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Stepping off a plane in Lima, Peru, was
like entering an alien world for Dr. Kirby
Turner. Nearly 30 years ago, traveling on his own with friends
to the Andes, he was tapped on the shoulder and interrogated by
authorities in a language he did not understand. With no support,
no tourguide and little background knowledge, only then did it dawn
on him that he was not prepared for his new environment. Despite
an adventurous nature and plenty of wilderness experience in his
home country, Dr. Turner was frightened. He realized that a little
more research before he left might have helped him avoid the culture
shock and disorientation that plagued him throughout his trek.
Older, wiser and with many more miles on his traveling shoes, the
Kneibert Clinic physician now offers custom itinerary analyses,
vaccination advice and illness prevention tips to patients planning
a journey. His doctor's bag includes travel medicine software, links
to the National Centers for Disease Control and the State Department,
a library of textbooks, the benefit of multiple wilderness and travel
medicine conferences, and years of experience both as a tourist
and as a medical missionary.
"Fully 50 percent of Americans traveling to a developing country
will get traveler's diarrhea, and that will spoil a vacation,"
he said. The tips below can help travelers stay
healthy. Generally, the tips do not apply for those traveling in
the U.S., Western Europe or Japan, where water supplies are considered
sanitary. Ex-patriots planning a longer stay can learn how to purify
their water supply from even unappealing sources.
In case prevention fails, he also arms his patients with a secondary
plan -- immunizations and medication for treatment.
"But by far the most common cause of health problems in travelers
is accidents and alcohol-related incidents, which can be avoided
with good common sense," Dr. Turner says.
The first step is submitting a travel itinerary with a list of
ports of call or destinations in the order in which they'll be visited.
He likes to have this several weeks in advance of a patient's departure
date. Using the itinerary with a computer program and other sources,
Dr. Turner will assess the traveler's risk for various infectious
diseases and recommend vaccinations accordingly.
"Some of that depends not just on the country but on the types
of traveling activities they'll be doing, whether they'll be in
the bush or in the cities. All that has to be taken into account,"
he says. "It takes a little while to do that. Some immunizations
need to be on board awhile before they're effective."
He checks to see that all the usual vaccinations, especially tetanus,
are up to date. Then he considers whether additional ones are needed.
Depending on the destination, typical additional vaccines may include
those for hepatitis A and B or yellow fever as well as malaria and
dengue prevention measures for those heading to the tropics. Dr.
Turner is accredited by the World Health Organization to administer
the yellow fever vaccine, typically recommended and often required
for a Visa for those traveling to Panama, South and Central America,
Honduras, Africa and other tropical destinations.
The next step is discussing primary illness prevention strategies,
avoiding oral/fecal contamination routes that can lead to infection,
as well as treatments in case prevention fails. Especially important
in tropical areas is avoiding mosquito bites that can lead to malaria
or dengue (called "bone-break disease" because it can
cause a high fever accompanied by bone-breaking pain). "If
you don't get bit, you don't get those diseases," he says.
He advises tropical travelers to avoid being out at night -- when
bugs bite -- if possible, treat clothing and a bed net with insecticide
(permethrin can be applied before departure and can remain effective
through several weeks and launderings), and spray skin with a repellent
containing DEET (diethylmethyltoluamide) when going outside.
Other diseases often discussed with travelers, depending on their
destination, include prevention of hepatitis B, HIV, meningitis
and rabies. A check with the Centers for Disease Control and the
U.S. State Department can provide information on disease outbreaks
and other dangers.
( Continued here ... )
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Dr. Kirby Turner
Beyond providing specific health information, Dr. Turner also considers
it his responsibility to provide additional advice if needed regarding
general safety and more extreme measures -- how to survive airplane
crashes, avoiding risks of crime and terrorism, urban or wilderness
survival skills, political considerations, high altitude illness,
diving and sports issues, how to make a camp, dealing with bears,
things of that nature.
"I have that kind of information but to go into detail I would
need a little forewarning of what your plans are," he says.
"We have a wealth of information to draw on."
Some of his personal experiences include numerous hiking and backpacking
treks in the mountains, trips to Egypt, Eastern Europe and the Amazon
as well as serving as medical missionary in Paraguay, Honduras and
Mexico.
"I think health care, like music, is an international language
-- that caring, especially in developing countries for people who
don't have access to the kinds of services we do here, is especially
important. It's also a way to learn about the local people and their
lives."
Five-star hotels may be nice, "but they all look the same,"
he says.
Although he's traveled the world, some of Dr. Turner's favorite
trips have been in his own country, especially within its national
parks. "There's so much to see in this country that is just
fabulous. You don't want to ignore the U.S. to go tramping off to
Timbuktu."
Wherever you go, as Dr. Turner attests from experience, it's best
to be prepared. And your first step toward that end can be a visit
to his office where a wealth of information is available on request.
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Avoiding Travelers' Diarrhea - Common-Sense
Illness Prevention Tips for Short-Term Travelers in Developing Countries:
- Drink bottled water that is well sealed
- Drink carbonated beverages
- Avoid tap water - don't rinse your toothbrush in tap water,
don't sing in the shower
- Eat only foods that have been boiled or that you peel yourself,
inspect first for blemishes. Boil it, peel it or forget it.
- Keep your hands clean - wash them frequently and use an antibacterial
gel.
- Avoid ice, especially in carbonated beverages or alcoholic beverages
on the rocks.
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World Traveler's Checklist -
Don't Leave Home Without These!
- Your passport and photocopies of it in alternate places
- Enough cash or traveler's checks to buy a plane ticket home
if yours is lost
- Your regular prescription medications in their original labeled
containers, plus any new antidiarrheal and antibiotic medications
prescribed especially for your trip
- Sunblock, sunglasses and hat
- Antibacterial gel
- Insecticides and insect repellent (with permethrin and DEET)
for tropics
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Helpful Links:
Centers for Disease
Control Travelers' Health - information by destination, reference
materials, specific pages on outbreaks, traveling with children,
special needs travelers, diseases, vaccinations, safe food and water,
insect protection, cruise ships and air travel
U.S. State Department
- Consular Affairs - current travel warnings, announcements
and publications
World Health Organization
Travel
and Wilderness Medicine - University of Missouri-Kansas City
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