commentary

on being sick abroad

I’m a strong believer in the power of sleep and ibuprofen.  Headache?  Head to bed early and pop a couple pills.  Back pain?  Same deal.  Fever?  Again, early night and two tablets.

But after my latest fever stint hadn’t disappeared after five days of first rearing its ill-timed head – Eid break, with lots of work on the to-do list – every nurse I had called back home had switched from that rest-and-ibuprofen tune to one of getting myself to a doc, pronto.

And after a slew of tests and a few days of waiting, back came a positive typhoid test and a doctor’s order to be admitted to the hospital – immediately – for a hefty dose of intravenously-administered antibiotics.

Typhoid.  One of the many vaccines I had gotten sometime in the past few years, part of the laughably long list for which the Resident Nurse at Somerville’s Harvard Vanguard had called me a pin cushion.  And one that is – take note travelers – only 50 to 80 percent effective.  Meaning not very.  And especially not during South Asia’s monsoon season, when the prevalence of diseases like dengue and malaria and hepatitis and, you guessed it, typhoid tend to spike.

So after nearly two weeks of trying to navigate this whole sick abroad thing, here’s a few notes that I’ve collected on the experience thus far, for any expats or long-term travelers or others who might just be interested in knowing what negotiating healthcare abroad is like.

A quick disclaimer – I am not a professional or expert on any of these things (you knew that!), and these are just a few of my own personal recommendations, things I would have found helpful in knowing a couple weeks ago.  Hope you find them to be so, too.

1. Have a medically-knowledgable someone you can call back home.  Whether it’s your general practitioner, or your lovely aunt who happens to be the world’s best nurse (thanks, Auntie Mariann!), having someone who knows more about health and sickness than you do is not just reassuring, but can be downright vital in deciding what’s the best course of action to take.  Plus, it just makes you feel better knowing there’s someone on the other side of the line.

2. Go into the doctor sooner rather than later.  Yes, it’s a pain, especially if there’s traffic and it’s inefficient and takes all day.  But having test done and results analyzed will (likely, hopefully) make for a faster diagnosis and less stress for you and all interested parties.  Maybe it’s nothing!  But maybe it’s not.  And for some illnesses, timing really is everything, and the sooner you can catch it the better.

3. Don’t just go to any doctor.  If you’re really sick, it’s worth calling your health care provider from home (or a family member’s, or a friend’s if you’ve given yours up) and seeing if they can refer you to someone in their international network, if they have one.  Otherwise, do some research online or ask around locally before making an appointment with someone.  Not all doctors are created equal, and the right doc can mean the difference between a real diagnosis and an order to just go home and sleep it off.  Which in some cases, you can’t.

4. Come with a copy of what your ‘normal’ blood results are, if possible.  Good for comparison’s sake, as not all reference ranges (the ‘normal values’ you should fall within on diagnostic tests) are the same for all people all the time.  A lot of healthcare providers now have online centers at which you can create an account and track your health history; check and see if yours does, and if they do, set yours up and get tests and vaccine information from as far back as possible uploaded.

5. Get international health insurance.  Just do it.  If you’re abroad in a disease-prone place for long enough, there’s a pretty good chance that you’re going to get sick, and it’s probably going to pay for itself in the end.  So.  Just do it.

6. If you have a bacterial infection, have a test done to see which drugs it is susceptible to.  I think it’s called a ‘panel’, and it’s important in determining what treatment you need.  For example, the South Asian strain of typhoid is resistant to Ciproflaxin (known to most as cipro), the antibiotic of choice prescribed by most doctors back in the US for most all bacteria-related travel ails.  Which means it just wouldn’t work on the strain of the disease here, and so you need a different drug.  Most doctors will automatically test for drug susceptibility when they do your bacterial culture, but it’s worth asking for it just to be sure.

Which brings us to…

7. Ask questions.  And don’t feel dumb or embarrassed for doing so.  For me personally, just being informed makes me feel better, and most doctors will be quite understanding – and even amused – at the string of questions fired off by a wide-eyed foreigner.  They know you’re far from home, they know you’re not used to this, and most likely they know the answer to what you’re wondering about.

And that’s all I can think of for now.  There is far more advice to give, and much of this many would consider excessive, but again, a few extra queries and a bit more info can’t hurt, ya?

Time in the hospital has put me in the market for entertainment – music or emails or  blogs or articles or whathaveyou – so if you have anything good, or have been feeling like writing an email, feel free to send it over my way.  And thanks to everyone who has been checking in from so many miles away, it absolutely brightens days in Room 2435.

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travel bugs

After the rave reviews that came in for my Mom’s debut blogging endeavor, Daughter in Dhaka (Mama, finish uploading your posts!), I knew that she would be leaving a travel-account sized hole in far too many people’s RSS feeds.  Well, you’ve waited long enough; now introducing Big World, Tiny Backpack, the escapades of one Miss Becca, who’s currently on her way to meander across S/SE Asia and collect elephant sighting along her way.

Her destination list is long and her backpack small, and she’s one of the swellest gals I know and definitely worth a bookmark.  You’re gonna wanna know when that elephant sightings counter ticks.

On a flight heading the other way around the world only a few days prior was Miss Laura Curren, one of Paris’ newest and most fabulous residents.  Google Maps tells me it’s a mere 11,523 km away from Dhaka town, and only requires one ferry (in addition to all the winding roads, of course).

Roadtrip, anyone?

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travel logs, 1: southeast asia logistics

The sites detailing where, when, and how to visit Asia are far from numerous.  But in planning recent trips, I’ve found information scattered across multiple sites, hidden within sub-pages, or just a bit too ill-formatted to enjoy reading.

So, in the interest of encouraging visits to Asia (new testimonials from Mama D’Amore to come!), I’m going to start posting travel information in segments on this site.  It’ll be grouped by region (South Asia versus Southeast Asia) and will include details on flights, visas, and health prep, as well as where to go and how to prepare to get there.  This first entry is a slightly more logistics-oriented one on Southeast Asia – a favorite destination on account of its high-value & low cost accommodations, fascinating history, and stellar beaches (really stellar).  Where to go and what to do will come in a later post.

Conveniently, as Bangladesh serves as some sort of boundary between South and Southeast Asia, it’ll be included in both groupings!  Surely no bias here, though.

SOUTHEAST ASIA-BASED AIRLINES:

Are numerous!  Often Singapore, Kuala Lampur, and Bangkok are the origins of the cheapest direct flights, so routing your trip through those locales will often save you time and money.  A few of the best/cheapest carriers are:

The airlines above that are bolded are the budget ones, often with crazy cheap tickets (read: $0 fares + taxes and fees, translating into $20 one-way rates).  There are other ones as well, but these are some of the best and most reliable.  For example, one other large Bangladesh airline is Biman (literally means plane in Bangla), but it’s notorious for delayed flights and shotty service.  If you’re in a pinch, though, it’s a good standby with non-stops to many locations – so if none of these have what you’d like, don’t be discouraged.

TO ASIA FROM THE UNITED STATES:

Airlines that fly from the east coast to Asia include Continental, United (the American, not Bangladeshi one), American, and Cathay Pacific.  Many Asian Airlines (like Singapore Air) are also beginning to offer transcontinental flights for cheap, often with pretty exceptional web-promos, so checking those sites sometimes works, too.  The Asian airlines listed above often fly direct to the west coast of the U.S., so it’s definitely worthwhile looking if you’re starting from anywhere west of the Mississippi!

Interestingly, roundtrip flights to Dhaka right now are relatively inexpensive compared to those that go straight to Southeast Asia than those to (1400 v. 1700 USD) – unfortunately, likely a result of the trouble in the Mid East.  While gas prices have risen for nearly everyone, it’s less of a worry for the mideast airlines (which are the ones that fly to Dhaka) – as the same governments who control the flights also control the wells.  Suggested airlines to take from anywhere in the U.S. to DAC are Etihad (the best, I think!), Qatar, Emirates, Gulf Air, and Kuwait Airways.  Flying on to Bangkok or Kuala Lampur is often exceedingly cheap from Dhaka (with one-ways starting at $100).

I usually find bookings on Kayak and then book with cheaptickets.com, which often has the cheapest fairs and decent customer service.  Which is very, very important.  I would NOT recommend airfare.com – when trying to switch my flight to Dhaka back in the Fall, I was put on hold for literally seven hours.  And then the call dropped.  Ask my mother, it wasn’t pretty.

VISAS

  • Thailand, Singapore, and Malaysia: not necessary for US citizens!
  • Cambodia and Laos: visas are about $25-$50 upon arrival for each.
  • Vietnam and Bangladesh: are the challenging ones in the region.  Travisa is an excellent visa processing service that doesn’t cost much more ($5 extra?) than just walking your passport over to an embassy/consulate yourself, so I’ve always gone through them.  You FedEx them your passport with all the various forms and a self addressed envelope, and they FedEx it back with when it’s done!  The length of time it takes to get a visa varies by country and  – unfortunately – your personal background (what your country of origin is, etc.), but for each Vietnam and Bangladesh I would allow about two weeks.  If you can do it a month or two in advance, that’d be even better.
    • Vietnam: tourist visas cost different amounts dependent on their length and whether they’re single or multiple entry   – the single entry 1 month visa is $75, while the multiple entry 1 month is $105.
    • Bangladesh: single, double, and multiple entry tourist visas for up to a year all cost the same amount ($155, SORRY!  we need the money?).  So if I were you, I’d just apply for the year-long one.  The ‘desh is a lovely place, why not come back??

VACCINES

As someone who was once called a pincushion by a travel clinician, I can tell you that getting vaccines has become virtually painless – most health insurance plans cover all vaccine-related costs, and the nurse practitioners who take care of such things are extraordinarily well informed.  Your primary care provider will likely have an in-house travel clinic, but if they don’t, you can search for one near you here.  Going to see the travel clinicians is actually quite fun – a trip to Asia inspires a few ooohs and aaahs, and they love doing the research needed for more oddball destinations.  It may be a few extra needles, but the security provided by getting these vaccines is great.  Cause often, hospitals where you’re going are not (although, increasingly they are!  But still get vaccinated!).

  • MalaysiaSingapore, and ThailandHepatitis AHepatitis B (three shots, spread out over six months, with the second shot 1 month after the first, and the third shot 3 months after the first ), Typhoid, and Japanese Encephalitis (this one requires three shots spread out over a month – at days 0, 7, and 30);
  • CambodiaLaos, and Vietnam: same as thailand, plus rabies (good if you’re planning on hiking or being in remote areas at all – as the vaccine doesn’t protect you from rabies, but does give you an extra 12-24 hours to get to a hospital after a bite);
  • Bangladesh: all the above!  Plus polio.
  • Yellow Fever Vaccine: many countries in Southeast Asia (Thailand included) require that you get vaccinated against Yellow Fever and then certified that you were vaccinated (they give you a lil’ yellow card that says so) before you can enter the country.  You have to present the card at immigration upon arrival, so do make sure you keep it after the travel clinician gives it to you at the end of the appointment.
  • Malaria: the best malaria prophylactic medicine is Malarone – while it’s a bit more expensive, the alternatives can give you nausea/hallucinations, so I’d not recommend those?  Worth the extra $20!  You need enough to take one pill a day 1-2 days before entering the affected area, then throughout the time you’re there, and a week after you leave.  Risk areas for different countries are:
    • Bangladesh: all areas, except in city of Dhaka
    • Cambodia: present throughout the country, except none at the temple complex at Angkor Wat, Phnom Penh, and around Lake Tonle Sap. (more information)
    • Laos: all, except none in the city of Vientiane. (more information)
    • Malaysia: present in rural areas of Malaysian Borneo (Sabah and Sarawak), and to a lesser extent in rural areas of peninsular Malaysia. (more information)
    • Singapore: none
    • Thailand: rural, forested areas that border Cambodia, Laos, and Burma (Myanmar). Rare local cases in Phang Nga and Phuket. None in cities and in major tourist resorts. None in cities of Bangkok, Chiang Mai, Chiang Rai, Pattaya, Koh Samui, and Koh Phangan. (more information)
    • Vietnam: rural only exceptnone in the Red River Delta and the coast north of Nha Trang.  Rare cases in the Mekong Delta. None in Da Nang, Haiphong, Hanoi, Ho Chi Minh City (Saigon), Nha Trang, and Qui Nhon. (more information)
  • Cipro: it’s also a good idea to get a prescription or two of cipro, an antibiotic used for travelers’ upset stomach that will generally kill anything that’s hiding in your stomach if you get bad food poisoning!

And that’s all for now.  By no means comprehensive, but hopefully a bit helpful in demystifying the process that is planning a trip to Asia.  For the actual length of the trip, I’d recommend at least three weeks, if not longer – the most expensive aspect of the trip, by far, is the flight.  Once you’re here, cost of living can be exceedingly low (depending on the kind of vacation you’re looking for) and there’s a great amount to see.  One aspect on which I differ from many travelers is the itinerary, often preferring to spend longer periods of time in fewer places, rather than trying to bounce around and hit every locale on the checklist.  Most places take at least a couple of days to get your bearings in, and so allowing yourself time to wander the streets and really get a feel for the place is, IMHO, well worth the price of not seeing nearly as many new spots.  But everyone has their own style, so feel free to completely disregard this portion of the post.  Or any part of it!  Hopefully it’s helpful, and do feel free to drop a line with any questions you may have.

Happy planning!

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musings

ajmer, rajasthan, india; august 2009.

ajmer, rajasthan, india; august 2009.

I find myself titling many documents, many pages in my journal this way these days. It’s been a musing sort of few weeks for me.

Because you see, the workshop provided much more than tehcnical photographic lessons (though not to lessen the value of those skills – learned so much in so little time!);  it provide a significant period of time during to just focus on one thing, write and think and write some more on it.  Immerse myself it in.

Furthermore, beyond the actual intended purpose of the workshop – telling a story through photos and words – it made me pause, take a break from the hectic existence I had created for myself this summer, working on far too many projects at once, bouncing back and forth between the assignments on my seemingly never-ending to-do list.  And while I like to think I thrive on fast-paced environments, no one can thrive on juggling seven tasks at once.  As a result, I ended up shortcutting them all.

So here was this beautiful break built into my summer, full of excitement, certainly, but also of long, hot afternoons to be filled with naps and journal entries and poetic musings (that word again!).  There’s something about the midday Indian sun that makes one want to curl up in a chair behind a brightly-colored curtain and just take down the random thoughts scurrying through your head.  Or I found it so, at least.

And it was wonderful.  I loved the time to breathe, to examine what I was doing, question why I was doing it, and see how everything in my life was fitting together, or not.  This past year I had worked myself into working overdrive, always with a baseline of stress that I felt in the pit of my stomach, nearly on a day-to-day basis.   And believe it or not, that’s not entirely pleasant.

So what does this all mean for the start of senior year?  I have no idea.  But there’s little things from India that I don’t want to let slip away, the feeling, the moments that I experienced there that I’m loath to let go of.  We’ll see if these are things that I can maintain back in the go-go-go schedule of school life.  Or, if maybe, I can lessen the go-go-go-ness of it all.

I rarely use this forum for personal introspection, mainly because I feel a little strange thinking out loud in such a public space. But I’m hoping to change that, at least a bit. Not to turn this little blog into a site where I spew out day-to-day banalities that I doubt would interest anyone, but rather to just get myself to question what I’m doing more often, to pause for reflection instead of just checking one task off and moving onto the next one.  To put up unfinished ideas, let them stew and develop.  And maybe even (if I’m lucky!), start conversations.

If you’ve not taken a few days to pause and reflect and re-evaluate lately, I highly recommend doing so.  And fall just so happens to be an excellent time to do so!  Find some beautiful late-afternoon light, a pretty journal, and pen that makes you want to write with it, settle yourself into a cozy chair and go at it.  And let me know what you find.

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a quick update

ajmer, rajasthan, india; august 2009.

ajmer, rajasthan, india; august 2009.

it’s wild here. completely overwhelming, but that was to be expected. Delhi was unbelievable – you take some hair raising car rides, and we took a train down to Ajmer that let us see the Rajasthani countryside. the colors are incredible – all the women, no matter if they’re rich or poor, wear these brightly colored saris – orange, neon yellow, florescent pink – and look so beautiful and ethereal in them. i think the internet is too slow to upload pictures, but i may try to let some load overnight. we’ll see.

there was this huge electrical storm tonight in which it didn’t rain for a long while – just lightning skipping between the clouds. but then, all of a sudden, the skies opened up and it just poured. a literal monsoon. we were about to eat dinner outside, and had to quickly dart in! but made sure to stop on the porch and watch the sheets of rain coming down for a while.

besides that, the jet lag still lingers and afternoon naps beckon when the temperature hits 100F. luckily, that’s when the light’s the worst for photographs! Jess and i have a lovely room that overlooks the courtyard and has a duck for a doorkeep, and we’re both pretty tired right now and are going to hit the sack. i’m still working on building my hindi vocabulary, but for now, namaste!

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just arrived in Delhi!

A quick post – Jess and I just got to the Ananda Hotel in Delhi, where we have a mere few hours before we have to head out again.  It’s midnight and we’re not tired at all, so we’re taking care of computer tidings while we have the internets.  And watching “Harry Potter and the Goblet of Fire.”

Check in at this site from time to time  – I’ll try to post whenever I find wifi.  For now, a quick shot to express our general sentiment.

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bienvenue à paris

A few early disclaimers to begin with. So, this has been promoted as a photoblog, and as I’m certainly not one that likes false advertising, I’m hoping to follow through with that very soon. But as this post will reveal, there’s a reason to this madness – and if that’s still not good enough for you, head over to http://www.flickr.com/photos/elizabethdherman, where I’ve uploaded a few thus far. Bookmark it, RSS it, compulsively click the refresh button – whatever you may desire, and I’ll do my best to satiate your internet hungers.

This has been a week of adjustments, not only to Parisian ways, but also to having a bit of free time plopped in my hands. Faced with an afternoon to myself – when does that ever happen, nevermind in Paris?! – I decided to walk all the way down from the ACCENT center where classes are held (near the Bastille), back to my dorm at the Cité U, down in the 14e arrondissement. Mapping my route out to the best of my abilities on GoogleMaps, it looks like it turned out to be about 6.5 miles, what with all my twisty turns and indirect strolls; it was a two and a half journey that took me across Ile. Saint-Louis, down boulevard Saint-Michel, through le Jardin du Luxembourg, beyond Denfert-Rochereau, and led me to discover le Parc Montsouris, a beautiful little treasure right across from la Cité. See the map for deets.

Though the D80 was in my bag (which reminds me, I still need a name for that one – suggestions?), I decided to leave it there during the hike. The earbuds also ended up packed away within the first ten minutes as well. Though not having to zip and unzip my bag was an added plus, it was more the ‘I need to feel this right now and not try to take a zillion pictures to attempt to capture it’ that won me over. Laura and I had had our day rollicking around taking photos in and around the parks of the 1e arr, but this time seemed more like a chance to blend into the fabric of the city and see how it worked and sounded and ate and moved. The camera, while I love seeing new places through its eyes, is, as you might guess, a hinderance at times. But! Have no fear, I’ll try not to let myself be deterred. Blindshooting is still one of my favorite past times, and aren’t sidewalk cafés just calling out to that?

For now, it’s off to bed for this one, while keeping one eye open in hopes of another lightning show like the one a couple hours ago saw. Stay tuned, folks, and thanks for checking in!

Bisous, or as they say here –
Biz

Responses below or to elizabethdherman (at) gmail (dot) com. Ask me for the cell!

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