Gadling gear review: Adventure Medical Kits Smart Travel

Staying healthy while on the go is one of the most important aspects for us to enjoy our travels. Nothing ruins a “trip of a lifetime” more quickly than contracting a stomach ailment or developing nasty blisters on our feet. Anticipating everything we might need to take with us to avoid these issues can be tough however, and invariably we end up leaving home without the one thing we really need.

That’s where Adventure Medical Kits comes in. The company makes a line of medical kits and survival gear that have long been favorites amongst the backpacking and adventure racing crowd. But they also have a fantastic set of med kids designed specifically for travel that offer everything we need for our next trip in one compact, well organized, package.

Take for example their Smart Travel kit, which is designed to support one or two people on an extended trip. The kit is essentially a well stocked medicine cabinet that you can take with you wherever you go. Weighing in at just over a pound, the Smart Travel comes packed with bandages, gauze, a thermometer, tweezers, medical tape, and much more. It also includes medications to treat a variety of stomach ailments, blisters, dehydration, fever, and other minor aches and pains. A comprehensive patient assessment form helps to diagnose exactly what it is that ails you, while a visual communications card allows you to communicate what is wrong, in multiple languages, just by pointing.

But that’s not all. The kit also packs in a handy 200-page pocket edition of a wilderness and travel medicine guide. The book offers tips and advice on how to handle everything from allergic reactions to snake bites. The book is so well organized and filled with great information, that it will come in handy even around the house. But having a compact version that fits snugly into the Smart Travel kit, is a nice addition to an already well stocked product.
Adventure Medical Kits recommends the Smart Travel for adventure travel through both developing and developed countries. They also give it a thumbs up for travelers on cruises or short term missionary tours. Personally, I think the kit is fantastic for just about any trip however and would recommend it whether you’re trekking through the Himalaya or staying in a luxury resort in the Caribbean. It is simply too useful to leave at home, no matter what your destination.

For those travelers who need something a bit more comprehensive, AMK offers the World Travel kit, which is designed to support 1-4 people. It is a bit larger, weighing in at a pound and a half, but comes stocked with even more emergency supplies. They even have a kit designed specifically for women, which was developed to meet their specific needs as well.

No matter which kit you use however, AMK has built them to be modular and easy to restock. That means that as you use it, and supplies begin to dwindle, you can simply order refills directly from the company, keeping your medical kit always ready to go. This is a handy option for those who want a simple way to ensure that they are always prepared for their next adventure, without worrying if they remembered to restock all the things they used on their last excursion.

The Smart Travel runs just $40, which is a small price to pay for staying healthy on your next trip. The woman’s specific kit and World Travel are $60 and $70 respectively, but come with even more medical supplies.

Anyone of these kits would make a great holiday gift for the adventurer on your list.

The travel illness that never goes away

It’s called Mal de Debarquement Syndrome (MDDS) and is a disorder of perceived movement that develops following plane flights, an ocean cruise, or train travel. It can persist for months or years. Despite references to MDDS that date back as far as 1796, little is known about the rare and annoying though non-life-threatening condition.

Common symptoms of the odd disorder include a persistent sensation of motion such as rocking, swaying, tumbling, and/or bobbing. This sensation of motion is often associated with anxiety, fatigue, difficulty maintaining balance, unsteadiness, and difficulty concentrating (impaired cognitive function). Often, the motion sensation seems to disappear when riding in the car or participating in other motion experiences.

Basically, it’s like the feeling one might get when they first get off a cruise ship or long flight as they adjust to not living on something that is moving.
Patty Boyd of Spokane, Washington was a U.S. Air Force medic, so her diagnosis of mal de debarquement seemed especially strange after cruise vacations in 2003 and 2005 left her rocking reports

“I did all kinds of traveling while I was in the Air Force, with no problems whatsoever,” Boyd says.

The rocking and bobbing lasted more than a year after the second cruise. Her third and current episode was triggered in spring 2010 by a flight to Hawaii.

In addition to motion, patients report episodes of feeling heavy heads, often described as “excess gravity”, and sensitivity to light and noise.

“It’s a difficult thing to diagnose. It’s rare, so it’s not the first thing you think of,” says neurologist Rodney Quinn, whose practice has less than half a dozen MDDS patients.

Normally diagnosed by excluding other illnesses, if you feel a constant rocking sensation which started immediately after a period of prolonged motion exposure and remains for days, yet everything else appears to be normal then it’s possible that you have MDDS.

There is no known cure for it. As a self-limiting illness, it eventually goes away on its own. Prevention is tough too. Valium and Ativan have been suggested as pre-trip medications to prevent recurrences of MDDS but then there’s the whole addiction thing to worry about.

Flickr photo by mio_pls

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Top five immunizations for adventure travelers

Spending a lot of money to get poked with a needle may not be at the top of your pre-trip to-do list, but it should be. While some countries require proof of certain immunizations before they theoretically permit entry (details later in this post), there are a couple of vaccinations all travelers should get, barring any prohibitive allergies.

Getting vaccinated greatly reduces or virtually eliminates the odds of contracting certain serious illnesses or travel-related diseases, and helps prevent the spread of contagions. This is especially critical in developing countries, where there is generally little in the way of preventative or active health care, and lack of sanitation provides a fertile breeding ground for disease. As is true at home, infants, children, the elderly, and immuno-compromised are at greatest risk.

I consulted with Dr. John Szumowski, Clinical Fellow of the University of Washington Medical Center’s Division of Allergy and Infectious Disease, for expert advice before compiling the following list. As he pointed out, it’s tricky to generalize which immunizations are most important, since it depends upon where you’re going, and what you’re doing there.

That said, all of the immunizations on this list are a good idea if you travel frequently to developing nations, even if it’s for business or budget travel. They are especially important to have if you eat street food or visit rural areas.

The top five, after the jump.

[Photo credit: Flickr user johnnyalive]1. Flu
With flu epidemics making annual headlines, there’s no reason not to get a flu shot. This is especially true if you fly frequently or use other forms of public transit. Think of an airplane as a flying petri dish; why risk ruining your trip, or exposing others if you’re coming down with something? If you have an underlying health condition such as asthma, diabetes, or other lung or heart disease, it’s of particular importance to get immunized.

2. Tetanus
I grew up on a ranch, so tetanus shots have always been a part of my life. Many people don’t think about getting a tetanus vaccine, however, and as Dr. Szumowski points out, “It’s under-appreciated, and worth getting prior to travel given challenges of obtaining adequate, timely wound care.” Beats lockjaw, any day.

3. Hepatitis A
“Hepatitis A is common and can occasionally be quite serious,” cautions Dr. Szumowski. “For anyone with underlying liver disease (e.g. chronic hepatitis B or C) this is an especially important vaccination.”

4. Polio
Polio hasn’t been fully eradicated in parts of the developing world, so an inactivated poliovirus booster is important when traveling to areas where it’s still a problem, such as Nigeria and India.

5. Typhoid
This vaccine can be taken either orally or by injection. Be aware that you must avoid mefloquine (an anti-malarial) or antibiotics within 24 hours of the vaccine doses.

Additional vaccines
Depending upon your destination, you may also require, by law, a Yellow Fever (tropical South America and sub-Saharan Africa), or Japanese Encephalitis/JE vaccination (parts of Asia and the Western Pacific). Dr. Szumowski recommends JE vaccine if you’re traveling for an extended (over one month) period in rural areas of affected countries.

Rabies vaccine isn’t usually recommended, but if you travel extensively in developing nations or have/expect frequent contact with animals, it’s a good idea. I’ve had a couple of canine-related experiences that have sold me on the idea. Dr. Szumowski notes that “excellent wound care and post-bite medical evaluation are still needed,” even if you’ve had a rabies pre-exposure vaccination.

It’s critical to allow ample time before your trip to allow the protective effects of the vaccines to establish themselves. Go to the Centers for Disease Control and Prevention’s vaccinations page for more information on what’s required and epidemic updates, if applicable. Often, your GP, internist, or local drugstore can provide some of these vaccinations; others require a specialist. For locations of a travel medicine clinic near you, click here.

Carry your immunization card with you as proof of vaccination, and email yourself a scanned copy, as well. The same goes for copies of your medical insurance cards.

Practice good hygiene and get enough rest, inasmuch as possible, while traveling, to maintain a healthy immune system. Airborne and Emergen-C are great immunoboosters to carry with you.

Consider travel insurance if you’ll be in a remote or sketchy area, or engaging in high-risk outdoor pursuits.

[Photo credits: swine flu, Flickr user ALTO CONTRASTE Edgar AVG. (away); polio, Flickr user Cambodia Trust;

Ask Gadling: You develop a serious illness while traveling

The very thought of acquiring a serious illness or injury while traveling strikes fear into the hearts of even the most stalwart adventurers. Speaking from personal experience, it’s terrifying to find yourself alone (or not) in dodgy accomodations, in a remote area of a developing country, with a raging fever and/or an uncontrollable case of the runs or other unsavory symptoms. Which isn’t to say the same ailments suffered in the comfort of a five-star hotel in Paris are a picnic, either. Any way you slice it, getting sick in a foreign country sucks.

And sometimes, despite taking precautions, you fall ill anyway, as I can attest. It can be a matter of circumstance (That water my guide “boiled” in a bamboo culm on a Thai Hilltribe trek? Yeah, I pretty much saw the resulting case of dysentery coming), or just bad luck. I’ve been on my own during most of my unfortunate on-the-road maladies. Between my experiences and those of fellow travelers, I’ve accumulated some wisdom over the years for dealing with sudden-onset illness in less-than-ideal circumstances.

For the purposes of this article, I’m not going to include injuries, pre-existing conditions, or focus on food poisoning, which was well-covered in a previous Ask Gadling post by Melanie. I also want to stress that we’re not medical professionals here at Gadling, myself included. For the technical stuff, I turned to Dr. John Szumowski, Clinical Fellow of University of Washington Medical Center’s Division of Allergy and Infectious Disease.

After the jump, tips on prevention, what to do when illness strikes, and how to get yourself home in the event of a full-blown medical emergency.

[Photo credit: Flickr user MoHotta18]

Before you leave home

Hit the internet
Do a bit of research on emergency medical options for a worst-case scenario. The U.S. Department of State produces a list of American doctors and hospitals in foreign countries.

If you have specific questions (about, say, where to find the best dentists in Europe), Lonely Planet’s Thorn Tree travel forum can be a useful place to get ideas (please do additional research before following any advice). Take the diagnostic-related questions directed to forum members with a heaping grain of salt, and save them for your doctor.

Get vaccinated
Check the CDC’s (Centers for Disease Control and Prevention) website to see what, if any, vaccinations you need before your trip. You can also get updates on things like outbreaks of cholera or bird flu. Be sure you allow ample time before your trip for the protective effects of vaccines to establish themselves. Dr. Szumowski also recommends the CDC’s “Survival Guide to Safe and Healthy Travel” webpage.

View more Ask Gadling: Travel Advice from an Expert or send your question to ask [at] gadling [dot] com.

Keep an immunization card on you (some countries require proof of certain vaccinations) as well as an online record, like Google Health.

All travelers should get flu and tetanus shots. If you’re a frequent world traveler, get vaccinated for hepatitis A, typhoid, and polio. Depending upon where you’re traveling, you may require a Yellow Fever or Japanese Encephalitis vaccine, or malaria prophylaxis.

I used to think a rabies vaccination was overkill until I saw a fellow traveler get seriously nipped by a puppy we were playing with in a remote village near the Myanmar border. The deathly silence that followed was sufficient motivation. Adds Dr. Szumowski, “It’s still important to remember that excellent wound-care and post-bite medical evaluation are necessary, even if a person has had prior rabies pre-exposure vaccination.” The International Society of Travel Medicine has a list of global travel medicine clinics.

I also carry an EpiPen, because you never know what could trigger anaphylaxis while you’re abroad. It also bears mentioning that you can develop a life-threatening allergy to something previously benign. A chef I know went into anaphylactic shock after tasting one of his dishes containing taro root, even though he’d been cooking with it for over 20 years.

If you get sick

Stay calm, and assess your symtoms
It’s easy to get carried away and assume the worst, but odds are your sudden fever isn’t malaria.

Try to identify the source of infection or illness

Know when to seek professional medical assistance
In general, says Dr. Szumowski, some symptoms or exposures that should prompt “expeditious” medical evaluation include:

  • high fevers (over 101ºF, especially if sustained or accompanied by shaking or drenching sweats)
  • bloody diarrhea
  • inability to keep food or liquids down in situation of significant vomiting or diarrhea
  • confusion or severe headache
  • severe cough, especially if accompanied by shortness of breath
  • animal bite or other animal-related attack

Tips for self-care

Stay hydrated
If you’re vomiting or have diarrhea, stay hydrated with (purified/bottled water), and Gatorade or other electrolyte beverages. If you absolutely have to travel, take Imodium as an anti-diarrheal.

Eat bland foods
Remember the BRAT diet for gastrointestinal upset: rice, bananas, applesauce, and toast.

Control your fever
To lower a high fever, take the recommended dosages of acetaminophen (Tylenol) or ibuprofen (Advil).

Wear ID
Wear a medical alert bracelet for serious conditions, allergies, etc., Write down your condition in your destination country’s language in both your phrasebook, and place a card in your passport.

Emergency Measures

Know when to self-diagnose
Sometimes, you find yourself in a position where you have no other option. That said, this is something you want to avoid for obvious reasons. Says Dr. Szumowski, “Self-diagnosis and treatment can be appropriate for less serious conditions such as traveler’s diarrhea, but it is important not to delay evaluation by a medical professional for more serious illness [see warning signs above]. If someone chooses to self-treat, it’s important to be aware of potential for counterfeit medications locally.”

What if the only available hospital/clinic/doctor’s office is seriously sketchy?
If you’re in a situation where the medical facility is primitive/lacking in sanitation, you’ve got a tough call on your hands.

I posed this question to Dr. Szumowski. He says, “It depends on the acuity and seriousness of the condition. In general, evaluation and treatment in a facility with adequately-trained staff and more comprehensive resources is preferable whenever possible–this may mean seeking evaluation in the capital, at a private hospital, or even returning home. Aside from limited diagnostics and medications, smaller/less-resourced facilities may have inadequate sanitary practices (e.g. reuse of equipment) and screening of blood products, raising the risk of contracting pathogens such as hepatitis C or HIV. Therefore, having evacuation insurance is advisable, especially for extended travels in the developing world.”

In other words, you may be shit out of luck. But this is why you’re reading this article–so you can be prepared for all kinds of situations! Read on.

OTC antibiotics
In many countries, you can buy OTC antibiotics, and indeed, this may be your only option, but heed Dr. Szumowski’s warning, above. Caveat emptor.

If you need to be evacuated, the U.S. government offers financial assistance and/or repatriation loans. The American Citizens Service and Crisis Management (ACS) is linked to U.S. embassies and consulates all over the globe. It’s a good idea to enroll in the U.S. Department of State’s “Smart Traveler Enrollment Program (formerly known as “Traveler Registration)” if you’re traveling for a long period of time, to a high-risk region, or doing any extreme adventure activities.

Travel prepared

Get antibiotic prescriptions (and carry copies with you) from your primary care doctor or internist, or visit a travel medicine clinic, and pack them in you travel first-aid kit (You don’t have one? REI has some great options). Some people also carry sterile latex gloves and hypodermic needles with them. If you’re diabetic or have another condition that requires injections, this makes sense, provided you have a note from your medical provider. For everyone else, this is a personal choice that comes down to, “How comfortable are you with the knowledge that you’re carrying drug paraphernalia?” If you backpack, travel in places with notoriously corrupt law enforcement, or countries like, say, Malaysia, you may want to hedge your bets.

Email yourself and family or a trusted friend copies of medical insurance, itinerary, and a list of medications, and doctors.

Consider traveler’s insurance.

If the worst happens

In the highly unlikely event you do come home with a mystery disease that isn’t responding to medical treatment, get to a specialist, asap. Depending upon where you’ve been, this may be an infectious disease or tropical medicine doctor, a dermatologist or rheumatologist who specializes in tropical medicine, etc.. You may need to travel–out of state–to find the right specialist. Find someone who has first-hand experience traveling/training or practicing in developing countries, and in diagnosing diseases not found in the U.S.. It may even be best to try and seek medical treatment in the country where you became ill (even if that means a return trip).

Unfortunately, I can speak with authority this subject, because I’m in my 22nd month of diagnostics following a trip to South America. If you do find yourself harboring a travel-related (or not) disease that defies diagnosis, you must be your own advocate. No one is more invested in your health than you are, and doctors are human. They may make mistakes, despite their best intentions. Seek not just a second, but a third opinion, from at least two different medical facilities.

And finally, don’t let anything in this article scare you and put you off travel. Odds are, you’ll come home with nothing more than great memories, and the eagerness to plan your next trip. I know I can’t wait.

[Photo credits: vaccination, Flickr user alvi2047; mosquito, Flickr user tonrulkens; toast, Flickr user snowriderguy; farmacia, Flickr user ibirque; drugs, Flickr user cavale]

Cuba Libre: Being sick and discovering “Cash Cab” in Cuba

[Though this might look like the U.S. Capitol, it is actually Havana’s Capitolio. The strange resemblance makes even stranger sense when you get to the “Cash Cab” comparison at the end of this post.]

Peter and Frank planned to leave for Trinidad on Monday, leaving Lora and I in Havana. They had hoped for a noonish start to their day and planned on renting a car for the remainder of their stay. (Road trip in Cuba? Yes, please! I tried my best to convince Lora to hit the road with the boys, but she was nearly out of cash, had somehow forgotten her ATM and credit cards in Canada, and therefore was relying on the three of us to fund the remainder of her trip).

The boys dilly-dallied for a good two hours by having lunch and weighing the pros and cons to Cuba’s expensive car rental rate, which would come to a whopping $75 per day. By the time they decided to go for it, the car rental guy informed them there were no more cars available. So, that evening, Lora and Frank went to see the famous cabaret show at the Tropicana. They paid nearly U.S.$100 each for three hours of entertainment. Peter and I were less interested in seeing scantily clad women wearing chandeliers on their heads, so we walked to a delightful little paladar called La Cocina de Lilliam in the Embassy district and splurged on a delicious three course meal with red wine.

This paladar was a pleasant contrast to the crowded yet intimate La Guarida in town. La Cocina was set in the side courtyard of a large, lavish house. There were waterfalls and fountains spread about the courtyard as well as plenty of green plants and birdcages with cockatiel and parakeets. Peter and I had a really nice conversation about traveling and other things that time seemed to float by undetected. Somehow we didn’t get home until midnight. Soon after, Lora and Frank returned from their cabaret date. After a nightcap of Cuba Libres, smoking a bit more of our Cuban cigars, and listening to the ocean on the patio, we retired at 1 or so.

It is never a good sign waking up pre-dawn with with a cold sweat, headache, and stomachache. The only time I felt this ill was when I ate a sweet (but apparently foul) mango in India and found myself on the toilet for two full days. My body felt weak, and I felt tired and gross.

Peter and Frank left early in the morning for Trinidad, but I couldn’t get out of bed. I slept almost all of Tuesday. Lora still made the most of her day, visiting la Plaza de la Revolución (with an enormous monument for pre-revolutionary figure José Martí) by cab and walking around our Miramar/Playa neighborhood. She found a cinema just a few blocks away and decided to have a quick dinner and catch an 8:30 movie (for just a dollar!). To her surprise and dismay, she was the only one interested in viewing this film and was turned away by the cinema attendant. Had I gone with her I think she would have been able to see it. So Lora was home by 9 p.m. and we watched a film on TV (I slept through most of it) and made it an early night. I didn’t eat anything all day.

My mysterious illness was a doozy (Pete and I think the lamb at La Cocina could have been the culprit), but I felt quite lucky to be in a 5 star hotel. I mean, things could have been much worse! I could have been like my friend Brody in the middle of rural Laos, who had to visit the village doctor to get hooked up to an IV and take an anti-vomit shot in the butt. If my situation had been more dire, I could have found myself in a Cuban hospital without travel insurance and maybe even lacking cash for medical care.

In the end, I think this sickness just made me appreciate the important things in life – like friends and a warm, comfortable bed. While I would have enjoyed seeing more of Havana, staying at the Melia Habana and with Lora was so comforting. In addition, as I am usually a solo traveler, I could have easily been much more depressed all by my lonesome and staying in some tiny casa particular.

The following morning I felt well enough to sit up and watch some TV, where I discovered my new favorite game show. Since I don’t have cable nor any real interest to watch TV here in Hawaii, leave it to my travels and stay in a 5 star hotel in Cuba (of all places) to hook me onto “Cash Cab” on the Discovery Channel. What a perfect and delightful premise and show! I watched 3 whole hours (that’s 6 episodes) of Cash Cab. It is utterly ironic how I stumbled upon this particular show in Cuba, though, for the contrast between the high-paced capitalist capital of New York City (the setting of Cash Cab) and my current environs couldn’t be more stark.

My excitement over this kind of game show just reaffirmed my Western upbringing. As I watched contestants win over $1,000 during a short cab ride (which is more than twice as much a Cuban citizen makes in a year), I wondered what Cubans thought of such a show. I was, however, watching it in English, so I imagine only educated and wealthy Cubans could actually comprehend the nature of the show. Regardless, the show’s premise is both perfect for the intended Western audience and quite jarring for Cubans (along with being a disgusting display of capitalism at work).

For a complete listing of my Cuba Libre posts, please click HERE or skip straight to the good stuff —