Doing my own travel consult :)

We're going to spend six months travelling overland from Istanbul to Singapore.  There's lots more last minute details to be taken care of, but immunizations are done and I have my prescription for medications to take with me.  Although I can't tell anybody what is best for them, here is a bit of a long winded chat about what I decided.

First off, full disclosure.  I am passionate about immunizations.  I believe strongly that they work and that they are safe.  Maybe that means that I have some immunizations that others might consider optional.  On the other hand, we will be travelling through areas where there are diseases I do not want to get sick from and where there is not likely to be treatment if I do.

• Routine immunizations.  dTap (Diphtheria, tetanus and pertussis), MMR (measles, mumps rubella) two doses if you are born after 1970, and influenza immunization.
• Food and water immunizations.  Hepatitis A series (don't go anywhere without it), Polio and Typhoid.  Didn't go for Cholera/E Coli as it isn't very effective. We're travelling through countries where there have been cases of polio in the last three years and near countries where there are cases of polio now.  My mum (who had polio as a two year old) taught me to do whatever necessary to NOT get polio.
• Blood and blood products immunizations.  Hepatitis B series.  If there was an immunization for HIV I would be first in line for it, but there isn't.
• Bugs and beasties immunizations.  My travel program recommended Rabies, JEV, and TBE; which would have cost well over $ 1000.  After consulting with our tour company (Kirsten), I went for rabies vaccine because of the numbers of deaths from the disease combined with the difficulty of finding safe treatment. Planning ahead, I also have Yellow Fever so that I am covered for the next big trip (I hope) to South America.

Then there is the question of what medications to carry.  I'm choosing to bring as much as I can from Canada rather than shopping along the way.  Some years ago, I listened to a presentation about diseases, medications and developing countries which made a lot of sense to me.  The presenter's area of expertise was TB and HIV in Africa and he worked with Medecins Sans Frontieres.  "If you buy medications in a developing country, one of three things will happen", he said:

• The medication you buy will not be what it is supposed to be
• The medication will be from North America or Europe and outdated so likely not effective
• If, by luck, it is what it is supposed to be, you have just taken a very precious and limited product that would be better used by the citizens of the country you are in.

Check out John Le Carre's "The Constant Gardener".

I started with the recommendations that are on the website, then refined my requests with Lonely Planet's "Treking in the Nepal Himalaya".  The chapter on health care and medications is clear, concise and applies to anywhere off the beaten path.

• Anti malarial medication.  North Americans tend to believe in prevention while Europeans lean more toward treatment if you get sick.  The advice I was given is that preventive medication is indicated if you are going to an area where malaria is prevalent for less than a year.  Over that, you are likely to get malaria anyway and the meds might mask the symptoms.  India and South East Asia have the kind of malaria that is deadly (as opposed to the stuff in the Caribbean that is just nasty) So, medication for nine weeks it is.  There's different effective choices, so you need to listen carefully to recommendations and then make up your own mind.  For me, I get nauseated even thinking about antibiotics and I burn easily so doxycycline wasn't even an option.  Weekly dosage with mefloquine wouldn't work for me (even at home I usually don't know what day of the week it is) and I didn't like the chances of night terrors and psychosis.  So, Malarone daily was my choice, even with the cost.
• Diamox for altitude.  Two weeks worth.  We ARE going to get to see Tibet and Nepal.
• Azithromycin for severe diarrhea (not upset stomach) or severe respiratory infections caused by bacteria.  Most severe infections in Asia are resistant to anything else.  Had an interesting discussion with my family doctor about this medication.
• Bactrim for parasites.
• Tinidazole for amoeba and Giardia.  Sadly, this medication isn't available in Canada so I will be bringing the old fashioned alternative Flagyl.
• A host of non prescription medications including imodium, antibacterial eye drops, first aide cream, cortisone cream, pain killers and anti histamines.  I react to strange bug bites so will also carry Benadryl.
• Sunscreen and insect repellent.

And with a lot of hand washing and a bit of luck, most of these medications will not be needed and I will dispose of them responsibly at the end of the trip.