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The Healthy Traveler

Powerful Patient, 2008 Week 12

Joyce Graff, host, on

Beginning March 17, 2008

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Altheada and Fred Johnson
Altheada and Fred Johnson


Joyce Graff and Altheada and Fred Johnson are traveling to South Africa for the opening meeting of the 18th international affiliate of the VHL Family Alliance. We speak with some experts to learn how to stay healthy while traveling to another country, with different health risks than we are accustomed to, to learn how to be "streetwise" in another country.

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Program guide for this show


Our Guests


Fred M. Johnson is retired from the General Board of Global Ministries of the United Methodist Church, where he trained information technology personnel for their disaster relief operations.


Judy Fern, R.N., is an operating room nurse from California.  In addition to considerable international travel with her husband, she has gone on several “medical missions” to Mexico and Viet Nam, helping to repair injuries and birth defects and improve people’s quality of life.


Kevin Cahill, M.D., Chairman of the Department of Tropical Medicine at Lenox Hill Hospital in New York, and Professor of Medicine at New York University.  Dr. Cahill wrote the foremost textbook on Tropical Medicine, and has also prepared a booklet, “Medical Advice for the Traveler,” which is available here at the PowerfulPatient.


Tips for Long-Distance Flights


  • Hydration
  • Exercise (especially moving your leg muscles)
  • Position (use a neck pillow to avoid neck strain)

Will You Need Vaccines or Preventive Medications?


Depending where you are going, you may need extra protections against diseases for which you do not have natural immunities. 


Contact the Center for Disease Control (CDC) at least 4-6 weeks before your departure date, to see what they recommend for the itinerary you will be following.  1-800-232-4636 (1-800-CDD-INFO) or


Start with your own doctor.  He or she may refer you to a Travel Clinic, where they will stock innoculations for foreign countries.  If possible, visit a Travel Medicine Clinic (list on the CDC site) or print out the information from the CDC site for the countries you will be visiting, and take it with you to your doctor.  It is helpful to take your itinerary with you, as it’s not just the country, but different areas within a country may have different levels of risk.


Be sure to brief the travel clinic on all your health issues, including whether you or someone else in your household is immune compromised.  This is very important, as some of the innoculations are live vaccines and might harm someone with a weakened immune system.  (This includes anyone with a transplant, or who has recently undergone radiation treatment or chemotherapy.)  Alternate forms are usually available, so the clinic will work with you to protect you and your household members from harm.  For example, typhoid vaccine comes in a pill form (live) or an injection (not live).  I was given the shot because my son has a kidney transplant and might contract typhus from coming into contact with someone taking the pill.


Ask the doctor whether you should carry an emergency supply of antibiotics.  Depending where you are going, this may be a good idea.  For example, if you get traveler’s diarrhea (sometimes known as Montezuma’s Revenge), and taking your over-the-counter remedy doesn’t stop it in a day, your doctor might suggest that you carry a supply of antibiotics to counteract whatever bug has caused this condition.  It is usually something in food or water.


Another example is Malaria.  If you will be going into a high-risk malaria zone (as defined by the CDC on their website) then the travel clinic might prescribe a medication for you to take beginning the day before you enter the high-risk zone, and continuing for 7 days after you leave the zone.  So for example, you might spend 5 days in Johannesburg (which is an industrialized city with little more risk than any industrialized city), and then you decide to go to the national park, which is in a high-risk area for malaria.  The day before you leave for the park, you would begin taking your malaria medication, and continue daily while you are in the malaria zone, and for 7 days after leaving the park and returning to the city.  Follow the instructions given to you with the medical prescribed.


Fill all such prescriptions before you leave your home city, as even within the United States you will probably not be able to fill a prescription in another state in the U.S., and certainly not in another country.  Carry the medication with you, and begin it only under the circumstances your doctor outlines.  If it turns out that you don’t need it, you can throw it away when you return.  Consider it good insurance.


Things to pack when visiting another country


Pack a sufficient supply of all prescription medications for the trip plus several days of possible travel delays.  Carry this with you on board, to minimize the risk of losing these essential supplies.

Remember that all liquids and gels must fit into a one-quart re-closable plastic bag.  If your medications include liquids that come to more than this, you are not limited in the amount or volume of these items you may bring in your carry-on baggage.  BUT if the medically necessary items exceed 3 ounces or are not contained in a one-quart, zip-top plastic bag, you MUST declare to one of our Security Officers at the checkpoint for further inspection.  See the Traffic Safety Administration guidelines at


It is wise to make a list of all your medications, possibly including a letter from your doctor stating that these are medically necessary.  It is also a good idea to take a one-page summary of your medical condition with you in case you need to see a doctor while you are on your trip.  For assistance with preparing the one-page summary, listen to our interview with Rod Brouhard on medical alert devices.

You should also take any over-the-counter medications or preparations you may wish to have with you.  Brands and dosages vary in other countries, and what you consider common here might not be available without a prescription, or may be in another form you don’t recognize, especially in another language.  It is safest to take with you what you might need.  For example:

  • Aspirin or aspirin substitute for ordinary headaches
  • Your favorite cold remedy
  • An anti-diarrhea medicine (e.g. Immodium or Pepto-bismol)
  • Antiseptic cream and band-aids to treat every cut


Even a small cut should be treated with antiseptic cream and carefully bandaged, to prevent entry of germs you are not accustomed to.


Street-wise Practices to Stay Healthy


There are four primary sources of health risk.  A few simple practices will help reduce your risk.  As Dr. Cahill says, put a barrier between you and the risk, and be in control.


Dry air. 


The biggest problem here is air travel, which is very drying.  All the germs of everyone on the airplane circulate and recirculate in dry air for as many hours as you are flying.  Keep your mucus membranes moist (with saline nasal spray and drinking water or juice).  If you are particular susceptible, you might want to wear a surgical mask.




Much of the world does not have clean and sanitary water to drink.  Even if the water is safe to drink, it may have a mineral content that is significantly different from what you are used to.  This change in mineral content alone can be enough to upset your bowels.  It is safest to drink bottled water, and make sure that it is sealed and opened by you, not brought open to your table.  I choose one popular non-gas brand and drink that one brand throughout the trip if possible (e.g. Evian is closest to the water I am used to).  Brands will differ in different countries.


Don’t forget to use bottled water when brushing your teeth or taking medications.  Even a small amount counts!  Hotels will often have bottled water in the rooms at a premium price (2 to 4 times market price).  See if you can stop into a convenience store and purchase water outside the hotel.




Pay attention to your level of risk.  If it’s cooked or peeled by you, the risks are lowest.  If it’s fresh, and possibly washed in questionable water if at all, the risks are highest.

  • Well-cooked meats and vegetables will usually be safe. 
  • Avoid fresh salads, as you don’t know if it has been washed, or the quality of the water in which it was washed. 
  • Use peelable fruits (oranges, bananas) in preference to fruits that may have been washed in questionable water.
  • Meat or fish that is raw or undercooked should be avoided.



Wear shoes, long sleeves and long pants to limit your exposure to insects.  Put a repellent on your neck, hands, and other exposed areas.  Follow the CDC advice on the percentage of DEET recommended for the area you are going into.


Sex with new partners


A sexual experience with a new partner should always follow safe sex practices.  In some countries, the risk of exposure to hepatitis, AIDS, or other sexually transmitted diseases  may be heightened.  It only takes one exposure to infect you.  Make sure that you are aware and in control of the situation. 


Insurance, and risk of Political Unrest


Check with the Department of State to see what they consider to be the level of risk in the countries you will be visiting. – click on “Travel warnings” and then choose the country you will be visiting.  For example, here is their page on South Africa:

The State Department encourages travelers to register with the embassy, which they can do online at so that in case of emergency your family can be contacted.

Travel insurance can help to reassure you both that the cost of the trip will not be forfeited if you have to cancel your trip, and that in case of medical or political emergency during your trip, you will be able to get the medical assistance, transportation, or evacuation you need.  For example, check out    


Have fun, Be well, and be a Powerful Patient!