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Before You Visit The Third World


Personal Business: TRAVEL

BEFORE YOU VISIT THE THIRD WORLD

If you're going to France, your biggest concern may be finding good restaurants where you can eat without taking out a second mortgage. If your destination is Uganda, as mine is, your chief concern may be: "How will I make it back alive?"

As a freelancer planning to report on the political situation there, I already know the water system is dubious, and the chances of getting diarrhea are about 10 in 10. There are active cases of malaria, cholera, and meningitis, a risk of yellow fever, and an AIDS epidemic. Plus, the State Dept. warns of "intermittent bandit and rebel activity."

To arm myself against this array of troubles, I visited the Tropical Medicine & International Travelers Clinic at the Yale University School of Medicine. It cost $125 for the consultation and about $100 extra for shots and lab tests. The clinic is one of about 70 around the country that specialize in travel immunizations. For a list, send a self-addressed 8 1/2- by 11-inch envelope with 98 in postage to Dr. Leonard C. Marcus, Travelers' Health & Immunization Service, 148 Highland Ave., Newton, Mass., 02165. Or call your state department of public health or the nearest major medical school for a local reference.

The clinics give you one-stop shopping for pretrip medical advice and shots, and they'll treat you if you return with a medical problem. They're recommended for anyone traveling to Third World countries, South and Central AMerica, or anyplace where you can be exposed to so-called exotic diseases. Many of the clinic doctors are members of the American Society of Tropical Medicine & Hygiene, which sponsors professional seminars and provides up-to-date information to physicians.

After my first visit to the Yale facility, I went home with two sore arms -- one from yello-fever and diphtheria-tetanus shots and the other from cholera vaccine. (I'll get a meningocal one on a second visit.) I also received an oral polio booster, along with a folder of general information on traveler's ailments and a State Dept. update on conditions in Uganda. Plus, I picked up a portable water purifier for $49.95, a handful of prescriptions, and a head full of advice form the clinic's co-director, Dr. Frank J. Bia.

BAD BITES. In addition to the obvious, such as trying to avoid getting a blood tranfusion in Uganda -- or Kenya or Egypt, also on my itinerary -- I got a minilecture on maleria.

The potentially fatal disease is on the rise again because of a worldwide ban on certain environmentally hazardous insecticides. There's no vaccine for maleria, but medications help prevent it. Chloroquine was used for years, but many malaria parasites are now resistant to it, so I got a prescription for Mefloquine, a new medication. To avoid mosquito bites in the first place, Bria suggested that I wear long-sleeved, dull-colored shirts and use an insect repellent that contains diethyl-m-toluamide (DEET) as its active ingredient.

As for cholera, he told me there's some controversy about giving a cholera series, since it's only 50% effective. But the injections are required for entry into Uganda. The best preventive is carefully watching food and water intake -- one reason I bought the water purifier. Another is avoiding diarrhea. But in case I do get it, I will be armed with prescription Imodium to help the gastrointestional tract and an antibiotic that knocks out a broad range of bacteria. I was further warned not to wade in fresh water, where might get the chronic parasitic disease schistosomiasis (formerly known as bilharziasis), which is released by snails.

Sure, the potential for disease is daunting. But I keep reminding myself that Winston Churchill, after seeing the mountains and lakes of Uganda, called the country the "pearl of AFrica." And if I pick up an unwelcome bug along the way, I know where I can go for help when I get home.SOME CLINICS FOR OVERSEAS TRAVELERS

ALBERT EINSTEIN COLLEGE OF MEDICINE Montefiore Medical Center, Bronx, N.Y., Dr.

Murray Whittner, 718

430-2059

INTERNATIONAL TRAVEL WELL CLINIC Travelers Medical Center, Emory University

School of Medicine, Atlanta 404 686-5885

TRAVELERS' HEALTHCARE CENTER Division of Geographic Medicine, Case Western

Reserve University, Cleveland, Ohio, 216 368-3496

TRAVELER'S MEDICAL SERVICE OF WASHINGTON Washington, D.C., 202 466-8109

UCLA TRAVEL AND TROPICAL MEDICINE CLINIC Division of Infectious Diseases, UCLA

Medical Center, Los Angeles 310 206-7663

UCSF TRAVELER'S CLINIC University of California, San Francisco 415 476-5787

DATA: BW

Barbara Carlson EDITED BY AMY DUNKIN


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