Health matters

When you travel for such a long time you're bound to go someplace where nasty bugs roam free. Our itinerary, hovering between the two tropics, is going to take us in so many of those places that some form of protection for our frail, pampered, immunity-lacking organisms becomes absolutely necessary. And the one great invention of western civilization that helps globe-trotters like use in this department are the vaccines. They seem to have one for anything nowadays, except stupidity.

One can't help having an ominous premonition that the nastiest air-borne and insect-borne diseases can be caught when travelling in places off the beaten path in Central America, South America, Africa and Asia. However I didn't actually know how many of those exist, and when I found out it became quite a shock: "you mean I can get... what? How did you call that thingy-fever, again?"

Angela made an appointment with the University of Washington Travel Clinic and we went there last Thursday morning for a consultation that took no less than four hours. We were briefly told about all the diseases that could befall us during our trip, and I say briefly, because there were just too many of them to go into details. For the sake of consistency, Malaria is one disease that affects all the countries we are visiting, save Egypt and Europe. Kevin, our health practitioner, was kind enough to provide printouts for all the scary things he didn't have time to talk about.

And here's a list of the things that can happen to you. Just a tiny part...

Malaria is among the diseases you cannot get vaccinated against and your best bet is to get preventive medication like Mefloquine, Doxycyline and Atovaquone. The problem is that medication usually turns out to have wild side-effects, from yeast infections to seizures and psychosis. People taking Mefloquine have been reportedly seen running naked on the street, thinking somebody was after them.

The most common annoyance for the exotic traveller is diarrhea. Contaminated water and food are the main causes that can send the north-american tourist straight to the bathroom, every ten minutes for a few weeks in a row. While the people living in the visited area would have developed some sort of symbiosis with many of the bacteria that jump hosts between soil, plants, animals and humans, you, the thirty-something year-old yuppie computer programmer from Seattle have certainly not, and nor should you try to. The easiest way to stay out of trouble is to buy bottled water which, thanks to the unavoidable process of globalization, is now available even in most third world countries (at least in those which tourists find worth visiting.) Eat well-done meats - yeah, no medium-rare antelope steak for me in Botswana - forget about milk and do not touch the tartar sauce. However, if these suspicious foods are commercially-packaged, they are usually safe because they are pasteurized before hitting the shelves.

What about street food? Sure, you'll have a wide choice of mouth-watering, appealing, cheap eats pushed at you by local vendors at that bustling Sunday-market in Lima. Should you even dare look at them? Nobody wants to travel in a glass bubble and exotic food is a necessary part of any complete travelling experience, but use caution and common sense. Peel fruits if they can be peeled, and avoid things that have been sitting in the sun for too long, look raw, or seem to be touched by too many hands.

We ended the visit to the travel clinic by getting a bevy of dormant germs injected in our arms - the actual vaccine shots, all seven of them.

• Meningitis - quite rare but not completely eradicated in the United States, it still ravages Africa across the so-called "meningitis belt". It's not a very common traveller's disease but we'd like to reduce all risks when it comes to germs...
• Polio - can cause paralysis and even death. It has been all but eradicated in most places since the aggressive vaccination campaign started in the sixties, but it's still endemic in India, and we're spending a long time there.
• Hepatitis A and B - "always wash your hands before touching food" my primary school teacher used to say, and most parents would hammer the same message into their children's heads. But what if somebody else touches your food? Although treatable, hepatitis A is still very prevalent in Central and South America, Africa and South-East Asia. It couldn't match our itinerary better! Hepatitis B is a blood-borne disease, the chances to get infected are much smaller than those of hep A, but they had the new twinrix vaccine for both A and B at the clinic, so we got the combo for maximum protection.
• TDaP - Tetanus, Diphtheria and Pertussis - the three graces. They're not country-specific but occur more often in parts of the world that are warm and damp and where vaccination levels are low. Let's be on the safe side.
• Rabies - "Ah, this monkey is so cute, can I pet it?" Sure, go ahead! A significant part of our trip will consist of seeing and being in the proximity of wild animals. We'll visit the Amazonian jungle, we'll be on a safari through various countries in Africa and we'll dip into the habitat of the gorillas in Uganda. Don't you think that somewhere along the way a mad possum might bite Angela's butt?
• Yellow fever - a disease spread through the bite of infected mosquitoes, that can get you very, very sick. It will make vomit blood and will ruin your vacation. It is still common in large parts of South America and Central Africa. It's not very common among travellers, and certain countries require that tourists be vaccinated against it in order to be admitted. So, there, no wonder it's not so common among travellers...
• Japanese encephalitis - Encephalitis is bad. Japanese encephalitis must therefore be sort of a ninja of germs. You don't want to run into it at night. You don't want to mess with it. There's a 25% chance it will kill you. It's common in many rural areas in south-eastern Asia - yes, Japan included. And yes, all Asian countries on our list...
• Typhoid fever - it usually spreads through contaminated food or water, it kills about 200,000 people a year and it's still common outside of the industrialized nations, and we don't have any of them on our list, bummer! The vaccine is not 100% effective, so you'll still have to buy that bottled water in Kenya...

Does that seem like a lot? It is... I hope the insurance covers it, because some of those dead and crushed germs can cost a fortune. I'll get into this when my statement from Blue Cross comes in the mail. When I asked them, they said that all travel vaccinations are covered, but can one really trust anybody in the insurance business?

We'll have to go back to the clinic twice for our second and third instalments of shots for Japanese encephalitis, rabies and twinrix. And we'll actually have to get the Typhoid fever shot for which we opted at the last minute instead of going for the pills, in order to avoid the hassle of having to go to a pharmacy and then getting to ask the unavoidable question: "where the hell did I put my typhoid fever pills? Honey, did you see them?"

Neither of us has had any adverse reactions so far, but Angela's arms are still sore where she got the shots and she's a little more tired than the usual. But that could also come from reading travel books until too late at night...