gone living

while preparing for an upcoming return visit to India, i was thinking about my own mosquito/malaria precautions that i take while travelling, and i thought i'd share them with the Gone Living community. note that I AM NOT A DOCTOR, SO DON'T COPY WHAT I'VE DONE, INSTEAD YOU SHOULD ASK YOUR TRAVEL DOCTOR ABOUT WHAT IS RECOMMENDED FOR YOU AND FOLLOW THEIR ADVICE. i am just telling you what *i* did while travelling.

since i was travelling for a year last year, i'm pretty serious about my precautions because they're pretty easy to do beforehand (and it's harder to change your mind about this once you're on the road, and getting sick while travelling sucks). here are my personal antimalarial (and antidysentry) precautions that i take while traveling:

1.) your primary line of defense against malaria (and other mosquito-borne nasties) is mosquito repellent. pack enough for your entire trip. if you don't have a brand you already know works for you, i like Cutter Skinsations repellent. while it has a really goofy name, it didn't smell like the usual horrible mosquito repellent smell, and repelled many more mosquitoes for me than the hardcore Ultrathon repellent (which burned my skin, didn't repel mosquitoes well, and was generally annoying) available at REI.

2.) always use mosquito nets when sleeping at night in malarial areas. know that you should leave the net over the bed knotted until you're ready to sleep, and then carefully open it up. i would carefully tuck the edges of mine under the mattress at night to avoid having mosquitoes slip up the sides at night. permethrin-treated nets are even better, if you don't mind premethrin (see point 3 below). always pack a small roll of duct tape so you can repair small holes in mosquito nets and screens (i ran into this a lot when traveling, and few things suck more than having a mosquito net with a hole in it while a cloud of hungry mosquitoes is looking for a way through the net to feast on you). the WHO recently discussed findings that showed that mosquito nets have a big impact on reducing malaria.

3.) if any of you are spending a lot time in the backcountry, you can also treat your hiking clothes with Permethrin before you leave. this will give your clothes a faintly musty odor, lasts for about 30 washings, and will make all mosquitoes stay far away from your clothes. a good third line of mosquito defense. (note you never apply this stuff to your skin. see http://en.wikipedia.org/wiki/Permethrin#Uses and http://www.travmed.com/trip_prep/insect_permethrin.htm for details. some people don't like using this stuff on their clothes because it's fairly toxic, albeit us-government approved. it sure kept the mosquitoes away from my hiking clothes, and i lived to tell about it. Your Mileage May Vary.)

4.) when i'm travelling, i go by the CDC Traveler's Health recommendations for each country (this is a great resource -- the main site is at http://wwwn.cdc.gov/travel/). for example, the current CDC recommendations for India as of the date of this blog posting are posted at http://wwwn.cdc.gov/travel/destinationIndia.aspx, and state "Malaria risk area in India: Risk in all areas throughout country except no risk in areas above 2,000 m (>6,561 ft) in Himachal Pradesh, Jammu, Kashmir, and Sikkim. Risk also exists in urban areas below 2000 m, including Delhi and Mumbai (Bombay)."

i know some of the travel doctors are saying that anti-malarial pills aren't needed for Delhi and Bombay right now, but my policy is to always go by the current CDC recommendations, and so i'll be taking antimalarial pills while in India. the standard doesn't-make-you-insane-or-get-sunburn anti-malaria pills are Malarone (i've had no side effects with these pills, and you only have to take one pill per day), and Malarone is not available to purchase in most countries that have Malaria!!, so you have to get buy these pills before you leave home. they're expensive, but your insurance will usually cover at least part of the cost (i got stuck with my crappy insurance at $5/pill for a 30-day supply). again, this is your third line of defense after the mosquito repellent and nets that you should already be using.

5.) in addition, i'm packing some Cipro for self-treating any unexpected cases of severe/long-term dysentery. this is handy to have when travelling (your travel doctor can give you a prescription for this along with self-treatment recommendations), but again, the odds you'll need this is really really low. i think i used mine twice in 400 days of traveling.

and finally, if you're wondering WHY malaria sucks so badly, you can get the medical facts on Malaria from the CDC Malaria FAQ, but i highly recommend reading Tim Cahill's essay titled "Malaria" from his book Pass The Butterworms: Remote Journeys Oddly Rendered. It details his own experience getting Malaria while travelling (after being fairly blase about it beforehand), and it definitely makes you want to not catch this disease.