Aug 252016
 

One of the most common questions I get about travel regards staying healthy. Not the normal stuff like how do you avoid catching a cold flying in a large tin can filled with sick people, but how do you actually stay healthy in developing countries? This question is usually followed by “oh I could never go to Africa, don’t you need lots of shots?” Well, yes, and no. To try and address some of these questions, I’ll break travel health in developing countries down into three categories: (1) what shots do you need (2) what medications do you need and (3) what is safe to eat and drink?

As a bit of background, two things I need to mention: this isn’t professional medical advice, but much of it is pulled from the US Center for Disease Control (CDC) or other governmental travel health sites. Consult your own travel health specialist for a professional medical opinion. Secondly, this isn’t advice for your next vacation to Paris or London. In general traveling in developed countries (most of Europe, major cities of Southeast Asia, Australia, Japan, etc) doesn’t require too much in the way of specialized preparation as far as travel health goes. Oh, but if you go to Australia the sun is most uncivilized, so you might want to bring extra sun cream due to the holes in the ozone later. Moving right along…

Eating and Drinking

As far as eating and drinking go, the first thing you should always think about is water. You need clean water to survive, and that’s not always the easiest thing to find. The good news is, in most developing countries lots of people drink bottled water for safety, so it’s relatively easy to find. Drinking tap water just isn’t worth the risk – it would be all to easy to at best catch some stomach bug that ruins days of your vacation and at worst you could end up with some nasty parasite. Even if this means getting extorted by your fancy hotel for a $5 bottle of water at the hotel restaurant, do it! Think of how much you spent on your vacation, and the $5 is a small price for staying healthy. Also, when buying water, make sure the bottle is still sealed. If there’s any question that the seal might have been tampered with, don’t drink it! People are of mixed opinions on brushing teeth with hotel tap water, but personally I don’t risk it. It just takes a few splashes of bottled water to brush your teeth, so again, not worth the risk.

Regarding other beverages, in many developing countries you’ll find lots of fruit juices for sale, especially on the street. Generally you have no idea how clean the press making that juice was, so I would personally avoid it. In hotel restaurants and in restaurants with a more middle class group of local people I would say beverages in general are safe. You should be drinking lots of water anyways, but any other sealed and bottled beverages are generally safe as well. Including beer…you should always try the local beer! (unless you think it was brewed in someone’s bathtub…)

Food is much, much trickier. One good rule to go by is to go to places that are popular. Locals usually know the safe (and tasty) places to eat, so anywhere busy that is popular with locals is a good bet. Even better if you see lots of expatriates there – word tends to get around the expatriate community quickly about which places are sanitary to eat and drink at. A few good rules are to always be cautious of salads. Lettuce tends to get washed (if at all) with tap water, which opens you up to all the water problems. Also, anything that’s been sitting out for a long time or that is covered in mayonnaise is also a no-go in my book. I also tend to avoid seafood unless I know it actually came from the sea and is fresh. You’re not going to catch me ordering prawns in the middle of Chad. Best case they came in frozen from somewhere over 1,000 miles away, worst case…well, I don’t want to think about that… If you’re going to eat fruit, peel it first, or at least make sure you can wash the skin with bottled/filtered water.

Medications

Getting sick happens, it’s a fact of travel. Especially colds and other viruses, these things can happen anywhere, but it especially sucks when you travel. Since in developing countries it can be difficult to get basic medications, I always travel with a few basics just in case. A good list of medications is aspirin/advil/tylenol/ibuprofen, something in case your insides go evil…and you absolutely have to leave your hotel like Imodium/Loperamide, and a generic cold/flu medication to treat things like runny nose and congestion. Hopefully they are things you won’t need on your trip, but you’ll be thankful you have them if you do!

Beyond that, there are lots of places it’s super-smart to take prophylactic medication against Malaria. There are several medications out there, and a travel health clinic can advise which is best for the country you’re going to. I personally take Malerone (Atovaquone/proguanil) as I’ve never had any side effects from it, and taken once a day it has helped me avoid Malaria up until now. The CDC has a great map of where malaria is found, but the mosquitos which carry it tend to come out more at night, and reproduce in standing water. It’s not nearly as common in cities as in more rural areas, but consulting the CDC map is a great place to start. Since I have no side effects from the medication I tend to be overcautious and take it if there’s any risk, but it’s a personal choice.

Shots, Jabs, Stabs, and Vaccines

First off, if you don’t believe in science or are an anti-vaxxer please stop reading. I’m going to recommend you get jabbed to protect yourself while traveling. Because…science.

Ok…now that that’s out of the way, vaccines really fall into two categories: those you must get to travel to a country, and those that are optional. Surprisingly, only one vaccine is generally mandatory for travel and that is the yellow fever vaccine.

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Many countries require you to show proof of yellow fever vaccine to enter the country, and if you can’t one of three things will happen: either you’ll be denied boarding by the airline before you even get on the plane (ask Ian his story about this happening to him in Colombia), you’ll be turned around and not allowed to enter when you land, or possibly the worst, you’ll be forcibly vaccinated at the airport by some needle and vaccine of unknown safety…and often charged for the convenience. Spare yourself this, and get the vaccine in advance if the country you’re traveling to requires it. You get a nifty little yellow book (also helpful for recording your other vaccines) that shows where and when you were vaccinated. The vaccine is good for 10 years, and after that you’ll need a booster to be allowed to travel. The medical community is still a bit out to debate on if the booster is really needed, but countries require it to travel, so you’ll need to get it.

Most people probably got a vaccine for measles, mumps, and rubella as a child. At least in the US, people generally don’t get booster shots for this, however, there have been recent mumps outbreaks in the US (I know people who got it), so it’s recommended you get a booster if you think there’s a chance of being exposed. Again, your doctor is the best source of advice on this, but most people have it taken care of when small. Another childhood vaccine to make sure is up to date is Polio. There have been outbreaks in recent years, so best to check with your doctor if you should get a booster.

That brings us to Diphtheria and Tetanus, also know as the DTaP, Tdap, or Boostrix vaccine in the US since it also covers Pertussis. Current FDA guidelines say that only one booster dose is needed in a lifetime, but I know many doctors still give additional boosters if you do stupid stuff like step on a rusty nail…I’ve personally had at least three boosters I know of, so best to check with your doctor as there seems to be different advice on this one. You probably got it as a kid, probably had at least one booster as an adult, but best to check with your doctor before traveling to somewhere you might not be able to get a booster if needed.

There are two different Hepatitis vaccines out there as well, covering Hepatitis A and B. Hepatitis A is spread by the fecal-oral route, and is a good thing to have if you’re traveling in developing countries. Food preparation and hand-washing standards might not be up to snuff, and the CDC strongly recommends you get a single dose before traveling…even if you’re going to be staying in luxury hotels. They say to aim for four weeks before travel, but any time before travel is better than not at all. Hepatitis B is blood-borne, and usually sexually-transmitted or through contact with needles or other bodily fluids. This one isn’t really travel specific, but the CDC has a rather long list of people they recommend receive it. Again, check with your doctor….

This brings me to a few less common vaccines that you can decide on for yourself in consultation with your doctor:

  • Typhoid is nasty, and probably a good idea to get vaccinated against. It can be spread by contaminated food and water, and is common in developing countries. Unfortunately the vaccine is only 50-80% effective, but hey, that’s better than nothing!
  • Meningitis┬áis mostly a problem in central Africa, and that vaccine is actually required before you can enter Saudi Arabia on Hajj pilgrimage. Not technically required for other travel, I got this vaccine anyways, because hey…who wants Meningitis? Plus, meningococcal disease can progress from a stiff neck and fever to death in a matter of hours, so prevention goes a long way to minimizing the chance of serious problems. It’s not long-lasting, however, and a booster is needed every five years or so.
  • Japanese Encephalitis is a problem in parts of Asia, but this is one I skipped. It’s usually only recommended if you’re going to be spending a longer period of time in the region. Like most mosquito-borne illnesses, it’s much more common in rural areas.
  • Cholera is also quite common throughout Africa as well as south and southeast Asia. The vaccine, however, is not terribly effective, and both travel medicine doctors I consulted with recommended not getting it. I did, however, get shaken down on the Congo-Angola border and told I had to have it…and the offered to give it for about $3 with their who-knows-how-sanitary needle…or I could pay $10 and just get a stamp and a wink. Cholera vaccine isn’t currently required for travel anywhere, so don’t fall for this!

So that about sums things about – lots to think about, but what it really boils down to is a little prevention can go a long way towards preventing serious illness. What travel health tips have you discovered in your travels that are worth sharing?

Jan 302016
 

Holiday Inn shuttle dropped me back at the airport, and there was a rather long queue to check in, but fortunately nobody at all in the business class line. Quickly printed my boarding pass, gave me directions to the lounge, and it was off to immigration. Again, super long queue, but none in the priority line and was through to security in a couple of minutes. Immigration queue seemed to have relieved the security queue, and there was no wait. Walked through duty free, and had no trouble finding the lounge.

This is where things got weird.

Gave her my boarding pass, and was met with “Oh good evening Mr M, we have been expecting you. Right this way.” She walked me to the back corner of the lounge, there was a table already set up, and she made sure to mention “this is the coolest corner in the lounge, we have a nice table and beverages for you, and there is a power outlet right there.” Either someone in this lounge secretly reads my blog (and somehow knew I was traveling?) or some friend or colleague tipped them off. I have yet to find out who…

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Stayed right up until flight time, and the cookies were, btw, delicious.

British Airways flight 78
Accra, Ghana (ACC) to London, Heathrow (LHR)
Depart 22:40, Arrive 5:05 next day, Flight Time: 6:25
Boeing 747-400, Registration G-BNLF, Manufactured 1990, Seat 5K
Miles Flown Year-to-Date: 13,491
Lifetime Miles Flown: 2,180,529

British Airways is funny, in that they don’t yet you choose your seat more than 24 hours in advance, even if you’re in business class, without paying for it. When I checked in at 24 hours, I noticed they were letting business class passengers choose the first class seats. A bit of research yielded that BA has just one old 747-400 left, and people get pissed if they pay for first and get these seats. So, instead, for the rest of its life BA condemned it to fly London-Accra (changed to Vancouver-Accra in February) and give away the first seats with business service.

I had to spend an hour with BA phone support to select the seat (something to do with being ticketed on an Iberia ticket), but soon was able to confirm in “first” seat 5K:

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Shot across the cabin…this actually kind of reminds me of the old 747 United first seats:

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Pre-departure champagne and really strange amenity kit:

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Power by emPower?! What is this 1998?!

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Shortly after takeoff, wine was offered with some nuts, and a very generous pour:

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Despite the late departure, a very nice dinner menu was on offer:

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To start the meal, another extremely generous pour…and who says the British aren’t drinkers…

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The salmon and salad were…acceptable. Roughly United standard in my book…but Archer made it much better…

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The chicken, unfortunately, was dry and flavourless. The jollof rice was a bit better, but…

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The pineapple tiramisu was nice, but more of a mousse with some pineapple sauce than really tiramisu.

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The cheese plate was…once again United quality…which doesn’t say much…

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Managed about four hours of sleep due to a comfortable seat. I should mention when I asked the flight attendant if she could please keep the cabin as cool as it was overnight and try and find me a second pillow, she was more than happy to do so. Also asked if she could wake me at the last possible second before landing, which she also did. The crew was really great on this flight, and really left me with a positive experience.

About 7-8 minutes before touchdown I was woken up, put on my glasses…and eventually stumbled extremely bleary-eyed out of the plane for my first T3 experience. Yes, fortunately, we hadn’t come into T5 today, and were in T3, so it made connecting to American easy. American actually has a nice transfers area when you arrive, and when I went up to the business class desk, she asked if I might like to take the earlier connection to Chicago. Originally, I had a nearly six hour connection (since that’s all that was bookable on the low fare) but this was great! She managed to get me an aisle seat, and I was off to the Admirals Club for a shower.

After a shower, I enjoyed a nice bacon sandwich for breakfast…along with a Diet Coke:

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Soon, it was time to board, a short walk from the gate. I vaguely remember T3 from the days United occupied it as well, but nothing looked at all familiar. Have things been remodeled?

American Airlines flight 87
London, Heathrow (LHR) to Chicago, O’Hare (ORD)
Depart 8:40, Arrive 11:35, Flight Time: 8:55
Boeing 777-200, Registration N792AN, Manufactured 2000, Seat 12J
Miles Flown Year-to-Date: 17,444
Lifetime Miles Flown: 2,184,482

Ewwww old slanty lie-flat seats, a 2-3-2 config? Even United doesn’t have slanty seats any more. Between BA and AA, so far I’m not impressed with transatlantic OneWorld business class. What I am impressed with, however, was the eight people occupying like 35 seats. Score!

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Lots of room:

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Sorry it’s blurry, but you get the idea. Transatlantic breakfast flights are always disappointing, and this one was no exception:

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Bubbles…just to see if American pulled the same plastic glass crap that United does. Answer is: yes.

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Taxi was past…Concorde!

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This was just a hot mess of a meal. I wanted something more than water, but not a cocktail, so settled on an old childhood standby: ginger ale and OJ. The flight attendant had never heard of it before, and honestly, it was the best part of this meal. The fruit was dry and flavourless, the biscuit was just plane dry, and the eggs? Yuck. The worst part, however, was the yogurt parfait slathered in whipped cream and artificial berry jam. I think I took four or five bits of the whole meal and gave it right back. Awful.

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At least the cheese plate was decent? I tried to get seconds, but were told there were “no more, that’s the last one.” Um, with only eight passengers, seriously?

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Slept another three solid hours since I hadn’t gotten much on the prior flight, watched some tv, and soon it was snack time. Diet coke and Jeff, I mean Oscar, I mean Hector’s famous split cashews:

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Nice little deli plate. Nothing outstanding, but solid. Much better than the breakfast, and a decent white wine to go with it:

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Soooo, then we land. Overall impressions: the flight was pretty good. I think had it been a full cabin I would have come away extremely unhappy. Seat wasn’t great, food was well below average, the crew was pretty average, it was just…meh for a transatlantic. That said, one flight doesn’t tell you much and I’ll certainly give American more chances to prove themselves going forward since I have Executive Platinum status for the year now.

Short walk to immigration in Chicago, and this is where the fun began. I hoped that having global entry might automate things, but one of the first questions to pop up was “Have you traveled to Guinea in the last 28 days?” Yes/No question, lying on Global Entry can get privileges revoked along with whatever other crimes they could charge you with, so I was honest and answered yes. This immediately spat out of the machine with no further questioning:

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There was a dedicated immigration agent helping Global Entry passengers, so I gave it to him and told him “I’m sure the X is because I was honest that I visited Guinea.” He said “wait, that Ebola thing? Isn’t that done? Let me check.” Tapped on his computer a bit. Called a supervisor over. Supervisor called someone on the phone, the made lots of notes, asked me how long I’d been there, what I was doing, where I’d gone, etc. I was honest that I was working on going to every country, and stayed in Guinea as short as possible to minimize risk, etc etc. He said ok, everything was documented, you’re good to go.

Walked through baggage claim, to the customs guy, gave him the receipt, and he said “oh, you’re the Ebola guy, I need you to go with these officers and speak to the CDC.” Uhhhh, ok? Got escorted to a desk near baggage claim with a bunch of CDC posters by it, and learned the Chicago was a designated Ebola quarantine station, one of a few airports in the US that had been designated to accept passengers from Guinea, Liberia, and Sierra Leone at the height of the epidemic. My flights were on a different ticket so I likely would have arrived in the US undetected, but if you were coming direct from one of those countries a few months prior, you were only allowed to enter at certain points of entry, one of which (fortunately for me) was Chicago.

I was walked into a back office by CBP, who were extremely friendly and professional through the whole thing. They called the CDC agents on the phone to tell them to come in, and meanwhile, started filling out an online questionnaire. Typical things about fever, rural areas, funerals, unusual bleeding, playing with dead bodies, etc. At that point, I was given a gift from the government:

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Fortunately, my temp came in at 99.1, which was way higher than normal – probably due to the dehydration of a long flight. Fortunately, it wasn’t over their caution thresholds, and I was given the thermometer to keep “courtesy of your government.” Gee, thanks! Who says the government never gives you anything for free?!

I thought I was done at this point, but nope. Now, it was time to have a chat with the CDC people. Same exact questions about where I’d been, unusual fevers or bleeding, dead bodies, etc, and I think I got off a bit easily because they could tell I was clearly Ebola-aware as well as medically-aware, and ensured them I would immediately call county health officials and self-quarantine if I experienced any symptoms.

They seemed satisfied with that, and let me go, but not before giving me this card and insisting I carry it with me for the next 28 days. Great…now let’s just hope I don’t get knocked unconscious and start bleeding playing hockey, mkay?

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Since the great fare I’d gotten was Accra to Chicago, I had to buy a separate ticket from Chicago to DC. Decided on United, and fortunately was able to confirm an earlier flight online as well. But, this meant heading over to the B-Terminal, where there was as very joyous lady on the inter-terminal shuttle proclaiming her love for America:

Had to wait nearly 20 minutes for TSA PreCheck line, but other than that I still had plenty of time to hit Chilis for an El Presidente Platinum margarita and some Tex Mex eggrolls. Priorities, you know.

United Express flight 6469 operated by SkyWest
Chicago, O’Hare (ORD) to Washington DC, National (DCA)
Depart 15:00, Arrive 17:55, Flight Time: 1:55
Embraer E-175, Registration N105SY, Manufactured 2014, Seat 4A
Miles Flown Year-to-Date: 18,056
Lifetime Miles Flown: 2,185,094

United domestic first on an ERJ – nothing to write home about, but we were more or less on time, beverages were served (no snack basket today), and that was that. Another fantastic trip in the books. Thanks again to Daniel and Jordan for joining, trips like this are much more fun when you have others along to share the crazy with. I was supposed to have no more international travel until May after this trip, and really thought I didn’t when I landed in Chicago.

However, in the approximately two weeks since then, trips to Quito, Belize, and two weeks in Cape Town for work have all come on the books. Add to that a two week trip to check off Tuvalu (and burn American miles thanks to now being Exec Platinum and not having change fees), with stops along the way in Hong Kong, Fiji, Paris, London, and Abu Dhabi to try the Etihad Apartments, and this spring is suddenly quite packed!