10 health tips for travel in the tropics

More travelers these days are taking trips into the tropics, areas where unfamiliar health risks can be a special concern.

Medical experts agree there are no health guarantees when visiting the tropics. You can do everything right and still get sick, or everything wrong and stay well. Your good health will depend on common sense, luck and your ability to resist infection.

Still, to help people cope, medical experts have complied what we'll call the Ten Commandments for Tropical Travel. Although the information seems simple, forewarned is forearmed.

Commandment One: Check with your doctor well before you depart for any tropical climate, both to get advice about your present health condition and to find out about any special risks for places you'll be visiting. Ask about any special vaccines that may be required or recommended before you depart.

If your doctor is unfamiliar with foreign travel health requirements, you can always check with the Allegheny County Health Department, (3441 Forbes Ave., Oakland; 412-578-8060; www.achd.net). It can provide immunizations for yellow fever, hepatitis A, meningitis, typhoid, rabies and cholera. Other official health resources include the World Health Organization (www.who.int/ith), the Centers for Disease Control and Prevention (www.cdc.gov/travel) or the State Department Consular Information Sheets (www.travel.state.gov). Another good Web site is www.mdtravelhealth.com.

Two: Acclimatize yourself before you arrive. In addition to getting into good physical shape before the trip for any strenuous activities you may be undertaking, this means taking measures to prevent jet lag and travel fatigue on long journeys, such as drinking lots of fluids and getting some rest en route. A strong constitution is the best defense, but it won't do you much good if you arrive exhausted.

Three: Use sunscreen and protect yourself from insects. Malaria is on the rise in tropical regions around the world. Recommended preventative measures for risk areas include taking chloroquine, proguanil or mefloquine. When in the tropics, use mosquito nets and bug repellents with DEET.

Four: Drink only boiled or purified water. The same advice goes for ice cubes. Just because the water is frozen doesn't mean it won't make you sick. If you really want the chill of ice but aren't sure of its origins, you can put the ice in a plastic sandwich bag and then put the bag in your drink.

Five: Eat only well-cooked food and freshly peeled fruits and vegetables. Of course, this can be problematic in the tropics, or anywhere for that matter. For adventurous travelers, the chance to taste new foods is a primary reason for any journey, while others are wary of putting anything unfamiliar in their mouths.

However, more disconcerting than an exotic entree ordered inadvertently is the case of dysentery you might get on the side. You don't have to be paranoid to be concerned about gastronomic horrors that may be lurking behind the kitchen door.

For example, although tempting, avoid egg-yoke rich sauces like hollandaise and bernaise, which must be kept at room temperature to be served and can become a Club Med for bacteria. Health officials suggest throwing out unused sauce after an hour, but few restaurants do, especially in poorer countries. The same goes for Caesar salads and buffet omelets, unless you can be sure the eggs have been freshly cracked.

Another unwritten rule is to never order fresh fish on Mondays, since fish markets are usually closed on the weekend. As an alternative, you can ask to see the fish before it's cooked. A fresh specimen will glisten and its eyes will be clear, not milky, and it will have an oceany smell. If the restaurant staff is hesitant to show you the fish, beware. And steer clear of mollusks such as clams, oysters, mussels and sea snails.

In less-developed lands, order fare that has been stewed or thoroughly cooked. Favor places where the chef is proud of the food. Avoid establishments with a menu full of ambitious dishes and a room full of empty tables. Assume that the kitchen is only as clean as the bathroom. Sometimes a busy street stall may be a safer place to eat than a hotel dining room. If you can, watch where and how the food is being cooked. Make sure raw meat and vegetables are kept separate. Cross contamination is a primary cause of food poisoning.

Six: Bring along self-treatments for traveler's diarrhea. These include palliatives such as Imodium or Pepto Bismol and oral re-hydration salts if you come down with a case of Montezuma's revenge.

At the other end of the spectrum, be aware that constipation can become a serious problem on a trip, so some mild laxative may also come in handy.

Seven: Since HIV is prevalent everywhere, sexually active travelers should take and use prophylactics.

Eight: Avoid walking barefoot or swimming in fresh water, which can harbor all sorts of nasty parasites. Be especially cautious about getting untreated water in your mouth, nose or eyes.

Nine: Always think about personal security. Keep a low profile, don't flash your money or jewelry, and always use alcohol in moderation.

Ten: Be cautious about your conveyance. All the previous health concerns notwithstanding, motor vehicle accidents are still the leading cause of death and injury to travelers. So be aware of the taxi driver and always wear seat belts.