Malaria Strikes in Haiti; Dengue in Puerto Rico

March 5th, 2010 by Frank Gillingham, MD

The US military announced on February 27 that 6 soldiers involved in the Haiti earthquake relief have been diagnosed with malaria. One day later, health authorities declared a dengue fever epidemic in Puerto Rico, which reported 210 cases in January. These news stories are a reminder that relief workers and tourists in the Caribbean face dangerous threats.

Serving in Haiti can be very rewarding, but there are significant health and security risks which must be considered before jumping on the volunteer bandwagon. An increase in the incidence of malaria and other infectious diseases already endemic in Haiti has been widely expected since relief efforts began almost seven weeks ago.  Although the greatest risk is among the weak and those in poor health living in the streets or in severely cramped quarters, healthy volunteers are also susceptible.

Even before the earthquake hit, Haiti was considered by the World Health Organization as a “high risk” country for becoming infected with the malaria parasite and was ranked 34th in the Maplecroft Malaria Risk Index.  ”Overcrowding in the camps for the displaced, inadequate shelter and sanitation, overburdened medical facilities, ruptured sewer systems — all these factors provide favorable conditions for the breeding of malaria vectors,” said Fiona Place, a British researcher specializing in disease risk analysis.

The CDC has published “Guidance for Relief Workers and Others Traveling to Haiti for Earthquake Response” for anyone intending to assist in the relief effort.  Take the proper precautions or risk becoming a victim yourself

Dengue fever, a viral illness with symptoms of fever, muscle aches, headache and occasionally a faint rash on the trunk and back, is relatively new to Puerto Rico but common in Haiti.  There is no vaccination or treatment. Since the disease is transmitted by mosquitoes, the same precautions taken to prevent malaria will help to avoid infection with the Dengue virus. Bug sprays that contain DEET, picaridin or oil of lemon eucalyptus are effective.

Photo info: http://www.flickr.com/photos/teutoburg/ / CC BY-NC-SA 2.0
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Quake knocks out hospitals in southern Chile: Santiago facilities receiving patients

March 1st, 2010 by Mike Hartung

Dr. Jorge Valenzuela, Internist at Clinica las Condes, and also a Regional Physician Advisor for HTH Worldwide, reports that today no hospitals in Southern Chile (Curico, Talca, Concepcion) are in operation.  Everyone is being transported to Santiago for medical treatment where the 2 main private hospitals, Clinica las Condes and Clinica Alemana, are in operation.  Condes sustained minor damage but is fully operational.  Alemana is fully operational, save some lab tests.  As long as those affected by yesterday’s devastating earthquake can get to Santiago, they should be able to get the care they need.

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Understanding Seismic Events: Chile Quake Rocks Richter Scale But Is Less Lethal than Haiti’s

March 1st, 2010 by Mike Hartung

Sadly, our recent post on earthquake-threatened cities was a timely introduction to the risks residents and visitors run when inhabiting destinations situated above enormous seismic stress. Now scientists reviewing the reports from Chile are drawing comparisons to Haiti that give further insight into the variables that affect whether quake fatalities reach the hundreds, thousands or hundreds of thousands.

Santiago, Chile did not make the list of most threatened cities because of its distance from the primary fault line and the building codes that have been enforced in recent years. Chilean President Michelle Bachelet said things could have been a lot worse than the present catastrophe if not for the country’s building standards.

At 8.8 on the Richter scale, the Chile quake released 500 times more energy at the epicenter than the Haiti event, but energy dissipates rapidly as distance from the epicenter grows. Saturday’s quake was centered an estimated 21 miles underground in a relatively unpopulated area, while Haiti’s struck about 8 miles down and right on the edge of Port-au-Prince. Furthermore, the ground beneath Port-au-Prince is less stable and “shakes like jelly,” says University of Miami geologist Tim Dixon. The U.S. Geological Survey reports that Port au Prince experienced “violent” to “extreme” shaking, while Chileans experience no more than “severe” shaking. Nevertheless, the latest news reports indicate 500,000 homes have been damaged and two million people displaced.

Plate tectonics is a dismal science when millions of lives are literally shaken.

Photo info: http://www.flickr.com/photos/bjornmeansbear/ / CC BY-SA 2.0
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Geoalcoholics – Russia’s unhappy truth

February 26th, 2010 by Andy Orr

Earlier this month, we posted about Russia’s heavy alcohol consumption levels as a follow up to our Healthy Planet Index.  It turns out that Russians may be what Alex De Jonge has called “geoalcoholics” in his book “Stalin and the Shaping of the Soviet Union.” 

This discovery all stemmed (no pun intended) from a link that Tyler Cowan posted on the Marginal Revolution blog.  It turns out that Europe has three fairly distinct alcohol belts – wine to the south, beer in the middle and vodka up north.  Much can be explained from climate and history, and the post on Strange Maps says it all, or at least a lot.  There is always more at Wikipedia, but I love the Terry Pratchett quotation and comment at the end of the Strange Maps post, “Geography is just physics slowed down, with a couple of trees stuck in it. And grapes, grain and potatoes.”

Whoever could have known that a belt of alcohol was more than just a drink?

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Quake-threatened Cities: Explosive Growth, Shoddy Construction Along Major Fault Lines Portend Disaster

February 26th, 2010 by Mike Hartung

New York Times reporter Andrew Revkin filed a story this week from Istanbul tracing the scientific analysis and sociological realities that are leading to predictions of disaster in fifteen world capitals that could dwarf the tragedy that is still unfolding in Haiti.  The poster child is Istanbul, where the population has grown from 1 million to 10 million in the past 50 years and where a billionaire real estate developer confessed to Revkin that most structures have been built with substandard materials, saying “If an earthquake occurs in Istanbul, not even the army will be able to get in.”

Seismologists have mapped the regions where there is a one in ten chance of a quake in the next 40 years.  Many world capitals are encompassed by serious threats:

Catastrophic:  Bishkek, Kyrgyzstan; Almaty, Kazakhstan and Katmandu, Nepal

Destructive:  Istanbul, Turkey; Tehran, Iran; Jakarta, Indonesia; Quito, Ecuador; Guatemala City, Guatemala and San Salvador, El Salvador

Very Strong: Bangkok, Thailand; Delhi, India; Lahore and Karachi, Pakistan; Cairo, Egypt and La Paz, Bolivia

Engineering and building structures to withstand the enormous energy unleashed along fault lines is beyond the means of any but the most affluent societies.  University of Colorado seismologist Roger Bilham estimates that an engineer is involved in only 3% of the construction that is currently going on around the world. With Turkey spending $800 million dollars simply to reinforce hundreds of schools, hospitals and other public buildings in Istanbul, imagine the price tag of making a whole city safe.

Humbling, daunting, scary and a problem in need of a solution to say the least.

Photo info:
http://www.flickr.com/photos/35188692@N00/ / CC BY 2.0
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The Long Arms of El Nino

February 25th, 2010 by Moira Bishop

Weather is enjoying celebrity-like status in the news this year.  The unusually warm weather in Vancouver has caused all kinds of problems with the outdoor Olympic events, but these abnormal conditions are not unique to British Columbia.  Many areas of Canada and the U.S. are experiencing unseasonable warmth and rain, or equally unusual cold and snow.  These strange patterns extend beyond North America as evidenced by floods and mud slides in Machu Picchu and Portugal.  The blame for this weather can be squarely attributed to El Nino once again.

El Nino emerges every 2 – 7 years and is caused by irregular warming and cooling of the Pacific Ocean west of South America.  This disturbance kicks up atmospheric conditions that give rise to unusual patterns of deluge and drought.  When El Nino delivers a large amount of rainfall to a desert area,   problems occur.  Likewise, El Nino can indirectly unleash freezing temperatures and precipitation that harm crops cultivated in areas used to a warm dry climate.

In addition to the immediate havoc caused by these weather patterns — floods, mudslides and crop failures, there are long-tem implications for public health.  As the World Health Organization (WHO) reports, flooding can cause pollution leading to food-borne illnesses that attack one’s digestive system.  Flooding also creates a moisture-rich environment ideal for mosquitoes to breed. More mosquitoes mean more carriers for vector-based diseases such as malaria, dengue fever and chikungunya

Recent reports from Environmental Research show how scientists are analyzing El Nino to predict some of these outbreaks.  Their insights can help determine which vaccines travelers will need to stay healthy.  As you plan your trip, don’t just look at the weather forecast.  Do some digging into recent weather trends to uncover any problems El Nino might be drumming up, whether it’s disease, digestion or the dislodging of entire mountainsides.

This map from Wikipedia (click to enlarge) shows the weather patterns created by El Nino. (http://upload.wikimedia.org/wikipedia/commons/5/53/El_Nino_regional_impacts.gif).

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Means to End Chikungunya Menace? Report Raises Hope

February 19th, 2010 by Frank Gillingham, MD

New Scientist magazine is reporting a scientific advance that may hold the key to defeating  a mosquito-borne virus that turned dangerous and deadly and has been spreading across the world for the past five years. Carried by the tiger mosquito and driven by the forces of global commerce, chikungunya  virus causes fever, headache, nausea as well as excruciating pain in smaller joints, earning it the nickname “knuckle fever.”  This virulent form first appeared in the islands of the Indian Ocean but has since invaded every continent by way of airports and sea ports.   The CDC highlights some specific reports of recent activity in Indonesia, Thailand and Malaysia on their website, where they also offer advice to clinicians and travelers. 

Now the U.S.  National Institutes of Health (NIH) are reporting a breakthrough in the search for a vaccine by using genetic engineering to create virus-like particles which perfectly mimic the virus without being infectious. Tests with Rhesus monkeys have shown the vaccine to be completely effective against chikungunya. Testing in humans is likely to begin in one to three years.

The NIH’s work with chikungunya  may have ushered in a new era of vaccine production that could prove to be safer and more effective than the many live virus vaccines that are in use today.  It may only be a matter of time before vaccines created from pieces of viruses will replace those derived from whole, live viruses. Diseases such as Kala Azar, sleeping sickness and Dengue fever that afflict travelers to tropical regions do not currently have effective vaccines.  In principle, the creation of vaccines from virus like particles could someday eliminate that problem.

Photo info: http://www.flickr.com/photos/deadmike/ / CC BY-NC-SA 2.0

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Fungus Among Us? Don’t Forget Your Flip Flops

February 18th, 2010 by John Wargo

Flurries floated to the ground as my taxi pulled up to the hostel in the Old Town of Stockholm. The facade of the hostel was immaculate and welcoming, unlike other parts of Europe where you truly get what you pay for.

I was stopping over in Sweden to visit my sister who was studying at the University of Stockholm. After a brief stay with her, my itinerary would take me through Finland and the Netherlands all the way down to the boot of Italy where I would catch a plane back to the states. I was pleased that I was able to fit all I needed (or so I thought) in my masterly arranged backpack, a skill inherited from my father.

My room in the hostel was just as expected, simple and efficient, something any Volvo owner would be proud of, with a shared bathroom down the hall. After my red-eye flight I was looking forward to a shower then meeting my sister for lunch. The first thing I looked for was my pair of flip-flops, and my heart dropped. In my mind I could see them sitting on my bedroom floor, across five thousand miles of Atlantic chop. Any (hygienic) college freshman values the flip flop. In the dorms, where 60-70 students share the same 10 showers, the flip flop offers protection from fungi, mycosis, athlete’s foot and any other sort of creepy-crawly hitchhikers that live in bathroom tile city. But I was in Sweden, one of the cleanest countries in Europe. The hostel was tidy and the bathroom looked better than the ones in my college dorm, so it must be okay to go sans flop, right? Wrong. I ended up paying the price in the form of a tag-along all the way to Rome, and he was no “fun-guy.”

Toenail fungus, known by physicians as onychomycosis, will affect 50% of Americans by the age of 70. Fungus infections occur when microscopic fungi gain entry through a small break or abrasion in the nail, then grow and spread in the warm, moist environment inside your socks and shoes. Symptoms of toenail fungus include swelling, yellowing, crumbling of the nail, streaks or spots down the side of the nail, and even complete loss of the nail. It is very difficult to cure so prevention is ideal. It helps to wear protective shoes or sandals in public showers, pool areas and gyms, and to avoid borrowing shoes or sharing socks or towels. Keep your feet dry as much as possible and change socks on a daily basis.

If you do develop a fungus, see a doctor.  You will want to be very clear about your symptoms, especially if you are in a foreign country. The common terms that we use in America don’t always translate well in other languages. For example, “athlete’s foot” in Italian is “il piede d’atleta”, but that won’t mean anything to a doctor; the medically correct translation is “infezione micotica.”  Once your condition is diagnosed, expect some common treatments such as trimming or filing affected areas and in severe cases, oral anti-fungal medication.

In conclusion, don’t let foot fungi uproot your travel plans. As inconvenient and unsightly as it is, fungi are easy to prevent — just think cleanliness. Also, don’t forget your flip flops, anytime you pack for a trip!

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Falafel, Shawarma and Pitas, Oh My! A Celiac Fights to Find Food in Israel

February 15th, 2010 by Jordan Silverman

I recently returned from a two week adventure in Israel with the Birthright program from the University of Delaware.  

Prior to leaving we were told we could bring a maximum of two bags each. Because I have a tendency to over-pack, this caused me some stress.  I managed, even though I had to dedicate one full bag to gluten-free foods.  I have celiac disease which means that many of the foods some people would grab for a quick snack are off limits to me.  Unless you have read as many food labels as I have, you probably can’t appreciate how many foods have wheat, rye or barley – ingredients that can trigger a revolt in your stomach and can cause long term damage to your intestines if you have celiac disease.  

As I was preparing for my trip, I began reading up on the popular foods in Israel — falafel, shawarma, pitas – and realized they are all made with bread! This could be an “oh-no” place for a celiac! I packed gluten-free cereal, gluten-free trail mix, gluten-free granola bars, fruit snacks, and a lot more. I knew I would have trouble finding things to eat.

The biggest problem was that I didn’t speak Hebrew and the locals didn’t speak English very well. It would have been so much easier in restaurants if I could have clearly communicated my food restrictions. Also, cross-contamination was a huge issue because foods are not always cooked by themselves or kept separate from others.  One night, while staying in a Bedouin encampment in the middle of the desert, we were served rice and meat inside a pita. After explaining my dietary restrictions to the staff there, they told me they could get me the rice and meat without the pita. GREAT! Except, not really, because the rice was mixed with orzo, another huge no-no for celiacs. That was a bad night.

The trip was amazing, and I am sure that other celiacs have traveled to Israel and have not had such a hard time. If you are going to a foreign country, bring someone who knows the language or a list of translations (companies like Select Wisely offer translation cards to help with this) regarding your food restrictions.  It will be so much easier to communicate your needs without confusion. Also, even if you speak the language, it is smart to bring extra snacks to have with you in case you can’t find something to eat. But most importantly, have fun!

Photo info: http://www.flickr.com/photos/jevnin/ / CC BY-SA 2.0

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Venturing to Vancouver? These Medical Services Take the Gold

February 11th, 2010 by Laura Hilton

The XXI Olympic Games will commence tomorrow in Vancouver, Canada.  If you are one of the 2.3 million people expected to descend on British Columbia you should familiarize yourself with the recommended hospitals and emergency information.  You could be perfectly healthy when you arrive, but the elements and the large volume of people in crowded areas will expose you to potential injury or illness.  The Centers for Disease Control has put together a webpage full of suggestions for keeping healthy at the games, but in the event these tips fail to help you, here is some additional information:

In the event of an emergency anywhere in British Columbia, call 911. 

If you don’t need immediate assistance, but you are looking for medical advice, HealthLink BC offers 24/7 non-emergency access to a nurse hotline by calling 811.

Looking for a pharmacy?  Chain stores include Shoppers Drug Mart, London Drugs and Pharmasave.  Pharmacies are also available in supermarkets and discount stores, such as Zellers.

The majority of the Olympic events will be held in Vancouver, but some events will be held in Whistler and Richmond.  Familiarize yourself with the options closest to where you will be staying and the events which you will be attending. 

VANCOUVER
St. Paul’s Hospital in Vancouver was selected by the Vancouver Organizing Committee for the 2010 Olympic and Paralympic Winter Games (VANOC) as the primary hospital for Olympic visitors.  Vancouver General Hospital will play a similar role for Olympic and Paralympic athletes and coaches.    

St. Paul’s Hospital
1081 Burrard St
Vancouver
+1.604.682.2344

Vancouver General Hospital
855 West 12th Ave
Vancouver
+1.604.875.411

Vancouver Coastal Health operates hospitals and urgent care centers in the greater Vancouver area.

There are also other facilities available in Vancouver, including the University of British Columbia Hospital, which also operates an Urgent Care Centre in the Koerner Pavillion.  A private outpatient facility called False Creek Surgical Centre is also offering urgent care services during the games.

UBC Hospital – Koerner Pavillion
2211 Wesbrook Mall
Vancouver
+1.604.822.7121

False Creek Surgical Centre
6th Floor – 555 West 8th Ave
Vancouver
+1.604.739.9695

RICHMOND
Richmond, the site of the speed skating events, is served by Richmond Hospital.  There is also a private urgent care center called MCI Medical, located next to Zellers at the Landsdowne Mall in Richmond.

Richmond Hospital
7000 Westminster Highway
Richmond
+1.604.278.9711

MCI Medical
8311 Lansdowne Road
Richmond
+1.604.276.9550

WHISTLER
Although there is no hospital in Whistler, the site of the alpine events is served by Northlands Medical Clinic:

Northlands Medical Clinic
101-4359 Main Street
Whistler
+1.604.932.8362

If you’re visiting the Olympics, but not staying in Vancouver, Whistler or Richmond, visit mPassport.com for information on the facilities available where you are.  Healthy Travel Blog readers, sign up for a free thirty day trial of the mPassport mobile website here, just select coupon code and enter the code “Vancouver.”

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