Wednesday, January 29, 2014

Travel Medicine by a Traveling Medical Student

Working the pharmacy during my volunteer stay in Peru
Traveling can be very exciting and sometimes a bit scary, especially when you get sick. Sometimes
its just the common cold but it can make you scared enough to call home to mommy. I know this from experience. After a taste of Salmonella flavored Chinese food in Peru, a Giardia spiced water in Nepal, a Hep A seasoned Lassi in India and a nice leg of lamb that cured with E coli for over a week on the counter of my families home, I learned the hard way that mommy is not always there to feed you chicken soup and take your temperature.

I was scared, alone (but not really because there was always a handful of other travelers hearing my hourly bathroom visits) and very dehydrated.

Check so see what the countries you are traveling to require, you might need to get certain vaccines to enter some countries. 
  • Yellow Fever - Amazon and Sub-Saharan Africa
  • Typhoid Fever - India or Peru
  • Japanese Encephalitis - South East Asia
  • Hep A - 2 weeks before you go (you will have to get a booster after 6 months)
  • Hep B - if you are working in a medical setting (three shots)
  • Rabies - stay away from stray dogs (which is a huge problem everywhere)
  • MMR
  • Tetanus
  • Polio - this is a new requirement for India
  • Meningococcal - Sub-Saharan Africa

Malaria Treatment:
  • Prevention:
    • Once a week: Mefloquine
      • watch out for the side-effects, can cause bad dreams
      •  Start one week before you enter area with malaria and continue through your trip and 4 weeks after you leave the malaria area.
    • Everyday: Doxycycline and Malarone (atovaquone and proguanil)
      • Doxy: start the day before and continue 4 weeks after you leave malaria area
        • can cause you to get sunburned easier
        • don't take before bed
      • Malarone: much more expensive but less side effects
        • start one day before and continue until 7 days after trip into malarial area
    • Mosquito repellent -  at least 45% DEET
  • Symptoms: fever, stomach pains, headache, fatigue chills, sweats, vomiting and diarrhea.
    • Treatment - its recommended to take prophylaxis and avoid the disease, but just in case:
      • CoArtem - Artemether/lumefantrine 

Acute Mountain Sickness and High Altitude Pulmonary Edema (HAPE)
  • Treatment is to descent and use oxygen if available.
  • Prevention:
    • Climb high, sleep low (this does not mean sleep on the ground, this means that instead of sleeping on the pass, sleep at a lower village)
    • Avoid alcohol and sedatives
    • Eat a high carbohydrate diet - lots of pasta and potatoes 
    • If you are really worried, take Acetazolamide (Diamox) - start 1 day before you start your trek and each day until you descend. WARNING: this makes you have to pee all the time (for me, no joke, every 15mins) so stay hydrated.
At 18,340ft - highest motorable road in the world

Sun Exposure:
  • Cotton has an SPF of 7 so therefore you still need sunscreen.
  • Don't put sunscreen on top of bug repellent, Apply sunscreen first, then repellent just before exposure to insect.
Water Safety:
  • What do you do about a jellyfish sting? Everyone always says pee on it or use some vinegar, I prefer the vinegar and it works. 
  • Don't pee in the water in the Amazon - Candiru likes pee and will follow the stream of pee... well you got the idea. 
  • Keep hydrated while in the sun. 
  • If diving heed all the rules:
    • Don't dive if you have a cold (Can prevent you from clearing your ears and caus excessive pressure)
  • Wear water safety items. It does not matter if you know how to swim its important to follow any rules. If white water rafting, especially a class V or above please wear helmets and life jackets. 
    • If the company does not provide them then I would think about switching to a different company.
Snorkeling in Puerto Rico


Travelers diarrhea is the most common traveler's illness.
  • Prevention: 
    • Only eat safe food (well this one is hard to do, but I guess if you really don't want diarrhea try to follow it...otherwise move ahead to treatment)
      • You can have: sealed food, piping hot food, fruit with a peal
      • Don't eat: ice, lettuce, tomatoes 
    • Brush your teeth with bottled water
  • Treatment:
    • Let it run its course - if your body is trying to get rid of something let it do it. 
    • While you are on the toilet make sure to stay hydrated. The easiest way are with re-hydration salts. These can be purchased at almost any pharmacy around the world. They often taste bad so mix them with some juice powder or get the flavored ones.
    • If that fails take Pepto-Bismol for nausea and diarrhea (don't take it every day) this may make your poop look black, don't worry.
    • If you have severe nausea and you can get your hands on some Zofran (Ondansetron), this will relive nausea in 15mins
    • If you have a fever, blood or mucus in stool, severe stomach cramps you might have a bacterial infection, this you will need to treat with antibiotics:
      • Levofloxacin 500mg for 1-3 days
      • Cipro 500 twice a day for 1-3 days
      • Azithromycin (Z-pack) 1g once or 500mg for 3 days
    • If you have diarrhea for over 2 weeks and is not resolved by antibiotics you probably have Giardia - to treat this you need Metronidazole (do not drink with this)
      • symptoms of Giardia include cramping and foul smelling stool, usually it occurs several weeks after exposure.

On long bus rides or plane journeys can always be hard, here are some over the counter treatments you can use:
  • Benadryl, Tylenol PM, or melatonin
  • Try not to take hard-core sleeping pills, you don't want to be robbed  
This can often accompany diarrhea or nausea, its a good idea to keep a small plastic thermometer in your first-aid kit. This will help you monitor your fever to determine if you should see a doctor or take medications. Acetaminophen (Tylenol), Ibuprofen (Advil), and Naproxen (Aleve) can help lower your fever. Fevers can also be the first sign of Malaria or other severe diseases, so always see a doctor if your fever is over 104 or if its accompanied by stiff neck, rash, or shortness of breath. As always stay hydrated.

 Volunteering at the clinic in Peru
General Staying Healthy
Sleeping, eating well, and taking it easy when you are sick are the best recommendations. Vitamins, in recent studies, have been found not to help much, unless you have an unbalanced diet or are in need of extra vitamins (pregnant, elderly, children). Probiotics especially during and after an antibiotic treatment is a good recommendation to replenish your normal flora (normal bacteria that help you combat infections, breakdown food, and metabolize vitamins). Anti-itch (hydrocortisone) cream for bed bug bites or poison ivy itching is a good addition to your first-aid kit.
Thanks for reading. Just note, I am not a doctor yet and this does not serve as a replacement to see your doctor, this is just a guide that could help you through some sticky situations. If symptoms last too long please go see a doctor. In most countries its actually fairly cheap and they often know better about local illnesses than doctors do in the western world.

I went to see a doctor in Nepal and in India, both visits were under $30. In Peru I was hospitalized for Salmonella for an entire day, I even had my own room. In the USA that would have cost thousands of dollars but in Peru it was about $200. 

Fellow Medical Student Volunteering in Peru


  1. Very good advice, Thanks

  2. Great Advice. I just got back from my first trip to Africa and the travel Dr. here had me pretty nervous about how sick I could get. These are excellent tips to avoid an uncomfortable situation.

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