Common problems that travellers encounter, such as stomach upsets and those from insect bites, can be prevented by taking . . . → Read More: Preventing Medical Problems]]>

Common problems that travellers encounter, such as stomach upsets and those from insect bites, can be prevented by taking simple precautions.

These include such things as good hygiene and safe food preparation practices, drinking (and using) only treated or clean water, avoiding being bitten by various insects and worms, and getting vaccinated and taking pills to prevent diseases.

Clean water and water treatment

Everyone needs a minimum of about two and a half litres or just over half a gallon of clean water a day. In hot climates while doing things like carrying a backpack, hiking or just walking around in the sun, you will need even more, maybe around 4 litres or about a gallon a day, mainly because of loss from sweating.

It is extremely easy to become dehydrated while travelling in hot and unfamiliar climates. It is recommended to take a water bottle with you each day.



Public water in all of the USA, western Europe and some parts of eastern Europe is safe to drink. A lot of countries around the world, however, are not so stringent about the cleanliness of their water supply, which can mean health risks for travellers.

Drinking water can be contaminated with all sorts of infectious agents, ice (for example, in drinks (even in alcoholic ones)) is a major problem, as is finding safe water to use when brushing your teeth, washing (and swimming).

Salads, vegetables and fruits washed in local water should also be avoided, as well as and water-based products such as ice cream.

Check destination information on the Internet to find out in which countries you are at risk from inadequate sanitation and contaminated water.

Sites such as www.tripprep.com and www.cdc.gov are good sources of information. However, the main danger areas are:

- The Indian subcontinent

- Africa

- Mexico, Central and South America

- Russia and the former USSR countries

- Asia

There are five basic ways to get clean water. Buying bottled water, and either boiling, distilling, filtering or purifying water from local supplies.

Robert Sangster’s book here is a good place to find more information.

Bottled Water

Generally easy to find and sold in various sized plastic bottles. Other bottled drinks are somewhat safe and routinely drunk by travellers.

Bottled water can be expensive, but the main problem, though, is availability. It can’t always be found everywhere you go (or when you want or need it), and even if do find it you can’t be sure that it is really safe. Anyone can fill an old bottle with tap water, reseal it and sell it to you.

The worst thing about bottled water, however, is the hundreds of unrecycled plastic bottles that get dumped or left behind.

Boiling

Boiling water for a minute or two is the best method for eliminating infectious agents. Also the best method to use when making tea, coffee, and soups.

While boiled water is safe, it should not be relied upon as the sole source of drinking water as you won’t always have access to a stove or pan.

Distillation

Distillation involves a unit that boils water and then condenses the steam into a clean container, leaving nearly all of the solid contaminants behind.

This will kill and remove bacteria, viruses, cysts, heavy metals, and other particulates, more so in fact than any other system.

Useful if you can’t tolerate or don’t like the taste of iodine, or for long-term travellers (where using iodine for extended periods may cause problems. See below).

Most systems do need electricity to work, however, although there are some non-electric systems out there. They are also quite slow to produce clean water, as well as being heavy and bulky.

They also leave scale behind, which means that the distillation apparatus be frequently cleaned.

Filtration

Water filtration devices work by forcing water through materials which screen out particles. What gets filtered out depends on the size of the pores in the material used.

Filters of about 0.2 microns will remove dirt, bacteria and parasites, but waterborne viruses, such as hepatitis and polio, are 0.04 microns or smaller so may not be removed, and the water will need subsequent boiling or chemical treatment.

Filtering doesn’t change the taste of the water, however, and there is no need to wait. You can clean and reuse filters so it is also cheap.

Again this is a good solution if you are sensitive to iodine or where viruses might not be a problem, such as for backcountry use in the U.S. and Canada. Also can be used where the user has had all the vaccination for local viruses.

Mechanical filters can, however, be bulky, heavy, and hard to use for less experienced travellers. Filters can become clogged and if further chemical treatment is needed the cost per gallon increases.

Purification

Water can be purified with one of a number of chemical additives. The most popular is iodine, either in tablet or liquid form. Chlorine and silver are alternatives.

Iodine is used by putting 2-3 drops or a couple of tablets in water and letting it stand for about 30 minutes.

The dosage must be doubled for very cold water (e.g. from mountain streams).

Tablets and liquids are very compact and are good for short-term use or with filters.

Regular iodine stains badly (if it leaks in your bag) but you can find uncoloured (as well as regular) iodine in some places, for example, in pharmacies around the world.

With iodine the water has a chemical taste (as it does with chlorine) which some find objectionable, and is coloured, although both the colour and taste can be removed by adding vitamin C (orange juice, for example) to the water, but only after the waiting period is over, otherwise the iodine will be neutralised.

There is some debate over the safety of iodine for long-term use and what is a safe maximum dose to ingest over and above the recommended daily amount. Reports of serious side-effects are few and far between, however. A 1998 study published in the Lancet described thyroid problems in a group of Peace Corps workers in Africa which was linked to their use of two-stage iodine-resin filters as their only water purification method for over two years. Then again a study in the 1960′s of Florida prison inmates who were given iodinated water for up to 15 years showed no such problems. Those with thyroid problems, pregnant women, or those with a sensitivity to iodine, might want to consider alternative solutions, however.

Read more about it here, especially the ‘Recommendations for Iodine Use in Water Treatment’ section.

Other approaches

A combination of methods works well. Some travellers (including myself) carry personal water purifiers which both purify and filter the water at the same time, and generally does it a lot quicker than with iodine alone.

Most purifiers use iodine as the active ingredient as part of a filter cartridge. The filtration process removes the larger, hard-shelled creatures such as Giardia and Cryptosporidium, then the water passes through an iodised resin bed, where bacteria and viruses are deactivated. Some systems incorporate a carbon filter at the final stage of purification. These filters absorb traces of residual iodine and greatly improve the flavour of the water.

The most convenient method I have found so far, and one which I thoroughly recommend, is the Aquapure Traveller Water Bottle. You can fill the bottle from ANY water source, streams, ponds, rainwater barrels, and obtain safe, palatable, clear, odourless drinking water. It kills viruses and bacteria and removes parasites such as Cryptosporidium and Giardia. Read more about it here, or watch the video:

As a backup I also carry a Steripen (the Adventurer model). This is an amazing product, it is an ultra-light UV water purifier that destroys 99.99% of the bacteria, viruses and Giardia in water. It emits UV light which purifies 16 ounces of water from any source in under 1 minute (32 ounces in 90 seconds). You can use regular camera batteries to power it but I bought the optional solar charger which means I can go anywhere in the world and not worry about drinking the water. I bought both the Steripen and the solar charger in the US but you can also buy them in the UK.

Another device (used by the US military), is MSR’s MIOX Purifier which creates a dose of mixed oxidants (MIOX) that is then added to the water to inactivate bacteria, Giardia and Cryptosporidium, (which iodine won’t kill). It runs on common camera batteries and uses regular salt to operate, and needs no maintenance.

The following is a list of some common and not so common illnesses and diseases to which you may . . . → Read More: Diseases from Insects, Worms, Bacteria, Viruses, etc.]]>

The following is a list of some common and not so common illnesses and diseases to which you may be exposed while travelling.

It is probably not complete and may not even be accurate, so again, make sure you consult a qualified professional before travelling and don’t rely too much on the information contained herein.

The list is in no particular order but commonest health hazards tend to be nearer the top.

For each there is a section listing where in the world it is usually found, what is its cause, symptoms, treatment and prevention.

Most of the diseases and illnesses below can be prevented by either vaccines or pills, good hygiene and safe food preparation practices, drinking and using (e.g. for washing, cleaning teeth, cooking with, swimming, cleaning fruit and vegetables, for ice in drinks, etc.) only treated or clean water, and avoiding being bitten by various insects and worms.

Diphtheria

Found – rare in developed countries due to vaccination, but is still endemic in developing countries and the former states of the USSR.

Vaccine is recommended for those who will be in close contact with infected people in endemic areas.

Cause – a disease of close contact, a bacterial illness transmitted through droplets in the air.

Symptoms – sore throat and fever. Can be life-threatening.

Prevention – by updating your diphtheria vaccine.

Tetanus

Found – rare in developed countries due to vaccination.

Prevention – by the tetanus vaccine. A booster is recommended every ten years, perhaps even every five years for developing world travel. Sometimes can be fatal.

Polio

Found – virtually eliminated in the developed world, but is still a threat to non-vaccinated travellers in developing countries.

Cause – by a virus.

Treatment – there is no effective treatment for polio.

Prevention – with either the oral or injectable vaccine.

Cholera

Found – mostly in the developing world. However, risk to travellers is slight.

Cause – infection is by ingesting food or water infected with the bacteria, but especially from shellfish.

Symptoms – severe water loss due to watery diarrhea and vomiting. Death can result in a few hours from rapid fluid loss.

Treatment – immediate rehydration therapy to prevent dehydration and death. ninety-nine percent of victims recover given adequate rehydration.

Prevention – drink only bottled or boiled water. Be careful with food as possible. There is a vaccine but this is not usually recommended due to its ineffectiveness, expense, and the rarity of cholera in travellers.

Dysentery

Found – bacillary and amebic. Both are prevalent in many developing countries, but rare in travellers.

Prevention – (for both types) eating only cooked vegetables and peeled fruits, and by only drinking boiled or purified water.

- Bacillary dysentery

Cause – from infected food handlers not washing hands and from unclean flies landing on food.

Symptoms – sudden watery diarrhea, abdominal pain, vomiting, nausea, and fever, then passing blood and mucus after a few days.

Treatment – rehydration therapy, with no solid food for the first day or two. Antibiotics can help. Most people start to recover after about a week. Death can be caused by dehydration in vulnerable people.

- Amebic dysentery

Cause – swallowing the histolytica cysts from infected water or food (lettuce, uncooked vegetables, and unpeeled fruit).

Symptoms – range from a few loose stools with rumbling pains in the stomach, to a severe case with high fever and bloody, watery diarrhea. Shaking chills, fever, weight loss, and painful enlargement of the liver.

Treatment – rehydration therapy and drugs (e.g. metronidazole). Doesn’t go away on its own, unlike bacillary dysentery.

Hepatitis type A

Found – worldwide. Most common serious disease among travellers in the developing world where food preparation standards are poor.

Cause – transmitted by a virus through contamination of food or drinks prepared by an infected person with poorly washed hands.

Symptoms – either nonexistent or begin abruptly two to six weeks after exposure. Similar to flu, fever, aches, loss of appetite, nausea, abdominal discomfort, and liver pain, darkened urine, light yellow stools. Four to seven days later the symptoms may become more severe, with diarrhea, vomiting, itching, and jaundice (yellow skin and whites of the eyes).

Treatment – there is no treatment for hepatitis A. Most people recover within six weeks. Hepatitis type A does not lead to chronic hepatitis. Rest and abstaining from alcohol until recovered are recommended.

Prevention – take care of what and where you eat. Vaccination with the full, two-dose series of hepatitis A vaccine is the best way to prevent hepatitis A virus infection. Immune globulin is available for short-term protection (approximately 3 months) and must be administered within 2 weeks after exposure for maximum protection. Good hygiene, including handwashing or use of hand sanitizer after using the bathroom and before preparing or eating food is essential.

Hepatitis type B

Found – in body fluids of infected persons. Type B is found worldwide, but is much more prevalent in Asia and Africa.

Symptoms – are the same as for hepatitis A, except sometimes more severe. Many people have no symptoms. About 10% of hepatitis type B cases lead to chronic hepatitis, a severe inflammation and destruction of cells within the liver, leading to cirrhosis.

Prevention – the hepatitis B vaccine, although this is usually only recommended for health care workers, people who have many unprotected sex partners, and drug addicts.

AIDS

Found – worldwide. The hardest hit area is sub-Saharan Africa. Also spreading rapidly in Asia.

Cause – spread primarily through heterosexual sex, blood transfusions. Nearly 20,000 people are infected every day.

Prevention – travellers in Africa should bring their own hypodermic needles for emergencies. Many countries now require HIV testing for long-term visitors of greater than six months, or applicants for work or residency. In most cases HIV testing is not required for visitors of a few months or less. Most HIV carriers don’t know they’re infected, and HIV is thought most infectious the first year after infection.

Typhoid

Found – developing parts of Asia, Africa, and Latin America.

Cause – is caused by the bacteria salmonella typhi. Feces, urine, and contaminated food and water are the principal sources of infection. Again often through a food handler with poor hygiene. Sewage-contaminated shellfish is also a source.

Symptoms – limited to a fever of one week, but can include headache, anorexia, general malaise, and constipation, giving way to diarrhea, a non-productive cough, nosebleed, and raised pink spots on the upper abdomen. Complications may result, and the death rate for serious cases is ten percent for those untreated, one percent for those treated.

Treatment – with antibiotics.

Prevention – by cautious eating and drinking, and by an oral or injectable vaccine, both of which are about sixty-five percent effective for five years. The oral vaccine is four pills taken every other day; the injectable requires two shots one month apart. The oral vaccine has fewer side effects. Antibiotics are not recommended as a preventive since they disrupt normal intestinal bacteria and can facilitate infection with salmonella typhi.

Malaria

Found – Africa and Asia. Poses the greatest health risk to travellers in warm climates, and is in fact the greatest health threat to humanity with up to 300 million cases occurring worldwide each year, with about one million deaths. The tragedy is currently increasing as mosquitoes become insecticide-resistant and forms of malaria become drug-resistant.

Cause – spread by the bite of the Anopheles mosquito, which generally feeds dusk through dawn. It is caused by four types of a single-celled protozoa: vivax, ovale, malariae, and falciparum. These parasites attack and explode red blood cells.

Symptoms – for the first three types may include the classic malarial fever in three stages. First is a cold stage characterized by severe shivering, followed by a high fever stage of up to 105F (40C). Finally there is intense sweating which brings the fever down. The victim may also vomit and have a bad headache. The patient is left weak and tired, and sleeps.

These stages may occur cyclically, either every other day or every third day, but only after the disease is well-established. Malaria can be very difficult to diagnose in early stages.

Falciparum is a more severe type of malaria as all red blood cells are attacked. Death may result a few hours after symptoms begin. The brain may be affected, and liver and kidney failure are common.

Treatment – usually with a big dose of chloroquine. Falciparum malaria is resistant to chloroquine, however, so other drugs must be used. Discuss treatment with your travel clinic before you go, and immediately with local medical professionals if you acquire malaria-possible symptoms.

Prevention – is complicated, so only trust a high quality travel clinic to prescribe the proper medications for your specific destinations and physiology.

Yellow fever

Found – Yellow fever is found east of the Panama canal, in parts of South America, and in much of Africa.

Cause – a virus hemorrhagic (bleeding) disease transmitted in urban areas from person to person by Aedes aegypti mosquitoes, which feed during the day. In jungle areas it is transmitted from monkey to man by various mosquitoes.

Symptoms – begin three to six days after infection, are relatively mild in eighty percent of cases, and include fever, headache, and weakness, which last up to four days. The other twenty percent are more serious, including high fever, chills, nausea, vomiting, bleeding from the gums and nose, and severe pain in the neck, back, and legs. These may last a few days, followed by a remission, and then followed by a more severe illness, including increased fever, vomiting of blood, and jaundice due to liver damage, hence the name yellow fever. Approximately five percent of all victims die within days of the onset of symptoms.

Treatment – maintaining blood volume and fluids. No drug works against this virus.

Prevention – by the yellow fever vaccine, which lasts ten years. A yellow fever vaccination certificate (yellow card) is required for entry into and from countries where the disease is prevalent.

Dengue fever

Found – in tropical and subtropical regions worldwide.

Cause – a viral, hemorrhagic disease transmitted by day-feeding Aedes aegypti mosquitoes.

Symptoms – appear five to eight days after a bite from an infected mosquito, and include high fever, severe muscle and joint pain, and rash. They subside and recur about every three days. Recovery takes several weeks, with victims rarely dying.

Treatment – pain killers to relieve symptoms. There is no specific treatment.

Prevention – avoiding mosquito bites. There is no vaccine.

Plague

Found – While a few cases of plague occur every year in the American Southwest, it is mostly a disease of South America, Africa, Southeast Asia, and India.

Cause – transmitted to humans by the bites of rodent fleas. The risk of plague to travellers is almost zero, especially if you make a habit of not handling rats, dead or alive.

Rabies

Found – worldwide.

Cause – a viral disease of the nervous system. Transmitted by animal bites, scratches, or even licks on an open cut.

Skunks, raccoons, and bats are the major carriers in North America. In Central and South America dogs and vampire bats are the primary vectors. Jackals are the primary carriers of rabies in Africa. In Southeast Asia and India dogs are the leading vectors to humans. Note, however, that any mammal bite may transmit rabies. Ireland, Britain, Norway, Sweden, Japan, Australia, and New Zealand do not have the disease, and require an extensive quarantine for pets entering the country.

Symptoms – begin from nine days to many months after exposure. These include fever, hyperactivity, seizures, and often an intense thirst that cannot be quenched since liquids produce violent and painful spasms in the throat. The victim will die within three to twenty days from onset of symptoms.

Prevention and Treatment – passive immunization before symptoms appear, and ideally within two days of exposure. Competent medical advice should be immediately sought after a bite in a rabies endemic country. Clean the wound thoroughly with soap and clean water for at least five minutes, but don’t stitch it closed. The sooner vaccination is begun, the better the prognosis. Today’s vaccines are not so painful, and are no longer given through the stomach.

There are about 30,000 deaths every year from rabies, nearly all in developing countries. Almost invariably fatal if left untreated.

Chagas’ disease

Found – rural Central and South America, but especially Brazil. Also called American sleeping sickness. Can be fatal.

Cause – transmitted by the bite of the assassin bug, which makes its home in thatched roof and adobe huts in This bug prefers to bite on the face and defecate. Single-celled parasites called trypanosomes enter the body, grow to huge numbers, then attack many organs, including the heart.

Symptoms – a hard, purple swelling which appears on the bite site about a week later.

Treatment – effective only if caught early.

Prevention – not sleeping in mud huts, by using mosquito netting, or by at least sleeping in the middle of the room away from walls. This disease is extremely rare in travellers.

Brucellosis

Found – rare in the US but not in Latin America and Mediterranean countries.

Cause – bacteria from unpasteurised dairy products.

Symptoms – high fever, shaking, sweating, and severe depression.

Treatment – antibiotics and rest.

Schistosomiasis (bilharziasis)

Found – is common in tropical regions worldwide, affecting about 200 million people.

Cause – several species of flukes (flattened worms) called shistosomes. They live in fresh water lakes and rivers, where they live part of their life cycle in snails.

Symptoms – vary from none to serious. The first is usually an itchy rash where the parasite has burrowed through the skin. Weeks later flu-like symptoms may begin, including high fever, chills, muscle aches, and diarrhea. The symptoms may go away and recur a month or two later. Long-term damage includes cirrhosis and kidney failure.

Treatment – a single dose of an anthelminthic (antiparasitic) drug, which kills the flukes.

Prevention – avoiding freshwater rivers and lakes in the tropics, but especially the Nile Valley, where schistosomiasis is rife.

Leishmaniasis

Found – the Middle East, South America.

Cause – a single-celled parasite transmitted via sandfly bites.

Symptoms – Some varieties affect mostly the skin, producing large ulcers at the bite area. In the Middle East this is known as the Baghdad boil. South American forms of the disease may cause more severe tissue damage, especially to the face. Another variety, called kala azar, causes internal organ damage.

Treatment – sodium stibogluconate.

Prevention – avoid sand fly bites by wearing shoes, socks, pants, long-sleeves, and by using DEET.

Filariasis

Found – in the tropics.

Cause – larvae or worms, and transmitted to man by insects.

Onchocerciasis (river blindness)

Found – in Central and South America, and Africa.

Cause – a worm infestation. The parasite is transmitted from person to person by the black simulium fly, which is found only near fast-moving rivers and streams.

Treatment – with diethylcarbamazine, which must be administered under close medical supervision since severe reactions to the dead and dying worms may occur.

Prevention – avoid black fly bites.

Giardiasis

Found – in the United States and worldwide, especially in the tropics and the public water systems of the former Soviet Union.

Cause – an intestinal infection caused by a single-celled parasite. Giardia cysts (eggs) are spread from the feces of infected animals.

Symptoms – the cysts hatch two or three weeks after ingestion, causing abdominal symptoms such as violent diarrhea, foul-smelling gas, and cramps. Sixty percent of those infected, however, show no symptoms.

Treatment – giardiasis clears up on its own after two or three weeks, although metronidazole speeds recovery.

Prevention – drink only pure or treated water.

Jiggers

Found – a type of sandfly found in tropical areas of the Americas and Africa.

Symptoms – burrow between toes and under toenails, where eggs are deposited under the skin causing a painful and itchy pea-sized swelling.

Treatment – removing the jigger with a sterile needle, and thoroughly cleaning with antiseptic.

Prevention – wear shoes or at least sandals, and by keeping nails well-trimmed.

Chiggers

Found – worldwide on grass and weeds.

Symptoms – red mites attach themselves to bare legs and ankles and feed on blood. May cause a painful, itchy swelling about a half inch in diameter.

Prevention – wear socks and pants, and by applying DEET to exposed skin, socks, and pant cuffs.

Bedbugs

Found – worldwide. Small, flat, usually brown bugs found in beds and furniture during the day, and come out at night.

Symptoms – a straight line of red bites across the skin. They rarely spread disease, but the bites should be cleaned with antiseptic to prevent infection.

Prevention – check bedding carefully, look for tiny red splotches on sheets and blankets. If found, take another room or use a hammock.

Sandflies

Found – tiny, nearly-invisible long-legged flies common to tropical areas.

Symptoms – walking at at dawn and dusk stirs up flies and results in bites. Can transmit several diseases to humans.

Prevention – remain indoors or in a hammock during dawn and dusk. Cover exposed skin, especially legs, ankles, and arms, and use DEET. Wear socks.

Lice

Found – tiny, flat, wingless bugs found wordlwide.

Treatment – body lice are killed by washing clothes in very hot water, or by using a hot dryer. Other lice can be killed with lotions and shampoos containing benzene hexachloride.

Scabies

Found – are tiny mites found worldwide that burrow into the skin and lay eggs.

Symptoms – intense itching, especially at night.

Treatment – with an insecticide lotion.

Hookworms

Found – half-inch long worms that live in the small intestines of 700 million people around the world, especially in the tropics.

Cause – burrowing into the feet, or by ingestion.

Symptoms – a red and very itchy rash on the feet that lasts for several days. A cough and pneumonia are also possible when a heavy infestation passes through the lungs.

Prevention – wear shoes or sandals.

Treatment – an anti-worm drug.

Guinea worm

Found – numerous African and Asian countries.

Cause – drinking water containing the cyclops crustacean water flea.

Symptoms – begin a year later when the worm is fully grown and ready to reproduce. It comes to the surface of the skin where a blister forms. Hives, diarrhea, and vomiting often occur at this time. When the blister bursts the end of the worm is exposed, and debilitating pain begins.

Treatment – wrap the exposed worm around a stick, and then gently wind it out over several days. This is dangerous (although impressive) as if the worm breaks an infection can develop.

Beefworm (botfly larvae)

Found – Central America. It is common in the jungles of Belize.

Symptoms – like a mosquito bite that doesn’t go away. After several weeks it resembles a boil, except for a tiny hole in the center. If you look closely with a magnifying glass you will see something pushing to the surface every so often to breathe and expel waste. As it feeds it occasionally delivers a sharp pain like a hot needle stabbing into flesh, which lasts only a few but very long seconds.

Treatment – the traditional Mayan method is to pour tobacco juice into the hole which kills the beefworm in about an hour. You then easily squeeze it out. Another method is to suffocate it overnight by covering the hole with multiple layers of glue and plastic wrap. It becomes poppable if you manage to cut off 100% of its air.

Tumbu fly

Found – in Africa.

Cause – fly lays eggs on clothing left out to dry, which later hatch with skin contact.

Treatment – similar to the botfly.

Prevention – ironing clothes to kill the eggs.

Below is a list of just some of the books that I have bought and found useful on . . . → Read More: Books]]>

Below is a list of just some of the books that I have bought and found useful on my travels. I usually read these before I leave and try to memorise as much as I can, as carrying even just one book with you when you travel adds considerably to your load. (That said, I do carry the first book on the list with me as it is tiny).

To be honest, these days I tend to listen to audio books on my iPod mainly, as I can fit a considerable number of books onto it and listening in this way also keeps your hands free when walking around. You can buy these online or in major bookstores on CD. Just search online for audio books.

(Click for US supplier) (Click for UK supplier)

Travel Health

Bezruchka, Stephen. The Pocket Doctor: A Passport to Healthy Travel. Mountaineers Books; 3 edition (March 1999). The classic reference for international travelers – completely updated.

Dawood, Richard, M.D. Travelers’ Health: How to Stay Healthy All Over the World. New York: Random House, 1994. With six hundred pages of advice from sixty British and American travel medicine specialists, this is the most complete travelers’ health guide.

Dessery, Bradford L., and Robin, Marc R. The Medical Guide for Third World Travelers: A Comprehensive Self-Care Handbook. San Diego: K-W Publications, 1992. This is a good health guide by two nurses with practical experience.

Schroeder, Dirk G. Staying Healthy in Asia, Africa, and Latin America. Chico, CA: Moon Publications, 1993. Another good travelers’ health book.

Equipment

Fletcher, Colin. The Complete Walker. New York: Alfred A. Knopf, 1984. Dubbed the “hiker’s Bible,” this is a highly detailed look at the gear and philosophy of a wilderness backpacker who has also written several other books.

Working Abroad

Griffith, Susan. Teaching English Abroad. Oxford: Vacation Work, 1994. This is over three hundred pages on the subject, including numerous personal accounts. Distributed in the U.S. by Petersen’s Guides, Princeton, NJ (tel. 800-338-3282).

Communication

Hall, Edward T. The Silent Language. Garden City, New York: Anchor Press/Doubleday, 1959. A groundbreaking work on nonverbal communication.

Pei, Mario. Talking Your Way Around the World. New York: Harper & Row, 1971. Interesting reading on languages by the popular linguist, although you won’t quite be speaking Indo-European come page 288.

Miller, Stuart. Understanding Europeans. Santa Fe: John Muir Publications, 1990. This is an incisive book by an American former professor of European comparative literature who has lived and worked extensively in Europe. It also helps you understand Americans.

A vaccination certificate may be required if you have previously visited areas where specific diseases are widespread or when . . . → Read More: Vaccination Certificate]]>

A vaccination certificate may be required if you have previously visited areas where specific diseases are widespread or when visiting countries where there are increased health risks for travellers. This is usually a yellow card which is like an international certificate of vaccination or medical passport.

The Yellow Fever section of the certificate is probably the most important part. If you aren’t going to or coming from countries where Yellow Fever is endemic (areas of Africa and South America), then you may not need one. Check with your doctor (or other websites such as the WHO or CDC) about this.

If you are travelling with your dog, then you may have to get a rabies vaccination certificate.  You can get these from a licensed veterinarian and should include the registration number and a professional stamp, as well as the serial number, duration, type of vaccine used,  and the dog’s color, weight, and so on.