Countdown to departure for Uganda: T-32 days

Vaccinations … Check!

I’ve done enough traveling outside the US not to be terribly nervous about going again, even to a new place. Granted, most of the places I’ve been have been more affluent and/or westernized than Uganda, but not all. The Philippines (particularly where we were) and parts of Israel and Eastern Europe are examples. But logistically, I’m used to travel. I already had a current passport. I’ve applied for Visas. I can pack efficiently for long absences without laundry services. I’ve dealt with language barriers, extremely foreign food, severe jet lag, power adapters, etc. I know how O’Hare works, even the extra rigmarole of international travel. And so forth.

What I didn’t know anything about, prior to beginning to plan for this trip, was the disease prevention side of the equation. I knew I needed a yellow fever vaccination and anti-malarial medication, because those requirements were explicitly stated when I signed up for the trip. But other than that, this has been a bit of a “figure it out” kind of adventure. So, I thought I’d share…

Checked in with the CDC

I started my research on CDC’s Uganda travel page. “If you’re going somewhere,” I was told, “always start with the CDC’s recommendations for how to go there safely.” They were right. The page was packed with useful data, and the folks at the CDC even did a pretty good job being concise. Still, I found it a bit overwhelming. My immediate thought was, “How can ALL this be required?!” So, printed out the page and started making rounds talking to people I trusted to get a real plan together.

Checked in with my wife, the nurse

First, I consulted my amazing nurse wife. Not everyone is blessed like I am with a nurse in their house, but I highly recommend it. If not marrying one, at least establish a friendship with a nurse (or doctor, I guess). She will know 100x more than you or I will about diseases and drugs, and it’s super-helpful to be able to just talk through planning with her.

(PS – Even if she’s not a nurse, always ask your wife. Law of nature; what can I say?)

Checked in with my doctor

Second, I consulted my doctor (to whom I am clearly not married). To cover all bases, I scheduled a general physical with our (new since moving) general practitioner, and warned him when I made the appointment that I would  be going to Uganda and wanted to update my general vaccinations. If I thought *I* covered all the bases, it was nothing compared to him. He worked me over. No, I mean he really worked me over. Everything I even so much as mentioned about my past earned me some sort of test or exam to get a baseline, update my records, etc. I loved his thoroughness. Well, most of it at least. Let’s just say that I’m a guy and I’m too close to age 50 to be safe from … um … certain unpleasantness in the presence of a doctor as thorough as mine seems to be. Sigh. #GettingOldIsntForTheFaintOfHeart

At any rate, he brought me up-to-date on the standard vaccines, which I thought I’d list here for those who (like me) are a bit clueless about this stuff. Here’s what the docs wanted me to be walking around with. Obviously, I’m no doctor, so don’t do ANYTHING because you read it here. I thought this article was helpful, but what really matters is what your doctor says to do, not WebMD and certainly not me. Did I mention that I’m not a doctor?

Anyway, hopefully this is helpful…

1. Diphtheria, tetanus, and whooping cough (pertussis). This is the TDaP (or DTaP) vaccine. This has to be updated every 10 years, so write it down somewhere and keep it current. (Read more)
2. Measles, mumps and rubella. Tis is the MMR vaccine.Your medial history should list this. If you’re unsure that you got it as a child, you can get a booster. (Read more)
3. Hepatitis A and B (Read more)
4. Chickenpox. I had theses severely as a kid, so nothing had to be done. If you haven’t had the chickenpox, you’re at risk for shingles, and ain’t nobody got time for that. (Read more)

As it turns out, my records didn’t indicate whether or not I’d been vaccinated for MMR, so the doc ordered a blood test to discover if I had the “MMR titers” to indicate I was properly inoculated. So, I fasted that night, came back in the morning, they did the blood test in literally 10 minutes, and I had the results back 2 days later. Positive. I’m all good.

So, my doctor got all that done lickety-split (two visit; couple days; no fuss, no muss), but in the middle of my initial visit I realized that the two things that were actually required for my trip weren’t on the doc’s list: yellow fever and malaria. I asked him, and he informs me, “We don’t do that.”

Jeff: “Excuse me?”

Doc: “We don’t do that.”

Jeff: “Well, you’re my doctor, so if you can’t make me a yellow fever and malaria fighting machine, then who can?”

Doc: [as if everyone knows this and I’m a little on the slow side] “You have to go to the travel clinic!”

Jeff: “Huh?” [proving I’m a little on the slow side]

Doc: “A travel clinic is where you go to get all the stuff you need to travel abroad that I, as a real doctor who worries about every day medical needs of families in this town, don’t focus on.”

Alrighty then. Next step…

Checked in with the Travel Clinic

Turns out there are travel clinics all over the place. They’re privately owned, staffed with nurse practitioners (or equiv) who can give you shots and write prescriptions, and exist solely for the purpose of helping people like me travel to places like Uganda. Cool!

The big company out there (admittedly, I did very little research) is Passport Health. Preparing people for travel abroad is a primary line of business, and they evidently have hundreds of clinics, and not just in the US. They dominated the headlines (the first page) of my google searching, there was one between my house and school, and I was able to apply online. So they won the coin toss. The two things I had to do to prepare for my visit were: a) fill out a three-page, far-less-painful-than-I-expected-it-to-be personal health history, and b) snag a copy of my general vaccinations history from my general doctor, and I was off to the races.

I found the Travel Clinic in a medical office park in a light commercial area (all that SimCity as a kid helps me to classify these things so clearly now for your benefit), on the second floor of what felt a bit like a converted private residence. I walked into the office, thinking it was a waiting room, and evidently barged right into the middle of an in-flight consultation. That was weird!  The whole thing gave me a not-too-professional vibe. But after waiting outside the door for a bit, I was waved in and we got down to it. The only person I met in the whole process was a female registered nurse who had prepared a personalized “health and safety plan” for me. It was a pretty beefy document, and she walked me through lots of possibilities and options. I could get this vaccination and that medication, this lotion and that spray, etc. On and on it went. And because, as we already established, I’m a little slow, it took me awhile to realize that each and every one of these things was something she could sell me.

The office visit itself was $75, which wasn’t the end of the world. And the yellow fever vaccine, which was mandatory, was $195. Ouch. So, they were into me for $270 the second I walked in the door. Next was the anti-malarial medication. There were three options, some daily and some weekly options, all at various prices per dose, which had to be taken for varying lengths of time, and which had varying side effects. Joy! I was hoping for, “Take this pill and you’re good for a year” or something, but … um … no. More like, take this pill for a week before, every day during, and 40 days after. It costs $10 per pill. And it will make you hallucinate.

Jeff: “Excuse me?”

Nurse: “I said, it’ll make you have crazy dreams and possibly even hallucinate.”

Jeff: “What if I do a missions trip to Indiana instead?”

In all seriousness, there were several options. I had no clue, but I had to pick one. And she only carried one of the options in-house: the expensive one. So, I clearly needed to shop around. I told her I wanted to check prices at my wife’s hospital (nurses rock!), so she wrote me a script for the expensive meds which I could get filled anywhere, and we closed that topic.

But then, she starts in on all the other meds and shots I could buy. I could buy special lotions or sprays for my clothes or nets to sleep under … all to ward off deadly malaria-infested (or worse) insects. I could get vaccinated for everything from Typhoid to Cholera to Polio, and myriad other prophylactic drugs were available. I even asked if she had anything for my baldness. The best was a $20/dose twice/day take-it-before-during-and-after anti-viral drug. That would have been $500 by itself. I could literally have spent thousands if I’d wanted to.

I didn’t.

So, I left with the basics — yellow fever vaccine and a script for Malarone, the nurse’s recommended anti-malarial med. Plus, I had decided that I clearly needed to consult a few people who weren’t making a living on my vaccination and drug choices.

Oh, one more thing though, before we move on. Upon receiving my yellow fever vaccination, the travel clinic gave me this bad boy (to the right) as proof of my yellow fever vaccine. I then filled out the rest of my vaccination history info in here, so now I have a complete, passport-sized record of everything. NOTE: I had to submit this with my passport to get the visa I needed to make the trip.

Checked in with my team

I going to Uganda with a team of about 20, some of whom had been there before — even multiple times. So, they know way more than I do. When I asked them about the food, the bugs, the myriad vaccines, the preventative pills, and the anti-baldness treatments, the pretty much said not to worry about any of it. Where we’re going to be, the food will be safe — very low probability of ordering a Typhoid salad — and you just need to make common sense choices about insect repellent, not drinking the water, etc. So, looks like I won’t be going back for $2,500 worth of extra shots. Whew!

They also recommended that I switch from Malarone to Doxycycline for anti-malarial medication, which I did. On the plus side, it’s much cheaper (than Malarone), and they all agreed that the side effects are manageable. On the minus side, I’ll have to take it longer when I get back, and it still presents at least a chance of fun dreams or even hallucinations. But the best / my favorite potential side effect is that you sunburn easily.

Jeff: *dumbfounded wide-eyed look of disbelief*

So … I’m German and English (and French, but we don’t talk about that much in our family), which means light hair (what’s left of it) and fair skin. I’m going to a desert city located like 3 miles from the equator, and I’m going to be taking a daily drug that makes me sunburn more easily? Are you kidding me?!

Well, always an adventure, I guess. I’ll just order some liquid sweatshirt — something around 10,000 SPF or so, and a really cool (at least I imagine Faith will think so … ha!) safari hat like this one.

Then I should be good, right?

Checked in with my pharmacy

Okay, last step…

The travel clinic peeps called my new script for Doxycycline into Walgreens. Turned out to be $25 for 28 tablets — way better than Malarone was going to be. And I walked into the store with my script for Azithromycin in hand. This is the only other drug besides Advil that I’ve purchased (or plan to purchase) for this trip. It’s the break-glass-in-case-of-Montezuma’s-Revenge 3-day z-pack. It was $7, and I thought well worth it … just in case.

Walgreens had it in stock, filled it in 15 minutes, and already had my Doxycycline waiting. They even texted me when my order was ready to go. The whole thing was super easy and convenient, and now I’m ready to rock and roll.

Okay, that’s a wrap!

I think that about covers the meds and vaccinations. Now it’s time to shop for the rest of the stuff I’ll need to take along, including the hat. Woot! I’m sure I’ll write about that soon. If you think there’s something specific I should make sure I take along, comment on it below. I’d love to benefit from your experience.

Thanks for being on this journey with me!

Image / Photo Credit:
1) Vaccination – Sydney Morning Herald
2) Doctor – Shutterstock
3) Travel Clinic – Healthy Gallatin
4) Int’l Vaccination Form – TripAdvisor
5) Safari hat – Zetaboards
6) Vaccination Baby – KEWO Science