he secret's out: Peace Corps volunteers aren't the only federal travelers who get diarrhea. The World Health Organization estimates that 20 percent to 50 percent of all travelers, stripe-suited government agency administrators and three-star generals among them, get it. It's the most common malady among international business travelers, says Dr. Bradley Connor, a spokesman for the International Society of Travel Medicine.
The most common ailment for domestic business travelers is colds and viruses picked up in crowded airports and airplane cabins. Many airlines that once pumped fresh air into cabins are now recirculating air because it saves fuel. Unfortunately, it also circulates germs.
There are steps travelers can take to protect their health before, during and after a trip. But swallowing vitamins may not be enough. Before they leave home, wise travelers also consider what they will do if their worst medical nightmare comes true. Because if it does, having to use an air sickness bag will be the least of their worries.
Dangers Lurk
What travelers don't know about the region they are visiting can kill them, or leave them with some nasty scars. In Latin America, for example, a bite from the 1-inch vinchuca or barbeiro insect, often present in rural and suburban accommodations, may transmit Chagas' disease, which, if not treated in its early stages, causes heart failure. Travelers can prevent the disease by checking their rooms for insects and using bug repellents and insecticides. In some areas of Africa, washing clothes in a hotel sink and hanging them up in the shower to drip dry, a common practice among feds who pack light, is not recommended. Tumbu flies lay invisible eggs in wet fabric, and when egg-infested clothes are worn, the larvae burrow into the person's skin. The first sign of infection is translucent pustules in which the wriggling larvae can be seen, accompanied by uncontrollable itching. Travelers can avoid starring in their own version of the movie Alien by making sure clothes are dried in a machine and pressed with a hot iron, which will kill the eggs.
Travelers visiting tropical and subtropical regions where malaria is present must take anti-malaria pills before, during and after their trip. Malaria is a potentially fatal blood disease transmitted by parasite-carrying mosquitoes. A patient can survive malaria, but the parasite cannot be purged from the blood stream and the disease may return years later. Malaria is continually evolving and becoming resistant to medications, so travelers must consult a doctor who specializes in travel medicine to find out which drug is currently most effective for their destination.
These days, the anti-malaria medication that the State Department and the Centers for Disease Control and Prevention generally recommend is mefloquine, sold under the brand name Larium. Larium is the strongest anti-malaria drug developed to date, and healthy travelers who have taken other malaria medications without incident have reported side effects ranging from insomnia and hallucinogenic dreams to acute depression and panic attacks. While hallucinogenic dreams are certainly preferable to malaria, many travelers have complained that their doctors did not sufficiently warn them of the risks. The manufacturer's research indicates that 22 percent of users will react adversely to the drug in some way. Travelers can minimize side effects by taking the weekly pill with a large, high-carbohydrate dinner, and washing it down with lots of liquid.
An Ounce of Prevention
The Centers for Disease Control and Prevention provides information on health risks on its Web site (www.cdc.gov) and its 24-hour automated telephone system (404-639-2572). The State Department's consular information sheets supply cursory information on medical facilities available around the world. The sheets are available online (travel.state.gov), from an automated fax system (202-647-3000) and at U.S. embassies and consulates overseas.
Medical experts recommend:
- Getting immunizations. Inoculations are not just for international junkets. Even domestic trips expose a traveler's immune system to new food, water, climate, altitude and airborne pathogens, so it's best to update all standard vaccinations-diphtheria, tetanus, measles, mumps, rubella, polio and whooping cough-before departure. Travelers shouldn't procrastinate about getting jabs--shots for some diseases require repeat visits.
- Packing a medical kit. When traveling abroad, carry prescription medicines in their original packages to subdue customs officials' suspicions. Carry copies of prescriptions for medications and for eyeglasses and contact lenses, translated into metric measurements if traveling abroad.
- Preparing a brief medical history. Medical Advisory Services for Travelers Abroad (MASTA) suggests travelers carry a record of medical problems and treatment, medicines they are taking, along with dosages and schedules, and allergies to medicines. This information, plus a blood type, can be attached to a traveler's immunization record. Travelers may wish to join Medic Alert, a nonprofit organization that provides members with a 24-hour switchboard number a physician can call to find out information that may affect treatment, such as allergies to medication or HIV status. To register, contact Medic Alert at 2323 Colorado Ave., Turlock, Calif. 95382 or call (800) 763-3428. Membership costs $35 for the first year, $15 for each year thereafter.
ISTM's directory of travel medicine clinics worldwide is available on the Internet (www.istm.org) or from travel agents.
During and After
During a trip, travelers can prevent trouble by exercising caution around food and drink. Besides causing travelers diarrhea, contaminated food and drink can transmit typhoid and paratyphoid fevers, poliomyelitis, viral hepatitis A and parasitic infections that linger for years.
On international trips, the World Health Organization recommends that travelers avoid uncooked food (apart from fruits and vegetables that can be peeled), unpasteurized milk and non-bottled drinks. Freshly cooked food served piping hot is safe. But, the organization warns, "cooked food held at ambient temperatures (15 to 40 degrees celsius) for some time (more than four to five hours) constitutes one of the greatest risks of food-borne disease, since contaminating or surviving bacteria may multiply in it." Wise travelers avoid ice, and brush their teeth with bottled or boiled water.
On domestic trips, unavoidable rich business lunches may set off a bout of travelers diarrhea. Travelers who pick at their meals may have fewer problems later.
Travelers who are on the road for less than a month and feel perfectly healthy the entire time need not see a doctor upon their return, says Connor. However, he says, a visit to a physician is in order for people who engaged in risky behavior such as eating raw fish in the Philippines; were sick while traveling, even if they feel healthy; or became ill after they returned.
Preparing for the Worst
Every traveler should know the answers to the following questions before they leave home: If [insert personal medical nightmare here] happened,
- How would I find a doctor?
- How would the doctor get my records?
- How would I pay for medical services?
- How would I notify my family?
Ailing employees who decide to head home are encouraged to book a contract-fare flight. But an employee is not prohibited from a non-contract fare flight if the plane leaves sooner or is more direct.
While incapacitated, an employee will continue to receive per diem for up to 14 days, after which an extension may be granted. If a federal traveler receives treatment at a government-run facility, they will not receive per diem. When federal employees travel, they're covered by workers' compensation 24 hours a day.
Before traveling, employees should contact their supervisors or human resources offices to find out their agency's plan for medical emergencies.
Travelers should also check their insurance coverage. Most insurance companies cover emergency care wherever an accident or illness occurs in the United States. In a non-emergency situation, however, a traveler may be required to visit a doctor within a particular health care network.
If travelers' health plans can't direct them to a doctor in a strange town, they can call the customer service number on the back of their government or personal American Express card, and an operator can refer them to medical care. Travelers can also join the International Association for Medical Assistance to Travelers (IAMAT) and receive a free directory of Western-trained, English speaking doctors in 125 countries. Association doctors charge $45 for an office visit, $55 for a house call and $65 for an evening or weekend appointment. To join, contact IAMAT at 417 Center St., Lewiston, N.Y. 14092, or call (716) 754-4883. Contributions are urged.
Not all physicians will fax medical records on demand, so travelers should find out their doctors' policies.
In case of death, travelers should carry their organ donor card with them. While not all foreign countries honor out-of-state directives, a traveler can register living wills with the 24-hour Docu-dial system offered by Choice in Dying, a nonprofit group. To register, contact Choice in Dying, 200 Varick St., New York, N.Y. 10014 or call (212) 366-5540. Docu-dial costs $55, or $45 for organization members.
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