Travel Can Be a Pain in the Arm

The trip has now become as real as the ache in my upper left arm from yesterday's two shots. We made a family visit to the University of Virginia Traveler's Clinic to look into what was required or recommended for visits to Vietnam and Cambodia. I had done some research on the Centers for Disease Control and Prevention website and had some information on general health issues. With seven months remaining before the trip (though my husband has yet to provide the exact dates during which he will be teaching in Hue), it seemed a good time to look into this.

I had heard of the Traveler's Clinic many, many years ago when I worked for UVa's Vice President for Health Sciences but wasn't sure it still existed. It does, and it likely saved us a bunch of trouble. For one, it was easy to schedule an appointment for the whole family, something I'm not sure would have been as easy with the family doc; as it turned out, the per-person charge was also less for a group since the 10-page-long recommendations document only had to be prepared once.

The highlights of that report and our visit are as follows:

Yellow fever. Not an issue since we won't be going to an area with yellow fever before we get to Vietnam.

Malaria. This is actually going to require us to come up with a firm idea of what we plan to do while we're there. Hue, Hanoi, and Ho Chi Minh City (Saigon) are not considered as at risk for malaria. This means that although we should protect ourselves against mosquitoes, we don't need to take a drug to help prevent malaria (chemoprophylaxis, which seems a superb word to me) while we're there. Although there is a risk of malaria in Siem Reap, Cambodia, chemoprophylaxis is not recommended for the typical traveler to Angkor Wat. Nor does it seem to be recommended for travel along the Mekong River between Ho Chi Minh City and Siem Reap, only in the Mekong Delta. So, we have to look at the guidebooks and talk to the travel agent and see what trips we might want to make to inland Vietnam or areas where the risk of malaria is high. Then, we figure out how many pills we will need, and fill in the number on the prescription we were given. There are various drugs used to prevent malaria; unfortunately, the one the docs recommended for us (based on the fact that malaria strains in Vietnam are resistant to some drugs and other drugs have some pretty wonky neurological side effects) is the most pricey, costing between $5 and $7 per pill. We would need to take one pill daily for two days before the visit to the malaria-prone area, the whole time we were there, and seven days after the visit. In other words, a one-day trip would cost around $250 for the four of us. What this means is that we won't be making several one-day trips, though I could see making a single trip of several days if there are some places we decide we really want to visit. And after we're back here, any unexplained fever or other serious medical symptom that arises in the next two years means a call to the family doc for a malaria test. And though we're all regular blood donors, none of us will be able to donate for a year.

Cholera. Not an issue, though it would be if we were aid and rescue workers.

Hepatitis A. This is recommended for all travelers, and none of us had had the vaccination series before. We all got the first shot yesterday and will go back on January 20 for the second. This is why I looked into all this seven months before the trip; thanks to the CDC website, I knew that Hep-A took six months, though we will have partial immunity from just the first shot.

Hepatitis B. This is recommended for anyone staying for a prolonged period. The sons and I had already had this series of shots, so the husband was the only one in need yesterday. He got away with only one shot, though, since there's a combined Hep-A and Hep-B vaccine. He has to go back in a month for the second Hep-B shot, and in January for the last Hep-A and Hep-B combination.

Japanese Encephalitis. If we were going in the May to October period, we probably would have opted to get this vaccination since that's the peak period of prevalence. Since we didn't get the vaccine, it's recommended that we be very careful with the insect precautions, something we'll be doing anyway bacause of the possibility of malaria.

Rabies. If we were going to be out in the countryside, this would have been recommended. Though it wasn't, we were warned to take any dog bite or scratch seriously in terms of follow-up.

Typhoid. As with Hep-A, this is recommended for all travelers. We elected to do the oral form of the vaccine rather than the shot, and will do that in January. It's five pills, taken every other day. The pills need to be refrigerated, something I found very interesting. It's easier to imagine a liquid needing refrigeration than a pill.

Finally, we all need to be up-to-date on the routine vaccinations, so elder son, husband, and I all got a tetanus-pertussis-diphtheria booster. Since younger son got one of these last year in preparation for going to college, he escaped it this year.

We also got a prescription for a high-powered antibiotic to take if we suspect we're getting "traveler's diarrhea." We were instructed to try a dose of Pepto Bismol or Imodium at the onset of any diarrhea, but if a single dose doesn't have any effect, to take a mega-dose of antibiotic. Several hours later, if there's still diarrhea, we can go back to the over-the-counter meds. The prescription is for enough pills to cover several cases for each of us, which we hope will be more than we need.

Armed with the travel report, I can now make more lists. First is things to put in our travel first-aid kit, including a thermometer, something I don't usually think to travel with. I also need to research the various insect repellants recommended (DEET for bodies, and permethrin for clothes) and see where I can get them in the quantities we might need. We were advised to carry DEET with us at all times and to apply it frequently. The docs stressed several times that as nasty as malaria is, it is preventable and treatable, and we must take it extremely seriously. Having done a bit of reading on malaria, I know to take the docs seriously in terms of the prevention as well as the follow-up.

And if this is more than any reader really wanted to know, well, part of recording this is so that I have everything written down for my own reference. It has also helped me sort through the various handouts we were given yesterday in addition to the lengthy report. I've already gone from a half-inch three-ring binder to a one-inch one. I may yet have to step up to the inch-and-a-half one or photocopy a bunch of stuff in duplex mode.