Wednesday, 8 April 2015

Things I learned while travelling III: Always listen to your public health nurse...

... but some things are more important than others, use common sense.

During our year of travel, I certainly learned that some pieces of advice are more important than others.  It was interesting to talk with other travellers about what sorts of advice they had picked up along the way and even though they all came from similar (first world) backgrounds what others decided was important often varied widely from what I had come to believe was true. I’ve learned to thoughtfully compromise on some things in order to experience the local culture but also to be firm about what seems to be most important.

Here are some of the things that I still think are absolutely essential if you are going to do long term travel that involves camping, hostelling, homestays, or travel to developing countries.

Pre trip planning

Immunizations including routine updates and anything recommended.  I wondered if I had over prepared when we included rabies vaccines in our list, but we were definitely in areas where there was the potential for bites AND where rapid treatment was not available.  I had interesting conversations with fellow travellers who had extensive experience with safaris in Africa or adventure travelling in areas of high incidence of rabies who had never thought this might be necessary.
Malaria medication if it is recommended.  Bring medications from your home country and don’t assume that you can buy the correct medication along the way. Bring extra to allow for a change of plans.  I discovered, for example, that I could not get Malarone anywhere in Malaysian Borneo (despite the high risk for malaria anywhere in the interior) and that only Doxycycline was available.
I brought a variety of prescription and non prescription medications to deal with common diseases as well as basic bandaging materials.  I used very little, but would definitely carry the same types of things again.  A good reference is the medical chapter in Lonely Planet's “Trekking the Nepal Himalaya”, even if it is dated.
Travel medical insurance that will cover you if you get sick or injured in the locations you are going to be and doing the things that you are doing.  Even if you never need to use the insurance, it provides peace of mind.  One of our fellow travellers had found the hard way why this was important.  He and his partner had the standard basic insurance, but when she was diagnosed with dengue and then hospitalized, they discovered their policy didn’t cover the hospitalization costs in an almost western style hospital nor did it cover trip cancellation.  She had no choice but to fly home.

Food and Water Precautions

This was definitely an area where using common sense played a large part. The common reminder “well cooked, served hot, washed with water you know is clean, comes from a bottle...or forget it” needed to be applied with some thought.
Travelling overland, we were responsible for many of our own meals – the purchasing, the preparing, and the ensuring that everything was a clean as possible.  Handwashing was stressed as was proper washing of dishes.  But, the disinfectant of choice was Dettol antibacterial liquid, primarily because the company has a very effective marketing arm, not only in Asia but also in the UK where our guides came from.  I felt this wasn’t something I could compromise on, even if others were ok with this so on our last trip to a western type shopping mall in Turkey I purchased a large container of household bleach and extra large containers of alcohol hand sanitizer.  It helped that someone else on the trip supported this – as a veterinarian this was standard procedure in her practice.  But, always carry extra because there are some places that these things may not be available.  Alcohol hand sanitizer in China is a prime example.

Water I knew was clean also was a priority.  We carried reusable water bottles and filled from large commercial bottles we could purchase everywhere.  And we made sure that the bottles were washed and soaked in a bleach solution on a regular basis.  Or we drank hot drinks with water we had seen come to a boil.  Interestingly, in China you would see locals bringing large thermal jugs to work filled with water they had boiled at home.  Don’t assume that anything in a bottle is safe to drink – on arrival in Uzbekistan, our guide explained which brands of water were recommended as some of the other brands did not actually follow accepted standards.

Not only was Nescafe the only coffee available.
Nestle also provided safe drinking water
(as well as baby formula)

Well cooked and served hot was generally a good recommendation but I will confess to using common sense when it came to ice cream and fresh fruits and vegetables.  How can one refuse beautiful homemade ice cream in a village in Kyrgyzstan after you have been smiling and visiting with everybody and enjoying the local meal that had been prepared before our eyes?  Would I have refused if I had known ahead of time that the dishes were being washed outside the door in a bucket of water from the community pump?  Or how to refuse the opportunity to try fruits and vegetables picked right off the tree?  I well remember stopping for lunch at a small town, finding a small local open air restaurant and negotiating fried rice for our meal. The chef began washing and chopping things and sent a child out to get the neighbour to pick some vegetables from the garden.  It was delicious, well cooked and served hot, even if the water probably wasn’t clean enough to drink.

Watching this wee girl eat her ice cream without spilling a drop
was just too irresistable...

local open air restaurant.  Bottled water, disposable cups,
clean table.  Plus we watched the food being cooked from
We encountered a few places where it probably wasn’t safe to eat and we tried to always have some packaged snacks for such occasions.  The day we stopped at a market on a muddy street where you could see that the water for washing reusable dishes was runoff from the rice paddies that was being used by humans and animals alike AND that the cooked market food was precooked and sitting in the open....  We ate chocolate bars and bottled water and were not sick the next day unlike some of our fellow travellers.  On the other hand, we also stayed in a community where we were the only western tourists (possibly this year as we were well off the beaten path) and there was only one place to eat.  We watched very carefully what locals were eating and tried hard to not watch how the dishes were being washed outside in large bowls of water.  Common sense says you can’t not eat for two days.
Being aware of food and water precautions doesn’t stop when you are travelling in a first world country.  In the same way that we hear of food borne outbreaks in Canada or of the need to filter or treat water when backpacking in the mountains,  common sense needs to be used anywhere you travel.  We were quite surprised on one outback tour where the things we had come to expect in developing countries were not available.  Water still needs to be treated if it is coming from a source that is untested, particularly if it is being used by humans and animals.  You need to maintain cleanliness of your cooking facilities and hand sanitizer needs to be available if running water and soap is not.

Beautiful campsite in the outback.  More basic than many we
used in central Asia.

Bugs and Beasties and Things that Nibble at you (Insect Precautions)

Mosquitoes carrying malaria or dengue aren’t the only thing to be aware of when it comes to insects.  We also became well acquainted with the local leeches, ticks, scorpions, spiders, and other interesting beasties.  I found it fascinating learning how to deal with these creatures from guides as well as fellow travellers.

This lizard got some emergency outpatient tick removal surgery.

We took antimalarial medication in risk areas and were very conscientious about insect repellent – DEET 30% from Canada then from Thailand.  It was difficult to find DEET repellent in Australia so we postponed purchasing any, thinking it would be easy to find in Indonesia or Malaysia.  NEVER assume.  All that was available in Indonesia were “natural” repellants and in Malaysia we finally found some “family strength” (14%) Off (and only in pharmacies).  The reason was that in these two countries, the accepted procedure is to spray your bedroom with a strong pesticide rather than put anything on your skin.
We had to make a lot of compromises about insect precautions based on the realities of the situation.  We didn’t carry permethrin treated nets (as is recommended by public health) for space reasons.  There were a couple of places where they would have genuinely been appropriate – sleeping in thatched rooms that were obviously open to the night air where the “bed nets” provided had huge holes.  Instead we liberally applied insect repellent and hoped for the best.  On the other hand, we had one night in a “basic” camp in the interior of Malaysian Borneo, where our sleeping platforms had good quality netting available.

Scenic jungle resort in Vietnam.  Thatched walls and roof
with decorative (not functional) bed netting.  Rural area with
significant risk of malaria.  No choice but to apply insect repelant
and hope for the best.

View from our basic hostel at camp 5 in Mulu National Park.
Definitely in a malaria risk area.  Each sleeping space had
bed netting to totally enclose you.  A great sleep was had.
The other compromise we had to make was as we came to the end of our travels.  We carried enough Malarone (I thought) for all the areas we were travelling through where there was a risk of malaria.  However, as we arrived in Borneo, we were running short just as we were starting to travel through the probably highest risk area of the trip (rural, jungle, interior of the island).  Yes, we found a western style clinic with a doctor trained in Singapore and yes he was prepared to be as helpful as possible.  But Malaysian medical clinics only stock Doxycylcine and it was Chinese New Year and the GSK representative was on holiday so not available for a special purchase of Malarone.  So, with enough Doxycycline in hand to get us back to Canada, but not really wanting to take a medication that had some nasty side effects, it was time for some serious thinking.  From the malaria maps we could access on the internet, and a careful discussion with our guide (how far, exactly, from the coast was this river lodge?) we took the chance that in our last week we would be passing through malaria areas in the daytime and sleeping in lower risk areas.
It wasn’t all about mosquitoes.  Travelling through the deserts of central Asia we became used to the assorted flying insects that were attracted to our moisture.  Eau de DEET was applied faithfully in combination with sun screen.  When we got to Australia, I was able to find sandalwood essential oil which once again proved to be an essential deterrent to the tiny flies that wanted to infest my eyes, mouth, nose and ears.  Not anything that we think about in Canada, but something that I had learned from a guide on a previous trip to Australia.

It can’t be stressed to much that the best advice is to listen carefully to the advice given by others – a health professional who can give you evidenced based recommendations, your guide who has expertise about his local area, and even your fellow travellers who will share advice they got as well as experiences they have had.  Then filter it through your knowledge of what has worked for you and what your common sense says is important. Will I do things the same on another long term trip off the usual tourist trail?  Some things, yes.  Will I make changes on the basis of knowledge and experience?  Absolutely.

No comments:

Post a Comment