thorns, cactus, sea urchins, etc)
  14. Mole skin (blisters on the feet)
  15. Band aids (minor cuts and scrapes)
  16. Gauze roll (minor cuts and scrapes)
  17. Antibiotic ointment (minor cuts and scrapes)
  18. Portable flashlight (looking into mouths, dark rooms)
  19. Thermometer (is that really a fever, how high)
  20. Latex gloves (protect yourself first)
  21. 4 x 4 gauze pads (minor cuts and scrapes)
  22. Hand sanitizer (dirty hands mean infected cuts)

Most craft stores have small resealable baggies used for carrying beads. These make excellent containers for individual medicines, not taken on a regular basis. The baggies are large enough to hold only a few days of medication, and can be written on with a sharpie. The point is only to deal with emergencies, not manage a problem that may require assistance. This kit is designed to be used in areas with a pharmacy or retailer to re-stock, when the kit gets depleted.

For initially building your kit, you can never go wrong with Adventure Medical Kits. They can be purchased from many retailers or directly from their site. The medicines are pre-packaged and more than half the stuff you need is already there. This can be added to your own kit, with a few other items.

The majority of traveler’s health problems, in larger cities or urban areas, consist of influenza like symptoms, diarrhea and fevers. I like to call them “nuisance illnesses”; just enough of problem to slow down a great trip but not requiring help. Bug bites, nausea, sun burn, diarrhea and the sniffles top the list.

Travel to more exotic destinations with harsher climates, or participating in specific recreational activities often require a supplemental kit. The point of this kit is to provide basic medical supplies to treat common ailments, either stabilizing before seeking more advanced care or managing the problem yourself. Hopefully, you’ll never have open this kit after you make it!