Keeping healthy on the road

Trying to climb into the hills of Cusco, Peru

Puff. Pant. Puff. Pant. Groan.

“Ha ha you guys are struggling to get up the hill and I’m the one that smokes!”

“Whatever Anthony. I’ve only been here for a day. What’s Daniel’s excuse?”

“Ok Robyn, but don’t you run or something?”

The three of us had met in our dorm room in Cusco, Peru, which is more than 11,000 feet above sea level or 3,400 metres, the night before. Daniel and Anthony, had already been in this gateway city to Machu Picchu for two days and me, one, so I felt justified in still gasping for breath.

The scary part? We were just trying to scale the minor hills behind Cusco, which are littered with ruins, llamas and a Jesus statue. Our puffing and panting had nothing to do, with the infamous Inca Trail (between four ad five days of crazy hiking through mountains).

To be fair my body, I threw it from Lima at 1,600 feet or 500 metres above sea level to more than 11,000 feet or 3,400 metres in an hour via plane. Had I taken my time via bus I may have adjusted. Perhaps this is why they serve oxygen at the airport? I’m not kidding.

But why do we experience altitude sickness? According to Dr. David Barber who is the Travel Clinic physician for the Department of Health in Bermuda, it happens because the amount of oxygen in the air decreases as we rise. This means: “People have to breathe harder to get the same amount of oxygen. People at high altitude also lose more water from their lungs when they expel the air.”

What are the symptoms? Headaches, gasping for breath and losing your appetite (not a bad one for me after binging in Argentina on steak and wine).

What’s my point this week in the Rock Fever Column with The Royal Gazette? Yes I am sure you would like me to get to it and it’s to take care of yourself on the road. When you are far from home things like altitude sickness could occur and if you don’t know what to do you may struggle to find doctors. So what should you do if you have altitude sickness? Drink lots of water and limit your exercise until your body adjusts. Well at least if it’s mild sickness. Oxygen (like at the Cusco airport) can also help while a doctor can prescribe drugs (thought not usually necessary) to help.

Which brings me to tip two in the ‘how-to-stay-healthy-on-the-road’ column this week: bring your drugs with you. Dr. Barber suggests having a good supply of medications you regularly need AND carrying them in your hand luggage. You know….in case the luggage gets lost.

Bringing medications prescribed by a doctor at home, leads to tip three in this healthy travel column: make sure you are in good health when starting to travel: dental problems and infections need to be addressed pre-travel.

A visit to the doctor post-trip may also be necessary. Malaria is particularly prevalent throughout Africa, but is also a problem in India and some other South East Asian countries. The pills to help prevent the disease are by prescription (pre-travel!) but if you return  and you don’t feel well (symptoms include high fevers, shaking chills, and flu-like illness) tip four is: make sure you tell your doctor EXACTLY where you’ve been so they can make a proper diagnosis.

Before you go, you should follow tip five and check with the Center for Disease Control (www.cdc.com) or guidebooks about the country you are going to and how safe their water and food is to consume. A Thai salad was fine. An Egyptian smoothie wasn’t.

Water bottles, drinking with a straw to keep away germs and hand sanitizer (it's there....in the lower right corner)

What does this tell you? How about the street food stall in India? Yeah tip six is that street stall in India is going to have questionable cleaning practices. So bring plenty of hand sanitizer which is compact, cleans hands and cleans cutlery!

And ensure the food you eat is fully cooked or the kind you can peel i.e. bananas, oranges. Why? Well Dr. Barber explained some illness including: Hepatitis A, which causes a liver infection and can cause Jaundice and Hepatitis E which can be dangerous for pregnant women and is similar to A are spread through contaminated food. I can personally attest to the intestinal parasite Giardia which was killed with two rounds of prescriptions. It wasn’t pretty.

Which leads to tip seven and sustenance of life which is: watching the water you consume….and that doesn’t have to be in the form of a glass. Nope. Depending on the CDC’s country diagnosis make sure you use bottled water for both drinking AND cleaning the teeth. Dr. Barber reminded travelers that of course ice is only as good as the water so if you can’t drink the water…..don’t use ice. Boiled water or water sterilizing tablets are alternatives while straws help keep contamination from the soda cans.

But water and food are not the only concerns. Tip eight is watch out for the cheese. This is not a Pink Floyd song with a hidden meaning. It’s seriously dangerous to eat dairy that has not been pasteurized properly.

Of course you shouldn’t stress too much about your trip though….don’t let it lead to alcohol abuse. Missed trains, planes delayed and travel buddies who don’t work can lead to the bottle. But tip nine is to restrain yourself. Dr. Barber explained that accidents, especially road accidents, are common for travelers. These can be attributed to unfamiliar roads, the ‘wrong side’ factor, but also the alcohol!

Coming from Bermuda our trips will also include plane travel. Well unless you’re doing the-soon-to-be ubiquitous term “stay-cation”. That said my final tip from Dr. Barber this week is to travel in comfort. Deep Vein Thrombosis – a blood clot in a deep vein (hence the name) – is a serious concern with prolonged travel in a plane or bus. Dr. Barber’s advice: Get up and move around when you can. Some other advice: Wear comfortable clothes! Nothing too tight.

Finally make sure you don’t pick-up germs from the plane with hand-washing and the antiseptic you don’t use for your cutlery in India.

Do you have any tips for traveling healthy? Leave them here or email at skinnerrobyn@gmail.com or visit my group on Facebook.

Travel Treatments

Me and My rice guys!

“Traveling is a brutality. It forces you to trust strangers and to lose sight of all that familiar comfort of home and friends. You are constantly off balance. Nothing is yours except the essential things – air, sleep, dreams, the sea, the sky – all things tending towards the eternal or what we imagine of it.”- Cesare Pavese

It’s Monday. It is brutal. So what can help? How about another column from Rock Fever? This week it is all about brutality. That which comes in the form of parasites unknown to my tummy.

I sat on the bathroom floor in Cairo, Egypt debating whether I would ever be able to exit. It was that salad! I knew I shouldn’t have eaten it but I wasn’t thinking. I had been traveling on little sleep and needed something quick.

The evil green lettuce leaves, feta cheese (or something that looked like it) and tomatoes attacked my stomach. They wouldn’t leave me alone for 24 hours. When I managed to escape their tortuous particles I found my bed and sent my travel buddy to find a pharmacy and some Sprite.

I spent the next two days trying to eat white rice and bananas. It wasn’t easy and was even harder being away from home. I’m very lucky it wasn’t worse.

Travel, while an amazing adventure is just that – an adventure. Food can attack, dogs can bite and weird illnesses can strike at any moment.

What does this mean? Not travel? No! Absolutely not. What it does mean is before the next trip you need to make sure you are prepared with the inoculations that defeat any salad attacks. I will be the first to admit I am terrible at remembering to do this, but immunizations are important and even mandatory for travels to certain countries.

And it’s an easy thing to do by visiting the Travel Health Clinic at the Hamilton Health Clinic on Victoria Street on Tuesday or Thursday afternoons by appointment. This week I spoke with Dr. Cheryl Peek-Ball the senior medical officer for the Department of Health about how Bermudians and residents should prepare their health for their trips.

Why would I go to the clinic rather than my doctor?

“Most doctors, I believe, do not chose to keep stock of the travel immunizations. If only one person travels and needs a yellow fever shot, then we end up wasting the other nine immunizations in the packet of ten.

“They also may choose not to focus on the practice of travel advice. Though there will be some routine adult immunizations they will do (i.e. Tetanus) which are also needed when traveling.”

How have you seen travel or visits to the health clinic change during the last few years?

“I think what has happened in the last couple of decades is that travel has accelerated and the world has become more integrated.

“I think people’s awareness for the need to prepare for travel has accelerated, especially when they visit in areas that are less developed. So the travel clinic in the last two to three years has expanded to two times a week.

“They are particularly busy in the summer months because of travelers, but added to that a lot of students are going away to university.”

Before you fly vaccinate!

An appointment can be made by simply calling the Travel clinic at 278-6460 But why do travelers need to make appointments?

“When we reach adulthood there are some vaccinations that should be updated. So it’s also a chance to make sure people are up to date with routine immunizations that people are given in child hood like the MMR. Hepatitis B should also be given to those working in an industry where they can get infections from body fluids.

“And then it’s a practical discussion about where they are going. And they need to talk about the water and food borne disease. It will be particular to the country they are going to.There can be some places where it’s not a problem. Western Europe is mostly ok, but then it can also have cluster outbreaks of measles and chicken pox. We use the CDC website and travelers should go to that website for up to date information about travel.

“The other part is making sure the risks are discussed and they have the right vaccines. We would talk to the traveler about the specific destination and what they are doing there.”

What should people remember before visiting the clinic?

1. An appointment is necessary: Simply call: 278-6460 to set-up a time during the weekly clinics on Tuesday and Thursday afternoons.
2. But don’t delay. Dr. Peek-Ball said: “They need to call well in advance of the travel. They need to make sure their passports are up-to-date, but we also have to encourage people to make sure they come well in advance of the travel.” Why? “We might be out of supply or they want to make an appointment and we are full. If four immunizations are needed then it’s better to come a month in advance and come in for two and then the second pair two weeks later. So the best advice would be to come two to three months before your trip.”

1. Bring a copy of your immunization records. “Some adults have their childhood records of their immunizations, but if not bring the yellow travel booklet. It is very very important to bring this to see which immunizations you already have. Because, for example, you only need Yellow Fever every ten years.”
2. Bring your itinerary and be clear on the specific itinerary. “If you are going to Indonesia every destination is not equal. There will be areas where a traveler will be more at risk for certain things than others.”
3. Know the dates of your travels: There may be specific times where the risk of certain diseases are more likely in the destination than others.

I understand it is free to visit the clinic, but the immunizations will cost money. Will I be covered by insurance if I go to the clinic?

“The Department of Health does not submit insurance claims there may be some companies who will cover these. The traveler will get a receipt for the immunizations they received and if they have that type of coverage with their insurance they would be covered.”

And of course visit www.cdc.gov/travel because Dr. Peek-Ball said: “The world is changing and places without Rubella and Measles are seeing outbreaks. It happened in South Africa and they were advising those going to the World Cup to get immunized. It’s good to be aware. It can certainly happen in various areas of the world.”

Have you got a story from your travels? Good/Bad/Medium? Did a salad manage to ruin your day? Or chicken cancel your plans? Let me know by emailing me at: skinnerrobyn@gmail.com. I’m always looking for more Bermuda Abroad stories!