November 15, 2013

by Cathy Liu in new York, ny

Bolivia is the only country on our route to require visa for Americans, and yellow fever vaccine is required as part of the Bolivian visa application. The last time I got vaccines was in high school, I had to get TB because I was working in a nursing home, an environment full of weak immune systems. It would be a good idea to get vaccines for our long travel. As Ken stated, we want to die doing wild stuff on our adventure, we don’t want to be killed by preventable diseases.

After more than an hour of wait at the Beth Israel Medical Center, I got to see Dr Salomon who specializes in travel medicine. While I was waiting, I kept on wondering if I got see the doctor at 13:36 for a 12:00 appointment, what would happen to the 13:00 appointment, what about 14:00 appointment, and the next one, and the next one… Well, anyhow, the doctor advised me to drink bottled water only, stay away from animals and street food, use hand sanitizer with more than 60% of rubbing alcohol, and educated me on the following:

Diarrhea is the most common travel related sickness. It should be treated as:

  1. day 1: use Imodium (2mg) after each loose stools up to 4 times a day, stay hydrated with salty water
  2. day 2: if symptoms improved, continue Imodium and hydration until diarrhea subsides (at this point I said, I never had diarrhea more than 2 days)
  3. day 3: if diarrhea continues, start taking antibiotic Ciprofloxain - up to twice a day for no more than 3 days
  4. day 5: visit a doctor if still having symptoms

Dengue is the most common virus carried by mosquito, followed by malaria and yellow fever. Strangely, after writing down this statement on a piece of paper, the doctor only prescribed preventive treatments for malaria and yellow fever, he did not mention another word about how to prevent dengue… For the record, Dr Salmon said to use mosquito repellent containing 30-50% DEET, such mosquito repellent can be found at camping stores, and mosquito repellent should only be applied on exposed skin for outdoors and must be washed off each night. I wanted to tell the doctor that we might not be able to shower everyday but decided to hold my tongue.

Different Malaria Treatment in Latin America - The malaria virus in South America countries such as Bolivia, Brazil, Colombia, Ecuador, Peru, and Venezuela developedchloroquine resistance, so malarone is to be taken once a day. In Panama, Costa Rica, rural regions of Bolivia below 2500 meters, **Guatemala out side of the capital, and Mexico,chloroquine is to be taken once a week. I was advised to start taking chloroquine one week before entering Mexico.

Hepatitis A, yellow fever, typhoid, and Tdap vaccines were prescribed to me, I was told to get the second shot of Hepatitis A vaccine 6 months later. When I took the prescriptions to the nurse, the nurse asked if I wanted to get all of them at once. I asked if these are conflicting vaccines, to which she replied n0, so I sat down, pulled up a sleeve and took out my beloved phone to continue my horse racing game while she prepared for all the shots. When the nurse got ready, she hid 4 Sharon needles under a sheet of tissue paper with one hand while trying to rub my arm with an alcohol pad using the other hand. I was very very puzzled, and I asked why she was covering the Sharon needles. She smiled and said that she was afraid that I would be nervous. I smiled back and said no, I have no reason to be nervous. I thought maybe this nurse was new, so I looked at my arm to make sure she’s not poking me too many times, then smiled at her the entire time to comfort her. When she finished, she told me that I’m much more relax than the average bear. Once again, I was shocked, I’m an adult, I’m not 6 years old, why would I be afraid of 4 tiny little Sharon needles? She said that some adults ask to lie down while taking vaccine shots. Well, alright, I was in a hospital, maybe this nurse is used to patients with mental sickness. I smiled and nodded, then quickly returned to my workplace.