Ask Gadling: You develop a serious illness while traveling

serious illness while travelingThe 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]

serious illness while traveling

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.
serious illness while traveling
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.
serious illness while traveling
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.
serious illness while traveling
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.
serious illness while traveling
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]

Five tips to reduce your health risk while eating street food

It was the 18th century food writer and gastronome Jean Anthelme Brillat-Savarin who famously said, “Tell me what you eat, and I’ll tell you what you are.” For certain cultures, street food is more than just a cheap, tasty, easy way to fuel the body. It’s part of a daily ritual, a way to catch up on neighborhood or community gossip, a means of eking out a living to provide for one’s family. By eating foreign street food, you get a sense of the social fabric and gender roles of a community or culture, but what about the health risks?

Some travelers equate a love of street food with a latent wish to sightsee whilst wearing an adult diaper. They steer clear of anything sold from a vendor, or resembling fruit, vegetable, or beverage not from a bottle (although when it comes to drinking water, you should always err on the side of caution, and there is something to be said about peeling or washing produce to avoid pesticide residue, since many developing nations use chemicals banned in the U.S.). What these folks may not realize is that foodborne illnesses such as E.coli, salmonella, and listeria don’t discriminate. FDA statistics show you’re more likely to get sick from preparing food at home than from dining in a domestic restaurant.

Is street food inherently more risky than eating in a restaurant when you travel? Sometimes, and it depends. Children, the elderly, and those with compromised immune systems are certainly more at risk of getting ill, and may be best off avoiding street eats. But there are certain precautionary measures healthy travelers can take before scarfing their tacos or mystery-meat kebabs that will minimize the chances of bringing home more than just a suitcase full of sweatshop-made tchotchkes as souvenirs. Read on.

1. Is there a crowd? Just like at home, go where the locals go, as they obviously know where to find the good stuff. But high volume also means that food is being prepared fresh, rather than sitting around attracting flies and turning into something useful for waging biological warfare.

2. Are basic hygiene practices being implemented by the vendor(s)? In Mexico, I’ve frequently observed street vendors slipping clean plastic bags over plates. With every order, a new bag is used, then discarded at the end of the meal. It’s an eco-nightmare, but it’s a lot more sanitary than dunking a plate in a bucket of dingy water doubling as a petri dish. Also bear in mind that in many parts of the world, the left hand performs double-duty as toilet paper. I can’t say it enough: Look at the sanitation practices before ordering.

You’ll often find co-workers whose sole responsibility is to handle money, to avoid cross-contaminating food (this isn’t always the case, however, so sometimes you’ll just have to–literally–suck it up). Once, when I accidentally handed my money to the wrong guy, he turned his hand upside-down to avoid contact with my filthy coins.

3. Is the stand or cart clean and well-maintained? Is hot food kept hot or cooked to order, and is cold food cold? Is purified water or ice used for beverages and frozen treats?

4. Are the ingredients fresh? If you’ve got eyes, a nose, and some tastebuds, you can figure this out for yourself. I look at the condiments and garnishes to determine if I want to eat at a given stand or cart. If I see crusty bowls of salsa, dessicated limes, slimy herbs, or flies congregated on any raw foods I might potentially eat, I’m out of there.

Stick to local specialties. One of the greatest joys of travel is eating regional ingredients or dishes. It also stands to reason that ordering seafood in an inland desert is a calculated risk. Raw protein products (egg, meat, poultry, fish, fresh cheeses) in general are to be avoided in the Third World. What about dishes like ceviche, where the acid in the citrus juice denatures (breaks down proteins, killing some potential pathogens in the process) the fish? It’s still risky, because technically it’s an uncooked food, and only application of heat over 145 degrees can totally annihilate anything potentially deadly lurking in fish. Again, use good judgment based on freshness of ingredients and basic sanitation, but remember that you can’t eliminate all risk.

If you’re in a coastal region, it pays to do a bit of homework on the cleanliness of the local fresh and ocean water supplies; algae blooms or cholera outbreaks will be widely reported. Try to avoid eating raw river fish or seafood, or river fish/seafood from just offshore; remember that many developing island nations and coastal regions use high tide as their toilet. If you’re eating pork in the Third World, always make sure it’s well-cooked. While trichinosis has effectively been eradicated from our domestic industrial pork supply, the disease is prevalent in other parts of the world. And not to get too graphic, but you’ll often find pigs in rural parts of the developing world lurking around latrines, searching for a snack.

Fresh ingredients don’t necessarily mean great food, but it helps. Delicious street food is ulimately a reflection of the loving care that goes into its preparation. Are the carnitas slightly crispy on the outside, with an interior succulent with greasy goodness? Is the masa in the tamales moist, with a sweet, earthy corn flavor? Are the noodles slightly toothsome, the herbs fresh and bright-tasting, the broth fragrant and piping hot? These things matter.

5. Use hand sanitizer before eating, take probiotics with live active cultures prophylactically, and pack a broad-spectrum gastrointestinal antibiotic and Imodium, just in case. I’m just sayin’.

For more information on food safety, go to this page on the USDA website.