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Sunday, March 20, 2011

Baby Boomers in Asia - Five Countries in 30 Days

Public Health and Infectious Disease Observations:  Five Asian Countries in 30 Days

            So, my husband and I thought we were 30-somethings again. We decided to trek around Asia, unescorted, for a 30 day and 5 nation vacation. 
Along the way, I made mental notes about the public health I observed. We visited Singapore, where my husband’s nephew and family live; and where the quality of the government run health care is excellent.  We noticed a marked change in the public health after we left the modern safety of Singapore. Third world countries like the two sites we visited in Viet Nam and two places in Cambodia appeared less focused on public health than what I observed in progressive Singapore. 
In Beijing China, I observed an interest in improving air quality and emphasis on hand washing in bathrooms and restaurants. 
Finally, Kyoto, Japan appeared to be as modern and focused on providing for good public health as any western nation, including the United States.
We planned an itinerary using frequent flyer miles.  Our intention was purely personal, but my nursing instincts drew me to pay attention to the public health of each country we visited.
Of course, I was also vigilant about our exposure to infectious diseases that are either prominent or endemic to Asia – like, Malaria, Tuberculosis or Dengue Fever. 
Additionally, we were aware of our risk for contracting intestinal disorders due to the variances in water quality common in Asian countries.   Obviously, we didn’t want to think about the risk of unexpected accident or injury. 
            Our local travel clinic in Brunswick was non-specific about special health risks we could be exposed to.  We received advice about having our tetanus immunizations updated.   Thankfully, our primary care physician provided a prescription of Ciprofloxacin (Cipro) in the event we needed help fighting off gastrointestinal or urinary tract infections. 
            Fortunately, our 30 day journey left us with beautiful memories and in reasonably good health given the exhaustive pace of our 5 nation travels. We never used the Cipro.
            Nonetheless, it’s a good idea to check the resources on the Internet before taking an extended visit to third world countries like Cambodia and Viet Nam. 
While I observed public health measures in effect in Asia, the effectiveness of initiatives and facilities to treat illness, infectious diseases or medical emergencies are not uniformly evident. For example, first aid or medical alert signage was noticeably not existent in the ancient Angkor ruins of Siem Reap, Cambodia; likewise in the Cambodian jungle where the 10th century temple at Banteay Srie is located.  Both of these Cambodian tourist sites present challenging terrain for travelers who may be unprepared for the arduous walking required, especially in 95 degree humid temperatures. 
            A visit to China’s Great Wall was an unbelievable travel experience for tourists like my husband and me. Nevertheless, be advised about the difficult climb on ancient steps while touring this Great Wonder located outside Beijing.  Driving in Beijing is also a public health risk because there are too many automobiles and novice drivers clogging virtually all the city’s highways. 
            This is a summary of what I learned by asking questions while we took our tours:
·        Singapore – public health facilities are excellent.  Record keeping is current about the incidence of infectious disease.  Electronic body temperatures are taken of all visitors at immigration.  Immigrants entering with a fever are quarantined until illness is determined and/or treated.
·        Viet Nam - provides health care for citizens up to 6 years old.  If private insurance is unavailable or unaffordable for those over 6 years old, the patients must go to charity hospitals.  Air quality in Ho Chi Minh City in South Viet Nam appears to be problematic, as some people were routinely observed wear surgical masks while commuting in the city.
·        Cambodia -  appears to down play risks of Dengue Fever, Malaria and even the remote chance of finding an undetected land mine in some remote villages where tourists are seen hiking on jungle paths, like at Banteay Srei .  Building a tourist industry is the focus of improving the country’s poor economy.  Public health seems to be provided by Europeans and at some Swiss run hospitals.
·        Beijing, China – appears to be struggling to get a handle on how to implement public health initiatives like improving air quality and prevention of infectious diseases.  Nonetheless, public toilet facilities in Beijing were modernized for the 2008 Olympic Games.  Hand washing was encouraged in all public places.
·        Kyoto, Japan* – appears to be on par with Western nations regarding sanitation and infectious disease prevention.  Hand washing stations in public facilities were emphasized and centrally located.  As in Singapore, electronic body temperatures were taken during immigration checks and electronic finger prints were required before entry to Japan.

My recommendations, for those baby boomers who want to take up a back pack or fly from place to place, are to research the Internet before embarking on what could be the journey of a lifetime.  Asia is a fascinating cluster of countries to visit, but travelers should be prepared for variances in economies, public health and often challenging terrain.  

*Since writing this story, the 2011 Earthquake and Tsunami in Japan has caused extraordinary damage to the beautiful country we visited. Although Kyoto was not directly hit, the collateral damage must be devastating throughout Japan.  I am deeply sorry for the Japanese people at this time; but I'm confident their culture will not be set back by the horrific destruction caused by the catastrophes of a 9.0 earthquake, a tsunami and resulting nuclear energy plant malfunctions and fuel leakages.

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