Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Preparing for the trip: Travel to a developing country requires careful planning.
From a health standpoint, most travelers should contact their doctor at least six weeks prior to travel.
Adventure travelers, those who plan prolonged stays, and those who will leave the usual tourist routes should contact their doctor six months prior to travel.
Food and water precautions: Both food and water can be contaminated with bacteria or parasites. Light contamination may not affect the taste or smell of the material but may still cause disease. The usual admonition of "don't drink the water" is good advice in developing countries.
Tap water may contain organisms that could cause days of diarrhea or, less commonly, more serious illnesses. Some hotels will provide a carafe of drinking water at the bedside. This is often filled from the tap in the kitchen and is not reliable.
Bottled water is usually safe, especially if carbonated. Check the seal on the bottle: Some bottles are re-used and refilled from tap water to be sold to unwary tourists. Boiled water and drinks made with boiled water are usually safe. This includes coffee and tea.
Ice is no safer than water. It is usually best to stick with bottled water, boiled water, or sodas.
What about brushing your teeth? Basically, use bottled water or no water when brushing your teeth. However, the risk of disease is proportional to the amount of water consumed. So some experts feel that it is all right to brush your teeth with small amounts of (hot) tap water.
Foods that are safest are those that are fully cooked and served hot.
Fruits that you peel yourself, such as bananas, are usually safe. The exception is watermelon, which may be injected with tap water to increase its weight at market.
Human waste (also called night soil) is a common fertilizer in developing countries. Fruits grown near the ground, such as strawberries, are more often contaminated than those grown on trees. Lettuce is also risky for the same reasons. Its crevices are almost impossible to clean, and the water used to do so is often contaminated.
Spices do not kill bacteria. Sushi that is so spicy as to burn the tongue is no safer than unseasoned sushi. Shellfish are notorious causes of disease because they are often grown in contaminated water and build up high concentrations of bacteria.
It may seem like the prudent traveler's menu is limited. Certainly, prudence must be tempered with practicality. Part of the fun of travel is to experience new dishes. The goal of food and water precautions is to help travelers make informed choices. There is nothing wrong with eating sushi in a developing country if you are aware of the risks and are willing to take them. For many travelers, a little bit of common sense and keeping some medications on hand will result in an enjoyable experience.
Insect precautions: Insects spread many tropical diseases.
For most travelers, the biggest insect danger comes from mosquitoes. Travelers to developing countries should carry an insect repellent containing the ingredient DEET. Mosquitoes can spread very serious diseases, including malaria and yellow fever. This is not a time for herbal preparations or mild lotions (such as Skin-so-Soft). Insect repellents should be applied and reapplied according to package directions. Remember that the malaria mosquito bites at night. In malarious areas, wear insect repellent to bed and use mosquito netting if it is available. Room sprays containing permethrin may also be used. For prolonged travel, clothing may be treated with permethrin to serve as a long-term repellent.
During the day, wear light protective clothing. Long sleeves and pants help reduce the risk of bites. Ticks are also a concern in many developing countries. If traveling in fields or woods, tuck your pant legs into your socks. At the end of the day, check yourself for ticks. The risk of disease increases if ticks are allowed to attach for more than 24 hours. Insect repellents reduce the risk of tick attachment.
The traveler's medical kit: In developing countries, even simple medical supplies may be hard to find. For this reason, pack some basic supplies.
Keep prescription drugs in their original bottles. Customs officials are not pleased to see plastic bags full of loose pills. For travelers with complex medical problems, a letter from a doctor or a copy of a recent electrocardiogram may be helpful.
The American Embassy or Consulate usually will be able to provide a list of doctors who speak English if you need a doctor.
Sex, cars, and drugs:Sexually transmitted diseases, including AIDS, are common in developing countries. The best rule is to abstain from sexual contact with native populations and fellow travelers. Travelers who violate this rule would be wise to carry a supply of condoms.
Automobile accidents are one of the most common causes of death in travelers. Look both ways before crossing the street, use seatbelts if available, and don't get in the car if the driver is drunk.
Possession or use of illegal drugs is a very serious offense in most countries. Long prison sentences have been meted out for small amounts of illicit substances.
Travel under special conditions: International travelers often seek adventure.
Take special precautions when climbing mountains to limit the risk of mountain sickness. Mountain sickness (altitude sickness) can cause headache, nausea, weakness, shortness of breath, and fatigue. In its severe form, brain swelling can cause disorientation, severe headache, bizarre behavior, loss of consciousness, pulmonary edema, or even death. The most effective way to prevent symptoms is to ascend gradually (1,000 feet per day) and to avoid alcoholic beverages and narcotics. Medications are available to reduce the risk of symptoms.
Scuba diving poses the risk of decompression sickness, such as the bends and puts a strain on the heart. If possible, travelers planning to dive should become certified prior to the trip, because courses at resorts may be shorter and provide less adequate preparation. Divers should follow all safety precautions. People who are out of condition should limit the depth and duration of their dives.
In general, chronic medical conditions and disabilities do not limit travel if you take sensible precautions. It is best to have a letter from a doctor describing any medical conditions and listing all active medications and doses. Medical insurance may not pay for care abroad. Travelers should contact their insurance carrier to ascertain their degree of coverage and arrange for extended coverage, if desired. Travelers with significant medical conditions should wear medical alert identification bracelets or necklaces.
Travelers with disabilities may find limited information on accessibility from the Centers for Disease Control and Prevention or the U.S. Architectural and Transportation Barriers Compliance Board. However, information on conditions in foreign countries is limited. In general, it is best to call ahead to ensure the availability of wheelchairs, specially adapted cars, ground-floor rooms, elevators, and other aids. Have a "plan B" in case the promised aids are not available on arrival. U.S. air carriers and cruise lines are required to make reasonable efforts to allow access by disabled persons.
Pregnancy should not keep you at home unless you have complications from an unstable medical condition, advanced pregnancy, or impending labor.
Some activities should be curtailed or eliminated. For example, water skiing and scuba diving pose potential threats to the fetus and should be avoided. Very strenuous activity may cause pre-term labor. Hot tubs should be avoided. Activities that require you to be far from medical care, such as high-altitude hiking, should probably be avoided.
Air travel is not advised after the 36th week of gestation and for travelers with impending labor. During flight, it is important that pregnant travelers move around to avoid blood clots from developing and to drink adequate amounts of water or other fluids.
Certain vaccines and medications that are normally recommended for travelers might be prohibited during pregnancy. All pregnant women who plan to travel should consult their doctors.
In general, children should receive protection against the same diseases as adult travelers. All children should be up to date on routine vaccinations. An accelerated vaccination schedule is available for some of the preventive vaccines and may be useful for children who will spend a long period of time in a developing country. Many vaccines are not effective in very young children. Parents should consult their child's doctor for specific information.
The following items are recommended for a traveler's medical kit:
Prescription medication: Keep it in the original bottle. Keep it in carry-on luggage. Take along more than enough to last the entire trip. It may also be helpful to carry a copy of the doctor's prescription.
Foot care products: Bring pads to protect blistered feet from further injury. Consider packing athlete’s foot powder if hiking in tropical or damp areas.
Cold remedies: cough drops, runny-nose remedy, and tissues.
Diarrhea remedies: Imodium, Lomotil, or Pepto-Bismol. Talk to your doctor about your travel plans and the possibility of carrying an antibiotic. See Traveler's Diarrhea.
Insect repellents: They should contain DEET. Also consider insecticide room sprays and mosquito nets. Permethrin may be applied to clothing and bed nets.
Skin products: Sunscreen (SPF 15 or higher), lip balm, tropical antibiotic ointment, and topical cortisone cream for rashes and bites.
First aid and miscellaneous supplies: Bandages, adhesive tape, gauze, tweezers, scissors, pocket knife, needle and thread, safety pins, matches, flashlight, sunglasses, thermometer, laxative, toilet paper, and premoistened towelette.
For women: Bring sanitary napkins/tampons if traveling to developing countries; medication for vaginal yeast infection.
