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Emily Moran is a guest contributor to Healthy Travel Blog. During the school year, she is a math teacher and curriculum coordinator at Greene Street Friends School in Philadelphia. During vacation, she travels when she can, and lived and studied abroad in Paris, France while receiving her undergraduate degree. She received her Bachelor of Arts from Haverford College in Mathematics with a minor in French.

Traveling Gluten Free

Wednesday, February 10th, 2010 by

Recently, a study was released regarding the increased prevalence of celiac disease. The Mayo Clinic in Rochester, MN analyzed about 9,000 blood samples taken in the 1950s and based on the findings reports that 0.2 percent of that population had celiac disease, but today an estimated 1 percent of the population has it. Celiac disease is a severe intolerance to gluten—a protein in wheat, barley, and rye. As more and more people are diagnosed, more organizations, websites, and blogs have been formed to help people find a variety of foods that are both tasty and gluten free.  

Over time those affected acclimate themselves to the labels, guides and menus available to help them navigate options in their favorite restaurants and grocery stores. But what happens when they go abroad? 

Because there is plenty of helpful information available, the celiac diagnosis does not have to deter anyone from traveling.  The National Institute of Health Celiac Disease Awareness Campaign is a good place to start—the travel section provides an outline of how to plan, travel, and then visit a different country. The Celiac Travel website provides even more detail.  One of the best features is free printable cards in 43 language describing celiac disease and the dietary limitations around them. They’re even available as an iPhone app! In addition to the general travel tips and tools, the “Celiac Travel Stories” section offers user-generated anecdotes and restaurant reviews. (For additional “traveling with Celiac” stories check out Celiac.com.)

The book Let’s Eat Out: Your Passport to Living Gluten and Allergy Free has compiled a list of country-specific Celiac organizations and information sources.  Use this information to help plan for and enjoy a worry free trip abroad. 

Do you have any travel-related or country-specific tips you’d like to share?

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Show Your Respect and Savoir Faire: Learn the Local Customs

Monday, November 30th, 2009 by

symbol for money in JapanFor many people, travel provides unique opportunities to get to know another culture. You can learn history through museums and monuments, but if you want to embrace the culture, you need to taste local foods, enjoy local entertainment and follow the local customs.  Our post last week offered a brief overview of some unusual local foods you might be expected to ingest. Today, we point you toward some resources that can alert you to some unusual local customs. It’s our way of helping you avoid potentially embarrassing or even dangerous situations arising from offending your hosts or hostile locals when you are away from home.

For instance, did you know that in Poland flicking a finger against your neck is an invitation for someone to join you for a drink? That the symbol used in the U.S. to mean “ok” means “money” in Japan? Or that in Indonesia neither men nor women should wear shorts, even in the heat? This video from CNN helps you avoid some other miscommunications abroad.  

These cultural traditions are important to know, especially for business travelers dining with locals or students lodging with host families.  Some of the best advice you can get will come from people you know that have lived in your destination country. If you don’t have personal contacts, you’ll want to do some research.

Two places to start learning are the web sites Kwintessential  and  Cyborlink. Both are geared towards business travelers but provide valuable information for anyone on the issues of attire, behavior, gift giving, and communication. If you’re going to be visiting a country for a long period of time or if you plan on staying with a local family, you may even want to consider buying a book about the culture of your country. Both Culture Smart and Culture Shock books get generally good reviews.

Take the time to learn some customs of your destination so you can make a good impression—you’ll see nods of approval when you eat your banana in Bolivia with a knife and fork!

Photo by circulating: http://www.flickr.com/photos/circulating/ / CC BY-NC-SA 2.0
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Posted in Travel Tips, Traveling Responsibly | 1 Comment »

You Say Turkey, I Say Fried Scorpion.

Wednesday, November 25th, 2009 by

friedscorpionWhile Americans were busy consuming 232 million turkeys last year (46 million of them on Thanksgiving), others were passing on the noble bird in favor of a snack of beetles, crickets and other arthropods and insects.  There are many places in the world that have markets full of these delicacies. If you sample this fare while roaming the world, are you being brave or just foolhardy?

In parts of Asia, Africa, South America and Australia insects, including locusts, crickets, beetles, caterpillars, and bamboo worms, are a common snack. Some people eat scorpions, and tradition says that eating the tail (where the stinger is) will make you strong. In China, you can also taste test exotics such as jellyfish, seahorses, starfish, and sea urchins.

Why eat them? Of course there’s the pure adrenaline rush around trying something new and unusual. But there are actually health benefits to eating insects. Pound for pound, insects contain more protein, fat, and carbohydrates than meat, and could help resolve hunger issues around the world.  They can even help address environmental concerns. Thailand’s countryside is drying out, possibly because of global warming, which makes it difficult to farm large animals, so some farmers are switching to raising insects.  

While insects have not yet inspired a holiday feast, many local outdoor markets are brimming with choices on a daily basis.  The Wangfjing Street Market and Donghuamen Night Market got a lot of press during the Olympics, and offer tons of variety. Time Out in China recommends other, less-touristy options.

A few words of caution as you explore: in the interest of general food safety, choose things that are cooked right in front of you and have been prepared on a clean surface. Be sure you know what you’re eating, for example “fugu” in Japan is blowfish which can be poisonous if not prepared correctly.  Finally, please note if you have allergies that blossom into asthma, you want to avoid fried insects! Recent research suggests they contain high levels of histamine.

If you’re an experienced insect eater, we’d like to know this: is it the flavor or the texture that makes the memory?

Photo: http://www.flickr.com/photos/rangama/ / CC BY 2.0
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Ime chortofagos! I’m a vegetarian!

Friday, November 20th, 2009 by

hummus in a Turkish restaurantIme chortofagos,  is Greek for ”I’m a vegetarian.” A poll from 2005 estimated that 4.7 million adults in the U.S. are vegetarians.  Vegetarians that travel sometimes worry about how to maintain their diet while in a foreign country, but as the population of vegetarians has grown, so have the resources. Here is some advice on what to eat while abroad. (If you are looking for ways to maintain your vegetarian diet in a culturally diplomatic way, check out this HTH Worldwide-sponsored post on Glimpse.)

Where to go? India, Italy, and (perhaps surprisingly) Turkey are often recognized as being vegetarian friendly. India is traditionally vegetarian, with 20%-40% of the population identified as vegetarian. The popularity of pasta in Italy is a safe bet for travelers, and local fare like couscous, hummus, and roast vegetables in Turkey is a nice alternative. Most other countries can accommodate vegetarians as well. The vegetarian website HappyCow allows you to search for restaurants around the world. There is even a vegan-only restaurant search. They also have some helpful traveling tips.

What to avoid? In many countries, vegetarianism is not very common. Occasionally, people may assume that you eat fish, just not meat, so you’ll want to be clear about what you will eat. You should also check to ensure condiments and sauces don’t include meat or fish products. In Japan, for instance, many things are cooked in fish broth, and even convenience food has fish or meat in it.

How to order. Check out the International Vegetarian Union. They have translations for vegetarian (and some vegan) phrases in many languages, some with printable cards. They also have lists of common vegetarian recipes—the titles could be helpful when looking through a menu. Just remember to be clear and respectful when communicating your needs, and enjoy the local food!

Photo by Alaskan Dude http://www.flickr.com/photos/72213316@N00/ / CC BY 2.0
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Eating Safely: What can I do?

Friday, September 4th, 2009 by
Escherichia coli (ETEC) - the bacteria that most commonly attacks traverlers

Escherichia coli (ETEC) - the bacteria that most commonly attacks travelers

A recent post on the Uncornered Market blog addresses the not-so-delicate topic of “how to travel without hugging the bowl.”   Though this is sometimes unavoidable, there are some steps you can take to protect yourself and your vacation from a gastrointestinal attack.

More than 200 foodborne diseases have been identified worldwide and include traveler’s diarrhea, Hepatitis A, typhoid fever, cholera, salmonella, and E. coli. For travelers, the most common foodborne disease is — you guessed it — traveler’s diarrhea.  What causes it? Generally it’s caused by bacteria, often Escherichia coli (ETEC). According to the CDC,  between 20% and 50% of travelers develop diarrhea.

Where should I be extra careful? The World Health Organization (WHO) says, “It most commonly affects persons traveling from an area of more highly developed standards of hygiene and sanitation to a less developed one” and reminds us that “While the risks are greater in poor countries, locations with poor hygiene may be present in any country.”  The CDC says that high-risk destinations are developing countries in Latin America, Africa, the Middle East, and Asia.

What’s wrong in these countries? Developing countries often lack either food regulations or the resources to enforce them. The Codex Alimentarius Commission is a joint organization of the WHO and the FAO (the Food and Agriculture Organization of the United Nations) that suggests voluntary food standards, but countries aren’t required to follow them. You can see the member countries of Codex here.

What can I do to stay healthy? The key is getting rid of the bacteria and viruses that cause disease.  Minimally, use the same judgment abroad that you would use when eating in your own neighborhood: Don’t dine in establishments that don’t appear clean or that have a bad reputation.  Make sure your food is cooked properly — whereas you might like your food a little rare, you may not want to leave that judgment up to the cook in a foreign country.  And when it comes to water, always choose bottled over tap, but know that sometimes bottled water isn’t what it appears to be. A colleague was in a resort recently where we saw employees filling up the bottles from a tap.  Perhaps the source was filtered and fine (many hotels have their own special systems to purify their drinking water), but who knows.  Ice is also a no-no.

The WHO has five basic guidelines that they cover in their traveler’s brochure Prevention of foodborne disease: Five keys to safer food.   You should also check out the CDC destination pages — each page has country specific tips about food and water. For instance, the guide for France recommends avoiding unpasteurized dairy and washing hands, while the guide for Kenya adds comments about water, street vendors, and cooked food.

Do you have any destination-specific advice to share or, worse, horror stories from the proverbial trenches?

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Posted in Food Safety | 5 Comments »

Is it Safe to Take That Taxi? Tips for Travelers

Wednesday, August 26th, 2009 by

taxisAs summer draws to a close and travelers are scrambling to squeeze in one more trip, it’s a good time to revisit the WHO Study of Global Road Safety. 

It’s great to know the dangers of the road when driving, but what about those times when you’re not the person at the wheel? Many travelers choose taxis as a primary method of getting around. Taxis are generally safer than many forms of public transportation, especially if buses and trains are overcrowded, poorly run or unregulated. According to the WHO report, in Kenya where public transportation consists of boda bodas, tuk-tuk’s, mataus (small vans with sliding doors, blasted reggae or R&B music and the strong smell of BO- window seats are best) and taxis, 38% of the road deaths were passengers in buses and mataus. Still, hailing a cab has its own potential perils.

When traveling in Panama City, an HTH Worldwide frequent business traveler was told not to trust the taxis there.  A security consultant advised him to have the hotel send a car for him and provide him with a password that he could request from the driver to verify that it was in fact the correct car.  So in addition to asking the hotel in advance to recommend a safe taxi service for you, here are a few steps you can take to minimize the risks.

Before You Get In

  • Use authorized taxis only. Not sure how to spot one? Go to a taxi stand, ask at the hotel, or ask a local. Legal taxis should have common characteristics such as similar makes/colors, radios and meters in the cab, phone numbers on the car, identification for the driver — so look for these indicators if you are on the street. Better yet, use a phone to call a cab and wait for it to arrive.
  • Be sure the car seems safe. Are there seatbelts in the back? Are there door handles on the inside?
  • Does your driver know how to get where you’re going? Have the address and phone number of your destination written down and mention local landmarks the cab should pass.
  • Use common sense. You don’t need to share a cab, and shouldn’t. If there’s no meter, settle on a price beforehand.

  Inside the Cab

  • Don’t try to fit more people into a cab than it can safely accommodate. Sit still and try not to distract the driver.
  • Know the local traffic patterns and rules of the road. Is the driver following the speed limit? Is he following posted signs?
  • If the driving is poor, ask the driver to stop; then get out and switch to another cab.

If you find a cab and driver you like, give him a nice tip and get a phone number. You may want to ride together again. Any other advice you would like to share?

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Swimming Safely at the Seaside

Monday, August 24th, 2009 by

ripcurrentNow that Bill has passed (the storm, not health care reform), we should remind ourselves of the dangers of ocean swimming.  Just this weekend in Acadia National Park in Maine, onlookers watching the huge crashing waves were overwhelmed by them.  Three people were swept into the ocean, and, tragically, one of them died.  Many others were injured.

The ocean is the perfect spot to cool off from the heat of the summer. If you’re traveling in the northern hemisphere at this time of year, chances are you’ll encounter and explore some tempting beach or bay.  These fun distractions are a great way to spend a day as long as you exercise care.

Of course, drowning is the biggest danger… In Texas this year alone, 30 children swimming in the surf died from drowning in June-a record month for the state.

Ocean swimmers have to contend with heavy surf, rip currents, and marine pests (like jellyfish).  This time of year, the dangers of ocean swimming are exacerbated by the arrival of hurricanes and tropical storms.   Do you know the international language of beach safety flags? They can be extremely helpful for you to understand surf conditions, especially if you are in a country where you don’t speak the language. The International Life Saving Federation helped create them, and has published background information and pictures here (scroll down for images). If you do get caught in a rip current, remember to swim parallel to shore until you’ve escaped the pull and then swim in to shore. The national weather service offers additional rip current safety tips on their website.  Be aware of lingering turbulence; after a hurricane or storm, the ocean needs time to settle back down. Don’t assume that the water is safe just because the storm has moved through the area.

And don’t leave your common sense on the beach house veranda. Experts agree that constant supervision is the best way to keep children safe while swimming, even for strong swimmers or in shallow water. For all swimmers, it’s important to know the depth of the water, fellow swimmers’ abilities, and that lifeguards are present. Avoid dangerous spots such as sharp reefs and sudden drop-offs. Plenty of adult supervision is key. Of course, grown-ups who have been drinking may have lost their adult judgment. Keep those beach parties under control to keep the lifeguards out of the water.  Make the most out of the rest of the summer: swim safely and enjoy yourself.

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Enjoy the Paella, but know the risks of eating shellfish

Wednesday, August 19th, 2009 by

paellaSitting down to a steaming bowl of paella–rice, broth, chorizo, clams and mussels–with a pitcher of Sangria is a fiesta for the tastebuds. It’s also a gastronomic adventure that can lead to serious illness caused by allergies, bacteria or Hepatitis A.

If you have a food allergy and are planning a trip abroad, you may have checked out our previous post.  But if you think you’re allergy-free, think again. Did you know that allergies often develop for the first time during your adult years? In fact, a shellfish allergy is the most common type to develop at a later age. According to the National Institute of Allergy and Infectious Diseases, seafood allergies affect only 0.6 percent of children but 2.8 percent of adults. So if it’s been a while since you sat down to crunch some crustaceans (crab, lobster, shrimp) or munch some mollusks (clams, oysters mussels, snails, squid, conch), consider the following:

  • If you have family history of allergies (including hay fever or asthma), your chances of being allergic to shellfish increase.
  • Most shellfish allergies are relatively mild and sometimes resemble food poisoning (which, as we all know, isn’t any fun).  
  • Rarely, a shellfish allergy can trigger anaphylactic shock. Anaphylasis is a medical emergency that requires treatment with an epinephrine (adrenaline) injection (experienced travelers often carry an “epi” pen) and a trip to the emergency room.

If you have any symptoms after eating shellfish, even if mild, you should see a doctor — quick treatment helps avoid more or prolonged problems. It’s also important to consider the proximity of competent medical care. If you’re going to be far from reliable emergency services, don’t eat the escargot.  Yes, escargot, or land snails, are mollusks too and bear the same risks as their sea-dwelling brethren (not really brethren — all land snails are hermaphrodites, but that is a whole other story). 

If you decide that strong risk factors and poor medical options warrant avoiding shellfish, remember that you won’t be using menus replete with allergy warnings. Be aware of the potential for cross-contamination, and the sneaky places shellfish can pop up — like in condiments of East Asian food. Check out this listing of shellfish risks by world cuisines.

Some notes of caution: In some areas the favorite local dish can get you into some serious health problems, like the one recounted in a recent Wall Street Journal article.  In Santiago, Chile a bowl of mariscal contaminated with E coli had near tragic results for a young college student.  Also, be aware that mollusks harvested from waters polluted by sewage often carry the Hepatitis A virus, which they ingest when they feed. No amount of washing can remove the contagion.  So eat raw clams and oysters at your own risk. Even high-end restaurants in cities like Venice have served up “Hep A on the half shell.” We’ll cover hepatitis, its various strains and the immunization that is available in an upcoming post.

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Warning: Jellyfish on the rise!

Thursday, August 6th, 2009 by

jellyfish21Jellyfish have long been a danger of the sea, and many summer beach stories involve a tale of a painful encounter. Now, according to researchers, there will be plenty more stories to tell:  jellyfish numbers are increasing, and they are migrating to popular swimming areas. The increase in jellyfish numbers can be traced to overfishing of their natural predators such as tuna, swordfish, and sea turtles. At the same time, jellyfish have started massing closer to shore, possibly responding to warmer seas related to global warming dynamics.

Jellyfish are found in most oceans, (check out this map of common tourist locations with jellyfish), and the National Science Foundation recently released a detailed paper on “hot spots” of recent jellyfish blooms that can help  anticipate problems in specific locations.  Of particular concern is the amount of jellyfish near Spain and the surrounding Mediterranean region this summer. Not only have numbers of Mauve Stinger jellyfish been increasing every year (with 300 people stung in Barcelona over a few hours in 2008), but this summer many Portuguese Man-of-War have been spotted. (While not technically jellyfish, they cause very painful stings and can cause chest pain or muscle spasms.)  This problem is definitely spreading as shown by the large number of jellyfish warning signs popping up on the beaches of the UK this week.

The bottom line is: if you’re at a favorite beach and encounter jellyfish, you’ll  need to know what to do if you get stung. The first, if obvious, rule is to get out of the water. Flag down a bystander or lifeguard if the pain is making it difficult for you to move in to shore. Once on shore, rinse with salt water (fresh may be more painful), ice it,  but don’t rub it. Remove the tentacles with tweezers and gloved hands. A vinegar rinse can help prevent the release of toxins, particularly with box jellyfish and the Portuguese man-of war. For these two species, you should also contact a medical authority. Many experienced beach bums recommend applying shaving cream or a paste of baking soda/water and then shaving or scraping with a credit card to remove stingers.  If you’re heading to a jellyfish hotspot you may want to consider adding tweezers, vinegar, and shaving cream to your first aid kit. By the way, the urban myth of urinating(!) on stings is just that — it won’t do any good, and could make it worse.

Jellyfish are actually fascinating animals. You can visit the interactive special report put out by the NSF if you’re interested in learning more about them through pictures, videos, and fun facts.  Just keep your distance from them in the surf.

What’s your jellyfish story?

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Walking Into Trouble: Pedestrians in Peru (and Other Places)

Tuesday, July 28th, 2009 by

Worldwide, 46% of all highway fatalities are “vulnerable road users”-pedestrians, cyclists and people on two-wheeled motor vehicles, according to the recent WHO report on road safety.  But we’ve run some numbers and found that in Peru, for instance, pedestrians alone account for 78% of all highway deaths. In the U.S. and India that figure is 12%.

Travelers typically explore their new surroundings on foot, so we think it’s worth investigating where pedestrians run (or should I say walk into?) the highest risks. The chart below shows the countries where pedestrians make up the highest proportion of road deaths.

Look Both Ways - Pedestrians as % of Total Deaths

Look Both Ways - Pedestrians as % of Total Deaths

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

Joining Peru in the “top twenty” are countries as diverse as Mozambique, El Salvador and the Ukraine. When paired with similar countries, large disparities in risk appear. For instance, Peru (78%) and Ecuador (43%) are Andean neighbors; Mozambique (68%) and Kenya (47%) are East African cousins; El Salvador (63%) and Panama (46%) are Central American siblings, and the Ukraine (56%) and Belarus (40%) are almost Eastern European twins. Why the spread? We’re not sure, but it’s well worth noting.

Even if you’re not traveling to one of these high risk countries, it’s a good bet your pedestrian experience will be very different when you’re abroad, particularly if you’re exploring big cities. Traffic patterns may be novel, sidewalks may be limited, and stoplights or crosswalks are often inadequate or non-existent. Check out these videos of people crossing the street in Vietnam (no death rate data available!): this one has a nice view of traffic pattern, and this one shows the perils even on a crosswalk!

So, wherever you’re walking (and running these risks), here are a few tips:

  • Walk where cars can see you-not behind signs or bushes.
  • Wear visible clothing-resist the urge to wear black at night.
  • Look both ways! If cars drive on the right (like in the U.S.), look left first, then right, then left again before starting to cross. If cars drive on the left, look right, then left, then right again.
  • Face traffic when you are walking on the roads (especially on the more narrow ones) so that you can see approaching vehicles.
  • Assume the motor vehicle always has the right of way.

If you have any tip or experiences that you’d like to share, please do! 

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