In last Monday’s column, a 67-year-old couple—Marilyn and her husband, retired teachers—asked for guidelines on how to stay healthy during their three-month stay in Tanzania, where they plan to work in a church-supported school in a rural area. Both are in good health, with these exceptions: He has glaucoma that is well controlled with eye drops; both have mild high blood pressure, well controlled with a medication; and both wear glasses. They described themselves as very fit, and they are avid cyclists. They are looking forward to cycling in Tanzania. Their question was, “What should we do to stay as healthy as possible, since we will be in this remote area for three months”?
Last week we covered vaccination recommendations for people visiting Tanzania (and other developing countries). Today’s post takes up the problems of infectious diseases and contaminated food and water. Though these guidelines are written for the couple traveling to Tanzania, many will be useful to readers visiting other countries with special infectious-disease risks. Most of this information was obtained from the many sites at the Centers for Disease Control and Prevention (CDC)—specifically, the Travelers’ Health Site, along with research at the World Health Organization (WHO) site. —Ed.
The Hazards of Contaminated Food and Water
Travelers’ diarrhea and other diseases come from contaminated food and water. It is essential that you develop a plan to avoid these illnesses by eating and drinking safely. The CDC recommends foods that you can eat and foods to avoid.
•Food that is cooked AND served hot
•Fruits and vegetables you have washed in clean water or peeled yourself
•Pasteurized dairy products
•Food served at room temperature
•Raw or soft-cooked (runny) eggs
•Raw or undercooked (rare) meat or fish
•Unwashed or unpeeled raw fruits and vegetables
•Unpasteurized dairy products
•“Bushmeat” (monkeys, bats, or other wild game
•Bottled water that is sealed (after some serious investigation, since the bottled water may have come from a local factory)
•Water that has been disinfected
•Hot coffee or tea
•Tap or well water
•Drinks made with tap or well water (such as reconstituted apple or orange juice)
•Any drink with ice in it
A review of WHO Guidelines and CDC information for travelers makes it clear that diseases caused by infectious organisms (bacteria, viruses, worms, and protozoa) are a common and widespread health risk associated with drinking-water. These guidelines come from the CDC.
- Treat the water you drink, to make sure it has no germs that could cause infection. To get rid of germs, you can boil water for 3 minutes and then let it cool. Another way to get rid of germs is to take 2 quarts of water, add 2 drops of 5% bleach, and wait 30 minutes before drinking the water. To improve the taste of the water and to further enhance its safety you can add a simple filtration system.
- Marilyn, contact the national church organization that supports the Tanzanian school you’ll be teaching in so you can understand what is already in place for water safety at this site.
- Review these recommendations at the WHO and CDC sites and with your local doctor.
- Assume, however, that the water is not safe and use precautions.
- Do not swim or wade in any fresh water in lakes, rivers or streams to avoid schistosomiasis, a disease caused by parasitic worms. There is no vaccination available and there are no drugs for preventing this infection.
Avoiding Dangerous Bug and Worm Bites
The CDC also has information about prevention of illnesses that come from bug bites in Tanzania (like mosquitoes, ticks, and fleas). Many of these diseases cannot be prevented with a vaccine or medicine. The CDC recommendation for reducing your risk of getting these diseases by preventing bug bites includes the following advice:
- Cover exposed skin by wearing long-sleeved shirts, long pants, socks, and hats.
- Use an appropriate insect repellent. For protection against ticks and mosquitoes, use a repellent that contains 20% or more DEET for protection and lasts up to several hours.
- Use permethrin-treated clothing and gear (such as boots, pants, socks and tents).
- If possible, stay and sleep in air conditioned or screened rooms.
- Use a bed net if the area where you are sleeping is exposed to the outdoors.
- Check your entire body for ticks daily and remove properly.
- Wear shoes that cover your feet completely in order to prevent infection with worms that enter the body through the skin of the feet.
Marilyn, since you and your husband both take prescription medications, take more than enough of these drugs for your trip in case these medicines are lost. Ask your doctor to give you a prescription with the generic name of the drugs. Take two pairs of glasses and a prescription from your ophthalmologist for new glasses in case you need them.
Ask your doctor for a prescription for epinephrine auto-injectors (EpiPens) in case you have an obvious allergic reaction. Carry all of these with you until you reach your destination.
The Healthy-Travel Packing List
The CDC has also compiled an extensive list of what to take on your extended stay in Tanzania called. Here it is:
Additional special prescriptions for the trip:
- Antibiotic for travelers’ diarrhea
- Commercial suture/syringe kit to be used by local health care provider. (Requires a letter from your doctor on letterhead stationery.)
- Medicine to prevent altitude sickness (if appropriate)
- Medicines to prevent malaria
- Diarrhea medicine (for example, loperamide (Imodium) or bismuth subsalicylate (Pepto-Bismol).PLEASE DISCUSS THE USE OF THESE MEDICATIONS WITH YOUR DOCTOR OR PEDIATRICIAN PRIOR TO DEPARTING
- Motion sickness medicine
- Cough drops
- Cough suppressant/expectorant
- Medicine for pain and fever (such as acetaminophen, aspirin, or ibuprofen)
- Mild laxative
- Mild sedative or other sleep aid
- Saline nose spray
Supplies to prevent illness or injury:
- Antibacterial hand wipes or alcohol-based hand sanitizer containing at least 60% alcohol
- Insect repellent
- Permethrin (insect repellent for clothing). Clothing can also be treated at home in advance.
- Bed net
- Sunscreen (SPF 15 or greater) with UVA and UVB protection
- Sunglasses and wide-brim hat for additional sun protection
- Safety equipment (for example, child safety seats, bicycle helmets)
- Water purification tablets
- Latex condoms
- 1% hydrocortisone cream
- Aloe gel for sunburns
- Antifungal and antibacterial ointments or creams
- Insect bite treatment (anti-itch gel or cream)
- Antiseptic wound cleanser
- Bandages (multiple sizes), gauze and adhesive tape
- Elastic/compression bandage wrap for sprains and strains
- Foam or small band aids for blisters
- Scissors and safety pins
- .Cotton swabs (Q-Tips)
- Digital thermometer
- Disposable gloves
- Eye drops
- Oral rehydration salts
- Health insurance card (your regular plan and/or supplemental travel health insurance plan) and copies of claim forms
- Proof of yellow fever vaccination (if required) or medical waiver
- Copies of all prescriptions, including their generic names
- Contact card with the street addresses, phone numbers, and e-mail addresses of the following: (a) Family member or close contact remaining in the United States; (b) Health care provider(s) at home; (c) Lodging at your destination; and (d) Area hospitals or clinics, including emergency services.
Finally . . . have a safe trip!
Dr. Patricia Yarberry Allen