Malaria: Our Decision

If you think something small can’t make a difference in life, think of a mosquito. One sleepless night, ruined picnic or one sore arm, a single mosquito can be the cause of so many of life’s displeasure’s. Unfortunately for travelers and many in the developing world, it is a little more serious. Mosquitoes carry two serious vector borne diseases: dengue and malaria. While there’s no vaccine or cure for dengue, there are chemical prophylaxis to help prevent malaria.

We’ve gotten a lot of questions over the last 16 months about malaria medications and we’ve asked plenty ourselves. Here’s how we came to our decision.

To drug or not to drug, that is the question.

The ever growing global discussion on vaccines, use of pharmaceuticals and immunizations is alive and well in the places%20affected%20by%20malaria Malaria: Our Decisionworld of travel. We met several long-term backpackers in South America who took no prophylaxis against malaria. On the other hand, we didn’t meet a single traveler in Africa not using a chemical prophylaxis. To put that in perspective consider this: approximately 90% of deaths due to malaria occur in Sub-Saharan Africa.

We began researching our options and speaking with our doctors regarding the different drugs. We wanted to take a chemical prophylaxis for a few reasons: 1) we didn’t want to get malaria, 2) we believe that the potential side effects of the drugs are less damaging than the disease itself and 3) we did not want to contribute to the spread of malaria across regions. Spreading Malaria is no joke, if we were to be infected with a particular strand in one region we risk spreading that strand to another region when we travel there. In some countries malaria accounts for over half of hospital admissions and public health spending. We try to be responsible in our travels and for us we didn’t want to take the chance that we could carry a new strand to a previously unaffected region.

We based our decision on where we would be, the potential side-effects and the convenience of the drugs. We knew we didn’t want to carry a daily drug with us, the storage space aside, its never good to show up at a land border carting around boxes of pills. Also, we wanted to take a drug that’s effective in nearly every region on our itinerary. I wish I could say my regular doctor was helpful in leading the discussion about the options, malaria cure Malaria: Our Decisionbut she unfortunately was not. Although Danny’s doctor was more willing to educate himself on the possible side-effects and have an informative discussion with him, I think the situation I faced is probably more normal. If your regular doctors is unfamiliar speak with someone at a travel clinic who can guide you through the options.

Besides taking a chemical prophylaxis, we also bought an insecticide treated mosquito net Malaria: Our Decision. Although most places we slept in had mosquito nets, it was good to have our own for the few places that didn’t.

The Options

There are several chemical prophylaxis options on the market. You should discuss with your doctor which one is best considering your time frame, travel locations, risk of transmission and medical history. No matter your choice you should always take precautions against mosquito bites, especially dusk to dawn when transmission occurs.

Chloroquine
COST: inexpensive
FREQUENCY: weekly
AREAS: Central America
OUR EXPERIENCE: 5 months in Central America, no problems.
 
 
 
Doxycycline
COST: inexpensive
FREQUENCY: daily
AREAS: South America, Asia and Africa
OUR EXPERIENCE: None. Doxycycline was impractical for us, it upsets Danny’s stomach and we didn’t want to carry 365 or more doxycycline pills each. We’ve met several travelers taking this and the most commonly side effect seems to be sun-sensitivity. An added benefit of Doxycycline is that because it is an antibiotic, it also helps when you come across a questionable meal or two. If we had trouble with Lariam this would have probably been our backup.
 
 
Lariam (Generic: Mefloquine)
COST: expensive
FREQUENCY: weekly
AREAS: South America, Asia and Africa
OUR EXPERIENCE: Lariam is probably the most controversial anti-malarial on the market. We took Lariam for several consecutive months in South America, Africa and Asia and have experienced no negative side effects. For us this was the most practical choice: weekly, effective and not as outrageously expensive as Malarone.
 
 
Malarone
COST: very expensive
FREQUENCY: Daily
AREAS: South America, Asia and Africa
OUR EXPERIENCE: None. We’ve met other short-term travelers taking it. Most frequent complaint we hear is the cost. For us this drug was impractical because of cost and frequency; too many pills to carry and too expensive at that.
 

Immunity?

Several promising vaccines are under development around the world, however none has yet been proven to develop immunity to the disease. You cannot build up immunity to malaria by drinking the local water. Seriously. People with sickle-cell disease or carriers of the trait have a substantial protection against malaria. Because the disease causes a deformation of the red blood cell, the malaria causing parasite attached to the red blood cell is destroyed before it has a chance to reproduce.

Tobias Index

Now that we’re off to Africa we figured it was about time to get our Latin America summary out there. Epic bus journeys in the south and more than a month of nights sleeping on buses…its been a real adventure.
Here’s a summary of the most “fun” statistics for the last 9 or so months:

8.5 – Months spent on the road

33 – Nights spent on a bus (Jillian’s note: We should have calculated our total hours on the bus!)

23 – Nights spent couchsurfing

20 – Hours of longest single bus ride

4 – Viewings of Transporter 3 on the bus

2 – Bathroom breaks from the bus where there was no bathroom present

15 – Countries visited

41 – Passport Stamps

2 – Hemispheres enjoyed

2 – Gastro-intestinal lab tests

4 – Ferry crossings

1 – Train

11 – Planes

6 – Most consecutive nights in the same bed

6 – Volcanoes hiked

2 – Active volcanoes hiked

6 – Rivers kayaked

4 – Guidebooks

4 – Countries where we bought and paid for a local telephone number

3 – Largest continuous amount of time, in hours, between March 13th and November 30th we spent apart…

Foodie Friday: The Quest for Beervana

3982902518 0819d69928 Foodie Friday: The Quest for BeervanaIt should be no surprise that along with lots of ruins, whitewater and trekking, our tour of the America’s also included beer. Lots and lots of beer. From Mexico to Argentina beer seems to be the local beverage of choice, and almost always its cheaper than soda or sometimes even bottled water. It was not unusual for us to find a liter of beer for less than $3. When it’s that cheap you just have to try it. So we did.

On what is now called our quest for beervana (thanks to our friends for the name), we’ve sampled the local brew in every locale, from ice-cold Salva Vida in Honduras to an amber Beagle down in Ushuaia. There have been some good beers, some beers good for the moment, and even one green coca beer in Peru. Most beers produced in the America’s are lagers or pilsners and it seems the hotter the country the colder the beer. The coldest beer we’ve seen was in Honduras and fortunately at the time we were sweating to death. According to the  Foodie Friday: The Quest for Beervanathermometer on the refrigerator the beer was stored at -9 Celsius (about 15 Fahrenheit). It was perhaps the most refreshing and delicious pilsner in the world, or at least at that moment.

Our quest for beervana has turned into challenge to create a substantial beer label collection. We’ve taken the labels off all sorts of bottles, many of which have been mangled in the process. Just for the record the sticker labels are the hardest to take off. Our quest to build a collection has resulted in choosing our selections by the label not the actual beer, which in some cases has led to mistakes such as the coca beer.  It has also led us to some delicious Colombian micro-brews and copious amounts of Brazilian  chopp (draught beer), err… maybe not the chopp.  That might be our own fault.

Our quest for beervana continues while we’re on “intermission” at home. This week we headed to the Y4157351295 78241ecee9 Foodie Friday: The Quest for Beervanauengling (my home brew) in Pennsylvania for a factory tour and tasting. Danny and I have been trying to get there for years, but for one reason or another it never worked out. Fortunately the quest for beervana took precedence this time and we finally made it. It was by far the best factory tour ever and not only because it ended in a beer tasting, actually truthfully it was because it ended in beer tastings, two in fact.

Anyway, as we head to Africa have no fear,  the quest for beervana will continue. Fortunately we’ve spent enough evenings at Brickskeller to know which African beers to avoid, but we’re always open to suggestions. Anything out there you think we should try or avoid? Where do you want to share a beer with us?

Salud!

It was the best of times…it was the worst of times.

We’ve survived our first week of “intermission”. In between forkfuls of turkey we’ve been answering questions about the trip. Lots and lots of questions. What was your favorite (fill in the blank here)? What was the worst…? well you get the picture. So here it is folks, our best and our worst of the last 8 months.

  • Best Way to Start a 2 Year TripBaja, Mexico.  Grinning ear to ear as those grey whales just swam right on up to let you pet them…then jumping into the water to swim with some sea lions.
  • Worst Night On a Bus – Bolivia…going from La Paz down the death road to the Amazon where we weren’t sure if we’d wake up alive.
  • Stupidest DecisionAmazon, Bolivia.  Swimming in that river with caymen…
  • Best Hot SpringFuentes Georginas outside of Xela, Guatemala.  These were built into the side of the mountain with beautiful views and clouds that just rolled in and out and there was a water temperature to please literally everyone.
  • Place we wish we’d stayed longerOmetepe, Nicaragua.  This beautiful island was covered in monkey filled rainforest where the food was good and the beaches were perfectly peaceful.
  • Strangest “Dish”Grasshoppers.  Oaxaca, Mexico.  Does this really need explanation?
  • Most Fun in One Day – Death Road, Bolivia.  It’s called the Death Road…what else is there to say?!.
  • Craziest MonumentThe Ecuator, Ecuador.  This place was just rediculous..
  • Most Overrated – Valle de la Luna, Argentina.  Nothing but a bunch of rocks.
  • Most Underrated – Copan, Honduras.  Best ruins we’ve seen, easy to access as well.
  • Best FoodMexico.  No, not tex-mex…I mean real Mexican.  Cheap and always enough spice to make you cry.
  • Most Extreme SportVolcano Boarding, Nicaragua.  Snow is soft, lava rock isn’t.
  • Most Diverse – Brazil.  People from every corner of the globe…they even have Sushi.
  • Best BedBuenos Aires, Argentina.  That’s what happens when your parents come to take care of you for a week.
  • Best VolcanoVolcan Pacaya.  Antigua, Guatemala.  Easily accessible and cheap to climb, don’t forget to bring along some marshmellows to roast in the lava!.
  • Best Foreign Movie - Romeo and Juliet…the Brazillian version.  Two opposing futbol (soccer) teams makes for one great comedy…plus no one dies.
  • Best Festival – Okotberfest, Brazil.  The largest Oktoberfest outside of Germany.
  • Best Stars – We had a new moon when we were in the Amazon…it was brilliant.
  • Most Fun with a CameraSalt Flats, Bolivia.  Rumor has it that we even messed up some NASA satellites that day!.
  • Best Sporting Event – Futbol.  Xela vs Guatemala.  Nothing better than flying, flaming toilet paper…in a country that never seems to have enough toilet paper!
  • Most Awesome Force of NatureIguazu, Argentina/Brazil.  The waterfall that puts all others to shame.
  • Best LuckLa Moskitia, Honduras.  We stumbled upon a mother turtle laying 99 eggs.  We were lucky to see it but the baby turtles were luckier b/c it meant being cared for in a lab rather than being eaten by the locals.
  • Best TrekHuaraz, Peru. Despite suffering from diarrea at 4700m in elevation and being thrown from a horse…well maybe that’s what made it so wonderful ;)  We blame this illness on having previously eaten a complete 3 course meal that cost less than $1.
  • Scariest Moment – Belize.  7.1 Earthquake.  Very scary and so we made a video to make ourselves feel better.
  • Most Gringos per CapitaCuzco, Peru.  If Disney ever created an “Inca” land…this would be it.
  • Most Invasive Customs Check – Panama.  They even searched us leaving the country.
  • Most Exciting Thing Coming Up – Africa.  All of it!

Foodie Friday: Perrito Caliente

Sure, yesterday was thanksgiving and we made  it back to the States in time to celebrate but featuring turkey just doesn’t seem right to us, given that it is virtually impossible to find anywhere south of the border.  Instead, in honor of Turkey Day, we figured we’d offer our readers a taste of another USA treat.  One we know and love that just hasn’t been the same south of the border: the hot dog.

There is an expression sometimes uttered in Washington, that the two things you never want to see made: sausages and  laws.  I don’t disagree.  So we’ll skip the creation process of these encased little snacks and instead focus on the different varieties we’ve tasted.

Guatemala- the rather tasteless cheveres scared us a bit and we generally shied away.  Only available after dark on the street they always smelled a bit foul and the fixins were never particularly appetizing.

3734740979 44c0e6d4d5 Foodie Friday: Perrito CalienteColombia- we had our first taste of the South American version of the hot dog, where it was actually called a perrito caliente (little hot dog).  It was smothered in smashed up plantain or potato chips, doused with an army of sauces and covered with onions.  The chips were really what separated it from the NYC variety, that and that in Colombia the one we had was microwaved instead of flame cooked or boiled in water. 3949885923 62dbdf411a Foodie Friday: Perrito Caliente

Brazil- I don’t remember what they called it, but we ate it at a stand in Cuiaba. It was on a toasted bun with cheese, ham, hot dog, lettuce, ketchup, mayo, crunchie fries and tomato.  It was by far the greasiest piece of meat we’ve eaten in our entire lives.  We felt sick afterwards.3870087593 77517160c9 Foodie Friday: Perrito Caliente

Bolivia- Instead of just a hot dog, Bolivia is a fan of salchipapas (also common in Peru), cut up hot dog on french fries.  The hot dog isn’t the highlight, but with all that grease on one plate, it can’t taste bad.  Plus, they always had ketchup.  Yum.

Argentina- had in my opinion, the most fun with the hot dog called a Super Pancho4034185137 0c52779308 Foodie Friday: Perrito CalienteIn these the dog was usually about a foot long, if not longer, and didn’t come close to fitting inside the bun.  The number of sauces piled on top (ketchup, mustard, mayo, golf sauce) is rather unsettling and these are almost never sold in street side stands and instead are sold in small Super Pancho shops.  The best part is that like Colombia and Brazil, crunchy potato sticks are put all over the top.

4063394777 8d340721bf Foodie Friday: Perrito CalienteChile- very similar to Argentina except that the sauces we tried were all… unsettling.  Also called a pancho, and the one we tried in Santiago, well we did have video, but trust us you wouldn’t want to see it.

In truth though, nothing comes close to a good Sabrett or Hebrew National dog from a NYC vendor, covered in ketchup (a rarity anywhere but the USA) mustard, onions, relish, and maybe some onions and if you’re really lucky some chili sauce.  In fact, just thinking about the late night dogs we used to get in college from Manouch has me salivating.  Washington, D.C.’s specialty is the half-smoke, a plump and short spicy beef dog served on a plain bun or better yet at Ben’s served smothered in chili.  Since we 4137113207 0c42252cee Foodie Friday: Perrito Calientehaven’t been up to New York (or even Washington, DC) in awhile we had to ask a friend to fine one to enjoy for us…it wasn’t too difficult to convince him to do it though.

(Jill’s Editors Note: Danny was raised by a New Yorker, so he’s completely biased. This post is clearly wrong.  He has left our the best hot dog on the planet- the Chicago Char-Dog.  A char-broiled beef delight covered in ketchup, mustard, onions and kosher dill slices served on a poppy seed bun. Hmm… it just makes my mouth water. Anyone know where I can get one of these on the east coast before mid-december?)