Adventure Medicine

You survive a plane crash in the Amazon? Who cares! What's far more likely to go wrong during an international journey is injuries and illnesses that would be easy to manage close to home but are much trickier on the far side of paradise. Here are seven frequent scenarios and how to handle them.

Dogs in the Street

   Photo: Photograph by Louie Psihoyos/Corbis

Adventure Medicine

You Get Bitten by the Village Dog
He looked awfully cute and friendly, then...snap!
DEAL WITH IT: If the teeth (or claws) broke the skin, even slightly, count it as exposure. Once symptoms develop, the rabies virus is incurable and nearly always lethal. Though incubation periods vary, you'd better hightail it to a hospital with human rabies immune globulin (HRIG) and a rabies vaccine, or call the U.S. embassy, which will have access to post-exposure treatments or be able to steer you in the right direction.
AVOID IT: Keep your distance from street dogs, of course. Overall, the odds of animal bites are low (in Nepal, the World Health Organization counted32 rabies deaths in all of 2007), and the vaccines are costly—up to $700. But if you're going someplace where there are higher rates of animal bites—like Southeast Asia or India—the pre-trip vacs may be worth the peace of mind.

You Scrape Your Foot

Adventure Medicine
 

It's just a tiny cut from a coral reef—no big deal, right?
DEAL WITH IT: In the tropics or any place warm, little cuts, scrapes, and blisters can quickly get infected—especially on your feet. At best, that'll make it hard to walk anywhere; at worst, it will swell up, turn red, and start to ooze—and you'll need to find a doctor. Even if it seems like a minor injury, wash well with soap and water, coat liberally with antibiotic or antiseptic ointment, and keep a clean bandage on it.
AVOID IT: Don't walk around the beach or campsite barefoot, and for God's sake don't go traipsing through the jungle in your flip-flops. If you must wear sandals, at least wear a pair with toe and sidewall protection.

You Can't Get Off the Toilet

Adventure Medicine
 

Two days of hell on porcelain: Is it serious?
DEAL WITH IT: If you feel fine otherwise (no fever, no blood in your stool), you can just carry on for up to three days. Drink lots of fluids mixed with non-irritating electrolyte drops (like Elete; eletewater.com). But who wants to spend their trip on the pot? Start an antibiotic (like cipro­floxacin; see "Just Say Yes," page 64), which may kill whatever's wreaking hell. And if you need to travel, don't buy that "Let it run its course" myth; you can also take a loperamide (Imodium) to get you through a bus ride—doing so won't prolong your condition.
AVOID IT: This will require vigilance—and perhaps a bit of luck. In places like sub-Saharan Africa and South Asia, up to 60 percent of all travelers will experience symptoms—mostly due to E. coli. Reduce your chances by following the basics: Wash your hands often, eat only well-cooked (boiled or well-done) foods, skipping raw veggies you didn't peel yourself, and avoid non-disinfected water—even for brushing your teeth.

You Cut a Finger Making Dinner in Camp

Adventure Medicine
 

A deep gash may require stitches. But how urgently?
DEAL WITH IT: You might be tempted to close it with superglue. Don't. If bacteria got in there, that will just accelerate infection. But if you can't get to a doc immediately, don't panic: After 12 hours, they won't suture it for a few days anyway. Wilderness doc Paul Auerbach, author of Medicine for the Outdoors ($23; Lyons Press), says you should apply pressure to stop the bleeding, irrigate the cut really well with soap and water, disinfect with Betadine diluted with sterilized water, rinse, apply Neo­sporin, and cover with a clean bandage. Cut tendon? If you can keep it clean, don't call the heli. That can be fixed weeks later.
AVOID IT: Slow down. Use a cutting board.

Your Friend Gets Hit in the Head

Adventure Medicine
 

Coconut, out of the blue! She insists she's fine, but it was a serious blow. Carry on or carry out?
DEAL WITH IT: Even if she seems lucid, you may still have an emergency on your hands—especially if she ever lost consciousness. A concussion can be accompanied by slow internal bleeding, even from minor trauma, and things could get worse quickly. Treat the head­ache only with acetaminophen (Tylenol); never naproxen sodium (Aleve), ibuprofen (Advil), or, especially, aspirin, all of which promote bleeding. Watch closely for 24 hours, even rousing her periodically from sleep. A worsening head­ache, wooziness, vomiting, unequal pupils, and changes in speech or gait are all indicators of a slow bleed. Mayday!
AVOID IT: Wear a helmet if you're mountain biking, rafting, or skiing—and don't push it as hard as you would at home.

You Think You May Have Frostbite

Adventure Medicine
 

Your toes and/or fingers are numb and white. Thaw them out ASAP or keep them on ice?
DEAL WITH IT: If you're in the backcountry, and there's a chance they might refreeze, leave them alone. Secondary freezing is worse than the first, and it's easier to hike or ski out on numb toes than thawed (and excruciatingly painful) frostbitten ones. But as soon as you're in from the cold for good, immediately warm them in a hot bath (up to 104 degrees). And take ibuprofen: New science suggests it opens blood vessels and speeds healing.
AVOID IT: Don't overtighten boots, stay hydrated, and make sure to keep your hands, feet, and core warm. The first sign on exposed skin is frostnip (numb, white, firm), which is easily reversible: Just bundle up—or better yet, get out of the cold.

You Suspect You Have Malaria

Adventure Medicine
 

You were in the tropics, and now you feel like you have the flu.
DEAL WITH IT: There's no telltale sign that you have malaria, but if you've got an unexplained fever and chills and you've been to a high-risk area, just assume you do. Before your trip, work out with your doc a prescription and emergency plan for the area you're traveling to—meds vary by region, and it may be that a quadruple dose of your malaria prevention pill can cure the disease. Either way, rush to a clinic while you're still mobile.
AVOID IT: Take the right antimalarial for the country (see cdc.gov/travel) and use a proven insect repellent like permethrin or Ultrathon (solutions.3m.com), which contains 30–50 percent deet, on your clothes and/or bed net. Avoid repellents with 100 percent deet, which are more toxic and only marginally more effective.

Just Say Yes

Prescription drugs may be cheap in developing countries, but there's a good chance they're also counterfeit (especially in South Asia). Your best bet is to have your doctor pre-prescribe a few for you—like these three, which we never leave home without. But always remember to bring your scrips with you. A Ziploc full of Percoset just might raise a few eyebrows at the border.

PAIN
Ask for: Oxycodone
What for: Takes the edge off debilitating pain

INFECTIONS "BELOW THE WAIST"
Ask for: Ciprofloxacin
What for: Diarrhea and urinary-tract infections

INFECTIONS "ABOVE THE WAIST"
Ask for: Azithromycin
What for: Ear and upper-respiratory infections

Burning Questions

A few more things that would be good to know on the road.

WHAT'S THE BEST WAY TO PURIFY SUSPECT WATER?
For clear water, be it from a tap, river, or lake, you can't beat the convenience of the SteriPen Adventurer ($100; steripen.com). Ninety seconds of swishing this UV-light wand around in your bottle zaps everything from protozoa to viruses like hepatitis, which tend to slip right through backpacking water filters. But these devices can also crap out on you unexpectedly, so bring extra batteries and, just in case, iodine-based tablets or drops ($18; potableaqua.com). Plus SteriPens don't work in anything cloudier than weak lemonade. For murky water, filter first with a bandanna, then boil or treat with iodine tablets. (More at cdc.gov/travel/content/water-treatment.)

HOW DO I FIND A GOOD DOCTOR ON THE ROAD?
First, sign up with IAMAT—the International Association for Medical Assistance to Travellers. They keep a free list of English-speaking docs who've met the group's quality standards in the area you're visiting (iamat.org). On a major expedition, consider hiring a group like Remote Medical, which provides custom med kits and is on call 24/7 for medical advice or evacuation help (remotemedical.com). And since some medical insurance plans won't cover you abroad, for a couple of bucks a day, travel coverage with Travel Guard (travelguard.com) is a no-brainer. Prone to disaster? A full-on rescue from a remote area could cost tens of thousands of dollars; for a $329 annual membership, Global Rescue will coordinate it for you and cover the costs (globalrescue.com).

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