Archive for the ‘Destinations’ Category

Malaria Strikes in Haiti; Dengue in Puerto Rico

Friday, 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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Geoalcoholics – Russia’s unhappy truth

Friday, 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

Friday, 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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Means to End Chikungunya Menace? Report Raises Hope

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

Monday, 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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Emerging Antimalarial Drug Resistance – Cause for Alarm

Tuesday, February 9th, 2010 by Frank Gillingham, MD

A report released yesterday by a United States Pharmacopeia program, in partnership with the World Health Organization, cited an increasing level of resistance to Artemisinin – the last affordable drug in the global arsenal against malaria.  The drug resistance is emerging in Uganda, Senegal, Madagascar, Cambodia, Thailand and Vietnam, and is thought to be due in large part to the sale of poor quality versions of Artemisinin in those countries.

The report indicated that between 16 and 40 percent of the drugs marketed as Artemisinin had impurities or did not contain enough active ingredient to be effective.  Drugs will typically lose effectiveness and allow parasites to develop resistance if not given at full strength or for the full recommended course. In the case of malaria, there is no useful replacement for Artemisinin currently available, and many could die or become gravely ill if the current trend continues.

“It is worrisome that almost all of the poor quality data that was obtained was a result of inadequate amounts of active ingredient or the presence of impurities in the product” said Patrick Lukulay, the director of the study.  Senegal had the most disturbing results, with over 40% of the Artemesisin based samples failing quality testing. Lukulay added “There are some countries where donated medicines are not subjected to quality controls, they are just accepted”.  This includes countries in Africa where Chinese products have been given and found later to be unacceptable.

Although results from other countries in the ten country study have not been released, preliminary evidence from the other countries surveyed – Cameroon, Ethiopia, Ghana, Kenya, Malawi, Nigeria and Tanzania suggest that failure rates in at least three of those countries were also high. 

Traditional antimalarial drugs such as malarone, doxycycline, chloroquin and mefloquin are still effective in many parts of the world where the malaria parasite is endemic.  In recent years, Artemesinin has been the last resort in areas where the parasite has developed resistance to these medications. However, for those travelling to sub Sahara Africa or southeast Asia, the risk of contacting Artemesinin resistant malaria is growing.  Although resistance is not yet widespread, it behooves the careful traveler to make sure that any Artemesinin based medication taken for treatment of a malaria infection is of good quality.

Photo info: http://www.flickr.com/photos/lonqueta/ / CC BY-NC-SA 2.0
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What’s Holding Back Happiness In Russia?

Monday, February 8th, 2010 by Chrissy Donovan

If you are a regular reader, you know we’ve been hunting for happiness. But sometimes on our travels, if we look closely, we gain insights into deeply rooted cultural sources of unhappiness.

We recently introduced our Healthy Planet Index, a ranking of 141 countries that is based on a measure called happy life years—a combination of life expectancy and satisfaction with life.   For instance, in Costa Rica, life expectancy in 2005 was 78.5 years and satisfaction with life (on a scale of 0 to 10) was 8.5; we used these figures to create a Happy Life index value of 66.7, which tops the Healthy Planet Index. 

As we reviewed the results, one country that caught our eye is Russia.  With 38.1 happy life years, Russia ranks 91st.  Russia is 75th when our 141 countries are ranked by happiness and 97th when they are ranked by life expectancy.  The question is, what problems are behind these low figures?         

The answers are numerous.  A substandard system of medical care, the prevalence of tuberculosis (a disease of poverty) and overindulgence in alcohol are some of the bigger pieces to the puzzle.  Let’s take a closer look at alcohol.  Everyone knows the stereotype that Russians are heavy drinkers.  We did some research to see how much truth is in this generalization.  First, we’ll give you the numbers.  According to the World Health Organization in 2003, 10.3 liters of pure alcohol were consumed by each Russian person over the age of 15.  10.3 liters of pure alcohol translates into 580 shots (1.5 oz. drinks) of 80 proof vodka (and yes, we chose vodka because we‘re talking about Russia).  That’s an average of 1.6 shots per day.  It should be said that 10.3 liters was not the highest figure for a country in 2003.  In Ireland, which was at the top of the list, the average was 13.6 liters.  Russia is not the only place where lots of alcohol is consumed.  On the other hand, the situation in Russia is said to be even worse than the official numbers portray because of the large black market for alcohol.           

There is more to the story than these raw numbers, and it’s something visitors to Russia should heed:  alcohol in Russia is often consumed more dangerously than in other countries.  History books, newspapers, Russian officials and ordinary Russians all say the same thing:  Russians tend to drink in binges.  And, of course, they tend to drink vodka, a highly distilled alcohol.  This is the Russian way of drinking.  And it is the kind of drinking that can kill in the span of a night.   Bootleg alcohol that has toxic ingredients is not an uncommon thing in Russia.   All of these circumstances add up to a high rate of death due to alcohol poisoning in Russia.        

That’s nothing to take lightly; however, it’s the smaller, more sensational side of the story.  Much of the self-destruction from over-drinking takes more time to show.  We’re talking about heart disease, alcoholism, cancer, violence, weakened immune systems, lost days of work, to name a few.  These ills are the larger villains.

The bottom line? Russia’s problems with alcohol are real, not just stereotypical.   Russia is certainly not the only country that faces a struggle with booze (hint hint Western world). But misery with company is still misery.

Photo info:  http://www.flickr.com/photos/atbaker/ / CC BY 2.0
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Mudslides in Machu Picchu

Tuesday, January 26th, 2010 by Moira Bishop

The heaviest rains to hit Peru in the past fifteen years have caused mudslides with serious consequences today — 4 people have been killed and 2,000 tourists have been stranded in and around Machu Picchu.

Reports from our contacts at Pardo Medical Center based in Cusco, Peru indicate that the heavy rain is not letting up and that is causing problems for transportation.  The trains are not running and the Cusco airport is closed until at least tomorrow, so the only way out is by helicopter.  The clinics are open for anyone who can get to them. 

Like many natural disasters, mudslides cannot be predicted.  If you are visiting or planning to visit a mountainous — or even just hilly — region that has recently experienced heavy rainfall or snowmelt, you may want to reconsider your plans.  

Ideally, you will never be in the path of a mudslide, but just in case, it’s a good idea to note these instructions from the Red Cross:

  • Quickly move out of the path of the mudslide or debris flow.  Moving away from the path of the flow to a stable area will reduce your risk.
  • If escape is not possible, curl into a tight ball and protect your head.  A tight ball will provide the best protection for your body.

Though you don’t want to spend time dwelling on worst case scenarios while preparing for vacation, a few minutes of planning can prove to be invaluable.

Photo info: http://www.flickr.com/photos/comprock/ / CC BY-SA 2.0
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More Happiness Data by Destination: Study Ranks States

Tuesday, December 22nd, 2009 by Mike Hartung

Louisiana is one of the happiest states in the U.S.The latest investigation into happiness by destination comes from Andrew Oswald of the University of Warwick (UK) and Stephen Wu of Hamilton College (NY) who have ranked all fifty states and DC using two data sets. One from the Centers for Disease Control compiles responses from 1.3 million Americans who were asked this: “How satisfied are you with your life?” The other is research conducted at the University of Southern California on indicators of quality of life such as sunshine, crime and environmental health. Surprisingly, Louisiana came out on top even in the aftermath of the Katrina disaster. And Mississippi is in the top six. At the bottom of the list? New York and Connecticut. There’s clearly little or no correlation with income per capita. The authors found a high degree of correlation between the subjective survey responses and the more objective indices. They speculate that “liberal angst” might be playing a role.

I’ve spent time in both New York City and New Orleans, and if we could measure the velocity of life, I think it would go a long way toward explaining these findings.

Photo: http://www.flickr.com/photos/philippeleroyer/ / CC BY-NC-ND 2.0
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Discover the Developing World’s Ten Best Ethical Destinations

Monday, December 21st, 2009 by Mike Hartung

The Earth Island Institute has published its 2010 Ethical Destinations Report at ethicaltraveler.org, shedding some light on the developing countries that have demonstrated the strongest commitment to environmental protection, social welfare and human rights. The report is a serious research effort to promote ethical travel: gaining an awareness of our impact and responsibilities as we explore the world. By all accounts it’s worth the trip. According to the authors, the countries cited represent “opportunities to experience nature at its most pristine, and to interact with local people and cultures in a meaningful, mutually enlightening way.” 

The authors have mined some of the best published data available to come up with this year’s Top Ten (see chart below). It’s interesting to find four South American countries, four African countries and two eastern European countries. Developing Asian nations did not make the list because of irresponsible development policies, human rights abuses and weak environmental policies. The comments we included in the chart are research findings measured against all countries of the world. These achievements are particularly impressive for nations without a long history of democracy. Though fledglings, these countries are ready to take flight as destinations for responsible travelers.

A handful of countries fell out of last year’s Top Ten: Costa Rica, Bolivia and Bulgaria have a growing reputation for child trafficking, and Nicaragua’s human rights record took a major step backward.

Do you have first-hand experience as an ethical traveler? The Healthy Travel Blog would like you contribute to this conversation.

ethicaltravelerchart

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