Staying healthy during a dive trip should be our number one priority, right? So, how do we do that? In this installment, I will discuss some of the components to maintaining health. You can control many of the variables involved. Let’s get started! Where can you find information about disease prevalence in a country? The best place to start is the Centers for Disease Control website. Here, you will be able to search for the country you intend to visit. For example, I am going to the Netherlands Antilles, Bonaire in two months. Finding that location, the web page about the country lists topics such as “Preparing for your trip to … ,” “Vaccine Preventable Diseases,” “Items to Bring With You,” ‘Other Diseases Found in the Caribbean,” “Staying Healthy During Your Trip,” and “After You Return Home.” The message of the website is subtle but very simple, “Your health outside of the United States is your responsibility.” Common things happen … well … commonly. So, let’s talk about what items you should take with you, and how to reduce the risk of major illness. First, your personal safety. On the CDC website, there are travel notices in effect for a variety of countries. Heeding these notices for the part of the world where you will travel is important. Scanning the list of travel notices, I saw two that were important; dengue fever and typhoid. Dengue fever, like malaria, is a mosquito-borne illness. All of the islands in the Caribbean have Aedes aegypti mosquitoes that carry the disease. Most of us are concerned about mosquitoes that feed in the evening hours, not so with Aedes. This mosquito feeds during daylight hours! The best prevention is a DEET-containing mosquito repellent (at least 30-50%), and using it whenever going outside especially during daylight hours. Typhoid fever does occur in the Caribbean and vaccination is recommended. Even though you have been vaccinated, remember that this vaccine is only 50-80% effective and does not prevent paratyphoid infection (different organism and more benign course). The message here is to be careful about food and water. You do not need to worry about malaria on Bonaire. Food and water. On Bonaire, the risk of infestations and disease is minimal. All water sources on the island are from desalination plants. Milk is pasteurized and meat, fruit, and vegetables are safe to consume. The bottom line for Bonaire is routine hand washing and sanitary care should prevent travel-related diarrhea and other food and water illnesses. A great Internet source for this type of information is http://www.travmed.com. Health insurance. Your health insurance card is likely to do you no good on Bonaire, or outside the country for that matter. Your VISA, MasterCard, or American Express cards will be acceptable forms of payment for physician or hospital visits. In some countries, the health care system should be avoided. On Bonaire, excellent health care and a fine hospital can be found. In addition, should you need it, a state of the art hyperbaric medicine facility is located several miles from the dive resorts. That said, you should consider upgrading your DAN member insurance to the “Preferred” level. If you dive outside the country, DAN provides up to $10,000 coverage for non-dive accident insurance. Do it, and don’t regret it later. For more information about DAN, click here. Do you take daily medications? If so, take enough for the length of the trip and several days longer. In some countries, the pharmacies are relatively open. You can get many of your medications “over the counter.” Not so in Bonaire. If you take prescription medications, take a good supply with you. Because you are going through customs, unlabeled medications can be suspect so take the original bottles with you. Traveler’s diarrhea is not a problem in Bonaire, but it is a frequent problem when traveling out of the country. Here is a great article for your review. Prevention is much more important than treatment, so remember the rule of “P’s.” Food is safe if it is “peelable, packaged, purified, or piping hot.” Lacking these, don’t eat it. Chewing 2 Pepto Bismol tablets three times a day (at meals) and an additional two tablets in the evening is a good preventive measure. Your stools will turn black from the bismuth, but otherwise should not be a problem. If you do get Traveler’s diarrhea, consider one of 3 medications; 500mg of Cipro twice daily for three days, one Bactrim DS twice daily for 3 days, or a Z-pack. There are 2 concerns with Cipro that you should be aware of: 1) Skin photosensitivity leads to the potential for severe sunburn, and 2) risk of tendon rupture with that class of drugs. These are rare complications, but you should be aware that they exist. If you are allergic to sulfa drugs, then Cipro will be your best choice.

Sitting on the sand comes with a low risk of cutaneous larval migrans, which is a teeny-tiny worm burrowing under the skin. A word to the wise; sit on a towel or expose your nether parts to the sand at your own risk. Other diseases, such as HIV are epidemic in some Caribbean countries. Don’t even think about it. Finally, consider your individual propensity for things like motion sickness, ear barotraumas, loose dental appliances, vision, and hearing. Take what you need for routine care, and be sure to take an extra pair of glasses. It is time for me to conclude this installment and head to the health department for a typhoid vaccination. As always, should you have questions about health, diving, and travel medicine, send a message to Josh at Dive Addicts, and he will pass it on to me. Enjoy your trip! With proper preparation, you should have a great time! Eugene R. Worth, M.D.