A. Pharmaceuticals & similar supplies: carrying & managing.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732362/

Pharmaceuticals – prescription & over-the-counter drugs, & vitamins have contributed mightily to America & world's health by combating  most widespread, deadly diseases (tuberculosis, malaria, etc.)

Unfortunately, US government & pharmaceutical industry ‘collude to control’ unnecessarily many drugs, yet failed to control the most dangerous — opiate crisis.

Often pharmaceutical use is age related. While young use over-the-counter Tylenol & ibuprohen occasionally, … the older you get the more likely # & variety of your drugs increase to control an increasing variety of maladies as our body continues its inexorable breakdown. 

        Anecdote: At 53, I was diagnosed with chronic conditions —Type 2 diabetes, mild high blood pressure, & mild high cholesterol — requiring a daily pill regimen.    

Unlike my father’s diabetic neuropathy, my Dr. advised years ago that daily diabetic drugs, diet & exercise should manage diabetes without complications.        It has. [ppl: MSTR Drug list]

As I aged further, other health events & conditions arose: eye infection, prostate issues, considerable back & knee pain, and dental implants requiring occasional anti-biotics & pain killer use. 

Each required I carry a ready supply while traveling to avoid wasting travel time finding English-speaking host-country doctors & pharmacists for conditions I already knew how to treat when they arose.

Some of my ills required CSS (“Controlled Substance) drugs (kinda like 'Most Wanted' list) based on their use & potential for dependency (opiates.) America even forces other countries to control such drugs.

        Anecdote: All day walks around Berlin required 3 - ½ pills of Vicodin pain killer and Carisoprodol to manage severe shooting pain in my knee. Note: eventually both knees were replaced & I traveled on.

An obvious question arises, “How to carry & manage pharmaceuticals when traveling? 

1. Daily Prescription drugs

[ppl: MSTR Drug list]

a. Trip Supply:

Ideally, you want to have your full trip’s inventory of pharmaceuticals with you before you depart. 

Many foreign countries have access to our American drugs often in exact same packaging, BUT at dramatically lower prices. Don’t waste travel time canvasing drug stores for an adequate supply.           Buy at home.

        Anecdote: In either New Zealand or Australia Tylenol/Advil     I needed more Tylenol/Advil, equivalents. I wasted 2-3 hours searching & finally buying very small packets of a few pills at a high price compared to Costco’s large bottles.  Thereafter, I always brought far more than I needed.

90-day limit:

Thanks to America’s specious drug control system even mail-order pharmacies usually limit you to a 3 month supply. However, with advanced notice, my mail-order pharmacy would make a Vacation Exception granting me a 3-month travel supply in addition to drugs I needed before & after my trip. 

Ironically, just recently (11/5/23) a foreign mail-order drug company allowed me to order a 180-day supply. You may also ‘ask’ your doctor to over-prescribe for a short period before trip so that you can build up an adequate supply.

        Anecdote: Online Pharmacy clerk: sabotaged my Vacation Exception order AFTER it was approved forcing me to leave USA with much less Piloglitizone (a critical diabetes drug) than I required.  I found them in a major Chinese city at a reasonable price. 

                           Start accumulating required drugs early

b. Drug List:  

                                                         [pplk; sub-pill: MSTR Drug List]

        Anecdote 2: My 2001 guidebook seriously warned: ... that drugs must be carried in their original bottles with pharmacy’s official label & info.

While OK, if young with few drugs, at 60 yrs with multiple bottles of each drug for a 2> 3-month trip, they would consume too much luggage space. 

            My Solution: My Pharmaceuticals Drug List [ppl: MSTR Drug list]

Instead, I let a ‘full & obvious’ pharmaceutical list  trump all those bottles.

I created my pharmaceuticals list that included: [ppl: MSTR Drug list]

• Each prescribing doctor’s name, phone # & email address.
• Each drug’s name, dosage, frequency, trip total #s*; description, & purpose (diabetes, etc).
• Included all daily use, occasional use of drugs & vitamins.
  Plus: 1 added week's supply in case of delayed trip departure.

NOTE: I carried my CSS drugs (Vicodin, etc) in their original bottle because it added credibility & bottle was full.

I have NEVER had an issue with my drugs including CSS.

c. Packing for travel: Full discussion

                                                      [jlk: Pharmaceuticals: Packing]

2. ‘Other’ Prescriptions:

a. Allergies: 

I am allergic to penicillin & sea bass fish. Penicillin can easily be avoided by using a myriad of alternative drugs

A ‘sea bass’ allergy may seem humorous, but it can be deadly, very deadly because you & your doctors may not recognize it as a potential risk until it strikes you & even then neither you nor your Doctor may draw a connection to sea bass fish. 

        ANECDOTE 1>3: 3 Sea bass ‘anaphylactic shock’ episodes 

            Anecdote 1: Dating Game Euro trip: Amsterdam’s Red-light District. At 28, after my Dating Game’s free Italy experience, I visited several other European countries including Netherlands.

In Amsterdam, a high-level advertising executive of an international advertising agency I worked for in Los Angeles, took his wife & me to dinner, at a historically famous Red-light District restaurant. 

Note: (Still a tourist site https://www.urbstravel.com/post/history-of-amsterdams-red-light-district#:~:text=)

Sometime during dinner, I went to the men's room, fainted & when awakened by my friends who found me writhing in bathroom floor’s swill. I remember little afterward except for 3-day recovery in my hostel.

US doctor tested me for some kind of seizure but found nothing.

          Anecdote 2: 2nd experience - getting worse.  A few years later, skiing Mammoth Mountain, CA, I had dinner, slept & awoke in bathroom screaming & trashing about knocking a shower door off its track until an Olympic athlete grabbed me around my shoulders … containing me. 

Again, curious & concerned, I sought a doctor’s opinion, nothing conclusive.

          Anecdote 3: Even worse effects, "Next time could kill me".   At 39, in solo law practice, I awoke in my apartment’s bathroom semi-conscious, thrashing in delirium .... hours before I had to appear in court.

Whites of my eyes were totally blood red (pre-Michael Jackson's "Thriller") Not blotched in varied shades, but totally blood red.       Scary as hell. 

I approached the court clerk, & she immediately said, "Wow you look like Judge _____ looked. "  "I asked what she meant?" & she forcefully suggested I visit the Judge in chambers for his response which I did.

Judge took one look at me, immediately asking if I had eaten sea bass. “Yes”, I responded, “Last night for dinner.”

He said, “Sit down. I have a story to tell you.”

Judge’s story:

Shortly after eating BBQ’d sea bass with friends I suffered what I later learned was an “anaphylactic shock.” An ambulance was called, but technically I died & was resuscitated en route to hospital. Once in ER, I died again to be resuscitated. Obviously, I recovered. 

Los Angeles Coroner, Dr. Tom Noguchi*, Chief Medical Examiner-Coroner for LA County, had my stomach contents analyzed, advising me that I was allergic to sea bass fish. Not every sea bass fish, only those fish from certain bays along Mexico’s western coast. 

These coastal bays contained very toxic bacteria that MY sea bass consumed causing OUR allergic ‘anaphylaxis shock’ & near death.

* Dr. Nuguchi, popularly aka "coroner to stars”, most famously for the autopsy of Natalie Wood, Robert Wagner's ex-wife & co-star in legendary James Dean’s, classic movie “Rebel Without a Cause”.

            My Solution: My sea bass allergy’s travel strategy:

1. Avoid ALL fish unless POSITIVE (?) not sea bass. 

2) Research & write down (on cell phone & “Important Info page”): all host culture's translations of “sea bass” in host country’s language of country(s) you will visit.

      e.g.: Thailand:  “allergy”. = โรคภูมิแพ้.     Rokh p̣hūmiphæ̂.                
                              sea bass: = ปลากะพงขาว. Plā kaphng k̄hāw

3) Epipen: I carry 2 for emergency allergy self-injection.

4) Once in host country, find someone fluent in both languages & confirm your translations are correct.

If you have allergies, Prepare before a trip to cope with your known allergic reactions, in case, for some reason, you don’t/can't avoid them.

b. COPD: Inhaler: 

        Anecdote: IN New Zealand snorkeling with manta rays off the coast my chest felt ‘tight’ & I could not get a full breath. Perhaps excitment’s tension/fear?

Later my doctor prescribed a COPD inhaler which I used seldom but always carried.

3. Over counter pharmaceuticals:

                                                                [ppl: MSTR Drug list]

These are pharmaceuticals neither FDA, DEA nor its pharmaceuticals industry deigns to control: 

         a. Obvious Use:  Tylenol, Ibuprofen, hand sanitizer, Sunblock small/large, Wet wipes, soap, lip gloss

         b. Blister kit: (in Ziploc bag after Camino de Santiago  blisters)

• Body Glide (or equivalent)
• Athletic Tape
• Tincture of Benzoin
• Breathable Band-Aids

        Anecdote: Killer blisters.Prior to my 600-mile Camino DeSantiago trek I seldom had blisters. 

After 1st day from Saint-Jean-Pied-de-Port France, over Pyrenees Mtns down to Roncesvalles, Spain I had a batch of large painful blisters that plagued me for several days. Fortunately, a nurse traveler advised treatment.        

                      Thereafter, I always carried my blister kit. [Full INV]

         c. Specialty Use +: 

• Talc powder (for hiking shoes)
• Vaseline
• Alka Seltzer/Rolaids (stomach, gas)
• Ex-Lax (or equivalent) constipation
• Face mask & Visine (or equivalent): Covid, etc & smog
• Tick Pliers: but MUST know how to use 
• Anti-biotic salve in tube.

4. Vitamins

Vitamin’s supply, Drug List & Packing is same as Daily Prescription drugs, but without any legal controls. LOL.

Some of world thinks our US addiction to vitamins is silly, so USA & few governments regulate, so beware of ingredients or claims.   Caution!

5. 1^st Aid Kit:

My first aid kit items are spread around my packs according to when I might need them. Often duplicated in different places including rolling luggage’s backup.                  [pplk: Inventory list]

      a. Belt Sanitizer: For example, a small bottle of hand sanitizer hangs on my belt for quick access, a slightly larger bottle in day pak & a large backup bottle stored in rolling luggage’s lower compartment.                           PIK belt sanitizer

Same with sunscreen, Bandaids, moskie repellant, tooth paste /brush, & ear plugs. 

      b. Purifying Bleach: Very Important!  A small bottle of bleach for purifying fruits & vegetables in Asia, Africa & South America.CAUTION: leaking bleach can destroy clothes etc., so, I carried it in a small, plastic, leak-proof bottle, locked 'closed' with a small strip of Gorilla tape & double wrapped in plastic baggies. Yes, paranoid.

  [jlk: bleach]   [ppl: Resource: Health Safety: bleach post] [ytlk: bleach]     

      c. Purifying medical alcohol: Very Important!  A small bottle of alcohol for purifying wounds is carried in a leak-proof container, tape closed & double plastic wrapped. CAUTION: not as destructive as bleach, but protects nevertheless. PIK of alcohol

6. Health Related Equipment: Full INVENTORY

                             [pplj: Resource> Docs > Full INVENTORY]

• Extra reading & sunglasses: 
• Mosquito netting: particularly in Africa, South America & Asia: head & bed

        Anecdote: Chaing Mai & Chiang Rai, Thailand River trip. Night before a small boat trip downriver between Chaing Mai & Chiang Rai, Thailand, my ratty hotel had window screens with giant flapping holes.        My full-bed mosquito net was a lifesaver. 

        Anecdote: Wyoming’s Oregon Trail.  On Wyoming’s Oregon Trail, there is a large, low, almost swamp-like area where Oregon Trail wagon wheel tracks still exist crisscrossing each other in their frantic frantic attempt to find solid footing for horses and wagons. 

Riding my horse & trailing a pack horse, I suddenly encountered a mosquito cloud that engulfed my horse & I in "full-on-attack" mode. 

Fortunately, I had a mosquito spray for horses, but I wouldn’t risk those chemicals on myself & my repellant couldn't cope with that onslaught.

My only recourse was to gallop 'hellbent for leather' from that swamp & it's moskies.              Never forgot that one.

• Steripen water purifier: Carried for foreign travel, but never had to use because widespread, safe bottled water everywhere.

Magellan’s Travel Supplies [pplk: Resource > Docs: Steripen]

• Yala’s DreamSack: (perhaps formerly called Cocoon): a lightweight silk ‘bag’ whose purpose is to separate me from unsanitary bed sheets & associated critters.
• https://yala.shop/products/dreamsack-the-original-luxury-sleepsack.               PIK Cacoon: iPh

        Anecdote:  Chungking Mansions   Hong Kong’s Kowloon is super expensive including lodging. Always penurious-acting (cheapskate), I opted for a small room in Chungking Mansions. [ytlk; China: video: 130 CHI: Hong Kong: Mansion room, Central Pier, Western MKT, Apple]

Chungking Mansion is a huge full-city-block building divided into 4 vertical quadrants, each with its own fleet of elevators (think … 4 tall buildings built tightly together.) 

Designed as a residential complex most of its apartment units have been converted into multi-room mini-hotels often called ‘hostels.’

The 2 bottom floors are a cacophonous market-like mall peopled by the broadest definition of cultural diversity. Allegedly, 10,000 people enter/exit this building every day representing, I suspect, every nationality, language & culture — certainly of Asia, if not world. 

At 1^st very unnerving, but after several days it was just a dicey, entry/exit sensory-adventure. 

[ytlk; China: video: 130 CHI: Hong Kong: Mansion room, Central Pier, Western MKT, Apple]

My small narrow room with its 2 tiny beds, 1 chair & bath became my paradigm for lowest quality accommodation I had yet experienced or ever intended to again, including an Oregon Coast’s small town flop-house hotel room with bare bulb hanging limp on a long cord from ceiling’s center 60 years ago when I was selling VO5 Shampoo to drugstores. 

Each morning I flipped on the light to watch giant cockroaches scurry for cover while an aroma of garlic wafted in from a restaurant across a light & air shaft my window opened to. 

Fortunately, carrying my lightweight compact sleeping Cocoon for years paid off when placed it carefully on dubious sheets & climbed in each night. 

https://yala.shop/products/dreamsack-the-original-luxury-sleepsack

I endured this place, in addition to being a cheapskate, because I assumed all future lodgings would by comparison be of higher quality & most gratifying. I also take a peculiar delight in enduring what I don’t have to endure … just for the challenge.

• Cold weather clothing: [pplj: Resource> Docs > Full INVENTORY]

B. Vaccines & Medical Regimens

1. Intro:

Living in United States, EU, Japan or South Korea, we are blessed with a high level of public & personal health, safety expertise & infrastructure that has essentially eliminated most major debilitating diseases except for cancer, common cold, & newest - Covid. Much of rest of world is not so fortunate. 

Unsafe water, smoggy air, inadequate sewage disposal, chronic malnutrition, ubiquitous longterm street trash & relatively modest medical infrastructure for many economic levels provides a rich breeding ground for endemic diseases that either exists continuously or rage occasionally thru an entire population. 

      Anecdote: An India traveler I met I met long ago described an un-named India disease that had frightening, permanent nasty traits (don’t recall now). In response, I purposely avoided India travel until I had exhausted better options & India was last elephant-in--room.

While some diseases may blanket an entire continent, some diseases are specific to certain countries or regions within them. In these areas, some folks harbor 1 or more of these diseases throughout their shorter lifespans. 

Air pollution kills 6.5 million people annually (70 % in Asia-Pacific) & threatens regional economy’s, food & water security, & climate systems hampering region’s sustainabilty & anti-poverty efforts. https://www.unep.org/regions/asia-&-pacific/regional-initiatives/restoring-clean-air#:~:text=

Africa’s infectious diseases are a major cause of mortality. Well known existing, emerging & re-emerging diseases like malaria, tuberculosis, HIV/AIDS, cholera, meningitis, hepatitis, schistosomiasis, lymphatic filariasis, sleeping sickness, Ebola, SARS & others are endemic … causing widespread suffering & high mortality.  (WHO, 2003a).            
NIH: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120372/#:~:text=

Asia is plagued with influenza, dengue, Japanese encephalitis, tuberculosis, pneumonia, & newly emerging Hendra & Nipah viruses.
      NIH: https://www.ncbi.nlm.nih.gov/books/NBK99573/#:~:text=

                    I suffered none of those on my several 2-3 month trips

South America’s tropical & subtropical diseases flourish in its high humidity & high temperature areas & is typically transmitted by mosquitoes making ‘moskies’ the world’s deadliest creatures. 

NOTE: Chikungunya & Zika cases are much lower than recent past. https://www.statista.com/topics/7301/tropical-diseases-in-latin-america/#topicOverview

2. My Vaccine List FYI:

 (normally at bottom of Drug/Vitamin list) [pplk: Resource: DVV List]

3. My Vaccine Research Method:

CAUTION: Doctor schedules & some drug regimens may require several weeks of pre-departure time. Start early to be safe. 

    a. List host countries, regions & environments (farms, jungles areas, etc) you’ll visit.  
         EX: Chile’s northeast rural jungle area & animal rescue facilities, 

    b. Guidebooks:

• List your guidebook’s cautioned diseases for your ‘Host Country(s)’ above.
• Peruse guidebook’s other relevant medical sources, for more ‘Doctor questions.’

    CAUTION: Don’t research too deep NOW because you're travel doctor may dismiss some diseases as not applicable to you.

    c. Your Travel doctor: Your GP doctor may/may NOT be travel knowledgable. Please tactfully make sure. 

Doctor should be able to assess risk potential of each country on your list above & prescribe appropriate vaccines, drugs etc.

    d. CDC (Center for Disease Control)

Now research each disease your doctor warned of including:
    1) pre-trip, vaccines & drug regimen.
    2) typical traveler symptoms, &
    3) recommended precautions & treatment. 

CDC’s recommended treatment should align with your travel doctor’s. Resolve any contradictions (re-ask Doc)

    e. Host Country’s Travel Pages:

Double check the above information in case there are recent changes.

    f. Finally, summarize in a list on your cellphone your trip's relevant disease symptoms & self-treatments. Much of the world, particularly rural, may have no Internet access that you can easily access. Paranoid?     ................Be Prepared!!!

                                                ???  Starlink solution

If you approach research in this measured fashion, hopefully, you will not obsess & freak out because ^{you really shouldn’t}. You will now be very knowledgeable on your pre-trip required VACs & drug regimens. 

Hundreds, if not, hundreds of thousands, have traveled where you are going without incident, & you'll probably do same. Even more important, when you have completed your pre-trip VACs & drug regimens, you can focus on traveling’s disease avoidance.

        Remember my quip, "Scott, you're not first traveler here.”

In my case, once I had basic vaccinations that any 1st World person has access to & basic vaccines for all foreign travelers, it was quite easy to add additional vaccinations or regimens (malaria) for subsequent trips.

Throughout the world, only personal medical issues I had were flu, common cold, infected eye, toe infection & of course occasional Montezuma's Revenge diarrhea which I self-treated with my prescription & over-the-counter medicines.   You can do same.

4. MY 2 ways of Classifying CDC's Travel Diseases

                                                    (FYconvenience only; not official)

CDC’s site seems to have everything you ever wanted to know about disease, vaccinations, etc. on a country by country basis. This link is to Vietnam specifically just FYI. Very much worth a quick perusal.                          OTOH, it might scare hell out of you.

https://wwwnc.cdc.gov/travel/destinations/traveler/none/vietnam?s_cid=ncezid-dgmq-travel-single-001

I made two trips to Vietnam, including moskie plagued Mekong delta, islands off of Hanoi & several large areas in between without issue.

a. 1^st: CDC’s vaccines by traveler ‘need’
        1) Vaccines 1st world’s citizens ALREADY commonly have.  
        2) Vaccines all foreign travelers should always have.
        3) Vaccines for diseases specific to your host country list.
           NOTE: Your Doc may advise ‘booster’ shots (e.g.: tetanus).

1) Common American Disease Vaccinations: Many, but not all Americans, have had these vaccinations.
    Tetanus Polio Covid (?)
    Flu (Influenza) Hepatitis A Hepatitis B.
    HIB (meningitis; pneumonia; pericarditis)
    MMR (Measles, Mumps, Rubella)
        Note: Perhaps booster shots if available & necessary.

2) “All foreign travelers” additional vaccines: COVID-19.
    Chickenpox Cholera.
    Flu (Influenza) COVID-19
    Hepatitis A. Hepatitis B.
    Japanese encephalitis.
      Note:  Never had: cholera VAC either

3) Country-specific vaccines:   
These remaining disease vaccinations are specific to individual countries &/or their intra-regions or environments (rural or in association with animals (farms, jungles, wildlife rehabilitation centers.)

    Rabies:
    Shingles:
    TDP (Tetanus, Diphtheria, Pertussis): 
    Typhoid:
    Yellow Fever:
         Note: Never had typhoid or yellow fever VAC

        Anecdote: My GP Doctor, a foreign traveler, would occasionally override a guidebook’s particular vaccine mandate for a specific country, because I was unlikely to be in that country’s region or animal-location where that disease was actually prevalent.

b. 2nd: CDC’s vaccines by Disease Context:

Food/H2O related: Brucellosis, Cholera, Listeriosis, Leptospirosis, Typhoid Fever & Hepatitis A & E, Montezuma’s Revenge (E.Coli)

https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea

Skin breaks/punctures: (moskies): malaria (moskies)

Sexually transmitted diseases: AIDS, Hepatitis B & C, crabs, Syphilis, Gonorrhea, Human Papilloma Virus (HPV) & Herpes Genital. All traveler’s should be vaccinated against Some have vaccines; some do not.      Should be part of your doctor consult.

High altitude sickness: often high mountain elevations, pulmonary edema (excess H2O in tissues/dropsy) & stroke.

        Anecdote: 1^st night high after direct drive from coast elevation to high Chilean Andes, I felt lightheaded walking back to my room from dinner, sat down on street curb for a few minutes, then walked to my room & slept.

Few days later I returned to a coastal elevation for a couple more days before returning to Chile’s high altitude again with NO further high altitude symptoms ever again including high Alps.

CDC article (below) indicates 3 syndromes or combinations of symptoms of this disease ranging from reasonable benign (mine) to more most dangerous symptoms requiring rapid return to lower elevations.

CDC:  https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-&-altitude-illness#:~:text=. 

Excessive heat & sun: dehydration symptoms. https://www.nhsinform.scot/illnesses-&-conditions/nutritional/dehydration/

Solar radiation: sunburns, dermatitis, skin cancers.

        Anecdote 1: My ‘fun’ with skin cancer.From high school’s 1^st summer vacation beach day’s full body sunburn with girls stripping of old skin weeks later (Ugh) TO sporadic 30s/40s sunscreen use TO quarterly Doctor's liquid nitrogen sprays to emerging skin cancers & a couple of ugly Mose Cancer & noise tip surgeries. Always use highest SPF levels, often, IMO.  Getting old ain't for wimps!

     PIK: K8 skin cancers.  

My Vaccines Inventory List: 

Normally, this is at end of my travel drug list: [PPLK" RESOURCES: Travel Heath]

C. Traveler’s Insurance, etc.:

1. Private Travel Insurance Benefits:  

Caution: may vary with plan you choose.
    1) Emergency Medical & Dental Assistance, 
    2) Emergency Assistance, Medical Evacuation & Repatriation,
    3) Trip Cancellation & Interruption, 
    4) Accidental Death & Dismemberment, 
    5) Lost Baggage & Personal Effects, 
    6) Reimbursement for unplanned expenses during trip delays, 
    7) Missed connection,
    8) Lost Baggage.

        Anecdote: Egyptian Revolution’s trip interruption:  After 9 days, US State Department graciously evacuated me to Istanbul, interrupting my planned 3 month Egypt exploration. 

Travelex immediately covered my Trip Interruption costs.

I ALWAYS buy travel insurance almost moments after I have booked my flights. At my age, I wanted to be covered for all costs of emergency medical care & evacuation. 

            Anecdote: I met a woman bit by a South Thailand dog forcing that couple to immediately fly to Bangkok for rabies PEP vaccine treatment interrupting their vacation at great UN-planned cost.  PIK: Rabid dog

Notes: 
    1. Many plans mix benefits, so research & discuss with insurer. 
    2. Travelex (or equivalent) [pplk: Resources> Docs>Travelex ]

[ppl; sub-pill: Travel insurance] ,also [~~~. Resources: doc]

                                                 Your call !!!!   

2. Medicare Insurance: 

Some Medicare Supplement insurance policies (aka Medigap) offer emergency coverage for foreign traveling, specifically, plans C, D, F, G, M & N. 

Please, research coverage benefits, limits & terms.

3. Health Insurance: 

Most heath insurance companies do NOT offer travel insurance, BUT, some credit cards & travel cards do. Mine never did. 

                                         Please research.

4. U.S. State Dept’s (USSD) Smart Traveler Enrollment Program (STEP):

 FREE, allows you to enter your foreign trip info so USSD, via our USA embassies & consulates, can assist you in an emergency.

       Find US Embassy: https://www.usa.gov/find-embassy

D. IMPORTANT Info & NUMBERS: 

At home we function inside an intricate web of connections between everything that makes our life flow easily; contacts, CC/DC pin numbers, bank account numbers, phone numbers, blood type, etc.

When we travel, we sever much of those connections EXCEPT that today’s modern world leaves much intact via cell phone Contact apps etc. & internet. 

23 years ago much of tech infrastructure was either primitive or I was, so I relied on a physical list backed up on iPad for all important numbers & info including Bank account & credit card detail info, etc. 

Today, were I traveling, I would STILL use a similar, but modified list because my paranoia would presume --
    1) an unexpected Internet failure or, 
    2) a lack of Internet reliability in rural areas I was traveling. 

                                     Call it a coward’s pacifier. [pplk: Important Info page

III. Trip Travel: 

A. Pharmaceuticals

1. Drug List:   

My Solution: I created My Pharmaceuticals Drug List

                                              [ppl; sub-pill: MSTR Drug List]

Instead, I let a ‘full & obvious’ pharmaceuticals list trump a lot of bottles.

NOTE: I carried my CSS drugs (Vicodin, etc) in their original bottles because added credibility & bottle was full.

                I have NEVER had an issue with my drugs including CSS.

2. Packing: 

I spread my pharmaceuticals between my person & my luggage, depending upon frequency & immediacy of my usual need. 

                   One drug list in my passport money pouch always

1) Passport money pouch: 1 drug list ALWAYS. 

2) On My Person: I carry 1 small Altoids metal container with a day’s worth of drugs & vitamins for traveling accompanied by/with my drug list.          

3) Day pak: 1 large (3” x1 ¼”) Altoids metal container with a multi-day supply of daily & CSS drugs) useful when flying, airport layovers, OVN (overnight) trips when main rolling bag is left in hostel’s secure storage.   

Always contains a drug list copy

3) Rolling Luggage: 

    main front compartment: One 7 day plastic drug container for week placed on top,  (PIK) covered by drug list so any Custom’s Agent will IMMEDIATELY & easily see both drug list & drugs. (i.e.: NOT hiding).

Each week I ‘re-loaded’ my ‘7-pill pak from my main zip-lock bag supply.

     large bottom compartment: 2 loose ‘clear’ plastic Ziploc bags; 1 for prescripts & 1 for vitamins … each with their own drug or vitamin list folded inside each bag. 

PIK 2 plastic bags

      Anecdote 1: TSA post-check-in searched my bag several times, I 
suspect, because it looked so ratty, each time disrupting little & leaving a nice note indicating inspection. 

      Anecdote 2: Valparaiso, Chile Customs

Arriving at Valparaiso, Chile by boat from Ushuaia, Argentina, Customs x-rayed rolling bag & asked to actually inspect my Ziploc bags of ‘little balls’. When I showed them my prescript drugs they chuckled & waved me on. 

They were looking for illegal seed smuggling that might damage their agricultural economy.

B. Water & Food Risks:

Disease RISKS of contaminated food & water. 

      Brucellosis, Cholera, Listeriosis, Leptospirosis, Typhoid Fever,    Hepatitis A & E & most common “traveler’s diarrhea”.are directly associated with consumption of 'bad' food & water.

“Traveler’s diarrhea” (aka Montezuma’s Revenge) is a mild ‘self-limiting’ disease lasting less than five days , … caused by bacterial infection & parasites (E.Coli.) For me, usually lasted less than a day.

C. WATER:

1. Safe Drinking Water, specifically

If most guidebooks allege a country’s water is safe to drink, confirm with local hostel folks. BUT in 2^nd & 3^rd world nations ALWAYS assume it is NOT. Today’s ubiquitous bottled water eliminates this drinking water fear … except

a. Drinking Water Sources:

1. Bottled Water: Universally available now, this has always seemed safest option. I don’t recall issues in my experience except ….

       Anecdote: Caution:  Several years ago a travel source cautioned that some unscrupulous sellers would re-fill old used drinking plastic bottles with unsafe tap water & seal them with a drop of superglue. 

Frequently, but not always, I checked purchased water bottles but found no evidence. Often, when opening a water bottle, its plastic cap ring will audibly ‘snap’ confirming its safety.

Note: Always refilled water bottles when I had access to filtered water (hostel etc).

2. Tap Water:

Even in 1^st world countries, drink only if owner's (home, hostel etc) alleges it is safe for foreign guests (you), Be even more wary in all other countries.

      Anecdote: My web site builder mentor said, "In India he wet his tooth brush in tap water & was sick for days afterward. NEVER drop your vigilance.  

                  You will quickly get used to these precautions.

3. Public Drinking Fountains:

Same as above unless local tourist knowledge indicates safe for tourists. Be careful to ask, “If safe for tourists.” IMO, locals MAY have an immunity I may not acquire, if at all. I sensed I had that immunity for my travels.  OrTOH, they just live with consequences. 

     Anecdote: India installed water pumps in neighborhoods that locals use, but I would NEVER drink from.

OTOH, on Spain's Camino de Santiagolocal village public drinking fountains or taps were labeled drinkable and I used. OTOH, in some countries local public drinkingfountains or taps were labeled ‘drinkable’ and I occasionally used.

4. Restaurants:

Generally, restaurants, frequented by tourists, work hard to protect their reputation, particularly in today's world of social media’s bad reviews which can severely damage a restaurant’s business.

Often, they buy filtered water in large bottles or have a filtering machine on premises. [ytlk: India: New Delhi hostel] ???

   Bring Your Own: If in doubt, take your own water bottle which you probably do anyway.

   Table served: Tourist-frequented restaurants need to protect their reputation by serving safe, drinking water. Always ask the waiter if their water is safe &, if you can, ask her how he knows. Often times restaurants will have a water filter.

   Also, Mixed alcohol drinks: Never drink mixed drinks unless you are POSITIVE water is safe. NOTE: alcohol does NOT make it safe. If in doubt, drink ‘bottled’ Coke, etc.

   Also, ice cubes: Never suck on or use in drinks unless you are POSITIVE ice cube’s water is safe. NOTE: Can’t solve issue by removing ice cubes which have already started to melt into drink.

5. Hostels/Hotel Restaurants: same as above.

      Anecdote: My New Delhi, India hostel had a large water filter mounted on wall that it's food service & all of we guests were free to use. Of course we all filled our water bottles every morning. Other hostels: I would not touch their water.

6. Natural Rural Water Sources: stream, lakes, farm homes etc. 

      Anecdote: NEVER, even in US, drink from mountain streams. 40 years ago I carried a long-handled aluminum ladle on my saddle so I could just reach down for a quick drink from a stream without getting off my horse.  No more!  

Cow spread Giardia disease infects most western US water sources although I used to drink directly out of lakeside springs tumbling directly from mountainsides down to my kayak.

I had Giardia once for several uncomfortable months.

b. Purification Solutions:

1. Portable Water Filter: Technology has made this amazingly reliable.   

      Anecdote: Riding solo across Wyoming's Oregon Trail on horseback with a pack horse, I ended up at day’s end next to only available water source – a yellow urine-stained pond, surrounded by cows. 

Absent my 1ltr bottle of "Security"
water saved for REAL emergencies, I had to drink from this yellow pond. My Katadyn water purifier worked great, BUT beware  ceramic filter can freeze & break. 

Foreign traveling later, I carried a SteriPEN Defender UV Purifier. BUT beware of ‘other’ available Pens that sound good, but whose design make it difficult to access water sources.

2. Chemicals: bleach (12 drops /gallon); water purification tablets. I always carried bleach, but never used it because of bottled water availability. Carried purification tablets as backup to filters & bleach. 

NOTE: standard boater's formula to purify water is: ½ teaspoon bleach for 5 gal of clear water. If cloudy water, increase 1½ teaspoon/5 gal & let water sit for 30 min+ if clear; 60 min, if cloudy.

IMP NOTE: do not use “shocked” chlorine method which is for cleaning tanks: (8 oz for every 10 gals of water, let sit, THEN, flush tanks) -- too much chlorine & too dangerous to drink

                             Yes, I know, I’m paranoid.

3. Boil: not much survives boiling water except a few creatures near super deep underwater volcanic vents.  

4. Water Traps: Interesting, but you would/should have planned better than to need this. 

Food Storage Guys: Jim Brewster article:
https://www.foodstorageguys.com/articles/water-trap-survival-tip

D. Food, specifically

1. Cooked Food: 

Again, in 2^nd & 3^rd world nations, ONLY eat what is served to you super hot so you are reasonably certain very high cooking heat killed any Filthy McNasties. 

a. Street or market vender/stall: 

Large open markets often have many food stalls clustered together to feed merchants, their customers & we tourists. They are often excellent & safe if food served hot. 

Like wise ‘street’ vendors’ are every where sometimes en mass, other times, solo locations.

         [ytlk: Ecuador market restaurant] [ytlk: China street stalls] 

   Tips:

      1) Ask hostel’s ‘safe’ advice/suggestions.

      2) Eat where you can see food being cooked.

      3) Avoid everything NOT cooked: salads, cold drinks, ice cream, raw anything, etc. 

       Note: While salads washed in filtered water was probably safe, I almost always avoided. I relied on my bleach for salads. (SEE below)

b. If NOT super-hot ask them to make hotter. 

                          You are not their 1^st tourist.😆. 

   Note: Chinese noodles are usually safe cuz always served boiling hot (that’s why they slurp it!  Cools it down.

   TIP: to communicate ‘hot’: quickly & briefly touch your arm with your finger, making a sizzling sound through your teeth & pulling you hand back quickly..       Yes, it worked many times.

c. Choose busiest stall with most merchants & customers.

      Anecdote 1: Shexian, Tunxi, China Side by side several street vendors were selling, but 1 was swamped with locals. I queued at the busiest. [ytlk: China: 059 CHI: Tunxi: daytrip to Shexian]

      Anecdote 2: In Khajuraho, India a single vendor was slammed all day with customers. I often visited twice a day avoiding nearby restaurants. [ytlk: Khajuraho, India ]

d. Public Restaurants/ Hostels/hotels: same as above

2. Fresh Veggies & Fruits

BLEACH: Scott’s ‘bomb proof’ SOLUTION

While I usually avoid 3rd World restaurant's salads, etc., I often got a real hankering for a salads, particularly after wandering through fantastic open markets with every vegetable you can imagine.

My supposedly 'bomb proof' technique: (I never knew it to fail.)

• In my hostel’s room or kitchen, I filled sink with tap water & added 12 drops of chlorine bleach. Then soaked all my fruit & veggies for a few minutes.      IMO, bleach kills everything.
• For daily walkabout snacking: pour some of sink's chlorinated water into a plastic & shake & empty to sanitize bag before putting sanitized food in ....  AND GO.
• Important NOTE: I carry bleach carefully in a small glass bottle sealed in a container. NOTE: Beware of non-glass containers cuz chlorine may degrade it & leak on clothes etc. SEE: [ytlk: food sanitizing] [pplk: Resources: Equip post]       

PIK: Bleach

      Anecdote: Mai Son, Thailand veggie snacks. In the early morning, before I started my walkabout, I would go to the open market & buy a couple carrots, cherry tomatoes, & maybe fresh green peas. Then, I'd sanitize them & their plastic bag insides.

Finally, cut off a tiny part of plastic bag's corner so water could drain, then tie the bag around my belt so I easily snack during day's jungle scrambling.  [ytlk: Thailand: Mai Son scramble up to temple]

3. Pre-packaged foods:

Pre-packaged cookies, Snickers etc. I usually presumed OK, but I also ate bags of dubious, but great tasting home cooked potato chips fortunately without issue. 

E. Specific Misc~ Dangers:

1. Dogs, bats, monkeys etc: 

Rabies is a zoonotic (animals > humans), a viral disease affecting central nervous system. Mostly (99%) dog-borne worldwide disease, very endemic to 2^nd/3rd World countries where dogs & other animals (bats, monkeys, etc) may often be essentially feral and when infected such animals are often irrationally aggressive. 

Disease spreads to humans via saliva, usually through bites, scratches or direct contact with mucosa (e.g. eyes, mouth or open wounds), BUT once clinical symptoms appear, rabies is virtually 100% fatal. 

95% of human rabies deaths occur in Asia & Africa amongst 

    1) Already marginalized, poor & vulnerable populations & age groups (mid-teen & pre-teens.)

    2) Rural travelers & people living in remote, high rabies-endemic areas.

Having written this, I would get rabies vaccine before foreign travel.

a. Rabies Treatment: PEP vaccine regimen

1) Pre-exposure vaccination:   Rabies pre-exposure vaccination (pre-exposure prophylaxis (PrEP): 
    1) simplifies rabies post-exposure treatment,
    2) may protect when exposure is unrecognized, or
    3) when post-exposure treatment is delayed.          
                    It does not AVOID appropriate treatment.

2) Post-exposure (dog bite):  

While minor skin licks or surface abrasions can often be treated with simple soap & water, …. skin penetration by teeth or claw demands an immediate full PEP regimen of vaccines & immunoglobulins perhaps over several days BECAUSE once clinical symptoms appear, rabies is virtually 100% fatal. Medical intervention timing is critical.

Unfortunately, there is a nasty time gap between mandatory start of an effective rabies PEP vaccine regimen & … time required to ACTUALLY verify you have rabies infection (absent testing offending dog itself ) 

So, you may be forced into PEP (post-exposure prophylaxis) regimen before you know if you actually have disease. Risk of not acting before you actually know you have rabies is once rabies enters central nervous system it is incurable & fatal. A nasty catch 22.

https://www.who.int/news-room/fact-sheets/detail/rabies#:~:text=

      Anecdote: I met a writer couple in Bangkok whose working vacation on a southern Thailand tourist island had been interrupted by a skin piercing dog bite forcing them to immediately fly to Bangkok for painful injections. 

3) PEP Treatment:

• extensive washing with water & soap for at least 15 minutes & local treatment of wound as soon as possible after a suspected exposure;
• a course of potent & effective rabies vaccine that meets WHO standards; &
• administration of rabies immunoglobulin or monoclonal antibodies into wound, if indicated.

https://www.who.int/news-room/fact-sheets/detail/rabies#:~:

b. Viciousness of dogs, generally:

The viciousness of dogs, or not, varies, apparently by country.

More than once I have been assaulted by individual neighborhood dogs, semi-feral street dogs & even packs of 4 or 5. Apparently, they know you are not local. My smell, clothes, ubiquitous shorts or because have never seen me before.

      Anecdote 1: India’s Pink City neighborhood solo dog attack.I had no weapons so I picked up several stones & started yelling & throwing. He retreated & then assaulted again. This time I pursued him into his back alleys until he had run out of sight. He didn’t follow.

Mexico’s city dogs are vicious. They will come running from a great distance.

      Anecdote 2:    Walking across one of Ayutthaya, Thailand’s huge open-spaced, former temple grounds, a pack of dogs caught me on open ground with nothing, but grass.    I decided I had to bluff. 

I looked over my shoulder to show them I saw them & kept walking at my same relaxed pace without a glance at the leader. Sensing no fear to get excited about, they wandered away.     Bullet dodged.

      Anecdote 3:  OTOH, India, Cairo & Ushuai, These dogs ignore all, often sleeping on sidewalk or in street extremely confident nothing will hurt or disturb them.

c. Vicious Dog Defenses:

IMO, dogs learned 30,000 years ago that their domestication was a double-edged sword: sustaining food vs physical pain. Even before domestication, wolves soon-to-be-tamed, learned that humans can throw a rock with deadly painful aim & impact. 

In my theory, dogs recognized the dangerous tell-tale of a human bending down to pick up a rock. Get out of range fast. 

      Ancedote: An elderly gentleman in Argentina somewhere watched me cope with an attacking dog & approached me with some advice, ‘When dogs attack, bend down & appear to pick up a rock, & that will usually stop them.” I have used his advice many times even when no rock was available to pick up. It works. I have used that advice many times even when no rock was available to pick up. It works. Thank you, Sir

    1) Carry a stick (cudgle) as a visible weapon. I suspect tamed wolves knew a stick in a human’s hands could inflict pain. So, I often carried a 3 ft stick when I was concerned. It seemed to work. 

2) Ignore nonchalantly, if you can control your fear.

3) Bear spray or mace would be useful, but very difficult to import (Canada does not allow importation).

2. Other animal Threats:

Monkeys: rabies, Ebola, Marburg, herpes B virus & tuberculosis. Southeast Asia: temples, tourist sites; do not touch or feed.

CAUTION: Monkeys hang out where tourists are for at least two reasons : 1) to beg or steal food, & 2) to steal everything they can quickly grab.  So hold your cameras/purse close. Don't risk painful bite or rabies. 

Rodents (rats/mice):  plague, leptospirosis, hantavirus disease, and rickettsial diseases; … bites, scratches, urine, feces, or fleas; Avoid droppings or nesting materials. Don’t touch anything that appears urine or feces contaminated.

Bats: rabies, histoplasmosis, Ebola, and Marburg. Avoid bat occupied caves, tunnels, or mines. 

Snakes: deaths are rare; Never handle, harass, or kill cuz prompts snake's defensive reaction.