February 02, 2016
By Brian Irwin
Photographer Jim Klug, founder of Yellow Dog Flyfishing Adventures, was deep in the Bolivian jungle fishing for golden dorado. He was visiting Tsimane Lodge on Bolivia's Asunta River and was heading back there after a day of fishing. His guide was navigating a series of rapids when the push pole became stuck. As the boat moved, the pole bent until the guide could no longer hold it. It sprang lose, striking Klug in the right eye. He was knocked unconscious, and when he came to his senses he was blind in one eye.
Fortunately for Klug, he had medical evacuation insurance through Global Rescue. The next day, he was transferred to a local hospital, then on to Miami, and eventually to his home in Montana, where he was able to get the appropriate follow-up. Just a few weeks later he was back out fishing, and enjoying a full recovery largely thanks to rapid extraction and medical attention.
Preparation for international expeditions goes far beyond tying exotic patterns or packing an extra rod tip. The world is peppered with equally exotic infectious diseases, environmental hazards, and cultural barriers. So if you're planning on going for peacock bass or even bonefish, it's wise to think about your health and plan ahead so you can come home with great memories, not malaria.
Plan ahead. One of the first steps in planning a fishing expedition is to prepare for an emergency. Trip cancellation insurance won't cover elaborate extrication or complicated foreign medical care.
It's wise to arrange for a satellite phone and purchase medical evacuation insurance like Global Rescue. Not only can they provide over-the-phone medical support, but they can cover your expenses in the remote countryside and fly you home on a moment's notice, should that be needed. For travelers going to destinations where there's little in the way of medical infrastructure, this is one of the most important investments you can make in your health.
Get shot. Another early step in planning for an international expedition is to review your vaccine history. Anyone playing with hooks should have an up-to-date tetanus booster. Hepatitis A is a viral infection that can cause serious illness and even liver failure (rarely). It is a routine childhood vaccine today, but most adults are not immunized.
This disease is common in many parts of Asia, South America, and elsewhere in the tropics. A booster is advised.
Typhoid fever is not a common disease, but when outbreaks occur they can spread like wildfire and if you're caught amid the spread it can be fatal. Over 200,000 people die of typhoid each year, and considering it's prevalent in Central and South America where fly fishers do most of their fishing for peacock bass, dorado, and other jungle species, you should consider a vaccine before you go there.
Yellow fever is a potentially deadly disease transmitted by mosquito bites, and it's common everywhere you'd fish for peacock bass or tigerfish. Vaccination is mandatory for entry into some countries. Parts of Africa have seasonal meningitis outbreaks, so a vaccine can be lifesaving. Likewise, depending on your itinerary, rabies is yet another vaccine-preventable risk.
Don't get bit. Not every disease is preventable through vaccination. Some diseases, like malaria, are best prevented by avoiding insect bites. Malaria is one of the world's most deadly diseases and is prevalent in South America, Africa, and Southeast Asia. Vigilant use of DEET is a wise precaution, and Simms Bugstopper pants and long-sleeve shirts can greatly reduce the risk of malaria, not to mention eliminate the discomfort of itchy insect bites.
Simms also sells a Bugstopper hat, neck gaiter, gloves, and sun sleeves that are all UPF50 and treated with Insect Shield (insectshield.com). This stuff really works, and as a doctor I don't recommend traveling anywhere in the tropics without this level of protection from both the sun and biting insects.
Dengue fever is transmitted by mosquitoes, has been reported in over 100 countries, and is rampant in the tropics. While it may only cause a flu-like illness, it could cause a collapse of your blood clotting system.
Chikungunya is another similar disease that can be prevented by avoidance of mosquito bites. Like dengue, there is no preventative medication, nor treatment beyond supportive care.
Tick bites are common in North America, Asia, and Europe. Not only can they spread the infamous Lyme disease, but they also are the vector by which Rocky Mountain spotted fever is transmitted.
Get drugged. Even with DEET and Bugstopper clothing, mosquito bites are still possible, and just one can transmit malaria. Fortunately malaria can be effectively prevented by taking antibiotics during and after your trip. Anyone traveling to a malaria-endemic area should seek expert medical consultation to acquire the best medication for your destination.
There are other preventive medication options for other medical conditions. For example, antibiotics or even Pepto-Bismol can help prevent travelers' diarrhea and could be considered if your trip can absolutely not suffer a medical setback. These modalities aren't standard convention, as any use of medications carries the risk of side effects. For travelers' diarrhea preventative meds to be appropriate for you, the risks of the disease must outweigh the risks of the medications.
Don't get clot. Distant fishing expeditions often require sitting for long periods of time en route to your destination. This puts you at great risk for blood clots in your legs. The veins in your legs are not terribly elastic pipes, and they largely rely on compression from the muscles in your legs to squeeze blood back to your heart. But when you're stationary in an airplane seat, those muscles don't do much, and the blood can clot.
If a blood clot forms, it can break loose and migrate to your lungs. If a clot jams up there, it can kill you.
While prescription blood thinners are available, for most people, simply getting up and walking every hour is the best medicine. By doing so, your ambulatory muscles move the blood back out of the veins, keeping the flow going and preventing clots. While often recommended, aspirin has not been proven to prevent such clots.
Stay off the pot. The most common medical complication during international travel is accidents. However, arguably the most common infectious complication is travelers' diarrhea. This condition afflicts up to 70 percent of international travelers, depending on the destination. Unlike the common viral "stomach flu" that often circulates in the United States, most travelers' diarrhea is caused by bacteria. E. coli is a common offending agent, as is Campylobacter and an assortment of other pathogens.
Quite frequently travelers' diarrhea can be prevented by judicious caution when choosing your meals, eating cooked foods only, avoiding raw foods like salads, and drinking only treated, purified water. Even then, it's prudent to have a course of antibiotics on hand so you can self-treat should this occur. Ciprofloxacin is the most effective medication in South America and parts of Africa; azithromycin is the best choice for Southeast Asia and India.
Come prepared. Even expeditions that are organized by outfitters in the United States often use local guides and services at the destination. The depth of preparedness can be spotty, especially in third-world destinations. It is always a wise idea to carry your own comprehensive first-aid kit.
In addition to the aforementioned medications for malaria or diarrhea, your kit should include a supply of nonsteroidal anti-inflammatory drugs. Wound care materials can prevent infection in the case of a laceration. A set of tweezers can help you pluck off ticks before they can transmit disease, or help to remove a painful sliver or thorn.
One of the most commonly overlooked components of a first-aid kit is a small thimble of temporary dental filling. This inexpensive item can save your whole trip if you crack a tooth on the Kenai.
Watch what you eat. We're fishermen. And although (hopefully) most of us release all indigenous fish, the fact remains that fish are tasty. I have a hard time passing up blackened mahi mahi for dinner when I've been chasing tails on the flats all day.
Mahi mahi, however, can cause an allergic-like reaction known as scombroid if the fish is not stored or handled properly. The typical presentation is dizziness, flushing, and headache. Bonito, bluefish, and other species can also transmit scombroid, so ensure that your fish comes from a reputable place where you are reasonably sure it's been refrigerated correctly.
Ciguatera is yet another form of fish-transmitted food poisoning. Predators that eat smaller fish (barracuda is the most notorious fish for transmitting ciguatera) harbor high levels of toxins and can transmit them to you when you dine. Nausea, vomiting, and even neurologic symptoms like peculiar sensations or even hallucinations can occur. Barracuda is delicious but incredibly risky.
Seek expert opinion. Planning for an exotic international fly-fishing trip can be complicated, but the result is usually a healthy, stress-free, and successful adventure. The best way to get started is with a formal consultation with a travel medicine doctor. The International Society of Travel Medicine has a list of providers and their locations at istm.org.
In addition to a consultation with a medical provider, you can research the basic risks and recommendations for your destination at cdc.gov/travel. This website has a broad collection of information that can help prepare you for the most memorable experience of your angling career.
Brian Irwin (brianirwinmedia.com) is a family physician and holds a Certificate of Travel Health from the International Society of Travel Medicine. He is a freelance writer, outdoor photographer, and frequently travels abroad to Belize and other international locations. He lives in Madison, New Hampshire.