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How Do You Stay Healthy on the Road? Awareness, Avoidance and Action



By Betsy Wade

“They sit here and they’re angry,” said Rebecca Acosta, executive director of Traveler’s Medical Service in New York, indicating the patient’s seat beside her desk. “They hear about vaccinations they should get before they travel and they’re leaving in five days and they ask who should have told them these things.”
    Who, indeed?
    For years in The New York Times I conjured readers to remember that in planning a trip, medical questions precede suitcase questions. Thumping that tub for some time brought minimal results because the natural intermediaries — airlines, travel agents and tour operators —  did not join in. I concluded they were reluctant “to cloud their ‘fly with me’ message by saying that paradise has a few bugs in it.”
    Since I signed off on my task as Practical Traveler, many things have progressed, especially ease of researching, but the question “who should have told us?”  still awaits an effective answer.

     The Yellow Book, the government guide to health considerations for international travel, is now available on line, along with copious other  information from the Centers for Disease Control and Prevention. But someone has to suggest you look. The small type in older passports suggested you update basic immunizations: measles, mumps, German measles, polio, diphtheria, tetanus and whooping cough. In today’s passports, the front material suggests checking with the C.D.C., which is easy, but unlike cigarette packs or beer bottles, the passport message does not mention risks. And there come clueless people to sit in Ms. Acosta’s chair to ask where they missed the message.  
    In daily health matters, people grasp that they must be their own advocates. This has not reached the level of health issues while overseas. Leisure travelers don’t instinctively call their primary physicians to say they are ticketed for Bali, Ethiopia or the Amazon.  And of course, whether a clinician considers malaria a hazard in Ethiopia depends on how the itinerary matches the malaria-transmission map.
    The need to educate travelers on how to avoid coming home sick — or not coming home at all — helped propel the creation of the International Society of Travel Medicine in 1989. Because the questions to my column were as often about health hazards as about cheap fares, I joined, seeking both to alert travelers and to guide them to the best data. The late Paul Grimes of Conde Nast Traveler, who wrote the Practical Traveler before I did, was a keynote speaker at the first conference, discussing life as a correspondent in South Asia and earlier times wandering home from the Far East.
    The ISTM mission is growing, as is clear from its Web site, www.istm.org. The members are physicians, public-health graduates like Ms. Acosta, emergency room chiefs, nurses and nurse-practitioners, corporate health officers, researchers and leaders at government and international agencies such as the C.D.C. and the World Health Organization. The core is tropical-medicine specialists. Many members, like Ms. Acosta and her husband, Dr. Alberto Acosta, and Dr. Richard Dawood of London, operate travel health offices.  
    Their two clinics, and other responsible places, give pretty much the same common-sense talk to first-time visitors. It is neither alarming nor exotic but that doesn’t diminish its importance. 


Do not start by worrying about yellow fever or malaria, they say, deadly as they are: What is statistically likely to zap you overseas is what would get you at home. If you have allergies or a chronic problem, be sure you’ve got an adequate supply of your medicines, plus extras for delays on the trip home. If you’ve got replacement parts, take your charts and figure out how tough it would be to get to the nearest hospital.
    Focus on avoiding accidents: Watch what sort of vehicle you get into and buckle your seat belt. Don’t drink a couple of Mojitos and climb on a personal watercraft. Pack condoms. Avoid swimming in fresh water if you can’t smell chlorine. 
    Buy trip insurance and cover air evacuation if it’s going to be the only quick way out; the cost is a flyspeck on the cost of your trip. Dawood, who is the author of a major book, Travelers’ Health, favors annual coverage if you travel a lot; the rate is lower and the question of pre-existing conditions does not crop up every six weeks.
    Both Ms. Acosta and Dawood, in their initial talks with patients, say they ask about basic immunizations. Many older people have not boosted their tetanus shots, a valuable step: it’s more likely to be a splinter in a meadow than the classic rusty nail that gets you. Hepatitis A, Dawood points out, is one of the most vaccine-preventable diseases of our era, and the disease is serious.
    As brief as these medical experts can make it: Be informed; prevention and avoidance are better than treatment. 
    Here’s a case in point. Dawood and the Acostas noted that there was recently an interruption in the supply of rabies vaccine for pre-exposure protection. It’s coming back into the market, but unevenly. This pops up in the news because Bali, a popular destination that was once rabies-free, has imported the disease. Ms. Acosta is terse about such hazards.
    “Tourists are not likely to have a rabid dog rush out at them and bite, ” said. “But they might pat a beach dog or a street dog and the animal might lick a break in the skin.”
    She has a mnemonic device: three A’s: awareness, avoidance and action. Awareness of what the hazard is —  rabies in Bali, for instance — should remind travelers to avoid dogs and other animals, making sure the kids get the message. And if someone is exposed, act quickly. Dawood, who says he was once bitten himself, favors using the rabies vaccine, primarily for peace of mind, he says, but also to avoid the hassle of getting treatment after exposure. The pre-exposure vaccine involves three doses over three weeks.
    These clinics are only two among many around the world that can counsel travelers on protecting themselves and can give any suggested shots. The Travel Medicine Society has an online directory of clinics, accessible through www.istm.org. The C.D.C. Website, www.CDC.gov/travel, links to the ISTM site, as well as a tropical-medicine specialist list. These are good places to look, but, like the C.D.C., Everett Potter’s Travel Report makes no guarantee about the practitioners on either list.
    The Acostas are at Traveler’s Medical Service, 595 Madison Avenue, New York, N.Y. 10022, www.travelersmedical.com.
    Richard Dawood, who specializes in preparing reporters for dangerous assignments, particularly for self-medication, is at Fleet Street Clinic, 2
9 Fleet Street, London EC4Y 1AA,  www.fleetstreetclinic.com.

    At the end of May, the International Society of Travel Medicine will hold its biennial convention, in Budapest. Along with rabies, Bali, malaria, high-altitude sickness and ceaseless discussion of travelers diarrhea, the organization will be talking about HIV-AIDS, the diseases of migrants, safe water supplies and emerging diseases. I will go to learn the latest and review the basics with the world’s experts in this area. We’ll be back to you.


Betsy Wade is the former writer of The New York Times Practical Traveler column.

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