We don’t often have much conversation around healthcare issues when we talk about global mission. I think we’re either uncomfortable, because we deem it something personal, or we’re afraid we’re scare people off. The reality, however, is that we all need to be equipped to exercise self-care.

First, let’s dispel the myth that somehow staying home will prevent exposure to things that might make us sick. To use an often overused phrase, we live in a global village. We come into contact with people who carry all kinds of things every day. In addition, you can die from contracting serious infections such as C-Diff in American hospitals, get food poisoning from manufactured products (… peanut butter crackers, anyone?), and get parasitic infections in restaurants from poor hygiene. Personally, I have had several major digestive illnesses/infections. While I may attribute some of them to my international travel, the fact remains that I could have contracted every single one without ever leaving the United States.

Mindful of the need for self-care, the questions I’d like to address include: 1 – What kinds of tips can help with pre-trip medical self-care? 2 – What kinds of things are worth considering while traveling? 3 – Tips on self-advocacy if life hands you a travel related digestive challenge?

Pre-trip Advice …

- Even before you head to any kind of medical clinic, educate yourself. Your first stop should be the travel pages of the CDC [ http://wwwn.cdc.gov/travel/default.aspx ]. It will provide you with specifics for your destination and prepare you to be an educated consumer.

- Go to a Travel Clinic, as opposed to your primary care physician (PCP). (Be aware, though, that coverage for travel medicine varies with HMOs. In some instances, you’ll have complete coverage and/or maybe a standard co-payment. In other instances you may pay up most or all of the cost yourself … which can run up to $600 or more.) Travel Clinics will have knowledgeable staff who are used to advising travelers. Your PCP may be well-intentioned, but may know little, if anything, more than you regarding your travel needs.

- When you go for your shots, take along an International Certification of Vaccinations, a little yellow booklet that fits inside your passport. Groups can purchase them in quantities … $45/100 available through Occupational & Travel Medical Supplies www.occmedsupplies.com (203-331-8649). This record provides a handy reference in the event of any kind of medical emergency. In addition, since countries are beginning to require certain vaccinations for entrance after traveling to certain locations, it’s useful to have a record with your passport.

- Take with you what you might need. If you tend toward sinus infections, take an antibiotic like clarithromycin (Biaxin) or Azithromycin (Z-pack). In the event of a major digestive issue, consider carrying ciprofloxacin (Cipro), another antibiotic often prescribed for things like urinary tract infections, digestive infections, etc. In ALL cases, don’t just ask for and take these medications. Be absolutely clear with your medical professional about your personal issues and how s/he recommends your use of these antibiotics. Before tossing back that first pill, keep in mind that you may be creating a new situation by taking the medications. Your digestive tract is filled with various bacteria, both good and bad. In a healthy system, the good bacteria (which some people boost with things like Acidophilus, the bacteria that makes yogurt) keeps the bad bacteria in check. When you take any type of antibiotic or steroid, YOU CHANGE THE BALANCE OF POWER. In other words, you may discover that taking the antibiotic has made you susceptible to a new infection. So don’t think of antibiotics as panaceas and be absolutely clear about what your taking and when … which is best determined between you and your medical provider.

- Be sure to have an adequate supply (extra) of any medication that you take regularly. Medications should always be packed in your carry-on. If your luggage goes to the Middle East when you’re en route to Africa, clothes are easily replaced … medications are not.

- Many of the medical aids you can, and should, consider packing are over the counter. TUMS and Pepto Bismol tablets are good for calming your stomach. When in the countryside, you might consider taking a tablet along with an acidophilus capsule before meals (in the privacy of your room, so you don’t offend anyone). Whether or not you take an anti-acid product, many travel doctors now recommend taking acidophilus supplements as a healthcare precaution.

Things to consider while traveling …

- CLOSED TOE SHOES ... mandatory ... many parasites access your system through your skin. Many also reside in soil. One way to fight them and possibly prevent exposure is to wear shoes whenever you're in the countryside. The best advice is to only wear open-toed shoes when you’re going to be primarily indoors.

- As stated above, only take antibiotics when/if absolutely necessary ... one of the ways that certain infections emerge is by having the good bacteria and enzymes in your system thrown off by antibiotics.

- There are a number of different opinions on this, but most professionals recommend taking a COMPLETE course of an antibiotic like Cipro when you start. My own feeling is that you shouldn’t stop when you start feeling better ... but rather, take a full course of a drug you were prescribed (usually 6 or 10 days). Again, though, you shouldn’t take my word on this … you should have a detailed conversation with a travel medical professional before deciding on proper doses of any medication.

Self-Advocacy (post-trip) ...

- If you start having odd bowel movements (diarrhea one day, constipation the next), pay attention to your body and speak with a medical professional. It’s a good idea to write up a couple of pages of your medical history along with your symptoms. Some practitioners will initially treat you like you’re a hypochondriac, but you’ll know they have the right information and you’ll also have an easily updated record for meeting with more than one healthcare provider.

- Be mindful of little changes such as not sleeping, or sleeping too much

- Eating issues that might seem like no big deal ... loss of appetite, feeling bloated, extra gassy, etc. ... could be signs. Pay attention and note what's not quite right, because the little things add up.

- ALWAYS start your conversation with “You need to know that I have been in _______.” This typically causes a doctor to start checking for parasitic infections (stool and blood samples) rather than assuming you have some other digestive disorder or illness. If you don’t say you’ve been traveling, they’ll assume things like colitis, diverticulitis, and gastritis. Unfortunately, they’ll find symptoms and inflammation that may lead them to believe they were correct, as you may have developed those related issues. What they won’t find is the culprit that caused you to have those symptoms in the first place. So you’ll receive temporary relief, think you’re well, and end up back at the doctors in a few months. In the meantime, you may take medication that inadvertently helps the parasite develop resistance.

- DON'T take “NO” or “YOU'LL BE FINE” for an answer. Be VERY persistent. No one knows your body better than you.

- EDUCATE yourself as much as possible starting with the CDC website. BUT, also be careful about where you gather information ... AVOID websites that are devoted to parasitic infections. Most are garbage, and are just glorified marketing campaigns to get you to buy their “miracle” anti-parasite treatment program.

- DON'T allow the medical establishment to rely on stool tests. Some people will tell you that is how parasites are found. THEY'RE WRONG! I’m aware of a hospital study (sorry, I don’t have a reference) in which they found that out of 2000 patients (using medical records as the reference), 50% had a parasitic infection. Only 2% of the participants had tested positive ... in other words, only 2% were identified through stool samples. That means that 980 people out of 2000 (a whopping 48%!!!), were initially told they didn't have a parasitic infection based on their stool samples. In addition, with HMO cut backs and cost savings, many labs run insufficient tests and/or have poorly trained lab techs leading to potentially incorrect findings.

- INSIST on blood tests. You want to know your white blood cell counts (particularly your eosinophils) and you want antibody and toxin tests for as many parasites as possible. Though some may find this a bit much, I like to find out the details of antibody tests and check with labs about how they run their tests. In the case of one particular parasite, I discovered that labs typically test for one toxin in the blood. Recent studies have shown, though, that the most reliable tests require two toxins. Before my physician ordered my blood work, I called all the regional labs to see how they conducted their lab tests. Based on that information, we selected the lab for my blood work.

- DON'T allow anyone to tell you, "Oh, it's common for people to have eosinophilia." If I had a buck for every doctor who said that, I might actually be able to start rebuilding my retirement account.

- Since many people can be asymptomatic, meaning you can be exposed to something but not have symptoms, you might want to consider adding some parasitic tests to your annual exam. For example, you may return from a trip and learn that one of the members in your group is ill with a particular parasite. Even if you don’t get sick, it’s worth determining whether or not you were exposed to the same thing. If you are having blood drawn anyway, you may ask for antibody tests for that particular parasitic infection. It’s a bit like stabbing in the dark, and most physicians will see it as an unnecessary expense, however, a positive result for a certain infection is a very good heads up for you and your doctor.

In closing, I want to make one last pitch about communication. We tend to treat healthcare as a very primate matter. That’s fine, and often very appropriate. However, when you’ve been on a mission trip with others, you are doing each other a disservice if you don’t communicate when a health issue arises. The catch is figuring out the best way to balance open communication with appropriate levels of privacy. If your issue is truly yours, you don’t want to panic everyone on your team that they have some rare disease, only to discover you have something like appendicitis that has nothing to do with your trip. On the other hand, if you are diagnosed with a parasitic infection that you are likely to have picked up on your travels, and to which others are likely to have been exposed, I would argue that you have a responsibility to the others in your group. You may be able to eliminate unnecessary worry, and provide substantive direction to their physician. The best way to manage how and when to communicate is probably to decide when you have sufficient information to make a judgment call. Just feeling sick may not be the time to publicize. But once you begin treatment in response to a positive test for a particular bacterial infection, you should probably contact your team leader and discuss the issue.

*Important Note: This document is not a complete medical guide for travelers. Always consult with medical professionals for specific information related to your needs and your medical history; recommendations may differ for pregnant women, young children, and persons who have chronic medical conditions.