100 Days to Rwanda: Health, Vaccinations, Insurance… Bleargh

Kid_VaccinationOh, boy. This one is a biggie. The “Heart of Darkness” is of course also the “Heart of Nastiness.” Ebola, typhoid, yellow fever, bilharzia, gorilla cooties – you name it, people will claim you can catch it in the jungle just by breathing the air. Or not. I mean, really: 98 percent of this stuff can be avoided with some basic common sense precautions. That ice cream cart on the lakefront? Yeah, we’ll pass, thank you very much. The lunch buffet at the local restaurant? Nope, not happening. Simple smarts: no ice in your drinks, ever never – unless you’ve made the cubes yourself from filtered water. And even then… No fruit you can’t peel right before you eat it. No fish, unless it was squirming on a hook a second before it’s cooked. The cute little monkey hanging out on your window sill in the morning? Just wave, don’t try to pet him, ‘mkay, honey? When in doubt, wash your hands. Yes, Purell is your new best friend.

But when all that is said and done, you’re still going to get shots for that off-chance of something nasty getting to you. You really, really don’t want to get any of the diseases that are so bad they’ve cooked up a vaccine for it that needs to live in a fridge and gets a stamp in your official WHO vaccination “passport.”

Now, in our case, Lisa is going to be hanging around a hospital all day, I’m going to be traveling to Burundi and the D.R. Congo, and Lea is going to be spending a lot of time at a riding stable in the hills outside Kigali where the risk of rabies is certainly a threat. (No, horses probably don’t catch rabies that often – but the dogs and squirrels and who-knows-what-else hanging out in the hay loft do). So we’re just going to order up the works, thank you very much.

Unfortunately, they can’t simply throw it all in the blender and give you one giant shot with the cocktail from hell. No, it’s pin cushion time. Big time. A rabies series alone consists of 3-5 shots given over a few weeks (which I just don’t get: our dog receives ONE single rabies shot every three years and is then protected, even though she’s much more likely to catch rabies than I am. So. Not. Fair.) Then there’s the alphabet soup of Hepatitis variations, yellow fever (they won’t even let you travel to most countries in Africa without proof of a yellow fever shot), encephalitis, typhoid — it’s like a medieval spa menu. This part is tough for the kids; Lea in particular hates all things needles and she drew a huge sigh of relief when they came out with the nasal spray influenza vaccine a few years ago. No such option for yellow fever and all the rest of them. Prepare the bribes/rewards, then call your local travel clinic, tell them where you’re going and what you’ll be doing, and they’ll draw you up a package. And remember to check your schedule for the weeks during which you’re in vaccine mode – you’ll need to stick to the schedule and can’t very well be out of town when you’re supposed to be getting round XXXIV of your shots.

All this injectable fun could also get quite pricey, so check if the employer that is sending you overseas is willing to cover this part of the preparations. After all, it’s in their best interest that you and your family not get sick while you’re there.

Then there are the preventative drugs, specifically: malaria prophylaxis. My wife works in infectious disease and knows more about options for malaria prevention than most, and even she is unsure about what we should do. But I’m going to let Lisa decide this one for us and simply follow her lead, taking whatever pill she slips me at breakfast (trust – the true meaning of love).When we worked in Tanzania well over 10 years ago the flavor of the month was Larium, a nasty little drug with some ugly side effects (so bad that most people bagged it after a few months, consequently going with little or no protection at all, or started doing little chasers of valium to keep the paranoid delusions and nightmares at bay). Today the hip money is on Malarone, which has fewer side effects and recently went generic, thus becoming almost affordable for long-term use. It’s a tablet a day, so when four of us are going for six months that’s an entire suitcase full of friggin’ pills right there…

If you don’t have your own in-house infectious disease doctor, this is one issue that will require some thought for anyone going anywhere with any significant malaria risk. Read up on the particular risks of the country you’re staying in, and discuss your options with your travel clinic doctor.

Insurance & Emergencies (and day-to-day care)

Don’t assume for a minute that your overpriced Kaiser-Blue-Cigna-Athem high deductible mismanaged care insurance plan will cover your anywhere outside of your own zip code. In some parts of Europe, you’re likely to get most of your treatment free of charge – socialized medicine and all that. Marvel at that for a minute, if you will. But a medical emergency in a village near the equator? You better be damn sure you have real coverage for that, up to and including some kind of Medivac option if things get really ugly. That goes for Europeans, too: once you leave your home country, your state-run health care comes to an abrupt end, and you’ll need medical insurance.

If you’re going for long enough, you need to think about preventative care, too. Taking any kind of medication on a regular basis will require a little planning: either you bring enough for the duration of your stay (and be sure to carry documentation that’ll allow you to get a bulk portion of it into the country), or be sure you can get re-supplied along the way. If you’ve got kids with orthodontics in their future, you may need to plan this carefully: they need to be seen at least every six weeks, so the braces may have to wait until you get back (or the trip wait until they’ve come off).

Don’t forget to figure out what you’re doing with all your insurance back home as well (more on that in the next installment). One question that I’m dreading to ask our insurance guy is this: will our life insurance policies cover us while we’re away? After all, they were drawn up on the assumption that we were going to living our boring, safe lives in little ol’ Vermont where obese people only exist on TV and our local cops spend their time teaching senior citizens about online fraud prevention. We’re meant to live forever, but now suddenly we’re in downtown Kigali, and perhaps there’s a disclaimer about that somewhere in the policy…