Travel Healthy, Travel Smart

by David Wortman
On a recent trip to Vietnam, I reluctantly found myself looking for malaria medication in the best "pharmacy" available, a bare room full of unmarked jars of pills down one of Ho Chi Minh City's back alleys. Luckily, neither the pills nor malaria got to me. However, poor planning can pose a threat not only to one's health but also to that of the ecosystems we visit.
Eat Locally—and Wisely
Local cuisines should be savored, but mind food-borne perils, particularly where sanitation is minimal and government oversight meager. Poorly washed raw fruits and vegetables as well as undercooked meats can carry a host of pathogens, such as E. coli, salmonella and noroviruses (common on cruise ships). Most often, the result is nausea, vomiting and diarrhea, which can turn travel into a misery.
More exotic foods, however, can mean more exotic diseases and the decimation of endangered species. In West and Central Africa, for example, trade in wild game, or "bushmeat," is the most acute threat to apes, and primates may account for up to 15 percent of the total bushmeat market. The danger to us is real as well: HIV-1, the virus responsible for the global AIDS pandemic, is believed to have leapt to humans through bushmeat hunting. With an estimated 300,000 to 500,000 wild animals eaten annually, "Every year there's a good chance that we could end up with some disease emerging," William Karesh, D.V.M., director of the field veterinary program for the Wildlife Conservation Society, told National Public Radio this March.
What You Can Do
* Stick to cooked foods served hot to your table; only eat street-vendor food prepared in front of you. Avoid salads, uncooked vegetables, undercooked meats and unpasteurized dairy. Wash fruits with boiled, bottled or filtered water and remove peels.
* Be skeptical of unfamiliar meats. "Anytime that you are served something you can't identify, ask questions, and in all cases stay away from eating primates," suggests Natalie Bailey, assistant director of the Bushmeat Crisis Task Force.
* Where sanitation is iffy, rely on bottled water or canned beverages, or disinfect by boiling for up to three minutes, filtering or treating with chlorine or iodine pills. Look for water carrying the International Bottled Water Association seal, and be cautious of bottles that may have been opened and re-sealed. When showering, keep water out of your mouth, nose and open wounds.
* Bring portable water purifiers that treat for bacteria, protozoa and viruses, such as General Ecology's First Need Deluxe or HydroPhoton's ultraviolet Steri-Pen Adventurer purifiers, both available at REI ($97-$130; www.rei.com, 800-426-4840).
Mosquitoes and Other Vectors
While protecting against food-borne illness is your first line of defense, other diseases await unwary travelers. Take care when swimming, as schistosomiasis, carried by parasitic worms, and "swimmer's itch," or cercarial dermatitis, carried by microscopic parasites, are common in freshwater in parts of the Caribbean, South America, Africa and Asia. Malaria-bearing mosquitoes, endemic in West Africa and South Asia, infect 300 to 500 million people worldwide annually, while mosquitoes in Southeast Asia carry dengue fever and those in Africa and South America carry yellow fever. U.S. travel isn't risk-free either; mosquito-borne West Nile Virus claimed 165 U.S. lives last year, not to mention rodent-borne hantavirus and tick-transported Lyme disease.
What You Can Do
* Contact your doctor or travel clinic four to six weeks ahead of travel to plan for vaccinations and medications. Pack a medical kit, including needed prescriptions, first-aid supplies, extra medicines and—if you plan to be sexually active—contraceptives; see sidebar.
* Consider medical insurance for travel to destinations with disease and poor sanitation, or for high-risk adventure plans.
* Fend off mosquitoes and other insect bites with long-sleeved shirts, pants and hats. Use repellents sparingly, especially DEET, which can cause skin irritation and blistering at high concentrations. The less-toxic lemon eucalyptus oil in Bygone Bugzz or Cutter picaridin-based repellents also provide long-lasting protection (see GG #108). Bed netting permeated with pyrethroid insecticides (see below), such as the Mombasa Defender Mosquito Net ($26; www.rei.com, 800-426-4840), can be a useful shield, but minimize contact with skin and clothing.
* In tick-infested areas, check yourself during outdoor activity and at day's end.
* Where swimmer's itch or schistosomiasis is prevalent, swim in chlorinated pools or saltwater.
With 650 million tourists crossing international borders annually, travel is a leading cause of unintended invasive-species introductions. Fungi, insects and seeds hitch rides in luggage, on food and clothing, even on our bodies. "The organisms...that we import intentionally pale in numbers beside the masses of smaller living things we set in motion incidentally," cautions Yvonne Baskin in A Plague of Rats and Rubbervines: The Growing Threat of Species Invasions (Island Press, 2002, $16). And not without cost: In the U.S., invasive species have contributed to the decline of up to 46 percent of imperiled species.
Some countries require aircraft "disinsection" to crack down on alien invaders, forcing airlines to spray cabins with insecticides, including synthetic pyrethroids, which can spark asthma attacks. Passengers may be subject to in-flight spraying on some flights to Asia, Africa, the South Pacific and the Caribbean, while other countries spray planes immediately before passengers board.
What You Can Do
* Thoroughly clean boots and gear after use and avoid transporting seeds, fruits or other natural souvenirs.
* Ask if disinsectants will be sprayed on your flight, and request to deplane beforehand (see GG #97).
In the end, if the litany of pitfalls awaiting your travels seems daunting, consider that most travelers return home healthy and happy, with memories of a lifetime. And—with planning and a little presence of mind—you should, too.
Information and Resources
Centers for Disease Control, Travelers Health Guidance: www.cdc.gov
U.S. Department of Transportation, Countries Requiring Aircraft Disinsection: ostpxweb.dot.gov
International Association for Medical Assistance to Travelers: www.iamat.org
International Society of Travel Medicine, Travel Clinic Directory: www.istm.org
Information on Travel Health Insurance: www.insuremytrip.com
U.S. EPA Guidance on Insect Repellents: www.epa.gov
Wildlife Trade and Monitoring Network (bushmeat): www.traffic.org
World Health Organization Travel Resources: www.who.int






