Traveler’s diarrhea (TD) is the most common infectious disease affecting international travelers. The vast majority of these cases are caused by bacteria, with viruses and parasites accounting for about 20% of cases. This disease can be effectively prevented and treated, if it strikes.

Are You Prepared?

Boil it, Cook it, Peel it or Forget it has been standard advice to travelers to reduce risk of TD. While we endorse this common sense strategy, surprisingly, there is little evidence supporting it in medical journals. In fact, there is only 1 medical study that concludes that being careful with food and beverages can reduce your chance of developing traveler’s diarrhea. Nevertheless, this recommendation makes sense. Keep in mind that we physicians commonly offer medical advice that we believe is sound, but may not be proven scientifically. For many medical conditions, proof that our advice is correct may be 15-20 years away, and we need to advise patients today.

New Developments in Traveler’s Diarrhea

• Some TD strains are now resistant to standard antibiotics. Your travel doctor will review your destinations and will prescribe the proper medicines to you.
• TD can develop into a chronic condition called irritable bowel syndrome, when diarrhea and cramps may become a permanent part of your life. Consider this when you are faced with food and beverage choices abroad.
• Active research for a travel vaccine against traveler’s diarrhea is ongoing, but we’re not there yet.
• Which of the following options would you prefer?
• Prevent TD altogether
• Treat it with medication when it occurs to shorten the illness
• Eat, drink, be merry and sprint several times a day to rest rooms and pray that you never encounter a sign that reads, Occupied!

Montezuma has had his revenge with travelers for too long. It’s time for traveler’s to take revenge on him. Our advice? Eat, drink and be careful!

Michael Kirsch, M.D. is a full time practicing physician and author. He is one of the founders of Travel Clinics of America, a national network of physicians that provides international travelers with expert travel advice and vaccinations in their own communities.  Before you travel, visit www.travelclinicsofamerica.com

Crime is a reality of life even on your trip abroad.  Many travelers who are caught up in the moment of an overseas adventure or vacation, let down their guard.  Savvy travelers know that, from the moment the plane touches down, they need to be more vigilant about their personal safety and belongings.  You may be far away from your familiar safety zone.  You need to have both eyes open.

It’s easy for natives to spot tourists as they wander through foreign cities with shopping bags and cameras dangling from their wrists.  Tourists are a high value targets for those who ‘earn a living’ off them.   Pickpockets and travel scammers spend their time trying to separate travelers from their cash & merchandise.  Travelers must be alert and cautious.  Don’t give up any personal  ‘souvenirs’ to local pickpockets.

Here are some travel safety tips.  Some seem obvious, but travelers often forget to pack common sense.

• Avoid wandering through unfamiliar territory alone.
• Never accept an invitation from a person you don’t know who offers you hospitality, a personal tour of the area, a drink, etc.  Be cautious about communicating personal information to friendly strangers.
• Don’t dress flashy.  This is a neon sign that you are a potential victim.
• Travel in legitimate taxis and agree on the fare in advance.  If you demonstrate that you are totally clueless about local currency, then look for dollar signs in the cabbie’s eyes.
• Be wary of pre-paying for local events from hawkers on the street, or even standing at the event location.  The ‘discount’ may end up being a donation into the scammer’s pocket.
• Are your pocket contents vulnerable?  Quick hands in crowded places can find out.  Keep your wallet and camera secure.  It’s wise not to keep large sums of $$$ in one pocket or in one place.
• Consider travel insurance that covers loss of money and personal property.  If you have trip cancellation insurance, does the policy cover wallet and credit card loss?
• Keep a photocopy of important travel documents, credit card numbers and airline ticket information in a safe place.
• Make sure that someone knows your daily itinerary.
• Have a cell phone with you at all times.
• Have phone numbers and contact information for law enforcement and the local U.S. diplomatic offices.
• Stay alert and follow your instincts.  If something doesn’t feel right, then don’t do it or don’t go there.

Speak with your travel doctor about crime avoidance.  Research your destinations to determine if there are any specific safety concerns there.  Be cautious. Be alert. Be safe.

Michael Kirsch, M.D. is a full time practicing physician and author. He is one of the founders of Travel Clinics of America, a national network of physicians that provides international travelers with expert travel advice and vaccinations in their own communities.  Before you travel, visit www.travelclinicsofamerica.com

The film documents the Massai people in Kenya and their struggle with conservation laws who have now become spokespeople for community-based conservation and the benefits they are able to reap in effect.  According to a recent update in April 2009, the establishment of Il Ngwesi Group Ranch  has provided the community with enough income to contribute to projects such as: “an HIV/ Aids program that has employed 17 people from the community, a training project to improve the quality and market-access for women’s handicrafts, upgrades to roads and the landing strip, an elephant fence around the school, renovation of teachers’ housing, a mobile bank, a new sinkhole and water pipeline repairs. “

Check out the trailer we featured in 2007 or visit their website to view other trailers and learn more about community development through conservation and other sustainable initiatives.

Happy New Year! I have two weeks to go in the Land of Blue Skies, and my research on agricultural policy and food security is done. Mongolia has an uncertain future that I’m afraid will not be all pleasant, but growing pains are probably unavoidable. I think the Western-educated younger leaders of the body politic place an increasing importance on free markets and rights-based political decision-making, while still maintaining communist-influenced traditional management of natural resources. It remains to be seen whether this will be sustainable, but I think it is a good sign. And while I understand the reasoning, I think Mongolia’s insistence on becoming domestically sustainable in food production is a waste of resources. I expect that priority will shift soon, but probably not before Russia loosens its stranglehold.

It’s brutally cold as we settle into the second of the nines. Rumor has it, vodka is indeed freezing (though not on my balcony). There are 81 days of winter in Mongolia, divided into 9 sets of 9. Each set has a distinct characteristic; in the second, double distilled mare’s milk or yogurt (arkhi) freezes. The upside is that I no longer have to do temperature conversions in my head (at -40, Fahrenheit and Celsius converge). The downside is that I can’t breathe.

The air in the city is unbearable. Estimates say that it is 20 times worse in the winter than the summer; 7 times worse in the ger districts than the southern part of city center. The attached picture is of the central square on New Year’s Eve, taken from the 17th floor of the Central Tower (home to Louis Vuitton and Hugo Boss). Contrary to what it looks like, it was actually taken through an open window (as an aside, standing next to an open window 17 floors up in a sleeveless dress in Mongolian winter is not to be advised), and not a dirty one. There are people standing on the square who of course cannot be seen. At least you can see the fireworks.

This weekend, I’ll be shivering in a ger, and hoping that my fire-building skills are up to par, with only the anticipation of 2 months in Kerala and Borneo to keep me warm. But while it will be cold, I will at least be able to breathe fresh air. Not a bad way to begin the new year.

China is a magnet for tourists, students and businessmen.  The Beijing Olympic Games in 2008 showed the world that China is prominently on the world stage.  Millions from all over the world visit China every year.  It offers an unparallelled adventure in the eastern hemisphere. In China, ancient treasures are juxtaposed against modern skylines and architecture.  There are world class hotels and cuisine in the same country where ancient Chinese medicine is practiced.  It is a very safe destination with a low crime rate.

China is no longer an enigma.  Americans are traveling there in increasing numbers.  Business ties between the countries are strengthening.  Many American high school students are studying the Chinese language.  Study abroad programs in China are flourishing.

Travelers to China face health risks.  Many of these illnesses can be prevented or effectively treated, if the traveler is prepared and has received essential travel vaccinations. Tourists, businessmen and travelers returning to China to visit friends and relatives (VFRs) should consult with a travel doctor several weeks before departure for travel vaccinations and travel safety tips. VFRs returning to their birth countries often wrongly believe that they are still immune to local diseases, but this is not the case. If they travel without travel vaccinations and other preventive health measures, they face unneccessary risks of preventable illnesses. Consult a travel doctor weeks before departure.

Travelers to China Need:

Routine Vaccinations

• Seasonal Influenza (routine ‘flu shot’)
• Chicken pox MMR (measles/mumps/rubella)
• DPT (Diphtheria/Pertussis/Tetanus)
• Rotovirus (for children)
• Poliomyelitis (if unvaccinated)

Required Vaccinations

• Yellow fever (if you are traveling from certain countries)

Recommended Vaccinations

• Typhoid
• Hepatitis
• Rabies (depending upon your itinerary)
• Japanese encephalitis (for rural travelers)
• Poliomyelitis (adults may need a booster)

Some diseases present in China have no available travel vaccines,  such as malaria, dengue and schistosomiasis.  Your travel doctor can give you important tips on minimizing your risk of contracting these diseases.

Your adventure in China is waiting.  Travel safe.

Michael Kirsch, M.D. is a full time practicing physician and author. He is one of the founders of Travel Clinics of America, a national network of physicians that provides international travelers with expert travel advice and vaccinations in their own communities.  Before you travel, visit www.travelclinicsofamerica.com.

Being landlocked and difficult to reach has made Mongolia an attractive destination for the adventure traveler. The thrill is part the novelty of visiting a place that few will ever see, and part the motivation and guts it takes to visit such a “non-touristy” destination: it’s a challenge. It is entirely possible to travel in luxury throughout Mongolia – several tour companies provide that service. But the fun and adventure is in exploring new places on your own, and Mongolia is the perfect place for the traveler looking for more than just sightseeing and beaten paths.

There are must-see sights- from Genghis Khan’s ancient capital to prehistoric rock carvings. But the beauty of travel in Mongolia is not the seeing, but the doing. The amazing variety of landscape and terrain offers surprises and adventure, and is best experienced not from inside a van, but on the back of a horse or camel. Fresh fish in the rivers tastes amazing over an open fire, and even more so when you catch and skin them yourselves. And nowadays, the far reaches of the west and north can be reached via plane or helicopter, but the points in between are not to be missed either.

Summertime is the high season for tourism, and the climate is ideal. Much of the country is high and dry, so even when the temperatures start climbing it is rarely uncomfortable (which is good news, because traveling in the countryside generally means foregoing daily showers). Even in the Gobi, summertime is not unbearable, but the best place to experience this time of year is in the north or the central regions, when rivers are high, and the grass is green. Rushing rivers makes for excellent fishing (and tasty lunch), and are also ideal for rafting or kayaking. After a few days’ rain, the rapids can be swift, so, for the avid whitewater fan, rafting can be quite the adventure.

As the weather cools, the rivers slow, and often freeze clear to the bottom, making winter travel more accessible than many other cold climates. It is also, of course, the ideal time for ice fishing. In February, the Ice Festival plays host to an international ice fishing competition, when competitors hike out onto Lake Hovsgol and attempt to catch the largest fish. Winter is also ideal for huddling around the stove in the ger, as temperatures dip far below freezing. But it’s also a great time to go dog sledding and, as the first official ski resort opens this winter, even snowboarding.

Until then, however, avid boarders can visit the Gobi, where the sand dunes rise to 200-300 meters, and try their hand at sandboarding. The hike up is quick, and the journey down even quicker, and the sand will remind you of the softest fresh powder. Sandboarding isn’t the only exciting activity in the Gobi. which boasts an attraction seen nowhere else in the world – the Bactrian camel. Bactrian camels have two humps and, in cold weather, an incredible amount of hair. Camel herders in the Gobi use their animals for milk, transport, leisure, and very occasionally food. A camel trek in the Gobi is an exciting adventure, often taking the traveler far away from already being in the middle of nowhere. Camels are slightly more comfortable than horses, which of course, are the popular mode of transport in Mongolia (after motorized vehicles, of course).

In Mongolia, even the typical road trip becomes an experience when the road becomes nothing more than dirt tracks winding through enormous empty spaces. The numerous mountain ranges offers opportunities for intrepid climbers, mountain bikers, and backpackers. Mongolia is an open campground, and only the sky is the limit.  I recommend it to any adventure traveler!

Planning a weekend getaway to Gabon?  Tourism to this central African nation is on the rise in recent years, as the government works to cultivate the travel market.   This coastal country offers tourists white sandy beaches, fishing and ocean attractions, tropical rainforests and are 13 national parks.  and numerous Planning a weekend getaway to Gabon?  Tourism to this central African nation is on the rise in recent years, as the government works to cultivate the travel market.   This coastal country offers tourists white sandy beaches, fishing and ocean attractions, tropical rainforests and are 13 national parks.  and numerous

Travelers should consult with a travel doctors several weeks before departure to discuss necessary vaccinations and other important safety advice.

You should be up to date on all routine vaccinations, such as tetanus, measles/mumps/rubells (MMR) etc.

Travelers to Gabon may need the following vaccines:

• Yellow fever
• Hepatitis A
• Hepatitis B
• Typhoid
• Rabies
• Polio
• Diphtheria
• Meningitis

You may not need all of these vaccines, depending upon your specific itinerary and length of stay.  Malaria prophylaxis is essential as this disease is present throughout the country.  This strain of malaria is resistant to chloroquine, so a different medication will be prescribed.  Reducing exposure to mosquitos is essential with skin and clothing repellants.

Unfortunately, there’s not a vaccine for every disease lurking in Gabon.  Travelers are at risk for dengue, schistosomiasis and other parasites.  Your travel doctor can give you specific tips on how to stay clear of these microscopic threats.

If you become ill after you return, make sure to advise your doctor of your travel history.  Malaria can develop in returning travelers up to a year after you return.  So, if you develop fever, do not take 2 aspirin and call your doctor in the morning.  Call your travel doctor right away.

While security is a traveler’s paramount priority during a West Bank visit, preserving health is an important concern also.  Travelers to the Middle East may need the following travel vaccinations:

• Hepatitis A
• Hepatitis B
• Routine vaccinations

West Bank travelers are not at risk for yellow fever or malaria.

See your travel doctor several weeks before departure.  Disease patterns can change and your travel physician will be current on evolving health issues in the Middle East.  Remember, there is no travel vaccination against poor judgment.  West Bank visitors should take a double dose of common sense every morning.

Michael Kirsch, M.D. is a full time practicing physician and author. He is one of the founders of Travel Clinics of America, a national company which provides international travelers with expert travel advice and vaccinations in their own communities.  Before you travel, visit www.travelclinicsofamerica.com.

Details of the President’s initiative have been developing since he initially announced it, but the core of his offer still stands. Compared to the alternative of offering the forests up to extractive industries for quick monetary gains, the impact for the world could be huge. According to Conservation International, the burning and clearing of tropical forests emits at least one-fifth of total greenhouse gases that cause climate change; more than all of the world’s cars, trucks and airplanes combined.

President Jagdeo has said he hopes his offer will help “create incentives to reward the conservation of existing forest and support our communities with new economic development alternatives for the 21^st century.”

One such emerging form of economic development surrounding the world’s remaining tropical forests is ecosystem services, which can be divided into four categories: Supporting (nutrient cycling, soil formation); Provisioning (food, freshwater, wood, fiber); Regulating (climate regulation, flood control, water purification); and Cultural (aesthetic, spiritual, educational).

In 2008, Guyana’s Iwokrama International Centre for Rainforest Conservation and Development – a million-acre rainforest reserve located in the heart of the Guiana Shield that is used for research, ecotourism, and sustainable forest management – and the UK investment house Canopy Capital announced a deal that is laying the groundwork of a system that will allow financial markets to price the ‘utility value’ of rainforests through their ecosystem services.

While international economists and climate change leaders discuss new business opportunities surrounding the preservation of rainforests, Guyana is also keeping its eyes on further developing one sector that is already a well-known money-generating ecosystem service: ecotourism. Outside of extractive industries, tourism by its very nature is one of the most environment-dependent industries. Of course not all tourism is done in a sustainable manner, but more travelers are choosing their destination based on its eco or sustainable tourism options. And within Guyana, the draws for tourists are many.

Besides the rainforests, which includes part of the Guiana Shield – 2.5 million square kilometers that is the world’s largest remaining tract of mostly undisturbed rainforest – there are exotic mangroves, wild coastal swamps, rugged Atlantic beaches, lofty mountain ranges and sprawling savannas that are as inspiring in their vastness as the rainforests are for their claustrophobia-inducing density.

Pristine ecosystems and a remarkable diversity of flora and fauna (including many species that are threatened and endangered elsewhere – jaguars, harpy eagles, giant anteaters, and giant river otters among them) that includes more than 225 species of mammals, 880 species of reptiles and amphibians, 815 species of birds and 6,500 species of plants. Guyana also has welcoming Amerindian communities, unpretentious ecolodges, some of the world’s best Neotropical birdwatching, and an emerging catch-and-release fishing sector.

With a population of roughly 760,000 people that are mostly clustered along the Atlantic coast – a mere five percent of the landmass – Guyana’s 83,000 square miles (comparable in size to Idaho) are virtually unpopulated and undeveloped. Guyana is essentially one of the world’s most unspoiled natural wilderness areas.

Guyana is also becoming recognized for a growing community tourism movement. Several of Guyana’s Amerindian villages, especially in the Rupununi Savanna, have been at the forefront of developing sustainable tourism products. By bringing ecotourism into their communities, it encourages locals to conserve and protect their natural lands and heritage. It also provides alternate employment options to more environmentally damaging (and common) jobs in areas such as logging, mining and the wildlife trade.

Surama, an idyllic village set amongst an enticing mix of savanna and jungle covered mountains, has long been the role model for community tourism in Guyana. The Surama Eco-Lodge and their tourism ethos and products – village tours, birdwatching trips, mountain treks, jungle walks, dugout canoe trips, wildlife spotting – were recently named the 2009 Responsible Tourism Showcase Honoree by the Educational Travel Community.

The recognition is deserved. The Surama Eco-Lodge and all tours in and around Surama are managed and operated solely by the local Makushi Amerindians. Of the village’s population of 300, more than 70 are employed through tourism. About 60 percent of the community’s income is now sustainably generated through tourism-related activities, with 75 percent of village households reporting tourism as a source of income. For Amerindian villages like Surama, and Guyana in general, tourism couldn’t be economically feasible without the rainforests.

President Jagdeo is currently heralding what is possibly the largest-ever carbon offset program in an effort to preserve Guyana’s forests while still allowing for economic growth in Guyana. People around the world are beginning to listen to Guyana’s forests, and tourism can be their voice. Through ecotourism, people can speak of the forest’s biodiversity, its cultures, its indigenous inhabitants, its ecosystem services, and the current efforts that are being implemented to preserve them.

Developing countries with remaining forests that can be used to fight climate change are very few, mainly because history has shown that the market will always win. The monetary gains that can be realized by razing forests for timber, farm lands or for valuable minerals is a powerful force. Guyana is in a unique position to change this and become a leader in a new business opportunity that creates revenues while focusing on a greater good for everybody, including adventurous travelers.

For more information on tourism in Guyana, visit www.guyanabirding.com and www.guyana-tourism.com.

Kirk Smock is the author of the Guyana guidebook published by Bradt Travel Guides, and Senior Writer for the Guyana Sustainable Tourism Initiative, a joint project of the Guyana Tourism Authority and the United States Agency for International Development/Guyana Trade and Investment Support project.

Learn more about the hiking tour here or call Boundless Journeys at 800-941-8010.