A few days before my wife and I and our 20 year old twin daughters left for a two week family trip to Thailand, Cambodia and Laos over the Christmas break the girls sat me down for a pre trip talk about getting a grip on my health anxieties. They know that if you could buy a haz mat space suit as casual travel wear Id own one faster than you can say medivac.
When it comes to traveling my wife and I have a division of labor - she deals with the small stuff like where we are going, how we are getting there, where we are staying and what we will be doing when we get there. I address the “big picture” - terrorism, war and pestilence.
The “dad we need to talk” sit down came after they caught me heading for the bathroom wearing a long rain coat, leather winter gloves a ski hat and one of my avian flu surgical masks to spray all of our trip clothing with industrial strength insect repellent on advise of our travel medicine doc - but the talk ended abruptly because in trying to describe what they saw both kids were laughing too hard to finish a sentence.
Its not entirely correct to dismiss me as a germophobic nut case. After I read the South East Asia vaccination and health alerts on the CDC, WHO and State Dept web pages it would be more accurate to dismiss me as a malaria, dengue fever, japanese encepalitis, diptheria, hepatitis (A and E) food borne viruses, waterborne parasites, rabies - phobe nut case.
A little background factoid -the family is still getting good laughs about the jumbo jar of gefilte fish I bought at Costco in the fall of 1999 to prepare for Y2k - a plan that depended heavily on adequate Red Cross stockpiles of horseradish.
So what's a germophobe to eat and drink in a part of the world where slabs of unrefrigerated raw meat, along with eggs and fish sit out all day on tables in local markets and there doesnt seem to be any government effort to provide sewage and solid waste disposal systems (not to mention schools or hospitals). We had alot of soups and stir fried dishes and scrutinized quite a few spring rolls looking for lettuce. So how was the food? I have no idea - I was too busy playing restaurant roulette with the menu to notice - as long as whatever was on the plate was overcooked I was happy.
We had a pretrip consult with Dr. John Cahill, an emergency medicine physician and the director of the tropical and travel medicine clinic at St. Luke's-Roosevelt Hospital. Dr. Cahill, is a confidence inspiring, incredibly nice and patient guy, with an impressive CV, who has lived and travelled extensively in Asia and Africa. His advice about the food safety issue was that the main rule is to make sure the meat, fish or chicken is well cooked. He also put salads and fruit that you can't peel on the list of no nos.
For us peeled fruit and especially little grilled banannas were our walking around snack food.
The visit to Dr. Cahil was not only for vacinations and malarone, to prevent malaria but he was also a good source of assorted third world travel does and donts -such as the useful fact that the antibiotic cipro hasnt been working in SE Asia -when he heard we might be rafting in northern Laos - he cautioned to make sure you don’t have any open wounds because of waterborne parasites - based on this advice my wife added water proof bandaids to our first aid kit. This revealed a significant difference between my wife's travel attitude and mine - If I have an open wound in Northern Laos the list of things on my mind will not include whether or not to take a dip in the Mekong River.
Our itinerary included Luang Prabang, in Northern Laos, a Unesco world heritage town followed by a six hour drive south to Vang Vieng, and then on to Ventiane, the capital, a flight to Siem Reap Cambodia, home of Angkor Wat and a flight to Pnomh Pemh. Arrange through Exotissimo, an agency with offices all over SE Asia.
Taking comfort in Dr. Cahill's advise and another talking to from my kids about the importance of experiencing local life when you travel we cancelled a dinner reservation in Luang Prabang and went to the food stall market and picked up a delicous fish on skewers held in place by strips of bamboo, stuffed with lemon grass and an assorted plate of cooked vegetables. The fish cost 25000 kip (under $3) and a plate of cooked vegetables from a vendor opposite the fish lady topped off by an ice cold Lao beer. The markets of Luang Prabang are memorable for the good humored easy going ladies selling crafts and dinner
While in Luang Prabang we got up at 5 am and sat on mats on the main street to give morning alms to a procession of about a hundred safron robed monks. This means people lined up on main street, after buying pots of sticky rice from a vendor and then putting little handfuls of therice with bare hands into the monks ceremonial bowls. Apparently this is not just chow time it's a time honored solemn buddhist ritual that has something to do with the monks as a link to departed loved ones. It was a safe bet that I was the only one thinking about all of our unwashed food serving hands. One guy I was pretty sure was not fretting the hand-schmutz issue was the chubby Italian tourist on the next mat who started eating his rice long before the monks got there.
Lake Tonle Sap in Cambodia, is the largest lake in South East Asia. Until we actually saw Lake Tonle Sap we didn't give a second thought to ordering Tonle Sap fish which is on menus throughout Laos and Cambodia. Our “what was I thinking” moment came during our boat ride in the sludge brown water of Lake Tonle Sap past the garbage strewn shoreline and the glimpses into crowded - floating sewage generating homes of impoverished families of Vietnamese refugees in this lake an hour outside of Siem Reap. Let me just say that I kept my lips tightly sealed on that trip while thinking- "boy - if there was ever a boat I did not want to sink - this was it!".
The busses and van loads of visitors, that clog the narrow road to Ton Le sap are required to stop and pay some kind of entrance fee. There is certainly no visible evidence that this, significant revenue stream is being spent on development for the desperate folks living in this area.
On an afternoon ride outside of Siem Reap to see ruins we had to pay another toll that did not look very official. Our guide said the toll is run by the company that is supposed to be building the road - huh? The contractor gets to set up a private toll booth?
For the health anxiety nut, the fabulous thing about being in a place that has both dengue fever and malaria, is that you can feel anxious day and night. Dengue is something you get from daytime mosquito bites and there is no medication that prevents it- you just slather on the insect repellent with scary sounding chemicals. Malaria you get from female mosquitos that bite during dawn and dusk.
A tourist handbook put out by the Laotian government offerred the helpful advise -
“Mosquito bites. Beware of the females. . . . Dengue fever is waiting to pounce. and I also appreciated the following helpful tip - Tiger bites? Very bad, especially in the rainy season. You will be comforted to know that your family will read about you in their daily papers".
You gotta love totalitarian humor
To protect against Malaria you take Malarone before and 7 days after you are in malaria country and sleep with mosquito netting treated with permethrin - unless its a place with air conditioning and closed windows. As advised by Dr. Cahill you should also spray your clothes with insect repellent with permethrin. One of the confusing things about the whole malaria/dengue danger was why so many luxury hotel dining rooms and lobbies are designed without walls like there is no problem?
My kids can't believe my gift in finding chicken little - doom and gloom -newspaper articles. The day before we flew from Ventiane Laos to Siem Reap, Cambodia (home of Angkor Wat) I take a break in a hotel bar and just happen to pick up an International Herald Tribune and of course there is a report of a spike in the number of dengue fever cases in Cambodia. It was like the paper had been created and left there for me by Ed Harris in a kind of Truman Show moment.
Another "best of" anxiety moment was the morning when I was up at 4 am reading in the bathroom of our hotel in Luang Prabang and I saw a mosquito in front of my nose. There I was on the toilet wondering if 4am was technically dusk and trying to see if mosquitos have genitalia.
My family really enjoyed the moment of our Mekong River boat ride when I had a hypchrondriacal meltdown because I was convinced that I had forgotten to take my malarone that morning The pill count when we got home proved me wrong.
At some point it finally dawned on me that all the malaria protection was merely a swiss cheese zone defense. When I got this for some reason I started to worry less - kind of an anxiety circuit overload. My spirit of travel adventure refocussed on the a more practical question - will Malaria and Dengue fever kill us. The comforting answer is probably not.
So here is the slightly cheesy finish - to my fellow germophobes - I offer the advise of my kids -just suck it up and deal -you'll be fine- hopefully.
Gotcha!
