For most travellers and volunteers heading off to the tropics,
their main health concern is usually infectious disease. Malaria
and diarrhea top the list, while a myriad of infections ending
in "iasis" (schistosomiasis, onchocerciasis, filariasis, myiasis,
trypanosomiaisis and more) pull up the rear. While I am sure
many of you will get diarrhea, and may well be told you have
malaria at some point, with a bit of common sense, most of
the others are unlikely.
In my opinion, and that of many other seasoned volunteers,
it's all about the roads. Motor vehicle accidents are the
greatest cause of death in travellers. Infections, on the
other hand, account for less than 1% of mortalities abroad.
If you are planning to travel to Nigeria, Peru or India (I
could pick lots of different countries), the risk you face
on the roads is even greater.
The reason for this state of affairs is not surprising -
poverty - which is the main reason you would go away to volunteer
there in the first place.
Firstly, think about the roads in many countries. Paving
is often a luxury, and even when roads are paved, Jacuzzi-sized
potholes are not unusual. Naturally, cars, trucks and buses
zigzag back and forth to avoid these potholes - but unfortunately,
they are often going in different directions. Roads are generally
not well lit at night, and fluorescent white lines down the
centre are non-existent. The shoulders of the roads, if there
are any, might be populated by people with enormous loads
on their own shoulders, or perhaps a wandering cow or baboon.
If you have ever travelled through the Andes, you might remember
the numerous crosses along the roadside, each marking the
spot where a bus toppled over a cliff. When I was there, traffic
was allowed in one direction on Mondays, Wednesdays and Fridays,
with the other days left for those headed the other way. Sundays
were a free-for-all.
So much for the state of the roads. What about the vehicles?
Well, let me be guilty of generalizing just a bit. Many public
buses resemble 1961 Volkswagen vans. Cracked windshields are
the norm, and sliding doors that just don't shut snugly are
a way of life. I have one patient who travelled crammed against
the doorway, and fell out of her moving vehicle. Another ended
up paralyzed from the waist down after the open truck she
was riding in ran into an overhead wire. Seatbelts, while
you should hunt for them vigorously, are usually nowhere to
be found. Dashboard dials usually don't work, though you can
always count on music blaring during your trip.
If you think you're going to stretch out on your bus and
get some rest while you travel, think again. Buses often don't
depart on time. Rather, they depart when they are full. Really
full! Local women and their babies seem to have the necessary
skill to fall asleep. I have never been so lucky.
And lastly, the drivers. Again, I generalize, but rumour
has it that the more people they carry, and the faster they
reach their destination, the greater the payoff. Drunkenness,
underage drivers and just plain reckless drivers are common.
Sort of like over here.
So what is my advice? I am well aware that there is not always
a great choice if you want to get from point A to point B
in country C. But please consider the following:
avoid nighttime driving in rural areas (repeat this phrase
every night)
avoid overcrowded buses (they are all overcrowded)
don't drink and drive, or get into vehicles with unsafe
drivers
stay off of motorbikes, unless you are well trained and
wearing a helmet
choose your taxi, and taxi driver, with care
at least look for a seatbelt
if you are travelling with small children, bring a proper
car seat
use a local driver (in spite of my kind comments)
don't be afraid to tell your driver to slow down, and if
he doesn't, get out
consider splurging on a bigger, more expensive (safer)
bus carry out-of-country medical insurance
My intention is not to scare you to death but, rather, to
raise your level of awareness about the greatest risk you
face travelling abroad. More about your bowels and the "iasises"
in future articles.
