Travel Article
From The Associated Press
HEADLINE:
Tourists Warned About Dangers of Malaria
BYLINE: JASMINA KUZMANOVIC, Associated Press Writer
DATELINE:
August 16, 1999, Monday, BC cycle - Singapore
SECTION: Travel
Bob brought home from the charming island of Bali a piece of coral, a batik
shirt - and a near-fatal case of malaria.
This kind of travel story often remains untold, as millions of tourists
from the
West are drawn every year to Southeast Asia's temples and mosques, exotic
jungles, coral reefs and white beaches.
But experts say many of these visitors, seeking a respite from their gray skies
and daily stress, are not fully aware of the health hazards that might be
lurking.
"I've seen a lot of ill judgment," says Dr. Paul Zakowich, a Singapore-based
U.S. internist and author of "Travel And Stay Healthy." His book was published
in 1996 in Singapore as part of the well-known "Culture Shock!" series for
travelers.
During his 16 years in this small, rich city-state, which offers some of the
best medical facilities in the region, Zakowich has helped manage numerous
medical evacuations within Southeast Asia. One was Bob, a U.S. college student
nearly killed by malaria while touring Indonesia.
Another patient Zakowich remembers is Ralph, a New Zealander who contracted
elephantiasis, a parasitic illness transmitted by mosquitoes. By the time Ralph
was brought from the island of Borneo to Singapore, Zakowich recalls, both his
legs and scrotum were swollen with growing larvae.
Zakowich himself was infected by dengue fever, another mosquito-borne illness,
while traveling in the Philippines several years ago. There is no cure or
vaccine for dengue, which sometimes can lead to hemorrhaging and even
death, but
most people, like Zakowich, recover.
"This sobering experience of being gravely ill on a remote and underdeveloped
island taught me a few hard-earned lessons," Zakowich recalls. "Keeping
mosquitoes away is one of them."
Of all mosquito-borne diseases in the tropics, malaria is the most dangerous.
The parasitic disease kills more than one million people every year, according
to the World Health Organization. Preventive anti-malarial medications are
available, but they sometimes have serious side-effects and do not always
work.
"While traveling in Asia, it is very important to know which areas have endemic
malaria," Zakowich says. "It's a judgment call. One has to weigh a risk of
side-effects against the risk of getting malaria."
While Bob, the young American Zakowich helped evacuate, was traveling in Bali,
one of the most famous and safest tourist destinations in Indonesia, he also
visited some of the less-safe nearby islands. And he failed to use any
anti-malarial medication, which must be taken on a strict multiweek regimen.
With revenues from Asia's tourism in the billions of dollars, it is little
wonder that many travel agencies are not eager to volunteer information about
the health risks in traveling abroad.
Ermgard Fill, at the Neckerman Travel Agency in Frankfurt, Germany, says health
warnings concerning malaria and other diseases are included in the agency's
brochures. But the agents don't personally warn the tourists.
In Singapore, several travel agencies that organize trips within the
region said
they do not dispense health warnings in their materials.
"We are dealing with mature travelers and, normally, they would find out on
their own," says May Ho of Travel Connections.
Newsman Travel, which also brings tourists from Europe and North America,
had no
health warnings about their upcoming package tour to Vietnam's Mekong Delta.
This beautiful estuary was recently hit by an outbreak of cholera, as well
as by
a particularly bad strain of dengue fever.
When asked if there is any health advice a tourist would need for a trip to
Mekong Delta, Newsman's agent Wendy Goh laughs. "What else is there to
know? No,
there are no health requirements."
"Nobody complained so far," an agent at Alisan Travel, which arranges package
tours to Bintan, an Indonesian luxury resort island near Singapore, known
for an
occasional malaria outbreak. Again, the agent gave no health warnings about the
trip.
Travel agencies should do more to inform their customers, Dr. Zakowich says.
"You can visit any place as long as you're aware of the health hazards," he
says. "A little common sense must be involved."
Most bugs that afflict humans in the tropics are not potentially lethal, but
they can ruin a holiday with travelers' diarrhea - which hits about a third of
the 20 million tourists who flock to developing countries each year. But the
risk can be lowered by following simple eating rules, Zakowich says.
"If you can't boil it, cook it or peel it, forget it," he says.
Zakowich was in a hurry. He had to see another patient, a European woman who
contracted a bad strain of malaria while back-packing in Sulawesi, Indonesia.
Like many others, she took no anti-malarial medications and mistook the first
symptoms of the disease for a flu.
By the time she was brought to Singapore, the parasite had spread to her brain,
liver and kidneys, leaving the woman comatose. Zakowich says her situation was
improving under treatment.
His final bit of advice: "Never feed the monkeys, they can be rabid."
---
INFORMATION: The U.S. State Department posts warnings about travel in certain
countries at the web site, or phone (202) 647-5225. The
Centers for Disease Control and Prevention in Atlanta has warnings about health
dangers at its web site.
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