The US Center for Disease Control (CDC) web site (wwwnc.cdc.gov/travel/) is my go-to internet source for travel advice regarding disease prevention and vaccinations. There has been a lot of controversy regarding vaccinations in the news, and I won’t argue one way or the other. I choose to get vaccinated and stay up to date for all the diseases listed by the CDC as necessary or recommended for my destinations. I also check back with the site periodically even if I know my vaccines are up to date, because new vaccines come on the market. Some are improved versions of older ones but others are for diseases formerly not covered. Do give yourself time and plan ahead; many vaccines are given as a series with shots spread over a month or more and the entire series (or at least the first two shots) required for maximum resistance.
If your memory is anything like mine, get a vaccination log book and keep track of your shots. In the US, one comes with your yellow fever vaccination, a folding yellow card slightly larger than your passport. There is an area for official yellow fever records, but also an area for other shots. I like having my records all in one location. I call this an “official” yellow fever vaccination because by law, a country can refuse you entry if you cannot prove your yellow fever vaccine is current. I have never been asked to show my records, nor do I know anyone who has. My philosophy is that while customs and immigration officials in most places are courteous and helpful, the occasional sticky situation could be compounded if asked and unable to produce this bit of paper. So, why risk it? I carry my yellow card with me and treat it similarly to other valuables.
In a recent conversation with a friend who has an autoimmune disorder, she told me she is unable to take the yellow fever vaccine because it is a live vaccine. Instead, she carries a note from her doctor stating that she is unable to take that particular vaccine. To date, it has not been questioned though it sounds like a great travel forum topic.
I generally take antimalarial drugs if traveling in a high risk area, but I have experienced the alternative. While visiting the Caroni swamp in Trinidad to see the scarlet ibis roosting (a magnificent sight), I was bit by a malarial infected mosquito. In reality I was probably bit nearer a town since malaria requires a human host, but I like the swamp setting better! In any case, I was completely oblivious to the event and it took me some time to realize that I was infected.
Because malaria, or the Plasmodium species that causes it, is best detected in a blood sample taken in the midst of an attack, and the first attack may not be for some months, malaria is a tricky thing to diagnose. As a graduate student, dragging myself to the doctor during the critical period, (lasting about 48 hours in my case) was not a priority. When the systematic repetition of attacks finally jogged my brain into action, US doctors were reluctant to trust my instincts. Left undiagnosed and untreated, I had attacks about every 5 months for nearly three years. My savior was a Mexican doctor met on a bus in the Yucatan who was kind enough to listen to my symptoms. He said it sounded like malaria and sent me to the pharmacy for less than a dollar’s worth of medicine. I have not had an outbreak since following his advice. May he live long and prosper!
As the Bill and Melinda Gates Foundation documents, malaria kills hundreds of thousands each year. Because it may reside in the human body in multiple life stages, and it has evolved resistance to many antimalarial medicines. Malaria is not always simple to cure. Also, symptoms are varied and as said, may first occur after some delay, weeks or many months after the initial infection. Do pay attention for any illness, flu like or other, if on an extended trip, or after traveling in malaria infested areas. If you see a doctor, be sure to tell him/her where you traveled in the last year (or more) and what vaccines and anti-malarial you took. And at the risk of sounding motherly, follow all the directions for your anti-malarial. I took pills while three weeks in Trinidad and Tabago, but neglected to take the remainder upon returning home and paid the consequences. For more information regarding malaria, the CDC webpage is an excellent resource (http://www.cdc.gov/malaria/about/index.html).
Lyme disease is transmitted by the bite of black legged ticks (Ixodes) found in temperate forests, brushlands and grasslands of North America and Eurasia. Many web pages indicate that the development of a characteristic “bulls eye” ring rash around the bite location is diagnostic. Unfortunately, the ring rash is unreliable with occurrence reported in from 50% to 85% of cases. Though treatable with antibiotics, if untreated it can affect joints (mimicking arthritis), the heart, and, or the nervous system. In my opinion, it is under-diagnosed where I live in western North America, a Lyme hot spot. Information about lyme disease and travel can be found at the CDC Lyme web page http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/lyme-disease.htm. Additional information can be found at the web site for Ixgenex, a lab that will test ticks for presence of Lyme www.igenex.com. Avoiding tick bites is similar to avoiding leaches, by not giving them a point of entry and using repellants. Also, check for ticks after being in the field. If you are bitten, and you have the tick in hand, the Igenex lab in California will test it for a fee. I’ve linked the request form downloaded 11/2013 here, purely for convenience; I have no ties to this company.
This quote from Alfred Russell Wallace is amusing only because of his understated language describing a worst case scenario. He was reportedly unable to walk for some weeks. It comes from his journals while collecting insects and birds in the Malay Archipelago in the 1780s.
Ever since leaving Dobbo I had suffered terribly from insects, who seemed here bent upon revenging my long-continued persecution of their race…On arriving here we were delighted to find the house free from sand-flies or mosquitoes, but in the plantations where my daily walks led me, the day-biting mosquitoes swarmed, and seemed especially to delight in attacking my poor feet. After a month’s incessant punishment, those useful members rebelled against such treatment and broke into open insurrection, throwing out numerous inflamed ulcers, which were very painful, and stopped me from walking.
Since it is pretty much impossible to avoid being out (birding) at dawn and dusk when mosquitoes carrying malaria and dengue are most active, what can you do? Cover up as much as possible and use repellent is my strategy. As mentioned elsewhere in this website, I have found that shirts impregnated with mosquito repellent work quiet well. They are available in most camping and travel stores. Keep in mind that with washing, the shirt will lose its repellant abilities, so consider how long you have owned it. Also consider how long it was on the store shelf before relying on it for protection. The one I bought from the sale rack was not as effective as the one newly displayed, though of the same brand. I also pack a frameless mosquito bed net and 20 feet of thin line for hanging it. Even if rarely deployed, I consider the mosquito net worth its weight in gold for sleeping in the occasional buggy room.
Deet is a very effective mosquito repellent, and your binoculars worst enemy. It dissolves rubber coatings, eye pieces, lens coatings, neoprene straps, cheap reading glasses, and cell phone buttons. If you chose to use it (and I do) be sure to stand well away from your equipment, and far downwind of fellow birders before applying. I once watched a fellow pull out an aerosol can in a crowd of birders and blithely spray his neck causing an instant scattering of people. Considered by many to have been a hanging offense, it was not a good way to make friends. Do use common sense before applying.
As stated, I do use Deet to treat the outside of my boots and clothes, and to a limited extent, my skin. Though it can be argued that roll-on applicators are better for preventing potential overspray, I use pump spray (not aerosol) containers because I find they give better coverage. I always store it in a separate zip plastic bag in my pack, and double bag it when possible, for airplane rides. To prevent the inadvertent transfer of Deet to my equipment, when applying to my face, neck, or head, I spray it on the back of my hand and apply from there, rather than spraying my palm or fingers and wiping it on. You also breathe less chemical than if spraying it directly to your head.
Something I’ve noticed is that a birder’s elbows are particularly vulnerable to mosquitoes. When holding up binoculars the shirt is pulled tight against them, and they become targets for mosies. I try to remember to give my elbows a little additional attention when applying repellant.
Some people are allergic to Deet, and if possible, I check with my guide and travel companions before using it. Because the allergy is so prevalent, and I hate using Deet anyway, I make my own repellant from scentless organic hand cream and citronella oil, available in most natural foods stores. I combine them at a rate of about 3 ounces hand cream (airline size) to ½ teaspoon citronella. You can experiment with strengths, but too strong and the citronella will burn, particularly where you are wind chapped or sun burned. Do not use citronella oil straight! Keep in mind that though very fragrant, it will need to be reapplied every few hours for maximum efficiency. Also, you may need to shake the container before application to keep it the oil in solution. When making the repellant, use unscented lotion to prevent inadvertently attracting other insects. I once used a lavender scented lotion with citronella which instantaneously attracted large and annoying bee imitating flies. Fortunately they were stingless, but my flapping around to keep them off didn’t increase my prospects for seeing birds. Similarly, think before using that lovely frangipani scented soap or cologne before going into the field; it can also attract unwelcome bugs. In any case, be sure to test your tolerance for a repellent before relying on it.
Leaches, to my knowledge, do not carry any human diseases of concern. They do make bloody messes of ones clothes. The strategy I employ with leaches is to try not to give them any point of entry, and to discourage them with repellent. By far, the best method I’ve used is knee high, rubber boots over trousers tucked into socks. The boot top and trouser leg are sprayed with Deet. Do I still get the leach bites? Yes, but because they are usually on my torso, I expect these are picked up from shrubs and low branches rather than the ground. I have not worn leach socks very much, but others swear by them. They do seem to be hard to find in US stores and I’ve noticed that most are made from light colored muslin, not a great color for jungle birding. The Oriental Bird Club (http://orientalbirdclub.org/clothing/) carries dark brown ones at reasonable rates.
When trying to remove a leach crawling on you, timing is everything. The technique I’ve been shown is to wait until they are making an “n” shape, when the head and tail are close together. Then flick them with your finger. For some reason, their hold is weakest at this moment. If you have one feeding on you, spraying it with insect repellent or sprinkling it with salt will cause it to release, though they will transform into a fire hose of blood. You can also scrape them off with a fingernail if nothing else is handy. The darn things use an anticoagulant that will see the wound bleed for much longer than expected, so be prepared for that too. And of course, like any open wound in the tropics, take care to prevent infection.
Small wounds, particularly from insect and leach bites are easily infected in the tropics if ignored. I carry alcohol wipes in my first aid kit just for this type of thing and follow it with a band aid or plaster and either antibiotic or antiseptic ointment. I re-alcohol wipe often, generally after my evening shower, and, or before applying a fresh dressing. In this way I try to prevent both incidental infection and water born infection from dodgy water sources. I re-plaster as needed, but as the wound heals, I find evenings are the best opportunity to let it dry uncovered. Colloquially speaking, if you see red streaks radiating from the wound, you might have a systemic infection taking hold and need antibiotics. You may not feel ill, but I encourage you to see a doctor and, or pharmacist. I’m not a medical practitioner, and I’m sure there is more and better advice out there, this is just what works for me. Any wound easily becomes infected in the tropics, so do take care.
Chiggers are teeny tiny mites and my least favorite human parasite on the planet. Unfortunately, they are relatively common in the tropical Americas, and probably elsewhere, but I’ve blanked them out of my mind. Mostly they are found in rough grassy areas like road edges, parking lots, and other wastelands. Mown lawns don’t seem to be a problem, but I am careful of these too. If you are invaded (they burrow into your skin), they will itch more and longer than any other creature on Earth, (and I’ve been stung or bit by quite a variety). Oh, and they are very, very tiny, so you can’t actually see one crawling on your skin to remove it. To add insult to injury, they prefer damp locations and tight spots like under your socks, bra straps, and elastic lines. I am shuddering at the memories. To avoid chiggers, stay out of tall grass and rough areas, and use the same covering techniques you would for leaches, and don’t forget the Deet. Shower as soon as possible if you think you were in chigger habitat, and scrub well with soap in the hope of shedding a few before they dive in. This latter advice is really just hearsay; I have no idea if washing works since I can’t see the darn things, but it makes me feel better. Good luck, and I truly hope that you never experience these critters.
And a few miscellaneous items…
- If you arrive in the tropics from a cooler country, give your body time to adapt to its new water requirements. Drink plenty of fluids, but go easy on the alcohol. According to the Australian pee color chart, your urine should be plentiful, odorless, and pale in color. Getting dehydrated is quite easy and seriously dangerous. If you are an athlete, you probably know all about this. I typically bring electrolyte tablets or EnerC packets for my water bottle during the first few weeks of a trip. The electrolytes help ensure that my fluid and electrolyte balance stays healthy during a time when I’m needing more water than usual. It also seems to keep me from getting headaches in those first few hot days. For more information you can go to the National Institute of Health at (http://www.nlm.nih.gov/medlineplus/fluidandelectrolytebalance.html) and other sites.
- The best way to avoid getting travelers tummy is to wash your hands with soap and water before each meal and after using the restroom (of course). You will notice that many restaurants have a sink in the dining room just for this purpose. If washing is not an option or you are in the field, use a gel hand sanitizer. Oh, and pay attention when washing to the thumb opposite your dominant hand. Something I picked up in first aide classes, if you are right handed, you tend to neglect washing your left thumb, and vice versa. Amazingly true.
- When hiking and I feel a blister starting to form, even a slight discomfort, I stop and put tape on it. Doesn’t matter what type of tape, anything will work. I bring a small amount of “mole skin” and, or, first aid tape in my daypack, but have been known to use electrical, clear, or duct (silver) tape. Taping the area helps prevent a full blown and painful blister from forming. Clean socks will give you fewer blisters.
- If you get tropical chaffing (generally in an awkward location), try applying a small amount of antibiotic ointment. Though a lot of people prefer drying out the area with powders, I find antibiotic ointment works better, and more quickly.
- Women, if you prefer tampons, bring your own. They can be very expensive and, or, very hard to find in many countries. Pads are readily available in most places.
- If you are allergic to bee and wasp stings, bring your Epi kit (Epinephrine injection kit). Be sure to let your fellow birders and tour guides know that you have the allergy, and where you carry the kit. You will need a special dispensation from your doctor to bring it on an airplane.