Hazardous to Your Health
By Richard Trubo
Reviewed By Gary Vogin
Vacations used to mean crowding the kids into the family sedan and heading for the closest national park, or perhaps boarding a jet for a trip-of-a-lifetime flight to Europe to pose in front of the Eiffel Tower. But in increasing numbers, Americans are giving new meaning to the phrase "get away from it all." Many have forsaken the traditional sightseeing holidays and have turned instead to the booming adventure travel or ecotourism industry.
In Walter Mittyesque style, they're heading for Africa, Asia, and South America to shoot roaring rapids, crawl through daunting caves, or scale mountain summits. In some cases, however, they're also contracting potentially serious illnesses with names they often can't pronounce.
Too often, people embark on these adventures unaware of the risks they might face with altitude sickness, for example, or infections with exotic organisms. "Ten years ago, the only people going to high altitudes were experienced mountaineers," says Fiona Bellis, MDBS, an emergency physician at Torbay Hospital in Torquay, England. "Now, just about anyone can go. And people are just not as well informed about the risks as you might expect."
At Emory University, infectious diseases specialist Phyllis Kozarsky, MD, is director of the TravelWell Clinic, and she stresses the importance of having a realistic view of your own capabilities for adventure travel. "So many people want to trek in Nepal," she says. "Some of them are of retirement age and have a long history of smoking, but still think they can easily climb to 14,000- to 18,000-foot elevations. They seem to have no concept that it's not going to be like traveling to Kansas City."
Altitude sickness is not only common among adventure travelers, but it is potentially fatal if it is not treated properly. It occurs most often at elevations above 8,000 to 10,000 feet, usually when a climber ascends too rapidly. As a decreased amount of oxygen reaches the brain, symptoms such as headaches, nausea, and fatigue can develop. In more serious cases, people may stumble and fall, become confused and irritable, and develop severe shortness of breath or a cough.
To complicate matters, the guides on these adventure trips can have varying degrees of experience and judgment. In just the past year, Bellis participated in mountain climbing expeditions in Tibet and Russia, and on both occasions, she treated fellow climbers who had developed moderate to severe altitude sickness. In each case, she recalls, the guides had exceeded the appropriate rate of ascent. Once, when a climber had become ill, the guide hesitated to order the proper procedure - an immediate descent from the mountain - to keep from spoiling the trip for the rest of the group.
"Generally, these guides are kind people who very much want to make sure that their groups have a good holiday," says Bellis. "They find themselves in the dilemma of needing to take one person down the mountain, which may mean the entire group has to descend as well."
If the high altitudes of some adventure travel don't get you, the infections might. Diseases with names such as leishmaniasis (caused by sand fly bites), and leptospirosis and schistosomiasis (both related to contaminated water) can be contracted by tourists in remote locales.
In one of the largest recorded recent outbreaks, about half of more than 150 participants in a multisport expedition called Eco-Challenge-Sabah 2000 in Malaysian Borneo contracted leptospirosis, developing symptoms such as fever, headaches, chills, and muscle aches. Investigators at the CDC concluded that these individuals, who participated in several grueling days of canoe paddling, open water swimming, and mountain biking, may have become infected while swimming or paddling in the Segama River, and inadvertently swallowing water contaminated by Leptospira organisms from the urine of infected animals. If untreated with antibiotics (such as doxycycline), leptospirosis can lead to kidney damage, liver failure, meningitis, and in rare cases, death.
According to Kozarsky, president-elect of the International Society of Travel Medicine (ISTM), there have been recent outbreaks of diseases such as schistosomiasis in people who have rafted down the rivers in Ethiopia, and histoplasmosis (a fungal infection) in groups who have gone into caves in Nicaragua. "None of these people was told ahead of time that there might be health risks," she says.
Participants in adventure sports need to keep in mind that if a health problem develops, they can't dial 911 and summon immediate medical help. "The last thing I want to do is limit the number of people going to these amazing, beautiful places," says Bellis, who wrote about her adventure travel experiences in the British Medical Journal in April 2002. "But it concerns me that many people do not appreciate what the risks are and how remote they are from help if a problem should arise."
Before embarking on an adventure holiday to unfamiliar regions, Kozarsky recommends visiting a travel medicine clinic and consulting with a physician who stays up to date on the health risks of particular areas and how to minimize them. ISTM maintains a list of these clinics on its web site (www.istm.org).
General guidelines for reducing your risk of altitude sickness include the following:
To minimize your risk of being infected by waterborne organisms, the American College of Emergency Medicine provides these suggestions:
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