Guest Post (and a damn good one): Sickness and Travel

It is inevitable that you will get sick on the road. If you are lucky, this sickness will involve a quick trip to the doctor and some anti-parasite medication. If you are me, your illnesses will straddle several continents, a multitude of body parts and an exploration of Eastern and Western medicine – all in the span of one year. I am happy to report that I am in the Philippines (and currently healthy!), and that the gamut of my illnesses were not life threatening. In fact, had I not been so stubborn about ignoring how awful I felt, I would have been able to avoid a lot of doctor's visits and insurance claims. But then I wouldn't have all this information about getting sick on the road, nor would I be guest posting on Michael's blog. From free hospitals in Argentina (who knew?) to a terrifyingly long wait time in Port Elizabeth to an incredible Tibetan medicine doctor in Siberia, I have explored a significant sample of what the world's medical systems have to offer. What started in April 2008 as a cold in bone-chillingly damp Punta Arenas blossomed into bronchitis, and then – due to a systematic and intransigent inability to admit how sick I really was – went downhill from there. The thing is, I had worked so hard as a corporate lawyer – for 6 long years – to save up for this trip. I wasn't about to let some little cold get in the way. So what happened as I stuck my head in the sand was that the cold turned into bronchitis, then all the resultant coughing bruised my ribs, then the illness moved to my sinuses, then I lost all hearing in my left ear and then I ended up on a flight from Johannesburg in July, shaking with 104 fever and delirious – and heading home. It took one month of absurdly strong antibiotics, a steroid inhaler and prednisone pills to get me strong enough to walk down the street again, and it took an extra month for me to feel more like myself. To make matters more interesting, in the middle of these frighteningly exponential problems, I tore two tendons in my ankle and got food poisoning from a llama empañada. Good times. After recovering back home, I took off for Russia in the fall of 2008, determined to not get sick again. This desire turned out to be laughable, since I somehow ended up with an uncontrollable, dry cough the second I arrived in Moscow. I was confused. I was used to that kind of phlegmy, wet cough that instinctively makes everyone around you cringe. What was this arduous hacking dryness? Without wanting to see a doctor immediately upon resuming my travels (I know, I know - you'd think I'd have learnt my lesson), I resorted to a Ricola cough drop on the roof of my mouth whilst I slept and some strong prayers that I wouldn't choke during the night. My pseudo-treatment seemed to work – and by “work” I mean “'not sleeping at all for most of September but not needing to be hospitalized”. Vanquished by my exhaustion and fed up with all the coughing, I finally caved when I was in Siberia. It was time to see a doctor again. I decided to approach my guide Andre about a doctor's visit when we were in Verkhnyaya Ivolga, a tiny Buddhist village in the semi-autonomous Buriyat Republic. Tucked into the Eastern shores of Siberia's cold, windy Lake Baikal, the village did not seem like an ideal place to find a doctor, but when I discussed the matter with Andre, he felt otherwise. Andre was one of the more knowledgeable guides I've ever had, with a wealth of information about the intricacies of Buriyat life (explaining that the houses in the Buriyat villages were scattered haphazardly about because the the local Lama was the one who divined where the house wanted to live, and thus actual town planning was nonexistent) and a healthy dose of sarcasm (when someone asked why Buddhists in Siberia eat meat, the response was “We're in Siberia. What do you suggest we eat instead?”). When I talked to him about potentially needing some antibiotics, he suggested that we go to the Tibetan Clinic instead – and I am really glad he did.

Verkhnyaya Ivolga, Siberia:

The clinic was a squat, chalky building right in the empty husk of town, and once the doctor ushered me into her office I had Andre run through the laundry list of my prior respiratory issues, ending with the dry cough that had plagued me for weeks. Other than my nationality, she had no information about me or my family history. Her examination started with the basics (blood pressure, heartbeat, breathing) and then I held onto a solid brass pen-like tube connected to a current meter with my writing hand, while she took another 5-inch brass tube and touched the reflexology points in my other hand. After taking out several plastic cartons, each with 10 small holes the size of a pencil tip across and 5 holes down, she used a different tool – baton at one end, exposed wire at the other – to prod my non writing hand with the baton and poke the exposed wire into an algorithm of the holes in the plastic sheets. The meter danced or remained immobile, depending on what holes the wire touched. She then put small sachets, one at a time, between the brass pole and my hand, and continued her examination. She started asking me questions about prior ailments and as translated through Andre, they were dead on: Did I have parasites recently? (Yes, thanks to the llama empañada.) Did I have a prior problem with wheat or flour? (Yes, they diagnosed me with a gluten intolerance years ago). And then she ran through my entire family's history – on both sides. Remember: I hadn't told her a thing about them or any of my medical history either, save for the coughing and bronchitis.

The diagnosis was scratched out on a piece of paper and translated through Andre that night (once he went home to comb through his Russian-English dictionary): I was allergic to wormwood, goosefoot, down and dust mites. I've never suffered from allergies before, and was dumbfounded, but since the woman had accurately and immediately provided me with my entire family medical history I believed her. She instructed me to take a spoonful of Tibetan powder, once at morning (a shot of powder followed by water) and once at night (boiled for 5 minutes and drunk like tea), from 2 small sachets that she prepared, and promised that I would have no cough in 10 days. I put the sachets up to my nose and inhaled deeply; their scent was strong, pungent and fairly indescribable. Were I to make a perfume called “Earth” I'd want it to smell exactly like the medicine she gave me. It tasted horrific, of course.

I got back on the trains, bound for Mongolia. Luckily, the only free thing on the Trans-Siberian or Trans-Mongolian lines is hot water – so taking my medicine was easy enough. Five days on: still coughing. I moved onto the Gobi, with my friend Bryce (who travelled on the trans-sib with me). No free hot water anymore, but Bryce had packed a camping stove and he generously boiled me water at night to take my Earth Medicine. Eight days, still coughing. And then, on the tenth and last day, my cough completely stopped. In the heart of the Gobi desert, living in a yurt with no running water and a family of nomads, I felt healthier than I had in months.

Me and my home in the Gobi:

The irony: I am allergic to Mongolia. Surrounding my yurt were plants Bryce and I recognized with a start: goosefoot and wormwood. Unable to explain the personal significance of these plants to the nomads, and unwilling to engage them in the subtleties of my illnesses (the age expectancy is 64 years old in Mongolia, so my allergies obviously paled in comparison to the problems they would have), I was content to laugh to myself about the turn of events. And of course, I was happy and relieved to have an underlying reason for the cough. Moving on from the Gobi, Bryce and I headed back to the trains. Staring out of the window as I watched the Mongolian steppes fade into the distance, to be replaced by staggering mountains as we dutifully chugged into China, I marveled at my first experience with a Tibetan doctor and resolved to be more open to Eastern medicine in the future.

Approaching Beijing, following the border crossing at Erlian:

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I am obviously not a medical professional, but below I've listed some of the Dos and Don'ts that I have cobbled together from 14-odd months on the road:

Do:
● Do try and bring a friend who speaks the local language. If that fails, bring a Point-It Dictionary and a lot of patience.
● Do keep sterile syringes on you. They take up very little room and are indispensable the one time the hospital or doctor has run out of clean needles. These are much cheaper to purchase on the road – I bought mine in Chile.
● Do invest in travel medical insurance. I took mine out as a Canadian national, meaning I am covered everywhere in the world except Canada. Check the riders for activities such as scuba diving, skydiving, jumping off random bridges or high altitude climbing if you've a bit of an adrenaline addiction, like I do. A good resource is BootsnAll's travel insurance page.
● Do eat street food, often. The reality is, street food is a great way to explore local culture and cuisine, will earn you props with the locals and is usually a safer option than whatever fancy restaurant is in town. So long as you stick to street carts that have lineups or a good turnover, and make sure your food is cooked through, you are less likely to get food poisoning than a quiet touristy spot.
● Do read How to Shit Around the World before taking off. If possible, try to read this book in public places, with the cover in plain view. You will make new friends.
● Do bring some acidophilus or probiotics tablets with you (the ones that do not need to be refrigerated, e.g. Pearls), to take after a cycle of antibiotics. These will help build up the good bacteria that your antibiotics cycle has destroyed. For the ladies, these will also help with some of the nastier antibiotics side effects.
● Do try and let traveller's diarrhea take its course without resorting to Immodium. the Immodium will just trap the bad bacteria in your intestines and potentially make you sicker in the long run. Instead, try and stick to oral rehydration salts and lots of water - unless, of course, you are taking an 18-hour overnight bus ride through the Andes from Cusco to Ica. In that case, go nuts with the Immodium. And then hope that the bus doesn't break down.

Do Not:
● Do not fall asleep in the hospital waiting room. You will wake up to a small child trying to tie you to your chair. Despite having 104 fever and a serious desire to crawl under the chair and sleep, you will muster up enough rage to push said small child away.
● Do not climb above 5000m (16,000 feet), for three weeks in a row when you have severe bronchitis. Similarly, do not climb a mountain requiring you to hoist yourself up steep ladders or ropes when you have several bruised ribs.
● Do not get food poisoning when you are about to embark upon a 3-day jeep tour through the Bolivian Antiplano. It will not be pleasant.
● Do not be as enthusiastic about antibiotics as your local doctor. Though they are important for certain types of ailments, the dosages and frequency will be higher than you are used to and it is equally important to be cautious about consuming so many – they take their toll on your body, believe me.
● Do not follow my street food rules, above, if you are in India.

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Born in Montreal, Canada, Jodi Ettenberg is a former corporate lawyer who quit her job to travel around the world. Starting in April 2008, Jodi has traipsed through South America, Russia and Mongolia, China and a good part of South East Asia, blogging the whole way. You can read about her adventures at http://www.legalnomads.blogspot.com/.