Readjusting After Medical Separation

There’s a long version and a short version of what happened.

Short story: I was medically separated from the Peace Corps on January 4, 2019 after being evacuated on December 23, 2018. I was shipped out of the country just before the government shutdown started. PC’s theory was, and it seems plausible, that the impending government shutdown would impede my departure if we waited until the official required separation date. Only 3 people in the USA knew I was coming home which allowed for surprise reunions with some of my favorite people.

Long Story:

On November 19, I was walking to meet some fellow volunteers at a restaurant, and tripped and fell on some rocks lining the sidewalks. I stumbled, almost regained my balance, but couldn’t and resigned myself to falling. I fell. It hurt. I didn’t rip my jeans so I thought everything would be OK… a bruise, but nothing major.

My leg the night of the injury… See the lump on the left side… That’s the problems spot

I was wrong. So very wrong.

I managed to make it to the restaurant, but I could feel my leg swelling rapidly. Another volunteer was headed back to our hotel so he and I walked back together. I cleaned the wound the best I could with the materials I had, and talked to one of my friends and told her to come check on me in the morning because I was concerned that I might not be able to walk.

The next morning I could walk, but my leg was definitely swollen. I sent a quick text to the PCMO who was scheduled to be as IST later that morning anyway. It read something like ‘I fell last night and have some significant swelling in my left leg. I can bear weight, but walking in painful.’ NBD.

Later that day, the PCMO thought that I should have x-rays even though she didn’t think anything was broken.

And she was right… Nothing was broken, but I had a ‘soft-tissue injury’. I was put on ‘conservative therapy’ ie leg immobilization and bed rest for a few days. The prognosis: I’d be back to normal within a few days.

The truth was I never left med hold until I was leaving the country. I never expected a ‘bruise’ to be a injury Peace Corps’ couldn’t handle. I never expected to be medically separated for a bruise. A few days turned into a week and a week turned into three weeks. After three weeks, still having difficulty ambulating, I had to push the PCMO to order a MRI on my leg. I finally got the MRI on December 17, had a consultation with an orthopedist on December 18, and began physical therapy on December 19. All of this happened after I insisted on consultation with the other PCMO. And then the decision was made to send me back to the US on December 22 after only 3 PT sessions. I’m not sure if the PCMO took umbridge with someone questioning her medical decisions or what, but despite making progress in PT, it was decided that Peace Corps’ could no longer treat my injury in country.

I figured I’d have to get used to American English, flush toilets, driving, and winter, among other things. I’ve heard about how much harder ‘reverse culture shock’ is from regular culture shock. The the readjustment to fast-pace American life is a much more difficult transition than the transition to rural ‘African’ life. But I was prepared for that. As far as American life goes, my pace is much slower than the average American. I live in rural South Carolina and while it’s not quite the same as rural Rwanda, there are a lot of similarities. What I was not prepared for was dealing with medical separation during a ‘partial’ government shutdown; I was sent out of the country where I was receiving adequate treatment to a country [my own] where I’m unable to receive medical treatment because of a pissing contest between the two major parties of the American government.

The government is shut-down—just like meeting with my community health workers–there’s no one there to do business
with

You see, medical evacuation and separation is fiercely different than a typical COS, or even an ET. Most PCVs have weeks or months to wrap up projects, pack, and say goodbye. I had two hours. Most end their service with world travel. I ended mine with uncertainty. Most PCVs get to prepare for life in the States again, looking for jobs and finding a place to live. I was on a plane 36 hours after they determined I would be leaving for good.

Minimal improvement after almost a month

I had no idea the emotional toll of all this. I was prepared to serve as a health volunteer to the best of my ability for the entire 27 months. Despite the difficulties [Newsflash: Peace Corps service is hard]. Despite the hardship. [It‘s not the spotty electricity or the non-potable water; its the overwhelming loneliness that will get you.] And despite any other difficulties that may have popped up.

Malaria Camp!

Rather than simply dealing with life back in the States, I have had to deal with being torn away from my job, my home, [not]mycat, and my friends, then be sent back to friends and family who just can’t understand it all. Because you can’t understand it unless you’ve been through it.

Day one back in America: I get to hang out with my 5 week old niece

I’m still readjusting. Every. Single. Day. Some days I still feel homesickness for my life in Rwanda. Not every day, but more days than not. My guess is the longer I am here [in America], the less I’ll miss Rwanda.

I know my life has been fundamentally changed through my experience with the Peace Corps. I know some things will never be as they were before I left. I have changed. But in some ways, I am still transitioning back. It’s taken longer than I ever thought it would.

My best friend and companion in Rwanda–Octavia

Holidays and Exams

It’s been a busy week out here in training-land.  3 holidays in one week, and only one day off. July 1 is Rwandan Independence Day [but it’s not celebrated].  July 4 is both American Independence Day and Rwandan Liberation Day, and for us, our only day off.  My fellow trainees and I went to the local hotel,  had pizza, fajitas, cinnamon rolls, and Fanta [or beverage of  your choice].  For me it was a welcome day off from the onslaught of language classes that the week brought.

On Saturday, we had our a mid-training language exam.  The target at this stage is Novice-high, but I have a plan.  My plan is to score Novice-Mid, get put in remedial Kinyarwanda class, get extra speaking practice, and then WOW everyone at the final exam with my Kinyarwanda prowess. But here’s the real deal, I have performance anxiety, and I have had it for years.  I almost didn’t graduate from college with my Spanish degree because I had such anxiety for my final  oral exam.  And this was with my professor who I had known for three years, and was very familiar talking to him.  So while yes, I am older and wiser, but I still have so much anxiety concerning ‘public speaking.’


On Friday, I picked up my first tailor-made shirt.  It needed a few minor adjustments so I snapped this photo of my [15 year old] tailor making the adjustments.

On Saturday, after our mid-training language exam, I went to the talent show at my host sister’s school. There was singing. And traditional dancing.  And Drumming. There was a skit [in Kinyarwanda–I didn’t understand any of it], and some kid read the news.  And then there was ‘fashion’.  Fashion consists of about 10 couples of modelling different African fashions.  And these kids are stylish.  And they have real talent… unlike most of the talent shows I have been to  in the past.

We’re fancy. We met the US Ambassador to Rwanda.

Every so often, I see beautiful tropical flowers in unexpected places.

Every.Single.Thing. I Packed for Madagascar

More than 1500 coherent words on what I packed for two years in Madagascar from the kind of suitcase I had, and everything I put in said suitcase; don’t say I didn’t warn you

I found out in July 2017 that I’d been accepted into Peace Corps | Madagascar.  That left me with 7 months to pack and clean out my apartment, and seven months to obsess about what to pack.  And this from someone who hates to pack. And someone who hates to shop.  And then I went and bought a house in October 2017. And I had already planned vacation for December 2018.  So I packed for Madagascar as well as my vacation to Germany/France in December while I was packing up the apartment for the impending move. I scoured other PC blogs’ packing lists–for Madagascar, other African countries, even cold weather Eastern Europe/Asian countries… just to see what I was up against. I put effort into packing. I drudged through Amazon customer reviews. I wandered up and down REI’s aisles without buying a thing. I enjoyed crafting the spreadsheet more than the actual shopping.
Not related at all, but a somewhat ironic tangent: I was once in charge of logistics for planning my college’s fencing team flight from Greenville to Philadelphia and securing lodging while in Philadelphia. 13 college students, flying with sabres, foils, and  epees constantly reminding them not to say ‘weapons’ in an airport even though that is totally what they are called collectively.  Reminding people to pack clothing separately from fencing gear in case bags were confiscated, and yet I forgot socks.
Other journeys have similarly been fraught with packing mistakes and my most epic one to date is getting to the airport only to find out I’d brought my recently expired passport instead of the new, active one.  Thankfully it was about 1 in the afternoon, traffic was reasonable, and I lived 20 minutes away instead of an hour away like I do now.Before I start the list, here are the premises I’m working on:

  • Despite popular opinion, this is not a 2 year camping/backpacking trip. I will be living mostly in one place for 2 years. A place that most likely lacks indoor plumbing and electricity.
  • Madagascar is a poor country.  No need to have $200 hiking boots when most, if not all, of my neighbors will be barefoot. All the time.
  • I’ll forget something.   Hopefully, it won’t be my passport.  Or underwear.

A giant duffel bag–with wheels, a hiking backpack, a school backpack x2 and a messenger bag. Not all of these bags are going to Madagascar. At least not at first. One bag has the December vacation clothing in it.


Packing is certainly one of the most stressful aspects of preparing for service, because you think, “how the hell am I going to fit 2 years’ worth of stuff in 2 bags?”  Just so you know now, the Peace Corps country handbook is of absolutely no use. So I put together my own list of what I thought would be helpful. This will hopefully take care of a lot of your potential questions up front, but please feel free to message me or comment if you have a specific question, or if you don’t see something on this list and wonder if you should take it. [Caveat: I am the proud owner of 2 X chromosomes so this is aimed at fellow XX-ers more than guys, but most of these suggestions also apply to men… except, you know, the parts about bringing skirts, bras, and tampons.]

The first thing to keep in mind is that no amount of stuff will make it easy, and no one item will make the difference between having a great experience and a terrible one. The second thing is to keep in mind that even though 2 bags doesn’t sound like a lot, you will still have way more stuff than any of your neighbors have. Having 3 pairs of shoes to carry you for the next 2 years might not sound like a lot, but remember that most people you’ll be living near are lucky if they have one pair of shoes. It is very humbling.  Hopefully my suggestions and advice below will help you avoid packing stress as much as possible but help you arrive to Madagascar well-equipped and excited to serve.

So with that being said…


To get the goods to a location, I’ll need bags. I’m allowed 4; 2 checked, one carry-on and one personal item. The checked bags must weigh less than 50# each. Since I usually try to do carry-on only, I did not have a large duffel or suitcase so I bought one from ebags. It’s my go to site for things luggage related.  So my four bags are:

    1. A suitcase. A duffel bag. Something big. Something sturdy. It’s going to get abused. It may fall apart; it may surprise me and last my full service.  I’ll probably use it as storage once I have a home.
    2. A hiking backpack. I have an old REI one. I’ll probably take the REI one; it’s no longer bright and shiny, and has already proven itself, has a cover, and I know I can pack a lot of stuff in it
    3. A school-type backpack. Can be stuffed to capacity and carry a weeks’ worth of clothing.
    4. A messenger bag. Good for books, notebooks, official documents, plane snacks, travel pillow, ect.

Inside the bags, things will be organized with packing cubes.  If you’ve never used packing cubes, they will change your life.  I also have two plastic storage boxes, 1 small and one medium. And inside those containers, I’ll have:

Outfits: 10 tops + 10 bottoms + 1 cold weather base layer

  • 1 nice outfit: 1 nice top + 1 skirt (mainly to be worn ‘out’ or for important events like swearing in)
  • 2 cardigan/blazer things to be worn over regular T-shirts when the occasion calls for it
  • 2 work outfits: 4 T-shirts + 2 skirts
  • 2 casual outfits: 1 T-shirt + 1 pair of casual pants, and 1 long-sleeve shirt + 1 pair of yoga pants
  • 2 pairs of scrub pants
  • 3 pairs of capri pants/knee length shorts

Additional Clothing

  • Jackets: 1 rain jacket, 1 zip-up jacket, 1 light jacket
  • Bras: 5 sports bras, 5 regular bra
  • Underwear: as many as I can fit into one packing cube [estimated 20-30 pairs]
  • Socks: 6 pairs cotton, 6 pair lightweight wool
  • 2 pairs of leggings

Accessories

  • 1 belt: a few years ago I bough a durable leather belt from the men’s section of REI.  I’ve never gone back.
  • 1 baseball cap
  • 1 bathing suit:
  • 2 pairs of sunglasses

Shoes

  • 1 pair of Tevas sandals–these are fancy dress-up Tevas
  • 1 pair of Keen sandals
  • 1 pair of hiking shoes
  • 1 pair of flip-flops for showering and around the house

Sleeping Kit

  • Sleeping bag: It’s down, but lightweight REI brand.
  • Sleeping liner:  really just a large king sized sheet sewed together to be used when it’s too hot for the bag or in sketchy travel hotels
  • Sleeping pad: REI brand. On past travel, I opted not to use one, but this time around is different.
  • Tent: REI-brand… two-person, simple setup, easy storage.
  • 1 medium compressible Thermarest pillow

Home

  • Cookbook
  • 2 water bottles: a 1L Nagalene and a 24oz stainless steel one
  • Wall decor:  USA map, SC flag, and UT flag
  • Umbrella
  • Clothesline. Braided rubber from REI.
  • Housewares:  measuring cups, cutting board, knives, vegetable peelers, bottle opener, can opener, ect
  • Drink packets / spices
  • Mug + stainless steel water bottles
  • ziploc bags, plastic storage containers
  • Towels: 1 large quick-dry, 1 small quick-dry
  • flat sheets
  • Gorilla tape roll

Tech

  • Kindle, USB cord, and case
  • Phone, USB cord, and case
  • Mini speaker, USB cord
  • 2 headlamps, one to stay at home; one to stay in the bag
  • USB hub, for all the above
  • Laptop, charger, and case
  • 2 sets of headphones* (nothing fancy, not blue tooth)
  • 2 flash drive
  • Shortwave radio
  • Travel alarm clock
  • Rechargeable AA and AAA batteries.  Not sure if I’ll need D or not so I’m waiting before I purchase them
  • A non- electronic alarm clock

Travel, Study & Fun

  • 4 packs of blank index cards
  • 2 decks of playing cards
  • 2 shopping tote bags
  • Travel purse
  • Earplugs
  • Gifts for host families
  • Pens and pencils
  • Notebooks
  • Blank journals
  • Photo albums of friends and family
  • Snacks
  • small umbrella
  • sunglasses
  • canvas tote bags
  • cards

Toiletries

  • Small bottle of your favorite perfume
  • Hand wipes/hand sanitizer
  • Multivitamins
  • Makeup: foundation, eye shadow, lipstick, face wipes, face lotion
  • Hair: comb + brush, shampoo + conditioner, bobby pins, hair ties, scissors, dry shampoo
  • Tools: tweezers, nail clippers, razor + blades, make-up brush, Q-tips
  • Dental: toothbrush, toothpaste, floss
  • Body: bar soap, lotion, razor + blades, pumice stone, deodorant, menstrual cup + tampons
  • Eyedrops
  • Mini first aid kit

And that’s it.

Note: At training I’ll be provided with a Peace Corps’ first aid kit. Again, this is my pre-service packing list. Overall I feel pretty good about it, but that’ll change: Things will break; I’ll send things home, and hopefully I will have some awesome friends who will send me things while I’m here.

Some people

I remember the first patient that I liked that died.  Really liked.  James was a 16 year old boy with Cystic Fibrosis.  He was surly, uncooperative, and mouthy.  He never wanted to take any medicines or do any therapy.  A lot of my co-workers would rather not have him as a patient, but whenever he was on the unit, I volunteered to take care of him.

One day, James said “you think I am sexy. . . that’s why you always want to have me.’  I replied ‘1. You’re jailbait, little boy. 2.  You’re scrawny, and you can’t even cough without getting short of breath.  Let’s do your breathing treatments and CPT.’  And he would let me.  Every.Single. Time.  For whatever reason, he responded to me not treating him like he was sick.  I always give him a choice–“do this… you know what your other options are–get intubated, put on a ventilator, and we can suck the goo out of your lungs all day long or do the CPT, take the treatments, and cough.”  He always chose to take the treatments.  He knew that if he ever went on the ventilator chances of coming off were not good.

One day, he asked me if it hurt… does being on the ventilator hurt?… does being intubated hurt?  My answer was truthful–whether it does or doesn’t, I can’t say because I’ve never been in that situation, but I do know you would be on pain meds and meds that will make you not remember.  He said OK then asked if I wanted to play chair basketball with him.  And we did.  Because that’s what you do in peds.

The next day was the Duke-UNC basketball game [James was a big Duke fan].  He asked me if I would watch it with him, and I said I would with the understanding that if I got paged, I’d have to go.  He said OK.

I got through first rounds, saving him for last, and we did his therapies while watching the game.  Duke won and after the game he told me he was ready to be intubated because it was just too much of a struggle to breathe.  I asked him if he was sure and he said he was.  I found the resident and told him what James had said.  He went to talk to him and James called his parents.  They came and it was decided that they he would be transferred to PICU and started on the ventilator later that night.

I stopped by to see him later that night.  He was still awake, had his blue, fuzzy Blue Devils blanket on his bed.  James said, “I know I can be a pain in the ass.  I know I’m probably not going to survive this, but thank you for not treating me like a kid.”  What do you say to that?  ‘You’re welcome’.  My pager went off and I was saved by the bell.  ‘I gotta run but you know you’re awesome, right?’  In typical teenage fashion he said ‘Yeah, I  know.  See you in my dreams.’  My last words to him was ‘Hush your mouth, jail-bait.’

James was right; he didn’t come off the ventilator, and died a few days later.  It sucked, but it’s life.  He knew he had a terminal disease.  He knew that most people with CF as severe as his didn’t survive much past 20.  He accepted life and a death with grace and dignity.  He may have been just a teenager, but James had a wise soul.

Nursing Lesson #1:  Some people.  The memory of some people stick with you forever.

Poop, pills, and parasites…oh my

Disclaimer #1:  I am not a doctor, but I do work in a hospital in the USA; I have graduated nursing school [just last week!], have examined my fair share of poop and snot, and have volunteered/visited several health clinics in my travels.  I DO consider myself an expert on all things related to green snot.

Disclaimer #2:   I do not advocate unyielding doctor avoidance or rampant self-medication. Sometimes,  there can be something seriously wrong that you can’t fix on your own, but quite often, there are simple ways to treat what ails you without spending piles cash on tons of medicine either at home or abroad.

Without further ado:  an around-the-world traveler’s guide to poop, parasites, pulmonary related issues, pokes, motion sickness, headaches, birth control and women’s health, cuts, breaks, sprains, scrapes, burns, and all things snot related.

At home, I am a healthy, but clumsy individual.  I attribute it to all the time spent around snot-nosed kids who happen to be sick and in the hospital.  My immune system is in overdrive.  All the time.  Flu-schmu.  I almost never get sick beyond a simple sore throat and cough.  But when I travel, it’s a difficult story.

Evidence #1:  Every time I change environments, this guy sets up in my chest [or more accurately, my nose].  I don’t freak out, run to the nearest pharmacy, or anything out of the ordinary.  He just has to run his course.

Mr. Mucus likes to travel too

Evidence #2:  While living in a low-malarial risk area [and on prophylaxis]  I inexplicably caught malaria.  Even though mosquitoes rarely bother me at home.  I thought I might die.  It was really that bad.

Evidence #3:  This little guy must live on my passport.  He’s responsible for all things related to excessive poop.  He always follows me out of the country.  Even to Canada.  Even though I carry a supply of metronidazole with me at all times.

[a member of the Giradia family]

Evidence #4:  I have had stitches and broken bones in five separate countries [USA included, but also Mexico, Peru, England, and Russia.]

Evidence #5:  A particularly nasty little bout of excessive poop acquired in Mexico robbed me of my will to live.

All of these incidents occurred outside the friendly confines of my home state.  So I know a thing or two about travel related maladies.  For #5, I called my boss [who was a Mexican doctor] and he called a friend of his who lived in the city I was visiting who brought me some oral re-hydration solution.  That saved my ass — quite literally.  It’s no fun pooping mucus.  Take it from someone who knows.

So after you have traveled all over creation, battled a few bugs, completed two health care degrees, got accepted into a health graduate program, worked in a hospital for a few years, worked and volunteered in hospitals and clinics all over creation, you come to know a few things. Or at least you think you do.   Or at least your friends and family think you do.  And they ask questions.

So here goes–a list of common travel illness scenarios, where they are likely to occur based on my limited experience, how you might want to treat what is going on, and some secrets on how to acquire drugs inexpensively.

Problem #1:  My snot is lime-jello green.

green snot

 

  • What it is:  More than likely it is a sinus infection.
  • Where it often happens:    In public places, touching stuff and not washing hands afterward.  In large, heavily polluted cities.  Anywhere air quality is poor.
  • What to do: After 7-10 days with no improvement, go for a round of an antibiotic like Amoxicillin. Amoxicillin [for sinus infection] is currently out of fashion in the US, but it is cheap and easy to get in most of the world. [Do not take if you are allergic to any of the -cillin family of drugs]

My disclaimer about antibiotics: I try to avoid taking antibiotics if at all possible because they kill all the bacteria in your body [not just the bad bugs]. Additionally, over-prescription of antibiotics in recent years has helped lead to drug-resistant strains of bacteria such as MRSA and VRE.

Problem #2. I’m pooping all the time! (and it brings its friend–vomit)

  • What it is:  More than likely it is traveler’s diarrhea. [or vomiting]
  • Where it comes from:  Most cases come from an intestinal bacteria or viral infection.  It could come from food, water, dirty glasses, pretty much anything.
  • Where and when it happens: Countries throughout Latin America, South America, Asia, and Africa.
  • What to do: Avoid getting sick, but if you do get sick, try the following:  Treat the emergent: You are about to board a night bus for _____.  You have a queasy tummy.  You know bathroom breaks will be few and far between.  Take loperamide [Immodium] or diphenoxylate/atropine [Lomotil].  But not both.  Or your intestines will turn to cement.  Crisis averted for the next few hours.
  • Address the cause: If you have bad traveler’s diarrhea doesn’t go away in a day or two, it’s likely you’ve got a bacterial or viral infection.   I always carry a supply of Ciprofloxacin [Cipro] or Azithromycin [Z-pak] — an antibiotic easily found almost anywhere in the world cheaply — as my first line of treatment. Often, you’ll see your body recovering in 24-36 hours. However, once you begin taking an antibiotic, you MUST take the full course. Never stop after you feel good.  This also contributes the the multi-drug resistant bacteria  surge.
  • If you can’t keep anything down, including medications–hydrate, hydrate, hydrate:  Don’t drink plain [bottled or boiled] water, but find yourself some packets of hydration salts, make your own using this formula, or buy some Gatorade and cut it with water. This will help replenish your system with salts, sugar, and minerals that your body has violently kicked out.  It’s all too easy to end up in the hospital from dehydration.  [I would have–twice–if I didn’t know how to start my own IV and carry a saline bag with me.  I don’t always do this, just to remote places]
  • If you have a virus, antibiotics will not help you. Period. If it lasts more than a couple of days without improvement, suck it up and go see a doctor.  They are almost always cheaper than in the US.  Especially if you have travel insurance.

Problem # 3  My burps smell/taste like rotten eggs.

  • What it is: When you’ve got a case of burps that smell and taste like rotten eggs or sulfur, there’s a good chance you are dealing with a water-borne protozoa like giardia.
  • Where and when it happens: Latin America/South America, Asia, Africa–any where that can’t purify the water system.
  • What to do: Take a full dose of  Metronidazole or Tinidazole (4 tablets at the same time). If you have this particular parasite, the burps will go away and you’ll feel better pretty quickly. If they don’t, get yourself to a doctor.  As a bonus, Metronidazole can be used to treat bacterial infections in the genitals. [should you need treatment for that sort of thing]

Problem #4  I can’t poop! [or my poop is really hard]

  • What it is: Constipation
  • Where and when it happens: USA/Canada… Pasta belt in Europe… Dumpling Belt of Central/Eastern Europe… anywhere where there is heavy food
  • What to do: Back off the pasta, dumplings, bread, and cheese. Eat as much fruit, greens, and water as you possibly can. If that doesn’t work, bring out the big guns and eat a bag of prunes (with another few liters of water).

Problem #5  Jackhammers are being used inside my skull.  

jackhammer

 

  • What it is: Depending upon the intensity and location of said jackhammer, you could be experiencing a garden-variety headache or a migraine.
  • Where and when it happens: After a series of overnight buses with blaring music and jerky stops. Sleeping in cheap hotels with giant pillows. People yelling outside your room ALL. NIGHT. LONG.
  • What to do: For regular headaches, Tylenol or Advil will usually do the trick.  For tension headache/migraines, try Tylenol with caffeine.   And quiet.  And darkness.  And not moving.

Problem #6  I don’t want to get malaria.

  • What it is:   A parasitic disease transmitted by the bites of infected mosquitoes
  • Where it happens: Africa, parts of Asia, select parts of Latin America, the Caribbean
  • What to do: Once you have an itinerary, consult the CDC malaria map to determine malaria risk for the regions where you are traveling. Two things will matter most: where you are going and in what season.  Not all malaria is created equal, so you’ll need different medication for different parts of the world.  [I contracted P. vivax  malaria in the Amazon even with Chloroquine–so take this advice with a grain of salt]
  • Doxycycline: Insanely cheap when purchased locally and fairly cheap in the USA. Two things to note: doxycycline tends to make people more sun-sensitive. It can also conflict with some birth control pills. It’s also an antibiotic.
  • Malarone: It’s insanely expensive, but its chemistry supposedly messes with your mind and body less than larium or mefloquin.
  • Chloroquine:   Not really cheap. Chloroquine tablets have an unpleasant metallic taste.
  • On the cutting edge of malaria remedies is the Chinese artemisia plant (or qing hao, “sweet wormwood” or “sweet annie”).  It appears to be commercially available from Novartis as the drug Coartem (Artemether 20 mg, lumefantrine 120 mg). It’s now on the WHO essential medical list. [2018 update:  Coartem is in in Peace Corps med kit for treatment of malaria so it is now a pretty standard drug].

Problem #7 I don’t want to catch Dengue fever/Typhoid fever.

  • What it is:  A viral infection transmitted by A. aegypti mosquito [dengue] or a bacterial infection caused by Salmonella typhi [typhoid].
  • Where it often occurs:  sub-tropic regions such as  Indonesian archipelago into northeastern Australia, South and Central America, Southeast Asia, Sub-Saharan Africa, and parts of the Caribbean [dengue] Most of the world except USA/Canada/Australia/ Western Europe. [typhoid]
  • What to do:  There is no prophylactic medicine for dengue. The best thing you can do is avoid being bitten.  These are the ones that come out during the day.  There is a vaccine available for typhoid, and it can be treated with good old Ciprofloxician. And wash your hands. Frequently.  Like become OCD obsessed with it.

Problem #8  I’m going to vomit on this bus/boat/plane/donkey cart/ect.

  • What it is: Motion sickness
  • Where and when it happens: On windy buses in the mountains of Ecuador, Bolivia, Peru.  In a donkey cart in Guatemala. On a research boat headed to the Galapagos Islands in a storm.
  • What to do:  Option #1– If you’re prone to motion sickness, keep a stash of Dramamine or my personal favorite Bonine  (aka Antivert, Meclizine) handy and take it 30 minutes before departure. If you take it once you’re on the road, it’s too late. As a side benefit, Dramamine will usually knock you out so you don’t have to watch the death defying acts of the bus driver.
  • Option #2:  Purchase a pair of pressure point wrist bands (usually go by the name of Sea Bands). Not sure if their effect is psychosomatic or real, but some people swear by them.

Problem #9 . I’ve gone too high. My head is going to explode.

  • What it is: Altitude sickness.
  • When and where it happens: Hiking or walking anywhere above 2500 meters, particularly if you’ve just arrived by air, train, or bus. The worst I have ever experienced was taking a bus from sea level in Ecuador up to Quito. I felt as if my head was going to blow right off.  La Paz, Bolivia and Bogota, Colombia were no picnic either.
  • What to do: If you can, take altitude slowly, acclimatize. Outside of that, try local remedies like coca leaves (recommended in the Andes, chewed or in served in coca tea) before resorting to traditional altitude sickness drugs like Diamox [which is a diuretic].

 Problem #10 .  I’ve got blood spurting from somewhere it shouldn’t.

  • What it is: Scrape, cut, gash, road rash.
  • Where it happens: Being smashed into rocks when trying to learn to surf in Peru.  Falling off the sand board in Chile.  Getting too close to the reef in the Caribbean.  Running into trees while skiing. Ect.
  • What to do: I always carry an assortment of band-aids, bio-occlusive dressings, gauze, steri-strips [for wound closing], ACE bandages, hydrogen peroxide, neosporin, saline, and iodine. And Cortisone cream–for rashes and bites.  I may be going overboard, but then again, I am pretty clumsy.

Problem #11. I do not want to get pregnant and/or a souvenir I can’t get rid of…

  • What it is and where it happens: Me hopes you should be able to figure this one out on your own.  But beaches, booze, and bathing suits are a heady combination.
  • What to do: Contraception options are many, but if you choose to take birth control pills, here’s some advice:  Before you leave home, ask your doctor to put you on a pill with a hormone formula that is more universally known.  Drugs are known by different names around the world, so write down the commercial name of the drug as well as its chemical and hormone structure.  Condoms are available [can be expensive], but especially if you need the non-latex variety, bring some from home.

In my experience, many countries outside of North America and Europe (and I assume Australia) will sell birth control pills without a prescription. Along your journey drop into pharmacies and ask if they carry your particular pill. Birth control pills are rather expensive (especially by local standards) and choices are limited in many Central and South American countries. However, they were relatively inexpensive and easy to find in Argentina. So, when you find yourself in a country that carries what you need for a good price, stock up.

How do you get all these drugs on the road?
Most pharmacies outside Europe, North America and Australia will sell you whatever you need without a prescription and at a much lower cost than you’ll find at home. My advice: if you’re going on a long journey, travel first to a country where prescriptions are not required for basic medications.

  • Prescriptions: not necessary.
  • Prices: much cheaper than back home
  • Medicines (at least based on my experience): the real deal

I have only had to buy medicine in countries where I speak the language, but knowing the generic name for a drug will help immensely.  Write down the chemicals (and percentages if you can find it) that go into the medication you need instead of just the commercial or generic name of it. The chemical names translate roughly the same in all languages even if the medication is called by another name in that country.

There it is.  My best advice for staying healthy on the road.  Take it or leave it knowing that I have had my fair share of sickness on the road, but it has kept me alive and mostly healthy.

Why even leave home

I live in an area where travel is not prioritized.  Most of my neighbors/co-workers, ect, think ‘traveling‘ is either going to the coast–whether Myrtle Beach, Charleston, Hilton Head, or gasp! Florida or going to the NC/TN mountains.  I have been to both, but I prefer to use these areas as either a day trip or at most a weekend getaway.

There is a lot more to the world than just the Southern United States.

That kind of travel is fine–for some people.  Some people never want to leave their home state [I’d wager those are the very people who NEED to leave their home state, but I digress].  Some people just want to be off work and lay on a beach.  It’s their vacation; they can use it however they want, but in my opinion that’s not traveling.  Neither is a week in Cancun, or the Bahamas, or Jamaica or DR or any other place where you don’t have to get involved.

bench overlooking the sea
I love the beach too, but this is more appealing to me than an all inclusive resort.

Some ‘travelers’ turn their noses up at pre-planned adventures or set itineraries.  I say that’s better than nothing.  It’s not my favorite way to go, but especially if I am in an area where I don’t speak the language, I may sign up for a day trip or tour bus just to get my lay of the land.  Usually these pre-planned adventures allow the ‘traveler’ to check off boxes or scratch off one more place off their ‘bucket list’, but what they don’t allow for is the type of travel I consider ‘real travel’–travel that has the potential to change your worldview and who you are at your core.  Would I have ever considered going back to school to become a nurse practitioner had I not volunteered in a health clinic for a couple months in Peru? Probably not.  Would I have decided to keep my focus on children had I not  volunteered in a pediatric hospital/orphanage?  Probably, but working in the peds hospital/orphanage cemented my desire to work with children.

Long-term travel–especially solo travel– allows more opportunities for self-discovery and self-reflection, but really any type of travel can be an avenue for reflection.  Is it harder to do at the family vacation spot?  Absolutely.  Is it impossible?  No way.  Can someone really have a life-revelation on a 9 day mission trip to Haiti?  Yes.  Is it likely?  Probably not.  My point is if you truly want to do something to change the direction your life is headed in, then you have to change your direction.

So why do we even leave home?

To be somewhere else of course.  It all starts with a desire to be somewhere that we are currently not .  For several reasons. Maybe you want to go to the Caribbean in January to get away from the snow.  Or to Patagonia in July to see snow.  Maybe your job sucks and you want to be ‘anywhere, but here.’  Maybe you just broke up with a significant other and everything you see reminds you of him/her.  There are a myriad reasons why someone would want to ‘get away’ for a while; most of them are not so alarming.

I have often thought of why I am different when I am traveling.  Part of it is because I HAVE to be more outgoing on the road or a may die of boredom.  At home, I have my friends, my cat, and my furnishings.  If I want to stay home, no one is going to make me go out and I don’t really feel as if I am missing anything.  But if I am in Alaska during the winter, and I don’t feel like going out, I may miss a once-in-a lifetime experience.  Part of traveling is exploring and discovering new things and it’s so much easier to do that in unfamiliar territory.  Would I have ever eaten anticuchos aka meat on a stick anywhere in the USA?  Not a chance.  But in Peru, when there are 10 stands set outside a football stadium, and the vendors sell them instead of hot dogs, yea, I gave it a shot.  And they were tasty little morsels.

I think when it comes down to it we leave home to search for something more.  More within ourselves.  More understanding of others.  More understanding of ourselves. More stories to tell.  More experiences to share.  Travel makes us richer; sometimes in ways we can’t understand until we aren’t traveling anymore.

I often wonder if I will ever have the desire to ‘settle down’ or if I will always have wanderlust. I know–at least for now–I will do all that I can do in order to satisfy my urges.

 

‘Stay safe’

I work with a dude, who is Panamanian in origin, always says ‘get home safe‘ instead of ‘good night’ or ‘bye’.  “Get home safe.” As if I had told him I was headed out in one of the most dangerous places in the world. As if I had said I were going to try bungee jumping or sky diving. Now, while, it’s true I often leave work after midnight, it takes me at most, 15 minutes to get home.  Traffic is very light, and well, I don’t have to worry about roadside bombs or guerrillas hiding around construction barrels. Maybe the occasional drunk driver, but generally there are no worries on my drive home.

Which got me thinking…

In some places, hiding in a bag is a perfectly acceptable safety measure. Hey there, kitty, kitty. Sometimes it’s hard being a kitty cat.

Why is it that here in the US, we tell people to be careful when they leave–whether it’s leaving work for the day or leaving the country for vacation?  Why not ‘have fun‘. ‘Don’t do anything I wouldn’t do‘. ‘Don’t fall off a cliff‘, or even a ‘I’m totes jelly‘ would be a better send off that ‘Stay safe‘ because being told to constantly on guard is no way to enjoy a vacation or a day off from work. So if you’re going to tell me to “stay safe” when I need my passport, I’d appreciate the same send off every time you say good-bye to me in America. I probably need the safety vibes more here at home.

There are currently 196 countries in the world; various websites take into various metrics when ranking countries.  These statistics are taken from several different sites.

There are 162 countries ranked. [I’m not sure what happened that the other 34 didn’t even get a mention in rankings]

  • Iceland is the world’s safest; Syria is the least safest [Although one website ranks The Bahamas as the most dangerous].
  • USA is 94; Australia is 9; UK is 39, New Zealand is 4, and Canada is 7. [From a safety point, I should be living somewhere in the United Kingdom]
  • Qatar is 30; Kuwait is 33; Kosovo is 69; and Cuba is  82;  [I’ve been to two of these, and it’s not the highest ranked of the bunch]
  • Saudi Arabia 95;  Brazil 103; Thailand 126
  • Jamaica is 109; Congo is 115; Turkey 135 [I have to question Congo being rank this ‘high’.  There have be declared and undeclared wars and skirmished since the 1960’s]
  • Mexico 144; North Korea 153; Somalia 157  [I know Mexico has had an uptick in violence/crime since I lived there, but it still shocks me that it’s fallen so far down the scale]

All this to say, more than half of the world ranks higher than the USA in safety.  A lot of the places that rank lower than the US are currently in civil wars.  I’ve been to  quite a few lower ranked countries and felt safer there than in NYC.

Hey there Rio… I never felt unsafe during the entire 6 weeks I was living in the city or 3 months of being in the country. I did however listen when people said ‘don’t go to that neighborhood’

Uxmal_Ruins_Selva
I traveled around the southern half of Mexico as a 22-23 year old often spending nights in the jungles and not being aware of local politics. Mexico is ranked 144 and the only time I felt unsafe was when people pointed large guns in my general direction.   Of course I was in an area of civil unrest at the time.

My point is, and I do have one, in case you are wondering, the world is not an inherently dangerous place.  If you believe, as the media would have you to believe, every country outside the United States is fraught with peril at every corner, you’d be missing out on 93 countries ranked safer than the USA… including all of Europe [expect Turkey, if you count that as Europe].

I offer only one piece of advice about traveling:  trust yourself. There were periods in my life where I was a bit more cavalier, but these days I am a little more cautious and take precautions to lessen the chance that I end up  in a bad situation. I stay sober and aware of my surroundings whether I am in Asheville, NC or Bogota, Colombia, or Moscow, Russia. Beyond that, I can’t stop random acts of violence on the road any more than I can at home.

There is no one-size fits all rule. Life is about assessing a situation, making predictions, observations, and acting based on those assessments. Sometimes the assessments are off and I make a bad choice. But it is an absolute fact that traveling has greatly increased my ability to size up a situation and a person and make an accurate judgment. I am not the most adventurous traveler by any stretch of the imagination. There are those who do all the big, risky things. That is not me.  I try to push the bounds of my comfort zone just a little, but there are many things I won’t do that others will.

Getting to Angel Falls wasn't easy, but I rarely felt unsafe even in chaos of Maricaribo.
Getting to Angel Falls wasn’t easy, but I rarely felt unsafe even in chaos of Maricaribo.

If something serious happens to me on the road it will likely be a transportation based injury — just like at home. Traffic accidents are far more common the world over than tragedies, and fatal traffic accidents far outweigh death from terrorism, plane crashes, or infectious diseases.

According to Bloomberg, on the whole, car accidents are the number 1 cause of death for US citizens abroad.

Now compare this to what people say when I go to Mexico or Colombia. I hear about the drug cartels, getting seriously sick, and the “scary people” who may harm me. The reality is that while precautions for the other areas are needed, sometimes our perceptions are skewed by what outside forces are telling us.

There are many things I may look back and regret in my life, but not traveling will not be one of them.  I have found more true kindness, friendship, and generosity in each corner of the world, in the mostly unlikely of people, and in countries other Americans assume are only filled with foes. People have gone out of their way to extend help when I needed it; times when I was at my most vulnerable — sick, lost, alone. Traveling becomes the sum of human kindness and it only takes a commitment to shifting your perspective to see that.