Traveling in Developing Countries

I recently went to China for a 10-day work fellowship, visiting Beijing, Xi'an, and Shanghai.  This opportunity to visit with schools, universities, and afterschool programs across China as part of a global education policy fellowship was a long-time career goal of mine, with plans to bring back lessons learned to my work in education policy here in the US.  I had a few months to plan for the trip, and while I have traveled to other developing countries, ranging from Bosnia and Croatia to Turkey, but nowhere quite as dramatic as traveling in China. Below are a few tips of the trade that helped me plan for managing my health and Crohn's as best as I could in the environment.

 Great Wall of China!





Read, Read, Read!!

I highly recommend, whether you are traveling in Africa or South America, to first and foremost --> read, read, read!  Everything you can get your hands on - from guidebooks to blogs to web searches and memoirs.  That will help you establish expectations, outline any concerns, and assess dietary issues well in advance.  Trip Advisor and Travel Blog are two of my favorite sites!  For China, I read about a dozen books, and here are some of my faves:

Moon Beijing and Shanghai 

 

Simple Guide to Customs and Etiquette in China


Oracle Bones: A Journey Between China's Past and Present





On China, by Henry Kissinger





Also, pick up a good phrasebook!

Talk to Your Doctors!

Do your research before you visit your doctor.  Be sure to visit the Center for Disease Control to find out what vaccinations you need; however, know that your doctor may weigh the risks and benefits for each vaccine.  For China, I opted for the Hepatitis A/B twinrix vaccine.  My tetanus was on par, and I had only my childhood immunizations.  I opted to not do malaria because of when/where I was traveling, and I decided to not do typhoid again because I was not visiting any rural areas or staying with locals.

Standard immunizations may include:
  • Yellow fever
  • Hepatitis A
  • Hepatitis B
  • Cholera
  • Rabies
  • Meningococcal disease
  • Japanese encephalitis
  • Tuberculosis

I visited my general practitioner and got my annual physical, the vaccines, and had bloodwork run to make sure my health was on point for the trip.  I recommend having your doctor write Ambien or a similar sleeping pill, especially if you have not traveled internationally before.  Adjusting to a 12-hour time difference can be extreme on your body those first few days!  While I prefer natural Melatonin, found in any health food or drugstore, having Ambien on hand isn't a bad idea!  For ladies, I recommend having a prescription on hand for a yeast infection; again, only if needed, so you don't have to navigate a developing country's healthcare system.

I then visited my gastroenterologist.  It just happened to be time for my annual colonoscopy, when I found out my Crohn's was in remission and all was looking good!  I talked to my doctor about food/water while abroad, and also got a prescription for Cipro - just in case.

As I mention on my Travel Tips page, be sure you have enough of your medication on hand to cover delays.  When I returned from China, half our delegation was facing the Sandy Superstorm in the NorthEast and faced days of delays.  You don't want to stress about missing medication. Also, do not check your medication!!  Particularly when traveling in developing countries, or flying on airlines that may not have the best track record with luggage.  You are allowed an exemption in your carry-on for liquid medicine, so don't fret, like I used to, that you couldn't get past that.  You just have to announce to the screener before your bag goes through the x-ray that you are declaring liquid medicine separately.  You also have the right to ask for private screening.
Shanghai Skyline at Night


I was also sure to buy travel insurance, which I purchased from my local AAA office.  I recommend reviewing your existing coverage options and supplementing as needed.  I also checked the areas I was traveling to for making sure there would be doctors available with my insurance coverage.

Pack Snacks Like a Boy/Girl Scout!

On my Travel Tips and Resources page, I describe how to approach travel, whether domestic or international, with IBD/Crohn's.  I highly recommend packing as much as you can take with you, even if it means maxing out the weight limit on your bag.  I look at the bright side - the more food I bring in my luggage, as I go through my trip and use up the food, the more room I am making available for bringing home souvenirs!  For China, I had a Boost/Ensure for every day of the trip, a few extra for snacks, a box of rice granola bars, Chex mix pre-packaged in ziploc bags, pretzels, nutella, and other such snacks.

If I was not traveling with a group, I would have been more adventurous in eating the Chinese food; however, there is nothing like ending up sick on a bus - without a bathroom!! - and a bunch of folks you just met and have to stick with for almost 2 weeks.  So I erred on the side of caution.  I was unsure about the sanitation of many restaurants - when there is no soap or requisite goods in the bathrooms, you have to wonder how the staff are washing up - so I brought my antibacterial soap and only ate rice and hot tea.  The mystery meats were carefully avoided, as was anything that was washed in the local water.  Let's just say I ate A LOT of rice!   

I supplemented with my snacks and then in the evenings, because we were staying in 5-star hotels, I felt comfortable ordering dinners like pasta and other safe foods.  

Students at a Shanghai Children's Palace

Don't Drink the Water

Perhaps most importantly of all - do not drink the water!! The quickest way to get sick is to do so.  Most of the hotels will have ample bottles of water placed in your room every day.  Be cautious as to not drink the water in the shower or let any seep into your mouth.  And the trick to not accidentally running your toothbrush under the faucet is to have a bottle of water sitting right by the tap, so you see it immediately.   

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