Physical Preparation

Not Risk Free

Travel to an underdeveloped country like Haiti is not without inherent risk. Haiti currently has a state department warning against travel. Please understand and accept these personal risks before coming. You will be traveling to a country with few western amenities, a poor social support network, and marginal medical delivery system. Travel outside major cities is the common during AFH trips. Haiti is at risk for many environmental problems including earthquakes and hurricanes. Every problem that can be anticipated is addressed by AFH but much risk remains. The International guide to travel health states: “During a one month stay in an underdeveloped country, there is a 65-75% risk that a traveler will have some sort of illness or physical symptom. However the chance of being hospitalized will be less than 1%.”1

Prevention is Key

There are many ways to prevent any unseen complications. Here are a few recommendations

Cardiovascular Disease – People with preexisting heart disease is one of the biggest risk factors for people traveling to Haiti. If you have any history of a heart condition you should consider to consequences conferred by the significant stress of this travel and seek the advice of a personal physician/ cardiologists before leaving.
Know safe water sources – We will provide you with all needed water. Do not drink any water from any source without checking with the team leader. Bottled soft drinks are generally safe to drink.
Immunizations – There is no excuse for not obtaining proper vaccinations. This will prevent a large number of the disease that will be encountered on a daily basis in Haiti. The recommended vaccinations as listed by the CDC are included in this packet
Malaria Prevention – Malaria is a significant problem in many of the areas we travel in Haiti. Prevention is needed. see recommendations later in this article
Avoiding contact – Rabies is present in Haiti. It can be prevented by staying away from all non essential animal contact during your travel. HIV is a large problem also. Ensure your safety by using universal precautions in all clinical encounters.

Water Safety

Here are a few things to always keep in mind in while in Haiti:
– Tap water is always contaminated. Don’t drink it. Don’t brush your teeth with it.

– Ice cubes are contaminated, no matter how many times the waiter says they are made from bottled water.

– Stream water, no matter how clean it looks is always contaminated

– Taking antibiotics does NOT protect you from all gastrointestinal disease, you cannot eat and drink anything because you are taking antibiotics

Aid for Haiti will provide you drinking water while in Haiti. This water comes from multiple sources. Wells with filtration systems are employed. When traveling to remote villages a method of high grade filtration is used.

Mosquito and Malaria Safety

If you have an allergy to any bug bites, including bee stings, please let the team leader know. You are responsible to bring an Epipen for emergency treatment. Mosquito bites and the disease they carry are a very prevalent problem in Haiti. Many of the areas we travel to have very high rates of malaria. The type of malaria that exists in Haiti is easily treated with chloroquine, but causes a serious illness that is most dangerous to pregnant women and young children. To protect yourself use the shopping list:

DEET – Bug sprays with DEET work by creating a vapor barrier over the skin that prevents bugs from landing. For adults concentrations of 15-90% should be used. The higher the concentration the less often you have to reapply (30% preparation generally lasts 4-6 hours). DEET is safe in pregnant and nursing women. Remember, sun block must be applied BEFORE DEET. DEET works by creating a vapor barrier which is prevented by sunscreen that is placed on top of the DEET. Waiting 30-60 minutes after applying DEET is recommended.
Permethrin- Permethrin is a very effective insectacide that in non irratating and kills bugs within minutes of contact, even on surfaces that were sprayed 2 weeks before! It has no use on the skin because the body breaks it down within 15 minutes of contact. Permethrin can be applied to clothing and fabrics and it will bond to the fibers. It remains active on clothing for over a month through many washings!
Malaria Prevention – Malaria in Haiti remains susceptible to Chloroquine. The recommended prevention strategy is one dose of 500mg chloroquine phosphate per week starting 1-2 weeks before departure and continuing for 4 weeks after returning home. Please see your doctor to obtain this medication.

Sun Safety

In Haiti, the suns rays are much more intense than what is normally experienced in the US. To compensate, remember to bring appropriate sunscreen. Recommendations include a sunscreen with an APF of 30 and remember to reapply every two hours for proper protection.

Motion Sickness

During a trip to Haiti you can expect to be traveling along many twisting and turning roads. If you have a history of motion sickness preparation is in order. Here are some tips adapted and tested under extreme conditions such as you will experience in Haiti:

Religiously take your Dramamine. Take a pill one hour before you leave on each trip and every fours hours during a trip. Remember to bring the non drowsy version.
Try to sit in the front half of all vehicles and ensure proper ventilation
Bring along salted crackers to eat when taking medication and in between meals as not to let your stomach become overly empty. Avoid large meals on traveling days.
If you chronically suffer from this problem, have friend pray specifically for this aspect of the trip. Many find it the most beneficial things to do for prevention.

The Heat

During a trip to Haiti you can expect to be in high heat the entire time. The most effective way for our body to deal with heat is through sweating and evaporation. During levels of high work the body can lose up to 1.5 liters of fluid per hour. It has been shown that thirst is a poor indication of how much water the body needs. Thus, “all persons in the heat should be considered dehydrated, unless they have recently been forced to drink more water then they desired.” 4 To prevent this it is up to each person to keep well hydrated. Drink 2-4 cups of water before beginning any trip or strenuous work. Everyone will need at a minimum 3-4 quarts of water throughout the day. While on a hike, bring at least a liter of water with you and drink it throughout the journey. If you feel lightheaded at all stop, rest and let a team leader know.

Immunizations

The following are taken directly from the CDC for recommendations for all traveling to Haiti:

Routine immunizations – This includes being up to date with all routine childhood immunizations that are given in the US. Many of these diseases are common in Haiti.
a. MMR – Measles, Mumps, Rubella
b. DPT – Diphtheria, Pertussis, Tetanus c. Polio
Hepatitis A – A disease that is transmitted commonly through food and drink. It can cause a serious illness that can damage the liver.
Hepatitis B – causes a sever liver illness that can become chronic and lead to liver failure. This vaccine is now commonly given to all children and healthcare workers
Typhoid Fever – recommended for all travelers to Haiti, especially those going to rural areas during the rainy season.
Rabies – Recommended to all travelers to Haiti who will be spending time outside and hiking in rural environments.

Travel insurance

Travel insurance is available under the Volunteer Missionary Insurance of Adams & Associates. The coverage includes 24 hour medical assistance for accidents and sickness, medical expenses, emergency medical transportation to the United States from Haiti, and property loss or damage to your baggage. This coverage is inexpensive. This is over and above your team fare. You can enroll on-line. You can find Adams and Associates at http://www.aaintl.com

1. Rose SR: International Travel Health Guide. Travel Medicine INC., 2001

2. Gross, Harmut: Food and Drink Safety. Global Medical Missions, Winepress Publishing, 2007

3. Carroll, Jim: Motion Sickness, Global Medical Missions, Winepress Publishing, 2007 Winepress Publishing, 2007

4. Gaffin SL et al. Pathophysiology of Heat-Related Illnesses, Wilderness Medicine. 2001 Mosby, Inc