Staying Healthy on the Road
Staying healthy while travelling should be of primary concern to all travellers. After all its not a lot of fun not to be able to leave the hotel room for days and feeling like death warmed up. There are a number of health concerns all travellers to Latin America should be aware of. Only awareness will help to avoid trouble. But at the same time, don't be alarmed by all the dreadful possibilities. I have described them at length here to help you stay healthy and safe and enjoy your trip. Remember that while these conditions exist they are not ubiquitous. Some travellers do get sick if they do not take necessary precautions, others never seem to get sick - there is no hard and fast rule about it. Just rest assured that not every mosquito carries some dreadful disease and even if you do get bit you will not necessarily get sick. Likewise, be cautious but not paranoid about the food you eat, or else you won't enjoy yourself and you'd better stay at home. At the lodges presented in these pages staff is trained in matters of hygiene and strict hygiene rules are applied. If people do fall sick the cause can usually be traced to other sources. But caution is the best prevention and that is the reason why I am giving you such a detailed and gruesome account of what may be encountered.
- Water Purity
- Water purity is the biggest concern - our stomachs just haven't been exposed to the same bugs and thus react far more sensitively than those of he locals. Quite often such bugs come and go quite quickly, but occasionally they can be very persistent. To prevent trouble drink only bottled water and use bottled water to clean your teeth. If you are not sure of the water or hygiene quality of an eatery avoid eating salads or raw foods that can't be peeled, such as lettuce or strawberries. Also avoid fried foods. Certain sea-foods, especially mussels and bottom feeding fish is also best avoided. Take some water purifying tabs or grapefruit seed extract with you to purify water if bottled water is not available. Also take some anti-diarrhoea pills with you - however, if you do catch a bug while travelling, even if you manage to control it with simple measures, it is best to see your physician, or pay a visit to the institute for tropical medicine upon your return to get a proper check up.
- Travellers Diarrhoea
- Also known as 'Montezuma's Revenge', this is very common. Follow guidelines for prevention like for cholera and you will probably be fine. I always try to add plenty of fresh chillies, garlic and lemon juice to my diet when travelling in Latin America and found that thus armed I have mostly been spared of any serious mishaps. If you do get diarrhoea the most important thing is to keep drinking a lot of fluids, preferably something astringent. Also take additional minerals and vitamins - lucozade is said to be good to restore the electrolyte balance, but there may be other smart drinks available. If you are not allergic to them, flax seed or psyllium taken with a lot of fluid will help to control diarrhoea as they both absorb a lot of liquid. (As well as providing relief for those who tend to suffer from the opposite problem)
- There are occasional outbreaks, usually in poor areas where water quality is very poor and sewage treatment is inadequate. It can be contracted by drinking infected water or eating infected food. Sometimes it is spread through sea-food. Raw and undercooked seafood from the Gulf of Mexico has led to Cholera outbreaks in the past. The cholera bacterium can also live in brackish rivers and coastal waters. However, there is no need for a generalized panic or to get a vaccine. There are many different strains of the bacterium and chances that you will encounter the same strain as given in the vaccine are not overwhelmingly high. Plus, outbreaks have become much rarer since sanitation has improved in many poor and rural areas around the world. If there have been cases in the area where you intend to go, it is highly likely that you will hear about it before you even get there. In any case, it is always best to get local intelligence on the current situation. In most places there is no immediate threat. Prevention follows the same general rules as above, for water purity, since cholera is transmitted via water:
Drink only water that you have boiled or treated with chlorine or iodine. Other safe beverages include tea and coffee made with boiled water and carbonated, bottled beverages with no ice.
- Eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself.
- Avoid undercooked or raw fish or shellfish, including ceviche.
- Make sure all vegetables are cooked avoid salads.
- Avoid foods and beverages from street vendors.
- Do not bring perishable seafood back to the United States
Hepatitis is one of the more serious and relatively common diseases people catch while travelling. There are several different types of hepatitis and some are more dangerous than others, though they are all pretty unpleasant.
- Hepatitis A:
- This is the most commonly transmitted form of hepatitis among travellers. It can be transmitted from one person to another by direct contact or through contaminated water - e.g. insufficiently washed plates at restaurants, uncooked foods or contaminated sea food. Hepatitis A symptoms can range from mild to severe. Incubation period is 28 days, so unless you are on a long vacation chances are it will not develop until you return to your home country. The disease is more dangerous for older people. Vaccination is available and recommended but must be administered well in advance of your planned departure, and usually requires 2 doses. People who have had Hepatitis A once become immune to it.
- Hepatitis B:
- This form of hepatitis is much rarer among travellers except among sex tourists, who use their vacation time exchanging body fluids with fellow travellers or locals. Occasionally it is also transmitted through medical treatment - e.g. infected blood or instruments - thus it may not be the best idea in the world to get your cosmetic surgery done in a developing country. In the United States many people are routinely vaccinated against Hepatitis B as children. But generally Hepatitis B is relatively easy to avoid - don't have unprotected sex with infected strangers, don't inject drugs and avoid, if at all possible, getting vaccinated while abroad (.e.g. in some areas where yellow fever vaccination is mandatory you will receive a compulsory vaccination if you can't produce a valid vaccination certificate.) And don't get tattooed, even if it seems a cool idea at the time - you don't know how clean the equipment is.
- Typhoid fever is transmitted via a bacterium that may be present in food and beverages if it has not been prepared hygienically and has become infected by infected people handling the food. It is a difficult disease to detect as symptoms can be very vague - persistent high fever that may be accompanied by loss of appetite, general malaise, headaches etc. Typhoid fever can be prevented by being cautious about what you eat (see above, water purity, diarrhoea). A vaccine is available, but it must be pointed out that this is not 100% effective - its success rate lies in the 50 - 80%.
Insect Born Diseases
- Maleria is present throughout the tropical areas of Central and South America. In San Blas, Bocas del Toro and the Darien, Panama, a chloriquine resistant form of malaria exists. Travellers are advised to check with the CDC as to which areas are at risk and which are generally considered safe and which drugs to take as for prevention. Preventative anti-malarial medication must be started before you actually arrive in the infected area and must be taken until after your return. Get the exact details on dosage from your physician. The CDC gives the following guidelines:
All travelers to malaria-risk areas in Mexico and Central America (except for Darién Province and San Blas Province in Panama; see below for those areas), including infants, children, and former residents of these countries, should take chloroquine as their antimalarial drug.
Travelers to Darién Province and San Blas Province in Panama (including the San Blas Islands) should take one of the following antimalarial drugs (listed alphabetically):
- mefloquine, or
- primaquine (in special circumstances)
Most antimalarial drugs are well-tolerated; most travelers do not need to stop taking their drug because of side effects. However, if you are particularly concerned about side effects, discuss the possibility of starting your drug early (3-4 weeks in advance of your trip) with your health care provider. If you cannot tolerate the drug, ask your doctor to change your medication.
Anti-malaria drugs can have side effects and are pretty tough on the liver. You can compensate by using Silybum marianum (milkthistle seed extract) protect the liver.
All this being said, it must be pointed out that even the medication is not 100% effective. Be sure to prevent being bitten as much as possible. The beasts that carry the malaria virus are mostly out at dawn and dusk. Cover yourself with long-sleeved shirts and pants and hats at those times. Also, take sufficient and insect repellent. Usually DEET is the recommended poison. It is quite effective, especially in the higher concentrations, but it is also quite poisonous to your system. It is absorbed through the skin and collects in the liver. Also, it has the disadvantage of melting plastics, thus, if you rub the palms of your hands with it you may find it to have a damaging effect on any plastic items you may handle subsequently. It should be mentioned though that the deadly form of Malaria known as Malaria Tropicana is not present in Central or South America. Lodges and hotels in mosquito infested areas usually are always screened.
- Dengue Fever
- Underestimated, but posing just as much of a risk is Dengue Fever, which is endemic throughout Central and South America, as well as practically all other tropical regions of the world. Dengue fever is transmitted by day-biting mosquitoes, although their most active times are dawn and dusk. However, the mosquito don't keep to a particular feeding time table and can bite at any time, especially in dark and damp places, such as jungle trails. There are two main forms of the disease - Dengue fever and Dengue haemorrhagic fever. Travellers are generally at low risk from developing haemorrhagic Dengue Fever, but may develop Dengue fever. Symptoms develop quite quickly after being infected. Incubation period ranges from between 3-14 days. Symptoms include sudden onset of high fevers, severe frontal headache, and joint and muscle pain, general malaise and weakness and often nausea, vomiting, and an itchy rash that looks a bit like measles. The rash appears 3-5 days after onset of fever and can spread from the torso to the arms, legs, and face. The disease usually subsides eventually, but full recovery can take a while. There is no effective preventative medicine, except by avoiding to get bitten. If diagnosed soon after infection it can be treated effectively. The CDC recommends NOT to use aspirin or similar as self medication because of the blood thinning properties. Focus on immune system strengthening medicines and liver support.
- Risk of contracting this disease, which is transmitted by sandflies, is highest in South American countries, such as Peru and Brazil, though it occurs throughout the region. Sandflies can be ferocious along the Caribbean shores of Central America. There are two forms of the disease - a cutaneous - manifesting as skin lesions that appear like badly infected bites that refuse to heal and form scabs which eventually fall off to reveal something that looks like a skin crater. The other form affects the inner organs. This variety is harder to detect but can be much more dangerous since it slowly but persistently nags away at the liver and other essential inner organs. The manifestations of visceral leishmaniasis, such as fever, weight loss, enlargement of the spleen and liver, and anemia, typically develop months, but sometimes years, after a person becomes infected. If untreated, symptomatic visceral leishmaniasis typically is fatal. Sandflies are most active at dawn and dusk and at night. Protect yourself well at those times of the day and watch for symptoms. There are no vaccines or preventative measures other than try to avoid getting bitten - Lavish greasing with coconut oil is quite effective since it drowns the attackers. DEET also works, but is more poisonous. Just don't go and lie in the full sun after applying the oil, otherwise you will be fried.
- Considering other insect related conditions, being bitten by a botfly is relatively harmless, though by most travellers it is feared the most. The life cycle of the botfly carries a kind of disgusting fascination - especially among biologists. The botfly lays its eggs on a mosquito which subsequently buries them in the subdermal layers of the skin when it bites its victim. The mosquito bite develops into quite a lump while the eggs develop into larvae underneath the skin. Eventually the larvae emerges to complete the last stage of its development outside the host body. However, few people will want to play host to a botfly larvae for this amount of time. The usual treatment is to starve the larvae of its oxygen supply by applying Vaseline, glue or anything else that seals the skin. But the larvae still has to be removed; otherwise you will end up with a skin infection instead. One old 'Indian' remedy is to cover the breathing hole with a small wad of tobacco and tape into place. After a few hours the bug will give up and come out. Other people swear by camphorated oils or ointments such as tiger balm, which incidentally is marvellous for soothing itchy bites. Apparently there are also some locals who are especially skilled in squeezing the bugs out. At any rate, a botfly bite does not leave any lasting damage to the host.
- There are parts in Central and South America where Yellow-fever is present and vaccination is mandatory. This disease, which is potentially very serious and may even be deadly, is also transmitted by insects. However, there have not been any outbreaks in tourist areas for many years. This is because the mosquito who carries the virus has its eyes on monkeys as a primary target, rather than humans and the indigenous population who lives in the forest in proximity to any possibly infected primates tend to have a high degree of immunity. However, one should not be complacent about serious health risks, even if the actual is low. Yellow-fever is preventable by vaccination and the use of mosquito repellent measures. In some areas, e.g. Tambopata region in southern Peru, Yellow Fever vaccination is a mandatory requirement to prevent the possible importation of the virus from other infected zones and the spread to urban centers. Travellers who are not in possession of a valid yellow fever certificate will be obliged to get vaccinated at the airport. The vaccine may produce side effects in some individuals. It is best to get vaccinated while still at home to minimize any risk and discomfort once you are travelling. The vaccine is valid for 10 years.
Snakes, Scorpions and Stingrays
While scorpion and stingray stings hurt like hell, they are not usually deadly. Scorpions like to sleep in shoes. Thus it is highly recommended to shake out your shoes before you put them on. Sleep under a mosquito net to prevent anything from falling or crawling on you and never put your hands or feet where you can't see what might be hiding - especially at night. Have a flashlight handy for going to the loo etc.
Stingrays are quite shy and don't attack unless you step on them. The problem is they can be hard to see as they are masters at camouflaging themselves in the sand. So, any time you want to get into the water it is highly recommended to let any sleeping stingrays in the neighbourhood know about your intention by making noise, splashing the water before you get in and stomping your feet close to the water line. This will be enough to wake them up and lets the scurry away to safety before you step.
There are some deadly poisonous snakes in Central and South America though which travellers should know about.
- A grown fer-de-lance is a mighty beast with a deadly bite. They are quite irritable and have no qualms about biting anybody that comes too close. Their hunting range includes fields and milpas where they search for rodents. Occasionally they may even stray into houses in search of food. Their colouring is beige brown, with well defined black blotches along the spine, not dissimilar to the bushmaster, though the bushmaster is much less frequently encountered.
- The bushmaster is the most feared of the poisonous snakes -probably because its bite is the most fatal. This is not just due to the fact that its venom is so powerful, but mostly because it inhabits very remote jungle areas where the nearest access to medical facilities can be hours, if not days away, thus minimizing the chances of getting help before the poison takes a lethal turn. However, it is a rare and shy snake that is very rarely encountered and is mostly active at night. It prefers to make off than to actually bite anyone.
- Coral Snake
- The coral snake is a beautiful, rather small snake with very distinctive black, red and yellow rings. It is not a very aggressive snake and prefers not to bite. It is present not only throughout Central and South America, but also in south-eastern parts of the United States. There is another, harmless variety that looks very similar but has the rings in another order. Rule of thumb to recognize it, is if red and yellow stripes touch each other it is a coral snake. Coral snakes sometime venture into human habitations, but generally speaking are rarely encountered.
- Jumping Viper
- This stout-bodied viper is a little unpredictable. It is mostly nocturnal and tends to sleep among the leaf litter during the day. Its colours are brownish grey, similar to the fer-de lance, but it is a much smaller snake. Nevertheless it can be dangerous at it is hard to see and it can actually jump in order to strike. It mostly lives in the forest, but can also be found in plantations.
- Green Tree Snake
- There is a green tree snake, which, as the name implies, lives in the trees. It is hard to see because of its colour blending in so well. Its usual fare consists of frogs and lizards. It looks very similar to the unrelated and non-poisonous tree boa and can easily be confused. The poisonous green tree snake can and does occasionally bite if one gets close enough to them. Best to stay clear.
- Caiman and Crocodiles
- There are several species of Caiman in the Amazon and the relatively small and endangered Morelet's Crocodile can be found in Central America. Only the Black Caiman which lives in South America can be dangerous to humans - but in practice it almost never is. All these reptiles may eat small animals, but they don't seem to want to bother with grown humans. They would have to be extremely starved in order to become dangerous to people. In many areas local people swim fearlessly in waters that are inhabited by caiman or crocodiles.
Altitude sickness is a very real and common condition that can affect anybody at any time who ventures out above their normal altitude range. Even people who frequently go into the mountains can occasionally suffer from it - there is no set pattern that lets us predict who will get it when and where.
Altitude sickness is caused by reduced availability of oxygen at higher altitudes. Thus everybody's breathing will change at high altitudes as the body attempts to re-establish equilibrium. Being short of breath and having odd breathing patterns is a normal reaction. The symptoms of Altitude sickness are headaches in combination with loss of appetite, nausea, or vomiting, fatigue or weakness, dizziness or light-headedness, difficulty sleeping
Denial can be dangerous - even life threatening. Thus it is vital that if you feel unwell at high altitude you eat your ambition and get back down to a lower altitude where your body is better adjusted until you have acclimatized.
Before attempting any long hikes at high altitude spend some time adjusting to the altitude ahead of time. Spend a few days doing shorter hikes so your body can get used to the changed conditions.
Ignoring the symptoms of altitude sickness can be fatal.
And finally another couple of health tips for travelling in the tropics, whether at high or low altitude:
- Drink plenty of fresh water!
- Profuse sweating under the tropical heat or thin mountain air can quickly dehydrate the body, which is potentially very dangerous. Always carry adequate supplies of fresh water with you and drink copious amounts of it.
- Wear sun protection
- The tropical sun is intense and close to the equator it is right above you. Sun screen and sun hats are a must, especially at high altitudes, but also in the jungle.
Sunscreen/mosquito repellent mixtures are not recommended. DEET, the most commonly used insect repellent is intended for low dosage use, while sunscreen should be applied copiously. Remember that in the humid and sweaty conditions of the jungle you will have to apply both much more frequently than what the bottle says.
- Prescription Medicines and Glasses
- Bring more than adequate supplies of any prescription medicines you are taking and bring them in the original packaging to avoid confusion at the border. Also take an extra pair of prescription glasses if you wear them. Even if you wear contact, it maybe a good idea to have a pair of glasses as well for backup - sometimes the tropical conditions make cleaning and handling contacts a difficult business.
For further information consult the CDC website and/or the institute for tropical medicine for advice on prophylaxis and vaccinations. Get a check up before going and discuss any worries you might have with your health practitioner.
AND: ALWAYS MAKE SURE YOU ARE ADEQUATELY COVERED BY YOUR HEALTH INSURANCE - if not, take extra coverage!!!
It is advisable to get a check up upon your return, even if you don't feel sick. Some bacteria and viruses are pretty asymptomatic - which does not mean to say that they are not dangerous if left untreated.
The advise given here is not intended as professional medical advice or diagnosis. It is simply provided for information. Please consult your physician or institute for tropical diseases in your country before going on a trip to the tropics.