Handling Illness While Traveling

I’m feeling a little bit under the weather today, which got me thinking about being sick while traveling. For one (sickness-induced?) moment, I wondered just why I never got sick on our travels but managed to get some kind of crud in the haven of my home. Then, I remembered that I was blocking things out. Like the time we were flying to Cuzco from Lima, and I got to make use of LAN’s barf bags not once, but twice. Or the time both Jeff and I came down with what we strongly believe was swine flu while in Siem Reap, Cambodia. Or the couple of instances when I was glad there was immodium in our first aid kit.

Yeah, I got sick on the road. Not often, knock on wood, but occasionally. I doubt that that comes as a surprise to anyone. Keeping strange schedules, eating unfamiliar foods, sharing cramped spaces with strangers, sleeping (or not) in uncomfortable places is bound to get to you sometimes, and every once in a while your immune system is going to yell ENOUGH! When it does, I’ve found it best to listen.

Because it’s unlikely that your mommy is going to be able to show up with glasses of Sprite and bowls of chicken noodle soup, I’ve found that it’s good to have an idea of how to take care of yourself. (Though if the mommy option is available, I highly recommend taking it.)

1. First of all, listen to your immune system and take a break. Jumping on the next train or pushing through another day of sight seeing when you’re not feeling well is not going to make you better. It will probably make you worse, and you certainly won’t enjoy whatever it is you’re doing if instead you’d rather be under the covers and moaning (and no, not in that way). Give yourself permission to take it easy. On longer trips, this is easier to do, but you should do it on shorter trips as well. In the end, you’ll enjoy the experience so much more—even if you do lose a day or two.

2. Upgrade your accommodations. Now is not the time for budget travel. You don’t have to end up at the Four Seasons, but you shouldn’t end up in the dorm room at a hostel either. First of all, no one else wants your germs. Don’t be a jerk. Secondly, when you have to go the bathroom NOW, you don’t want to sprint down the hall to find it occupied. You also don’t want to be contemplating when the last time the bathroom was cleaned as you hang your head over the toilet or curl up on the bathroom floor. When I got sick in Cusco, we had already booked a night at a hostel that turned out not to be good for illness. It was freezing cold, and the bathroom was barely enclosed, meaning Jeff and my brother Gregory got to hear all of my retching. So they immediately headed out (leaving me under about 10 blankets) to find another place. The hostel we originally booked let us out of our reservation, but even if they hadn’t, it would have been worth the money lost to relocate. When we were sick in Siem Reap, we were luckily already checked into the perfect place. It had a lot of things that we originally thought unnecessary since we planned to spend all our time at Angkor Wat (TV, AC, huge bathroom with hot water), but which we were glad to have when we were in the throes of swine flu. Trust me, I said multiple prayers of thanks for the hot water shower, as I stood under it in fever-induced shivers at 3 a.m.

3. Indulge in comfort foods. When we travel, we usually try to avoid the fast food joints and the American-style restaurants and instead opt to eat where the locals eat. It’s almost always cheaper, and it also allows us to expand our palettes. It also helps us meet and interact with locals. When we’re sick, however, we don’t spent a moment feeling guilty about not trying the local cuisine. If a bowl of tomato soup from the Panera style cafe or a big serving of mashed potatoes for KFC is going to make me feel better, than there’s no reason for me not to have it. When I’m back up and running, I can try the fried crickets or whatever else the local delicacy is.

4. Consult the medical kit. Though most of the time, a medical kit feels like extra weight, the moments when you need it, make it worth every ounce. By carefully packing a medical kit before departure, you can put yourself immediately on the road to recovery when illness sicks. You’ll want ibuprofin or aspirin to deal with the aches and pains, a packet of Cipro or some other broad-spectrum antibiotic for when you come down with strep throat or some other treatable bacterial illness, and immodium for times when you need a bathroom but there’s not one around. It’s a good idea to know how you handle certain medicines before you go. For instance, we took Pepto Bismal tablets with us. I’d never taken them before, but just assumed they’d work fine. In fact, they worked like ipecac syrup for me. The moment one went in my mouth, I hurled. Another great thing to have in our opinion are the individual Gatorade packets. We took these for our hiking trips, but they were wonderful when we were sick and needed to rehydrate and up our electrolytes. (Also, even if you are like us and drink the local water 90% of the time, it’s worth splurging on bottled water when you’re sick. The last thing your body needs is more foreign bodies.)

5. Get help when necessary. If you have a fever that won’t break, have injured yourself (broken bones or bad cuts), been bit by a stray or wild animal, throw up blood, or just feel beyond horrible, give up on self-treatment and seek help immediately. Though I am weary of foreign medical experiences (perhaps it’s because of that doctor in Athens who cut my spider bite open without a bit of anesthetic or antiseptic and thus caused an infection that took six weeks to heal and required daily medical attention—or perhaps it’s just natural weariness), I would never avoid help if I needed it. If we had not begun to feel some sense of recovery after 24 hours with what we thought to be swine flu, we would have sought help. We didn’t immediately seek help because Cambodia was quarantining people with swine flu, and we really didn’t want to be quarantined in a foreign country (though we did opt for self quarantine), and additionally because we had a good college friend who lived in Siem Reap and checked up on us regularly. If you don’t want to go straight to a doctor, stop in a pharmacy to see what help they can offer. Be smart about drugs, however, as fakes are unfortunately common. Ask for pills in their original packaging and try to seek out a pharmacy of good reputation.

6. When there’s no other option, suck it up and gut it out. Though I highly recommend giving yourself a break whenever that’s a viable option, I recognize that sometimes it’s not. The reason Jeff, my brother Gregory, and I flew to Cuzco was to hike the Inca Trail. Arriving there ill had me worried, but we arrived three days before our departure for the hike. I spent the first one doing nothing but relaxing and taking care of myself. I then woke up on day two feeling 100 percent fine. A 24-hour virus I decided. We spent the entire day touring Incan sites around the city. No problem, On hike day, I woke up again feeling fine. No problems on the bus ride, at breakfast, or as we set off on the hike. At a stop about 30 minutes before lunch, I started to feel a bit queasy. Altitude, I thought. Or maybe just hunger. When we sat down for lunch, I scarfed everything on my plate. When we stood up from eating, I promptly lost every single bite into the buses. Tears streamed down my face. My brother had flown all the way from home to do this hike. This was the only part of our entire trip that we had booked in advance. I had my heart set on this. Plus, it wasn’t like I could just step off the trail and be done. My options were to hike forward or to hike backward. I opted for forward. I took a pill. I kept away from everyone except Jeff and Gregory. I was careful to not share anything. That afternoon was torturous. I had just finished work on a hiking book that summer and had expected to lead the group. Instead I was forcing myself to take ten steps before stopping and resting on the side of the trail. But eventually I made it to camp, and when I woke up the next day I was fine. And I was fine on the next one too. And I was fine, as well, on the final day when we marched down to Machu Picchu, the final goal, the reason we’d signed up to hike the trail in the first place.

We’ve Got Answers

Thanks to all of those who left us questions when we opened up the floor. Here is our attempt at answering. If you’ve thought of something else you want to ask, go ahead and do so. We have received other questions via email, and we plan to answer those in a later installation.

Did you ever have to get medical treatment or even buy medicine?
Only two sicknesses stick out in my mind. On New Year’s Eve 2008, two days before we were to begin our hike to Machu Picchu, I came down with a stomach bug. I first got sick on the flight from Lima to Cuzco, and it didn’t let up the rest of the day. Making it worse, we were in a freezing cold room with a crappy bathroom. It was also pouring rain. And to top it off we had to go to the trekking office to make our final payment. I had to stop about every 20 feet, and at one point, I was so bad off my brother actually offered to carry me. The next day I felt better, but then it returned the next day, our first day on the Inca Trail, when I hurled the second I stood up from the lunch table. Unfortunately, I also passed it on to my brother, who got to learn just how tough he was when he was horribly sick on the hardest (and what turned out to be the coldest and wettest) day of the hike.

The second incident was when Jeff and I both simultaneously came down with what we strongly suspect to have been the swine flu. We were in Siem Reap, Cambodia, which was experiencing a big outbreak of the epidemic at the time. We had all the symptoms—crazy delusion-causing fevers, respiratory issues, horrible aches and pains, and overall yuckiness. I also had the bonus of stomach issues. We were sick for about three days, but there was one night I thought we just might die. I may have actually wished to die because I felt so miserable. Luckily we were able to secure some Tamiflu, which really helped.

Other than that, we were pretty much healthy. Our stomachs also proved to be made of steel as we handled the local food and water with nothing more than a blip of discomfort here and there.

What is the one things that pissed you off the most?
We got annoyed at the fact that most people in the world have no idea what a line is. We got tired of being quoted prices many times higher than they should have been and having to haggle for a fair price. I thought the guy on our Inca Trail hike who didn’t think we needed to tip our guide or the porters was an ass. But I only remember getting really pissed a few times.

Once was when the bus left us, as well as the four other tourists onboard, at the Vietnam-Laos border, forcing us to hunt down and pay for a private mode of transport because it took us too long to get our visas. I actually took the getting left behind in stride; what were we to do? What got us pissed was the company’s refusal to take responsibility or give us any sort of fair compensation.

The second was when my purse was stolen on the train in India. I wished all sorts of evil on him, and if I had had a chance at him, it would not have been pretty.

The third was later on the same day in India, when we saw the reality of the caste system come into play and witnessed the level of inhumanity that so many people live with every day. We haven’t told this story here before, and it would take too long to explain in this post, so check back next week when I’ll tell my Varanasi cycle rickshaw story.

What made you smile the biggest?
I immediately thought of the kids in Africa when I read this question. It’s funny because I wouldn’t say that either of us are huge kid/baby people. Don’t get me wrong, we like them, and might even want our own one day, but we definitely don’t fawn over every one we see. But the kids in Africa were so spirited, so funny, so contagiously in love with life. And they were always so damn thrilled to see us (unless they were absolutely scared to death of us). I still remember turning this corner in Zanzibar and coming across a group of three small kids. As soon as they saw us, they started shrieking “Mzungu! Mzungu! Mzungu!” (what they call white people), jumping up and down, and going absolutely crazy. It was like they’d just won the lottery. Simply amazing. We don’t quite get the same reception around here.

World’s best airline? Worst?
Air Emirates has earned its reputation as a top-tier airline. The seats were comfy and came with individual entertainment systems with tons of options, and food and service was good. We also had a good experience on Air France, getting exit row seats and a choice of approximately 1 zillion movies on our own individual systems.

Air India Express was probably the worst. Our flight was delayed  for 6 hours, and we could get absolutely no information on why or when it might possibly leave. Also, the passengers on this airline were nuts. I think every single person went the bathroom during the flight (which was less than 2 hours), and they made a line all the way down the aisle of the plane. And more than one person actually got up to attempt to go the bathroom as we were landing. We were literally about to put wheels down when they stood up. I know this isn’t directly about the airline, but the flight crew didn’t seem to have much control or influence.

Where in South America should I go?
What a beautiful continent! I’m ready to go back. Go to Patagonia if you want to see natural beauty the likes of which you can’t imagine. Go to the Galapagos because you get to snorkel with seals and penguins and see things you won’t see anywhere else in the world. Go to Buenos Aires to eat steak, ice cream, and wine, be seduced by the tango, marvel at the beautiful people, photograph the architecture, and try to speak their crazy version of Spanish. Go to Machu Picchu because it’s mystical and magical and simply astounding.

You are supposed to go to the dentist every 6 months. Did you?
No. I don’t even like going to the dentist here (though yes, I do it). There was no way we were braving it in some foreign country.

Best thing you ate? Worst thing you ate? Strangest thing you ate?

Best according to Jeff:
Coconut Ice Cream with Dulce De Leche (Argentina), Steak (Argentina), Keow Teow Noodles (Laos), Malai Kofta (India), Naan (Amritsar, India)

Best according to Theresa: Steak (Argentina), Cau Lao Noodles (Hoi An, Vietnam), Fresh Fruit Shakes (Asia), Mangoes (Malaysia), Naan (Amritsar, India), Potato Momos (Dharamshala), Omelette with chips and roti (Mbeya, Tnazania). Strangely enough, what I find myself most craving though is gallo pinto, Nicaraguan style basic beans and rice.

Worst: Neither of us cared for the chincheros (fried pork skin) given to us by our host family in Granada. I also have to say we’re not big fans of cassava, or the million other names third-world countries around the globe have for the starchy white stuff that fills the world’s stomach without providing any real nutrition.

Strangest: We didn’t eat bugs or any of the other creepy-crawly-type things that really freak people out. In Africa, we did try ostrich, springbok, kudu, and some other types of wild game. In Asia, I had fish balls, which I actually liked.

What’s your favorite place in the world and why?
Africa, Africa, Africa. If I were to be given another year to travel, I’d immediately hop a plane to Africa, buy me an old 4WD, and spend the entire year exploring the continent. The landscapes were phenomenal, and the people even more so. I felt like our most “authentic” experiences were in Africa, that we experienced it on a more intimate level than most other places. I also have to say that I never, ever, ever got sick of looking out my window and seeing an elephant or zebra or lion or whatever. It’s just simply the most amazing place I’ve ever been.

A Pain in the Arm and the Wallet

I type this with a right arm that’s a little bit sore, and a left arm that’s not too bad off, but wouldn’t be happy if you gave it a friendly punch. This morning Jeff and I accomplished one of the big to-dos on our list: we got vaccinated. In an earlier post, we invited you to vote on what vaccinations we should receive. And you should be pleased to know that we listened … for the most part.

I can now say that we are vaccinated against Polio, Tetanus, Meningitis, and Yellow Fever. We are 1/3 of the way towards being vaccinated against Japanese Encephalitis. And we have a pack of Typhoid pills hanging out in the refrigerator, and by the end of next week, we’ll be vaccinated against it too. So yes, we got 5 shots in the arm today, and we have two more to go. Fortunately, we’d both already been vaccinated against Hepatitis A & B, so we could forgo that one, and we passed on the Rabies. Although, to be fair, we didn’t have a choice. The rabies vaccine is in short supply right now and is being restricted to those who have actually been bitten. I can’t help but say I’m a little pleased by this, because it means I didn’t have to make a decision.

In addition to all the vaccines, we have a mountain of prescriptions waiting to be filled: two different types of malaria pills, anti-diarrheal pills, and general antibiotics.

We also have two bound books filled with information specific to our trip.

That makes me feel a little bit better about the office visit fee, and to be fair, we were there for an hour and a half, and they were very friendly, helpful, and knowledgeable. They were also more than a little blown away by our plans. I think they thought we were a little loony. (She did double check with us that we didn’t have any known psychological issues when going through our medical history forms.)

As for the answer to the question you’re all wanting to ask—what it all cost—well my friends, the answer is $1,263. And finishing off the Japanese Encephalitis vaccines will cost us another $540.

For those unable to do math, that’s a whopping $1,803. (You can see how that breaks down in the Details section of our site.)

It’s a phenomenal amount of money when you consider that what we got out of it is some sore arms and the possibility of feeling like we have the worst case of flu ever (that’s a direct quote from the doctor, but so far, so good).

But it’s a tiny amount of money when you consider that it will go a long way towards keeping our brains from exploding, our jaws from locking, our limbs from paralyzing, and our organs from failing.

In the end, you were right. You can’t put a price on your health, and I’m fairly certain that my life is worth more than $901.50.


Next on the to-do list in regards to health:

1. Make a decision on health insurance policies.
2. Get life insurance.

You Can Put a Price on Your Health

Taking a trip outside of the United States is a little bit like going to kindergarten—you have to be sure you have your shots or you might not be admitted. Whether it’s from having a member of the opposite sex touch you on the playground (the formally established way of getting cooties) or having someone poop on their hand and then touch your food (the less established but much more terrifying way of getting cooties), no one wants to get the bug.

So I’ve been doing a bit of research on the Center for Disease Control’s Travel page to determine just how many times Jeff and I need to get stuck in the arm before we set out and what the various concoctions will protect us against. By using their destination list to investigate every possible country we might visit on our round the world trip, I came up with a comprehensive list:

  1. Tetanus: Also known as lockjaw, tetanus is a disease that causes tightening of the muscles. It enters the body through a break in the skin and leads to death in 10-20% of cases. Though we were immunized against tetanus as a child (as part of the diphtheria, tetanus, and pertussis vaccine), a booster is recommended for adults every ten years.
  2. Polio: Though eradicated in the United States for decades, polio is still out there, and outbreaks have recently occurred in countries we plan to travel to such as Cambodia, Madagascar, and Indonesia. In extreme cases it can lead to paralysis and death. Though again, we were immunized against this as kids, a booster is recommended for adults traveling to countries with known outbreaks.
  3. Hepatitis A: A viral infection of the liver, this disease can be spread through fecal matter as so kindly mentioned above, through contaminated water, ice, shellfish, fruits, vegetables, or other uncooked foods. It’s common throughout the world, but easily prevented with the vaccine, which is given to pretty much every traveler. Fortunately, both Jeff and I have already received this vaccine.
  4. Hepatitis B: This version of hepatitis is spread from blood to blood or sexual contact, so it’s harder to pick up, but it’s still pretty prevalent around the world. Jeff and I have also been vaccinated against this disease.
  5. Typhoid: Typhoid is a nasty gastrointestinal disease caused by exposure to the bacteria Salmonella enterica, usually through contaminated food and drink, particularly in the developing world. It can be life-threatening if not treated with antibiotics, and though the vaccination is highly effective, it is not 100% effective as there are multiple strains with various resistances.
  6. Yellow Fever: This virus is transmitted to humans via mosquitoes in South American and sub-Saharan Africa. At its worst it can cause hemorrhagic fever. Areas infested by yellow fever carrying mosquitoes require proof of immunization before you are allowed to enter this country, so this is the one immunization that we absolutely must have. No ifs, ands, or buts about it. The vaccine is good for ten years.
  7. Japanese Encephalitis: This is another mosquito-spread disease, and it’s similar to West Nile Virus, although the survival rates are much worse. In fact between 1/5 and 1/3 of people who get the disease die, and 50% of survivors have major neurological disorders. The upside, however, is that the disease is rare, with only 50,000 cases a year at most. In general, it’s restricted to rural areas in China, Japan, Korea, and eastern Russia (none of which we plan to travel to), but cases have also been recorded in rural areas of other Southeast Asian nations.
  8. Rabies: We all know how this one works. Rabid animal bites you and gives you the infection, you start going crazy and foaming at the mouth, you have hydrophobia, delirium, convulsions, and then go into a coma and die. Once symptoms show up, it’s too late. You’re dead. A series of shots given post-bit and pre-symptoms is effective, however, in preventing the onset of rabies. The vaccine for this does not prevent rabies, but is basically the first couple in the series of shots you would need, thus buying you a bit of time to get the rest.

Additionally, we need all the standard immunizations, the ones we had to get as kids—diphtheria, pertussis, measles, mumps, rubella… Fortunately, we didn’t have crazy parents who thought vaccines were evil, so we’re all good here.

So what this breaks down to is eight vaccines. One—yellow fever—is required. Two—hepatitis a and b—we already have. Three—tetanus, typhoid, polio—are recommended and we plan to get. And two—Japanese encephalitis and rabies—we aren’t certain about.

Why not just go ahead and get them all, you ask? Well, for one, I don’t really like getting stabbed in the arm and I don’t want to risk side effects if the vaccines aren’t necessary. Am I actually going to be somewhere where Japanese encephalitis is prevalent and will I be there in the season when the mosquitoes that carry it are active? Since I still have to get all the rest of the rabies shots, will having one really do me any good?

The second issue is simple, money.

Even though Jeff and I are lucky to have fabulous insurance, we’re left high and dry when it comes to adult immunizations. Apparently they’d rather treat the typhoid after we get it. So how much is it going to cost us to get all these immunizations? Well, oddly enough, figuring that out is tough. You’d think one dose of yellow fever vaccine would have a set cost, but you’d be wrong. I called various clinics—public and private—in DC and Maryland and even one in Kentucky, and I got a range of prices—from $90 to $150 for yellow fever. Obviously, go with the cheap one, right? Well, um, not necessarily, because while they might have a low price for yellow fever, their typhoid price could be sky high. And don’t forget that office visit charge. I’ve outlined the price range for each vaccine that we definitely plan to get below:

  1. Tetanus: $45-$85
  2. Polio: $30-$65
  3. Typhoid: $65-$85
  4. Yellow Fever: $90-$150
  5. Office Visit: $0-$48

And though it looks like we could get away with it costing $225 each, that’s not the case, since no one place offers all of the shots at the lowest price. If we get vaccinated here in our area, we’ll each be paying a minimum of $310. (I got these price quotes a few months ago, so they may have gone up.) In Louisville, we could get them for $281 (but of course, we’d have to pay to get there, so that’s no savings, unless we’re already in town for some other reason). Ouch! And that’s the cost, not the stab in the arm.

Add in the vaccines we’re not sure about and the cost soars. Japanese encephalitis requires three jabs, at approximately $90 a piece, and the rabies shot also requires three shots, priced at over $150 a poke. So you’re looking at $270 for the Japanese encephalitis and $450 for the rabies! I’m not one to take health concerns lightly, and I do value my life very highly, but you have to wonder where to draw the line. What’s being smart and what’s being paranoid?

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