Ebola, Missions, & Missionaries in Uganda
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Signs of a Medical Emergency
Travel to any third world country should not be undertaken without due consideration of health risks. Travel to Uganda is no exception. The group I work with, The Africa Christian Training Institute has been working in Uganda since 1983 and has developed a protocol for dealing with health issues that has proven both safe and effective. The goal is to minimize the risks of illness among team members while in Uganda. I like to think of this approach to health issues, immunizations, proper sanitation, safety consciousness, and a general knowledge of potential risks, to all be weapons in the war against accident and illness. No army would want to take only one weapon to the battlefield and we should not approach health issues in a "one size fits all" mind set. We want to use all the weapons at our disposal. The purpose of this section is to give a summary of what those weapons are.
PLEASE NOTE: Much information circulates on the Internet that can easily alarm an individual and produce fears of all the many things that "could happen." You can read all kinds of horror stories of illness and reactions to medications that frankly, we have not seen occur in thirty years of ministry with hundreds of individuals making trips to Uganda with our groups. On the other hand, consider this true story from a team in 2011. A team coming to Uganda for four months had read on the Internet that anti-malarials can be harmful to the liver. So collectively, they took nothing. Once in Uganda, one of their team members became infected with malaria and died. A very sad outcome.
We recommend immunization against meningitis, yet the per 100,000 population risk for meningitis was actually higher in Florida than it was in Uganda in 2005. Yet many find it such a "great health risk" to travel to Uganda but think nothing of visiting Florida. Fact is, there are risks everywhere, you simply need to know what precautions you need to take wherever you are going.
You are encouraged to follow the links below to helpful information and then consult your personal physician and/or health department to determine what is best for you in the light of your own medical history. Please understand the risks are real, but so are the precautions that can be taken. The following quote appeared on the Travel Africa News Group in January of 2002:
Subject: Increase in tropical diseases in Britain
From: Patricia A
The British government has announced that there are increasing numbers of travelers returning home from "exotic" holidays with various diseases. It seems that people may not be aware that they should seek
advice on the inoculations they require and also ignore some of the advice they are given. For instance malaria prophylactics should not only be taken in the holiday resorts but continued on the travelers return. Swimming in lakes and rivers can result in Bilharzia, care should be taken with food and bottled water should be drunk....
YOUR MEDICAL HISTORYTravel Folder
If you have a special medical condition, special medication, or a medical history of seizures, allergic reactions, etc. that are "uncommon," it is absolutely essential that others traveling with you are aware of the condition and what to do for you in an emergency. In Uganda, your companions can't dial 911, they are 911. If you wear a "Medic Alert" bracelet or other similar device, the retrieval in Uganda of relevant information from a database in the US or UK might be very difficult. Therefore, I strongly recommend that you take the time to write out such information on paper and put one copy with your travel documents and give your team leader a second copy sealed in an envelope with instructions to open in an emergency. Additionally, it would be wise to have your doctor briefly explain your situation, medication, and any suggested maintenance protocol on his/her letterhead stationery and include this with your documents as well.
As always, the purpose is not to alarm but to encourage those who travel to Uganda to be informed and adequately prepared for ministry. We want to avoid losing ministry time in dealing with circumstances that could have been prevented or at least prepared for. You should also consult the U. S. State Department Medical Information on the Web and CDC Health Information for Uganda.
Health Issues |
Health Issues |
One only needs to make a short visit to any public restroom in the United States to realize that general sanitation has become the task of the individual. Small foil wrapped towelettes are available for cleaning your hands as well as surfaces in which you skin comes in contact. A number of antibacterial products are also available that allow you to "wash" your hands without water. Most team members have found the towelettes and hand wash products to be helpful.
International travelers must take any and all prescription medications they might need with them on the trip. Never assume you will be able to find such medications abroad, especially in a third world setting. Prescription medications should be kept in the container in which they were dispensed which lists the name of the doctor, the pharmacy, the name of the medication, the dosage and that it was prescribed for you. If you take any medication that is considered a "controlled substance" (e.g. a narcotic pain reliever), then it MUST be in a container that clearly identifies what it is, that it is prescribed for you, and that the quantity you have with you is commensurate what you might need based on the length of your trip. If there is anything unusual about your medicine/medical condition, it would be wise to have your doctor briefly explain the situation and suggested maintenance protocol on his/her letterhead stationery.
Keep your prescription medications in your carry-on luggage or a fanny pack or purse. It is wise to take a quantity to cover the entire time of your travel plus several days after your planned return in the event weather or some other factor delays your return. If you have prescription medications that come in high count bottles, ask your pharmacist to provide you with a smaller container (properly labeled) that lists all the vital information on the medication but takes up less room in your luggage.
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Avoiding Stress |
You should take the common over-the-counter medications you have found effective. Even if you find you have a very infrequent need for over-the-counter medications, it is wise to take them with you as it is a mistake to assume you could find such items in Uganda should you need them. There are a number of such things I take with me and then leave them with my Ugandan hosts on the last day as I start to leave.
The following list is intended as a general example of the type items others have taken (or wish they had) and found useful. Your own past need of such items and your experience with various over-the-counter medications will be your best guide.
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Travel Check List |
- Pain and fever reducers - aspirin, naproxen, acetaminophen, etc.
- Sun screen and lip moisturizer - if you are sensitive to the sun
- An antihistamine - such as Allegra®, Benadryl®, Claritin®
- A decongestant - such as Contact®, Sudafed®, etc.
- Cough drops, throat lozenges
- Eye drops, ear drops, nose drops or spray
- Loperamide tablets (Immodium®)see section on diarrhea
- Topical steroid (hydrocortisone 10%) - such Calamine lotion for skin rash and insect stings
- Other over the counter meds that are effective for you
First Aid Kit
It is recommended that each team member carry with them a personal First Aid Kit. A small Ziploc® "snack" bag is ideal. It should contain several regular bandages, two of the extra large size, and a small container of generic Neosporin Ointment® (Neomy Sulf/Bacitra/Polymyxin B). This will enable you to properly and immediately care for an open wound. Additionally, you should carry some Benadryl®, and your favorite pain reliever (aspirin or acetaminophen). I carry one of these with me at all times as you never know when it will be needed.
You should also include in this kit a couple of sterile syringes and alcohol pads. Should you need an emergency injection, there would be clean and safe syringes available. Thankfully, no ACTI team members have ever needed such an injection, but I still think it is very wise to be prepared.
See also prescription medications and over the counter medications as well.
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Travel Check List |
Safe bottled drinking water is widely available in Uganda. Should you visit an area where you cannot find the bottled water, your Ugandan hosts will gladly provide you with clean, safe, boiled water. I have found that the Ugandans will go out of their way to see that our team member's needs are met. I recommend taking at least three of the 500ml bottles of spring water with you each morning when your team heads out for the day. This will make certain you have water for the day. Our teams typically buy a case of bottled water and keep it in our van so we know we have adequate water. No matter where you buy bottled water, do not drink it if the safety ring of the plastic cap is broken. In addition to water, you may find yourself drinking hot tea several times each day and bottled soft drinks (Coke®, Pepsi®, etc.,) are available but not always cold.
On my second trip in 1994 I purchased a Pur® hand operated water purifier. I took it to Uganda with me in 94 and again in 1995 but never used it. The presence of safe bottled water is a far better option. I have not taken it sense. I consider giving it to a Ugandan family but realized they would not have access to the consumable parts of the filter system and in time it would become ineffective and actually give the family a false sense of safe water.
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Travel Check List |
In all my trips to Uganda I have always eaten with my Ugandan hosts and I have never become ill from something I have eaten, but I know others who have. One must consider the implications of not eating what your host offers and how that might impact your ability to minister to a people you are unwilling to eat with. Most Ugandans are very poor and the food the place before is often at great sacrifice. To refuse what they offer is hurtful. Usually children eat after the adults so you need to mix the conflicting goals of eating what you are offered while leaving enough for the kids. I follow a few simply rules.
CDC Info on Food, Water & Safety
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- Always be thankful for what God provides and ask Him to bless it and make it safe. Remember, people get food poisoning every day in the United States so this is not just a "third world" problem
- Wash your hands before eating. Most hosts in Uganda provide warm water and soap both before and after a meal. (I let my hands "air dry.") Take and use one of the antibacterial Hand Sanitizers when soap and water are not available. I put the 1/2 ounce travel size in my fanny pack and store the 4 ounce size in my bags to refill the travel size with.
- Know who prepared the food. Items prepared and served by our Ugandan hosts have proven to be safe, in fact, they go out of their way to make certain things are adequately prepared for visiting teams
- Eat and drink only items in which you have confidence in the source (here I am talking about food items offered at bus and taxi stops where you will be surrounded by young lads selling bottled water, soft drinks, cooked chicken and beef on a stick, peanuts, muffins, etc.)
- Fruits with skins (bananas, oranges, etc.) are safe as long as you peel them yourself or you know your host peeled them. Their fresh pineapple is the best I have ever eaten!
- Most travel sites recommend against eating salads since lettuce
- Bottled soft drinks and water (hot or cold) are safe as long as the caps and safety seals do not show signs of being previously opened. There are reports that empty water bottles are sometimes refilled with unsafe water and resold but I have never encountered this myself. (Note: Remember to use bottled water when brushing your teeth and keep your mouth closed when taking a shower. It is wise to take some anti-septic mouth wash to rinse you mouth with after a shower)
- Hot tea and coffee are safe as they are made with boiled water.
- Some frequent travelers recommend taking a single chewable Pepto Bismol® tablet (Bismuth Subsalicylate) just before eating to help minimize stomach upset.
- I take one of the 18 ounce containers of the instant mix Gatorade®. You can mix two scoops in a standard half liter of bottled water and you have a good tasting beneficial beverage, especially after a long hot day.
Diarrhea & Sick Stomach
One of the most common illnesses that travelers the world over experience is travelers diarrhea. The change in water and diet and the stress of travel all contribute to this condition. Immodium® (Loperamide HCL) is very effective in treating diarrhea. It is available in 2 mg tablets and in liquid form, both-over-the counter. The tablets are preferred while traveling.
A word of caution is in order. Sometimes diarrhea results from the ingesting of contaminated food, beverage, or an organism that results in an intestinal infection. The resultant diarrhea is the bodies way of expelling the contamination. In such a case, the diarrhea is just a symptom and to attempt to teat the symptom without dealing with the contamination is not wise. You run the risk of stopping your bodies natural defense of expelling the contamination which is a serious danger. Generally, this type diarrhea is also accompanied by vomiting as well and this is a good sign you have more than travelers diarrhea.
In this case, in addition to Immodium®, the very effective antibiotic Cipro® (Ciprofloxacin HCl) is administered. You should discuss this issue with your physician so that you understand the difference between the two types of diarrhea. This will make certain you understand the proper circumstances under which to take the Cipro®.
Many regular travelers recommend taking a single chewable tablet form of Pepto Bismol® (Bismuth Subsalicylate) just before the trip and before each meal which coats the lining of the stomach and helps prevent stomach upset and diarrhea. Ask your physician's advice about this as well.
Sick Stomach I suggest each of our team members take one or two cans of chicken-noddle soup so if someone becomes ill, we have something with us they are familiar with for them eat when they begin to recover. I also buy a six pack of Ensure® and split it among our team members. If one of our team members is ill for several days we have something with us that needs no preparation but provides effective nourishment. If these items are not needed (and we have only needed the soup once and that was in Guatemala) I leave them behind in Uganda to help someone else. In fact, I leave behind everything I can, including over-the-counter medications, etc.
Snacks Most of our team members also take along some candies and their favorite snacks. This is fine but if you eat them in front of Ugandans, you should share with them.
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In a growing number of areas in Uganda, a western style hot shower is available. In other areas, your Ugandan hosts will provide a plastic pan with two or three gallons of warm water for bathing. You will want to have your own soap, (keep soap in Ziploc® bag) bath cloth and towel plus a small plastic cup to dip the water with. Use the cup to wet the bath cloth and soap for bathing. After you have lathered yourself with soap, washed you hair, etc., then use the cup to rise off the soap and shampoo. If you put a soapy bath cloth in your pan of water, you will then have rinse yourself off with soapy water.
Remember to keep your mouth closed when showering as the safety of the shower water is uncertain. In fact, I take the antiseptic mouth wash Dr. Tichenor's® and rinse my mouth after each shower. Dr. Tichenor's® comes in concentrated form so it is less weight and volume in your luggage. Once in Uganda, I take a standard half liter of bottled water, drink a little of the water, then add 2 ounces of Dr. Tichenor's® and I have enough antiseptic mouthwash for several showers and after brushing my teeth. The 8 ounce bottle of concentrate is typically enough for a trip with nearly three weeks on the ground in Uganda. You can find Dr. Kichenor's® at WalMart® Walgreens®. and online at Amazon®.
You can also take a hot EN ROUTE SHOWER at major airports. There are public showers at both Heathrow an Gatwick Airports in London that are free. For a small fee they will provide you with a towel. At Schipol Airport in Amsterdam they charge a fee to use the shower but provide soap, shampoo, and a towel. At Entebbe there are hot showers in the departure area. Since most of my travels have been through London, I save old towels at home that are ready for the rag bin and take several of them with me. I pack a couple in my carry-on en route to London, use them upon arrival in London and then discard them so I do not have wet items in my bag from London to Entebbe. I do the same thing in London on the way back home. I have never made the trip through Brussels, but I assume they would have showers as well.
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Health, Travel, & Medical Evacuation Insurance
You must check with your own insurance agent concerning any limitation your present health insurance coverage might impose on overseas travel. Some policies exclude coverage outside the United States or provide restrictions on treatment options. If your company does impose restrictions, the purchase of an overseas rider may be all that is necessary. In either case, I would have them send you a written statement of overseas coverage.
Even if your health insurance provides coverage outside the US, you should seriously consider the purchase of an overseas travelers policy that provide emergency medical evacuation by air. This one benefit is worth the small fee you pay. While no ACTI team member has ever needed air evacuation, it just makes sense to have it. The cost is based on the length of the trip and the age group of the individual. You can search the Internet for such companies. ACTI uses Good Neighbor Insurance of Gilbert, Arizona.
In most cases, the medical air evacuation coverage does not fly the sick or injured person back to their home, but only to the nearest competent medical facility.
You should also take a copy of your health insurance DOCUMENTATION with you. This is another of those items I make a hard copy (photocopy) of as well as scanned copies of all relevant documents into a file that I leave on my computer desktop. In this way, a family member back home can fax or email whatever I need. See section under home travel folder. I have never actually had to have anything sent to me, but it is prudent to know it can easily be done in case of need.
A business traveler from my home town was injured in Peru and her firm had a membership in MedJet Assistance, and had a very positive experience in her medical evacuation back to our local hospital. So far I have not felt the need to join this service, but you are certainly welcome view their website or call them at 800-963-3538. Other medical transport services I have been made aware of (but never had need to use) are Pilots for Christ, and the Air Care Alliance which has an extensive list of mercy ministry type flight services in many U.S. states.
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