Staying healthy

English only article – Slovak version coming soon | Článok je iba v angličtine, preklad pribudne čoskoro.

When going on a long term overlanding expedition, staying healthy can be challenging – but the better you’re prepared, the better are your chances – and your whole journey. Again, there will be some Latin America specific advice, but most of this can be applied generally.

Let’s start with some tips how you can avoid unnecessary risks:

Research

Do your research, period. Depending on which countries are you going to, check what possible diseases and dangers you might encounter there. A great place to check this is Center for disease control and prevention – look through the website, open the countries you’re planning to visit and read what’s what. The first thing you’ll probably find and it’s a good place to start is…

Vaccination

Being properly vaccinated is one of the easiest ways how to minimize the risk of some nasty diseases – some countries won’t even let you into the country if you don’t have some of them – so check that CDC and WikiOverland sites.

We did all the vaccinations necessary + some optional ones. For Latin America, the only mandatory vaccine you must have is Yellow Fever – without a certificate of vaccination they may deny your entry to Brasil and some other countries. All of the others are optional, some of them highly recommended – Hepatitis A and B, Typhoid, Rabies. In the end, we decided to do all of these, including rabies – this one isn’t by no means necessary and has only limited usefulness, but it was not expensive, so why not.

Probably the most infamous disease is Malaria – there is no vaccine against it, but you can protect yourself with antimalarials. The way these work is you still can get Malaria – but if you do, the symptoms are way, way easier for you and you can be on your way quite quickly.

Thing is, you have to start taking them before going to risky areas and continue taking them during and after your stay – the duration vary depending on the type of the antimalarial. Note that none of them are 100% effective and you have to be a bit cautious and use other forms of protection as well (clothing, mosquito net, repelent). They can have quite nasty countereffects, or can be very expensive (or both). In the end, we opted not to use these and be very careful in potentially dangerous zones, using repellents with high concentration of DEET and long sleeves.

This is very important, as there is also Dengue, Chikunguya and the infamous Zika fever – with no safe vaccination, prophylaxis or cure available as well. All three of these are contracted by the same type of mosquito – you can distinguish it by its black and white legs (we got quite good at it). (note on Dengue – there is a vaccine called Dengvaxia, but due to this controversy I will leave it to your judgment if you’ll want it – and it’s almost impossible to get to.)

In the affected areas, you can and you should protect yourself – it’s not that hard and most likely you’ll be just fine. Wear long sleeved clothes, avoid staying out shortly after sunset / before sunrise when they are most active (or protect yourself), and use repellent with DEET or Picaridin. Don’t use the “natural” citrussy things, or other similar natural-but-definitely-work repellents. Yes, DEET is nasty, you have to be carful when using it and don’t touch colourful things, sunbathe or put it on the clothes, but it is one of the only things that actually work. I only found about Picaridin while travelling, and it looks like it might be the best option – it was proven to work in some studies and seems to have less negative effects. Stock up at home before flying into these areas – surprisingly, good repellents can be hard to get here (sometimes due to higher risk of the mosquitoes developing resistance)

You can also “impregnate” your clothing with repellent made for clothing, that contain Permethrin.

A note on Zika: as far as I know, it is still not conclusive if it can cause microcephaly (undeveloped brains in newborn babies). Since you can contract Zika and have no symptoms at all, and still have the virus in you for even a year – I would stay clear from affected countries if you plan on having a baby in the next year or two. Other than that, you should be OK – dengue is far more common and has worse symptoms than Zika and people are not so afraid of it 🙂 (not a great consolation, I know)

Travel Insurance

Next is travel insurance. Do not go for an overland expedition without one – the risk might be low, but you take the insurance to avoid potentially life changing outcomes – getting in a hospital in the US can leave you indebted for years, or even decades, if you don’t have one.

A good tip is to check, if you can opt out of your insurance you have back home. In my country (Slovakia), health insurance is mandatory and if you’re unemployed by choice, you have to pay on your own. But if you declare that you’ll stay outside the country for more than 6 months, you can cancel it – with some proof of leaving the country like a flight ticket. This is what we did – and funnily enough, the travel insurance was actually cheaper and covered more…

A few things to note:

• If you’re like us and carry a lot of electronics (cameras, phones etc) – don’t really bother with the anti-theft insurance that is included in these. Most of the time, the limits are just way too low (like 300eur max for single item) – this didn’t even cover a single lens for my camera. If you find one with good limits, think about it – for us, it was easier to keep money at side as our own “we’ll buy new ones if they steal it” insurance, and the saved money paid for this. Also, we never got anything of value stolen, so we saved the money in the end.
• Another tip is to look for insurance excluding US and Canada, and only paying extra for days you’re going to spend there. The reason is that thanks to cost of medical services in these countries, the insurance would cost roughly double what it costs in the rest of the world.
• Always check the fine print.
• If you need to extend your policy, or start a new one while you’re already travelling, check with the insurance company and also read the fine print. We wanted to change to another company while abroad and despite multiple reassurances, we found out in the fine print that it would render the policy invalid (and got the manager apologizing to us). For short term extensions while abroad, TrueTraveller is the best.

Insurance companies

• The most common medical insurance between overlanders seems to be World Nomads. I only heard good things about them, they pay out and take care of you without a problem. They are more on the expensive side though – a year with them (excluding US) was about 1000 eur.
• For EU based travellers, the best deal we’ve found (and used) was Allianz – it offered the best deal. Basically good travel insurance with unlimited medical was only 260 eur per year.
• The second recommendation for EU based travellers would be TrueTraveller. We used them, and they paid out without a problem when I had salmonella in Ecuador – just by emailing them the recipes and documentation from the doctor. These actually work with Allianz too, but offer probably the easiest and most user friendly travel insurance for backpackers and travelling nomads. You can easily select what you want and what you don’t and save some money on unnecessary items. A big plus is easy and transparent extension or new policy while already traveling. We used them to extend our former Allianz policy, as we needed just one more month.

General advice for staying healthy

So you’re vaccinated, bought your repellents and long sleeved clothing to protect you from the mosquitoes and on your adventure already. What more can you do to stay safe?

Again, this will be just some general advice, most of it might be very obvious but it never hurt anyone to read it again.

Water

• Always make sure you drink potable water. If in doubt, drink bottled or filtered water. If in restaurant, ask if the water is “potable“, or in Latin America “agua de bidon” or “agua purificada“. Don’t just ask a local if it’s safe to drink – locals sometime think that it is safe to drink because they drink it and they’re okay – that definitely doesn’t mean that you will be. Better to check online as well.
• The same in a restaurant – if there’s lemonade, or something with ice, ask if it’s from purified water. The one time I forgot to ask in Perú and drank a cup of delicious iced tea that locals were drinking, before I realized what I’ve done, I ended up for several days at a hotel bathroom.
• If you have a larger van and want to have peace of mind, think about installing a water filtration system. However, in most of the areas in Latin America, it’s very easy and cheap to get purified water in large 20l jugs practically anywhere- so water was not an issue.
• We had a backup Lifestraw water filtration bottle – it’s cheap and good backup. We used it as a normal water bottle with the filter removed, but if we ever had a problem with getting water, we could pour almost any water into it and it would be reasonably safe to drink. Also, it’s good for hiking – you can take an empty bottle and drink water from (almost) any water source, so you save weight.

Food

• Getting sick from food is probably the most likely thing you’ll encounter. Definitely pack some medication (see next point)
• Street food – always a tradeoff. Personally, I am a big foodie, so I will rather risk getting sick from time to time than to avoid it altogether – but I am trying to avoid those where you can clearly see the hygiene is bad.
•  Wash the vegetables and fruits, always. Back home I’ve been very lax with this, and almost never had a problem. In Quito, Ecuador, I ate a 2-3 unwashed strawberries bought in a supermarket in the most posh neighborhood and ended up with salmonella. My bad.
• If you have problems, medicate yourselves, find a nice place to stay and wait it off. If you have high fever and it doesn’t stop, go see a doctor.

Altitude

• The higher up you go, the less oxygen there is in the atmosphere. If you go high enough, you can start developing signs of altitude sickness.
• The threshold where most of the people start noticing some more pronounced effects is usually around 2500-3000 meters above sea level.
• The best way to avoid getting sick is to acclimatize properly. Try to spend at least a few days (or a day) in a higher altitude before going over 3000.
• Try to avoid smoking, drinking alcohol, moving too fast or doing unnecessary exercise.
• Some shortness of breath or headache is quite normal in the first day or two, but if you can see that you are developing serious symptoms, go back to lower altitude immediately. Acute altitude sickness can be very serious and it’s not worth risking it.

Medication

• Basic first aid kit
• Anti diarrhea: Nifuroxazid (anti diarrhea), supported by Diosmectite (Smecta – better than activated charcoal)
• Fever: Paracetamol (acetaminophen), Ibuprofen. Can be taken together if the fever is severe.
• Broad-spectrum antibiotics. Get your doctor to prescribe you some. Use these only if you can’t get to a doctor. (remote locations).