My battle plan

In nine days, Steve and I will depart on the longest trip of our lives: seven weeks in India, a week and a half in Sri Lanka, and a few days of South Korea and Japan (in transit). As I’ve planned the arrangements, the question I’ve been asked most is: aren’t you afraid of getting sick?

My answer (a bit of a dodge) is that I’ve done my best to prepare us for fending off germs. They’re likely to get at us in three main ways:

Breathed out by other people

Starting more than a dozen years ago, when we began traveling to more adventurous destinations, we’ve been vaccinated against a bunch of infectious diseases, including yellow fever, typhoid, polio, meningitis, hepatitis (A and B), tetanus, diphtheria, whooping cough, and flu. Steve is a Kaiser patient, and when he called their excellent travel clinic back in August, the nurse confirmed that he (and I) have already been immunized against everything that people in India are likely to spread to us by breathing. Relief!

The bad news, however, is that illness spreads in other ways, including…

Via mosquito

Mosquitos in India transmit several nasty diseases, including yellow fever (for which we’ve had the vaccine) and several for which no effective vaccine exists (chikungunya, dengue, Zika). Japanese encephalitis also exists on the sub-continent and can kill people, but there IS a vaccine that works well against it. The nurse told Steve our chances of getting Japanese encephalitis are low since we won’t be spending months out in the countryside. But the vaccine is safe, and Kaiser could provide it at no charge (to him). He rolled up his sleeve, and apart from some transient soreness, suffered no ill effects.

Unlike Steve, I have no coverage for travel medicine. I must pay out of my own pocket for any shots or pills I get in preparation for any trip. When I inquired at a local travel-medicine clinic about protection against Japanese encephalitis, the news was stunning. The vaccine would cost $403 per shot, and two shots would be required. The clinic-visit fee would add another $65 to the total.

Since we’re spending three nights in South Korea en route to India, it occurred to me to research travel clinics there. I quickly found one with a good reputation, where I can get a single-dose version of the Japanese encephalitis vaccine for just $63 (instead of the $868 it would cost me in Mission Valley). I’ve made an appointment to visit that place, in Seoul, a week from Friday. There both of us also are hoping to obtain a reasonably priced vaccine against a scourge that attacks along the third major route…

Eating or drinking contaminated food or water

Although we were immunized against typhoid years ago, in India cholera poses another danger, one reportedly on the rise. For some reason, the cholera vaccine was unavailable from Kaiser, however. Instead the nurse simply warned Steve to be careful about what he eats and drinks.

I learned that my Mission Valley travel clinic could administer a cholera vaccine (by injection) for a mere $295. But the travel clinic in Seoul sells an oral version, taken in two doses a week apart, for about $64. Dukoral, as this version is called, was approved by the European Union in 2004 and is available over the counter in Canada. The World Health Organization has judged it to be safe and effective. It supposedly protects not only against cholera but also traveler’s diarrhea. That sounds good to us, so Steve will get it too.

India also has the fourth-highest number of malaria cases and deaths in the world, so we’ll be taking anti-malarial pills every day. Kaiser told Steve doxycycline should work well there. That was good news. We’ve taken it before, and the only obnoxious thing about it is that you have to continue on it for 30 days after you’ve left the affected region. Steve’s 80-day supply from Kaiser cost about $40, and my doctor didn’t make me come in for an appointment but instead kindly called in a similar prescription to CVS. To my shock, the cashier there told me my 80-day supply would cost $189. Suspecting that a different formulation might be cheaper, I asked if they could make the switch. When they did, the same number of almost-identical pills cost $2.20.

Our preparations won’t end there. This weekend, we’ll spray most of our clothes with (mosquito-repelling) Permethrin.

We’ve bought two tubes of time-release bug repellant that’s more than 30% DEET, and we’re assuming we’ll be able to buy more in India once we run out.

To further protect our guts, we’ve also resolved to each take two tablets of Pepto-Bismol with breakfast, lunch, and dinner every single day. (The evidence that this can help protect against traveler’s diarrhea convinced me.) After intensive online shopping, I got 24 boxes of 30 tablets for $77 from Target.)

360 Pepto-Bismol tablets actually don’t take up much space

We won’t pack the UV water purifier that we bought years ago for some African trip; it turned out to be a pain in the neck, and we never trusted it. But after reading about how even bottled water in India can sometimes be contaminated, I did buy tiny bottles of iodine pills and taste neutralizer. If we never use them, at least we’re only out about $10 and a couple of square inches of suitcase space.

Of course, cars and traffic also kill a lot of people in India. Unfortunately, as far as I can tell, only vigilance provides some immunity against getting hurt that way.