1. Diarrhea

Diarrhea is the most common problem that can affect your trip. I always say, “Listen to your mom for good travel eating advice.” Don’t eat anything that is not properly and thoroughly cooked. Avoid tap water, ice, and veggies washed in tap water. If the restaurant or food stand looks dirty or the chef has a sore on his hand, don’t eat there!

But I confess, I am what travel docs call an “adventurous eater” and I don’t always follow my own advice. For those who do the same, and get diarrhea, there are many options.

First, stay hydrated with lots of water and electrolyte drinks. The presence of blood in diarrhea or high fevers can mean the infection is invasive and may require antibiotics. Ciprofloxacin is a common antibiotic for TD (traveler’s diarrhea). Loperamide is an antiperistaltic agent that slows down your bowels. This can be useful if you have a 5 hour bus ride and no toilet. Use caution with anything that “stops you up,” as this may only trap the invasive bacteria in your intestines, giving it more time to do damage.

Travel First Aid Kit. Photo by Mat Honan

2. Blisters

A common complaint from the hiking crowd, shopping tourists, and sightseers alike is blisters. Making sure your shoes fit well and are broken in can do the most to prevent blisters. Wearing a new pair of shoes on the day you are trying to hit every museum in the city is not a good idea.

Blisters are caused by friction and heat. Eliminating both decreases your chance of getting a blister and helps slow down the hot spot you have forming on your heel. Many skin lubricants are commercially available and this is a good option for prevention. Perhaps the best treatment is using moleskin. This is available in most hiking/outdoor stores and is basically a felt pad cut to fit and placed over a blister.

3. Respiratory Infections

Nothing fancy here: I am talking about the common cold. The ubiquitous upper respiratory infection is found everywhere, and generally caused by viruses with names more exotic than the capital city of Mongolia (Ulaanbaatar). Symptoms include runny nose, slight fever, ear pressure and muscle aches.

Knowing if this is a simple URI or the beginning of something more serious is the key and the hardest part, even for doctors.

If you’re unsure or feel particularly sick, see a healthcare provider!

Symptomatic treatment centers around nasal decongestants like pseudoephedrine, and fever control with acetaminophen or paracetamol. Inhaled nasal steroid sprays can also help with ear pressure and work wonders for travelers with nasal stuffiness or “ear fullness”. Staying hydrated and taking time to rest are also key. Remember to have a low threshold for seeking medical help when you are far from home.

4. Bladder Infections

Symptoms include a sense of urinary urgency (”I have to pee and cannot hold it!”) or hesitancy (”I try to pee but cannot get started!”). Most common in women travelers. Darker and stronger smelling urine is often noted. Problems occur when the infection spreads to the kidneys, causing fevers and side pain. This requires serious help and antibiotics. Common medications used to treat Urinary Tract Infections (UTIs) include tmp/smx or ciprofloxacin.

The most common bacterial cause is E. Coli, a bacteria found commonly in feces. Hygiene, including regular showers and changing and wearing clean underwear, can help prevent UTI’s.

When using the toilet, women should wipe “front to back” to prevent bacteria from the back reaching the front. Staying well hydrated also helps flush the area through frequent urination. Cranberry juice has been shown to prevent bacteria from sticking to the cells of the urinary tract.

Unsafe drinking water. Photo by hdptcar

5. Tooth Injuries

Nothing ruins a trip like having a tooth problem. Loose dental work, fillings, cavities and chipped teeth are all potential culprits. Make sure you visit your dentist before your trip, especially if you are gone for more than a week or two.

Problems on the road can be temporarily dealt with using a few basic supplies from your travel first aid kit. Clove oil can be placed on a cotton ball or cotton tipped stick to help relieve localized mouth pain. Temporary filling material, such as Cavit or zinc oxide eugenol (ZOE) can be used to fill holes, smooth rough surfaces and protect the nerves underneath. Evan candle wax works in a tough spot.

Warm salt water rinses can help keep problem areas clean, and then you should start looking for a dentist. Mouth infections can be very painful and dangerous. Don’t delay treatment.

6. Superficial Skin Infections

Cuts and scrapes happen when you travel. Superficial infections in these cuts also occur, as people are traipsing through jungles, climbing on and off buses and sitting in dirty pubs. Local infections are marked by redness and swelling around a break in the skin. Warning signs include fevers, pus or discharge from the wound, and pain out of proportion to the injury.

Eliminate another worry by making sure your tetanus vaccine is current before you travel.

Keep your cuts clean and protected if at all possible. Open wounds should be thoroughly cleaned and irrigated as soon as possible. Use lots of soap and water, make sure there is no debris in the wound, and apply a topical antibiotic cream.

Cover the area with a clean, dry dressing that gets changed at least twice per day. Clean the area often, again with soap and water.

I try to draw a circle (using an ink pen) around the area of redness, so that I can tell if the infection is spreading and moving outside my circle. If the infection looks bad or if you have other medical conditions or problems, get yourself to a healthcare worker.

Mosquito bites. Photo by LOLO FROM TAHITI

7. Mosquito Bites

Mosquitoes carry diseases like malaria, dengue, yellow fever and many more. Avoid being bitten by wearing long sleeves, long pants and being prepared with a few items. Using a permethrin spray on your clothing, as well as using tents and curtains, can reduce bites. For personal protection, a 35% concentration of DEET spray should do the trick.

Anybody who sleeps outdoors or with open windows should seriously think about using mosquito netting.

8. Muscle Aches and Pains

Uncomfortable sleeping positions on trains and planes, lugging heavy luggage and lots of new activity can lead to sore muscles on the road. Ibuprofen is a great medicine for muscle soreness and should be carried in every first aid kit. Take ibuprofen with food, as it may cause problems with the stomach lining.

Acetaminophen is another great option, although it does not reduce inflammation like ibuprofen. These medications are available in most pharmacies and general stores around the world.

9. Jet Lag

Wide-awake at 3 AM, only to be drowsy at lunchtime. Problems acclimating to a new time zone can slow down trips, ruin meetings and make for grumpiness.

There is no magical cure for jet lag but there are a few things you can do to help. Bright light stimulates your body to be awake, so if you need to be awake, open the curtains or get outside. Conversely, if you need to get yourself to bed, use dim lights inside and sunglasses if you must be outdoors.

Caffeine can help give a boost, allowing you to stay up a bit more or feel less fatigued. An outstanding resource can be found at thecureforjetlag.com.

10. Sexually Transmitted Diseases

People like to have a good time on their trips, and for some that includes sex. But nobody wants to come home with an unwanted “souvenir” from his or her trip, like a sexually transmitted infection.

All contact with a new partner should be made using a latex barrier, like a condom. Common infections include syphilis, gonorrhea and herpes. HIV is another large concern and should be at the top of everybody’s mind when clothes start coming off. Condoms help prevent infection and pregnancy.

COMMUNITY CONNECTION

Matador member noellejt found herself in a dental emergency in Chiang Mai, Thailand: read about her experience in the blog “Maybe you’re just meant to be in Chiang Mai…?”.

Have a question for the doctor? Ask away in the comments below!

Feature photo by obLiterated. Photo above by Travel Aficionado.

As an expedition physician, one of my main responsibilities is pre-planning for medical emergencies. Depending on where my team is going, I research the condition of local airstrips, what types of evacuation aircraft can land on their runways, and whether local roads are drivable.

Knowing the conditions of local hospitals, the capabilities of local health care providers and the availability of equipment is vital should someone require advanced medical care.

You don’t need to be an expedition doctor to start thinking about what you would do in the event that you need serious medical treatment, however. Consider the following:

When and where to seek medical attention?

When we’re on the road, we often wait until some nagging symptoms have worsened and the matter becomes urgent. If you need to get some help and you need it soon, there are several options and places to seek medical attention.

The most important factor to determine your options is how quickly you need assistance. Any life-threatening emergency requires help as soon as possible. Calling the local ambulance service or taking a taxi to the local hospital is a first step to take when you’re seriously ill or hurt in an urban area.

The facility where you are treated may not be up to the standards of your home country, but it’s probably better than bleeding to death on the road.

Photo by uncultured.

A telephone call to your local embassy often yields advice on trusted clinics and hospitals that are used by embassy staff. Embassies do not have the responsibility of providing you medical care, but can point you in the direction of where to go. Plus, speaking with someone in your native language can often calm fears.

A list of international embassies for all countries can be found here.

Remember: internet access is often limited, especially when you are trying to get help as soon as possible.

Taking a few minutes ahead of time to write down the local address and phone numbers of the nearest in-country embassy can save vital time when you’re looking for health care.

Notifying the embassy of your situation also helps keep officials aware of your status; embassy staff can also help notify family or friends back home.

Travel health Insurance

The potential for serious illnesses or injuries is exactly why travelers purchase travel health insurance. Make sure to carry your insurance policy number, membership card, and a list of contacts. Travel insurance providers often have satellite offices around the world, so carry this information, as well.

Time zones, difficulties dialing out of country, and high costs are a few reasons why it is better to call the local number when seeking help.

If you’re new to travel insurance, factors to consider when making your selection include your medical history, the types of events you are planning for your trip, and repatriation (being flown home). Not all insurance providers are equal.

Photo by stenbough.

The International Society of Travel Medicine maintains a wonderful list of clinics and health care providers around the world. The ISTM list can get you in touch with a local doctor who has experience treating travelers and their unique health problems. These doctors can also offer advice on local hospitals, conditions, where to buy medicine, and how to navigate payment systems.

The International Association for Medical Assistance to Travelers (IAMAT) is another organization whose sole purpose is to assist travelers with staying healthy. Membership in their organization is free, although good karma is acquired by making a small donation for their effort and materials.

Membership provides access to an internet site as well as a member’s book of medical clinics specializing in treating travelers. This is an extensive list and offers resources for almost all locations on the planet.

Photo by Sailing “Footprints: Real to Reel” (Ronn ashore).

Health care providers who offer service to IAMAT members agree to do so at a fixed rate for consultation, helping avoid the mess of international payments, insurance, and concerns of “Does my insurance cover this, or do I even have insurance?” Addresses, phone numbers and email addresses are provided in their 70-plus page book. IAMAT also features useful resources for preventing disease, vaccines and other travel health information.

The most important thing to remember is that if you feel you need medical care, seek it! Do not delay in your search for health care. There are many resources to start solving your problem. Pre-planning for the unforeseen emergency can be vital for a safe journey.

COMMUNITY CONNECTION:

For more tips to stay healthy on the road, check out Emergency Travel Medicine: 5 Useful Remedies from Easily Found Ingredients.

Have you ever had a medical emergency while traveling? Share your story in the comments!

Photo by James Jordan. Feature photo by Julien Harneis

Malaria is a global killer. However, humans are advancing technology against this parasite, working to develop a vaccine.

Vaccines prevent illness and death from infectious organisms. Anybody who has been vaccinated owes a debt of thanks to Dr. Jenner and his cows. In the late 1700’s, smallpox was a common and fatal disease. Dr. Jenner used a concept of variolation, believed to have originated in India in the 8th century, to develop a vaccine against this highly infectious disease.

Jenner noticed that milk-maids, who spent a lot of time around cows, were not getting smallpox. He then noticed that smallpox was very similar to a cattle infection called cowpox, but much less severe.

In a move that would likely provoke a seizure in the FDA today, Jenner deliberately infected an 8 year old boy with cowpox. By using the pus from a milkmaid’s hand blister, containing cowpox, Jenner was able to prevent smallpox!

Today’s vaccines are much more regulated, tested, and studied, but use the same basic concepts. In fact, the term vaccination comes from the Latin word “vacca,” meaning cow.

Photo by hdptcar.

GlaxoSmithKline, one of the world’s leading vaccine and pharmaceutical producers, has been working in a collaborative effort with phase three clinical trials in early 2009.

The excitement about the malaria vaccine, called RTS,S/AS, is that it has recently been shown to reduce infections by 53% to 65%, in children aged 5-17 months, over an eight month period. This may not seem like that big of a reduction, but it represents the most significant advance in the history of malaria vaccination research.

Photo by zmxncbv.com

The study, published in New England Journal of Medicine, was originally attempting to examine the efficacy of the vaccine being administered with other routine childhood immunizations such as diphtheria and tetanus.

As part of the study, the children were also followed for malarial infections. Of note is that the malaria vaccine showed no interference with these co-administered, routine immunizations.

The difficulty of producing a malaria vaccine has to do with the inherent cleverness of the malaria parasites. Malaria is one of the oldest documented diseases and has made numerous changes to overcome medicine’s treatments and preventions.

Here are some basic facts about this disease:

Basics:

Parasitic infection of the red blood cells and liver that is acquired from the bite of an infected mosquito. Main symptoms include fatigue, muscle aches, and fever. Fever is known to undulate (come and go) approximately every three days. There are four main types of the disease: Plasmodium Vivax, Plasmodium Ovale, Plasmodium Malariae, and Plasmodium Falciparum.

Location:

Most every tropical area of the world. P. Ovale is localized to West Africa. All other types are found worldwide.

Transmission and Incubation:

Transmitted by bite of infected Anopheles mosquito. Incubation period of 9-20 days, or longer.

Diagnosis:

Use a blood smear that demonstrates Plasmodium species, try to draw blood during fevers.

Photo by chrisrobinson1945

Prevention:

Avoid outdoors at dawn and dusk (mosquito feeding times); wear long clothing to cover arms and legs; use bed nets; wear permethrin treated clothing; use a DEET body spray; destroy mosquito breeding areas and use anti-malaria medications.

Diagnosis:

Use a blood smear that demonstrates Plasmodium species, try to draw blood during fevers.

Treatment:

Based on species and sensitivity to medication. Chloroquine sensitive infections can be treated with quinine (600mg base initially then 300mg base at 6, 24 and 48 hours later) or with doxycycline for 7 days. Mefloquine (15mg/kg one time) is used for chloroquine resistant species. Multi-drug resistant strains can require artesunate.

Experienced travelers to the tropics are often already in the know about the idea that there are different types of malaria and that an anti-malaria medicine that works in one area may not work in another.

Certain species of malaria can and have developed resistance to the traditional treatment of chloroquine. This is why it is important to know the species and medicine advised for the geographic area where you are traveling.

Vaccines for diseases and travel health go very well together. Travelers go to strange and exotic locations, putting themselves in contact with new cultures, foods, experiences and diseases. Fortunately, for some of these diseases, such as yellow fever, a vaccine exists.

An effective vaccine for malaria has been a “holy grail” not only for travelers, but for those who live and die in malaria areas. Hopefully, this vaccine will progress into a usable option for millions of people, saving lives and easing travel to tropical areas.

COMMUNITY CONNECTION

Not all Matador members think you should get vaccinated.

Check out contributing editor Tim Patterson’s article 10 Travel Risks Worth Taking . And if you don’t have plans to travel to a malaria-prone area but care about the health of people who live there, check out special managing editor Eva Holland’s article, Travel to the Amazon with Nets for Ninos.