Just because it's there, you don't have to go

By Dr. W. Gifford Jones

Sir Edmund Hillary when asked why he felt compelled to climb Mount Everest, replied, "Because its there." I agree challenge and travel to distant lands adds spice to life. But like mountain climbing, wandering the world has its hazards. I recently journeyed to Casablanca and Marrakesh in North Africa to attend an international medical conference. I returned home weak, dehydrated, many pounds lighter and, I hope, a lot wiser. During the ordeal I drafted the Gifford-Jones dictum about travel, "Just because it's there, you don't have to go." This is sound advice even if you're in perfect shape. It has particular merit for the disabled and those with other medical problems.

The odds facing travellers in some parts of the world are worse than playing Russian roulette. 80 per cent of my colleagues in Marrakesh were struck with what's been crudely labelled the,"Casablanca Crud". Some were experienced globe-trotters who refused ice in their scotch- and- sodas, realizing typhoid germs survive freezing. They ordered meat well done, drank only bottled water, brushed their teeth with carbonated drinks, and followed the dictum that,"If it can't be peeled, boiled or well done, don't eat it." But they too were brought to their knees, some seriously ill.

Preventive measures are easy to read in books, but tough to follow during a trip to the Kasbah. There are flies everywhere in North Africa even in the best hotel restaurants. You don't know how long foods have been prepared in advance. Or whether the chef has washed his hands. And what do you do when the King of Morocco invites you to a banquet and serves fish? Do you insult your host by reminding him you're several hundred miles from the sea and it's unlikely the fish has been refrigerated? Or if waiters serve you strawberries for dessert do you say no because in Africa they're often fertilized with human waste?

Next year if I can't resist travelling down the Nile river in Egypt, I'll forget the old saw, " When in Rome do as the Romans do." Instead I'll reduce the odds by taking prophylactic antibiotics. This is a potentially dangerous approach. On rare occasions antibiotics can cause serious damage to the bowel. But you can't experience the excitement of travelling down the Nile if confined to the bathroom for the entire trip. In certain situations the advantages of antibiotics outweigh the danger.

A 100m milligram capsule of doxycycline (Vibramycin), a relatively long-acting tetracycline taken daily will prevent diarrhea in 70 to 95 per cent of travellers. It should be started on the day of departure and continued for two days after returning to Canada. But the trip must not last longer than two weeks. Doxycycline can itself cause diarrhea and should be consumed with or immediately following a meal to decrease the chance of nausea. Like other tetracyclines it can cause photosensitivity reactions and vaginal fungus infections. It should not be given to pregnant women or children under eight years of age because it can stain developing teeth.

Trimethoprim/sulfamethozazole (Septra), one tablet twice a day helps to prevent infection but in one to four per cent of travellers causes skin rash and a sore mouth. If the person is allergic to sulfa, trimethoprim can be prescribed alone.

Norfloxacin, 400 milligrams a day, was given to 120 students attending summer school in Mexico. Only 7 per cent of those taking the antibiotic developed diarrhea. 67 per cent of those not on this medication lifted their eyes to Heaven praying for a bathroom.

Having just returned home like a whipped dog with his tail between his legs I'm obviously not the world's authority on how to prevent the "Casablanca Crud". But after suffering this malady for several days and nights I reached at least one conclusion. It would take the second coming of Christ to entice me back to North Africa if I was confined to a wheelchair, elderly or suffered from diabetes or inflammatory bowel disease. The risk simply isn't worth it.

Let's assume hospitalization was needed to treat severe dehydration due to unrelenting dysentery. Or that surgery was required to remove an inflamed appendix. North African physicians told me their hospitals can't afford disposable needles. I'd be concerned about the use of reusable needles in an area where AIDS is rampant.

Officials associated with the disabled argue that, "Where there's a will there's a way." But even Humphrey Bogart would need much more than positive thinking when the Casablanca chills, fever and incessant diarrhea strike with a vengeance.

Being confined to a wheelchair is difficult under the best of conditions. But imagine the obstacles trying to cope with this malady in a strange hotel room if you're partially paralysed! Or if the pain strikes suddenly outside the hotel and no one speaks English. That's when book learning proves useless and you suddenly realize that you and not the author have to find the solution, immediately. And there's a good chance you would agree that just because it's there you don't have to go.

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones

Canada Free Press, CFP Editor Judi McLeod