Niece to spend time in Bolivia this fall

Paramedic Pete (and anyone else with solid info) - one of my college kid nieces is going to Bolivia in September. The rough itinerary is:

8 weeks
home stay in Cochabamba (9,000 feet, major city) there may not be running water or electricity all of the day

4 weeks
wherever, doing her research and data analysis

5 days
rural work stay with indigenous native speakers of Quechua where there will be no
running water

Excursions to (and staying at hotels, cabins and bed and breakfast, and if the big city doesn't always have running water, I doubt if some of all of these rural outposts will have running water):

La Paz ans Lake Titicaca (13,000 feet altiplano)
Sucre and Southern Highlands
Santa Cruz (low land semi tropical) and
Bolivian Amazon

Bolivia is not Ecuador and so forth, but any general (or specific) tips/advice? And/or do you have any acquaintances who have recently spent time in Bolivia I could talk to?

I know the usual sources of information and so forth; am looking for reliable first-hand tips.

PM me if you prefer or leave it as an open discussion.

Aside - I'm about to have paramedic #2 son and #1 son is no. 2 on the hire list for the Fire Department. Yay!

Regards,

Tom

Hmm, I reckon some places it ain't easy being christian either.

Back when I was in the Navy, I recall some pretty harsh times abroad. I wonder if I can sue them because they didn't tell me life could be tough away from home???

I bet there's some kids in Compton California that wouldn't be anymore traumatized by such treatment than they already have been. Then again, they didn't have a choice in the matter, so I suppose that makes it different.

Not that I'm saying the exchange program isn't at fault, but the boy survived, and maybe learned a thing or two about how the rest of the world really works. Might be some value in that.

Then again, if it were my kids, I reckon I'd be on the next flight to Cairo looking for some payback.

Hi AyersTG

Your niece may need some time acclimatising to the altitude, by spending a few days at say 4000, 6000, 8000 feet each and watching out for mountain altitude sickness (AMS)

http://en.wikipedia.org/wiki/Altitude_sickness

Going straight to 9000 feet can sometimes present problems especially if your neice has never been in high mountains areas.

Ingnoring the warnig signs for AMS can sometimes be fatal.

I can't help you with info on Bolivia, sorry But welcome back! Long time no hear from...

The things I would make certain to bring; immodium -- a bunch of it, water treatment whether chemical or otherwise -- a few straws might be nice, antifungal creams -- my sister once came home with ring worm, antibiotic ointments, and some plain old antibiotics.

I have been quite lucky in my travels throughout Ecuador in terms of not becoming significantly ill. My family and I have gotten the stomach and associated aliments for maybe a day or two after visiting some of the more remote rural areas. A few doses of Pepto-Bismol, Citrucel and some yogurt or lactobacillus tablets were generally sufficient to reestablish intestinal stability. Once or twice I resorted to anti-diarrhea medication, so far I have not had to resort to any antibiotics (usually CIPRO). I did get sick real bad one time, but that was due to motion sickness while riding in the back of a bus along the curvy and rough roads prevalent throughout the country, so having some motion sickness medications might prove helpful. She should bring and use hand sanitizer often. She should bring her own first aid supplies and may consider purchasing a kit which has needles, syringes, sutures and other sterile medical supplies, that can be hard to come by in many areas.

Quito, is around 10,00 ft and no matter how fit one is (my daughters 18-22 yo were at the time, competitive swimmers and still had as much problem as their old unfit dad) or is not, the altitude can have a profound effect on your ability to function. Climbing stairs/hills cannot only make you winded, but you muscles will burn and headaches may be common. For us, it is hard to acclimate to the altitude, as we will often leave for the coast (sea level) or other low-lying areas for a few days and then return Quito. You can get DIAMOX, which works by increasing respiration rates and can offset some of the signs and symptoms of mild altitude sickness, but for severe altitude sickness (pulmonary edema) the only easy remedy is to get to a lower altitude.

For water purification or beverages, stick to bottled/canned soda, boiled water (not bottled, unless it is sealed and a major brand) or use some type of purification system. I have and use the Katadyn Exstream Purifier Water Bottle most of the time, as it provides a ready source of drinking water (and for brushing one’s teeth) without being too insulting to our hosts. If, I belive the circumstances warrants not using the water bottle, I will either ask for tea/coffee or bottled/canned soda –no ice (Coke products are widely available, even in some of the smaller towns). I also bring an MSR ceramic filter, Steri-Pen and MIOX and use these as needed, mostly to produce larger quantities of clean water or for others to drink or for medical applications.

I avoid fresh vegetables and salads whenever possible and try and eat only fruits with a peel (plantains, bananas, oranges, mangos, papaya, etc,) although I have been known to eat a washed apple. She might want to bring snacks to munch on and to make friends by sharing.

Make sure to get all of the vaccines (yellow fever, Hep A, typhoid, etc.) recommend in enough time for them to be effective. I also take anti-malaria medication, use insect repellent (if I remember) and sun block (I received a severe case of sun burn on the top of my bald head during my first trip). Mosquitoes are not a problem in the higher elevations, but if she travels, she needs to consider being prepared.

As to safety, we have been very fortunate, in that we for the most part we travel with native Ecuadorians, although we have been placed on the bus a couple of times alone, but so far without any problems. For the most part wherever we travel in-county, we are accompanied with someone who speaks Spanish fluently and in most of the smaller towns and villages, we are treated as honored guests/family and the residents keep a close eye out for our safety. We have had a few near “incidents” where things could have gotten dicey, but local intervention kept things to minor inconveniences. The roads are terrible and very dangerous, especially in the mountains – no guardrails (several thousand foot drop), narrow (it is nothing for them to pass two-three deep including buses and trucks on a narrow-windy road) and in many areas washed out or non-existent. Pedestrians have no right-of-way, be very careful crossing busy streets. Adherence to red lights is spotty at best.

I generally, do not bring anything I would be sorry to lose; I have a cheap Timex watch, distribute my money (do not bring traveler’s checks), they are useless, even in the bigger cities and found only one bank in all of Quito that would even cash them) into several wallets and have a “throw-away” wallet with a few dollars to surrender if needed. We are lucky, in that Ecuador uses the US Dollar as legal tender, so no conversions, although I understand the new president has considered going back to the Sucre (sp?). Ecuador mints it’s own coinage, but also uses US coinage, so even their coinage is standard with US coinage (pennies, dimes, nickels and quarters) and also like the US coin dollar, since it lasts so much longer then paper money. Small bills are preferred, so mostly $1s, $5s and $10s. Twenties can be a problem. Even though, she is not going to Ecuador, I suggest smaller Bolivian bills and coins. We take a chance with our cameras and so far have been lucky. We carry large quantities of medical/rescue/fire equipment and supplies and again have been very lucky, I think once people find out we are providing medical/rescue care and training, they take extra care to make sure we are okay. Still I am very cautious in the bus terminals and areas where the locals really don’t know who we are and why we are there.

I make several copies of my passport, drivers license, airline tickets and in-country contact information and distribute these copies throughout my luggage. I also carry my Paramedic license, and since I was made a formal member (I have the rank of lieutenant) of the Tosgua Fire Department, the ID they presented to me, just to demonstrate that I have in-county contacts and that I am there for the benefit of the people.

We have stayed in some very nice hotels/hotels and some very bad ones. Most of the homes we have stayed in are nicely maintained. Have her bring her own toilet paper and carry some with her at all times, most of the public rest rooms/out houses do not have TP. On our first trip, while traveling on a bus to the coast, we stopped at a roadside restaurant and my daughter went to the bathroom, on her way some guy was waving TP and trying to get her to buy some, she did not realize until she got into the stall there was no TP.

If I think of any more items or if you (she) have any questions, I would be glad to try and help out.

Congratulations to you and your sons.

Pete

I even use chemical treatment on the bottled water.

I was in Egypt and had been buying bottled water from a local store until I saw the kids taking our empty bottles, refilling them from a wall tap and popping a sealed cap onto them. They would then take the refilled and sealed bottle back to the local vendor and get a bit of change for "recycling".

Now when I travel I usually try to take my own water bottle and treat my own water. Chemical treatment is nice in that it is easy to slip into a bottle without pulling out an elaborate filter and you are not as likely to offend anyone by implying that they are giving you something contaminated.

The recommendation to take motion sickness pills is good but be aware that they can cause drowsiness so make sure you are with someone who can look out for you if you fall asleep.

In addition to Pepto or Imodium I like to have some electrolyte powder to help get the body back in balance if you get dehydrated from diarrhea or other illness.

Thanks; I'm pretty familiar with all of that and she should be, too. On second thought, I may have been taking her knowledge for granted, so I'll run her through it to be sure.

...and "Howdy" back at you! Seems like I get so darned busy I almost never check in any more. Scanned a few of your recent posts and sounds like y'all are enjoying life.

Best regards,

Tom

(Last was to OBG - I'm readin in flat mode and quick reply seems a little off...)

I'm having her practice safe water and food at home this summer. There are oocystic organisms endemic there, so chlorine dioxide is the only practical chemical treatment unless filtered first. That means either Micropur MP1 tablets (expensive water) or Aqua Mira (PITA to use - and D.R. doesn't like it). We can debate other chemicals ad nauseum, but keeping it fairly simple for her is one of my goals - she's smart and attentive, but not a gearnut like most of us here.

More on this in my reply to Pete.

Thanks - affirms some of what I've already told her.

Super! Thanks for the link and I'll pass this on to my niece.

Pete - I really appreciate all the time you took to reply. Thank you!

RE: Altitude - I know, I know - I even used to take diamox as a prophy when we had to do a high altitude rescue (= body recovery). She SHOULD know this stuff - Grampa lives at 8,500 ft ASL and we pop up to 13k or 14k when we visit (her from essentially sea level and me only 600 ft ASL), but I WILL cover it pretty amply with her later. As I wrote previously, I am assuming too much about what she KNOWS vs what she has done. FWIW, I'm giving her a copy of Wilderness Medicine and she will read it all.

RE Travler's lament - I told her to assume that she will suffer a bad case of a norovirus type ailment for 4 days (for planning purposes). I told her to ask about a prescription A-D, bring OTC like Imodium A-D, bring Kao-Con, and pack 16 packets of Hydralite that are reserved for re-hydration in this sort of medical need. The lactobacillus tablets are a good idea - thanks.

PFAK - Already on it. Am dunning her about NOT using any of those supplies on others - told her to pack additional 1st aid stuff for that but cardinal rule is PFAK is ONLY for self treatment. As for the sharps, I would do that for myself but don't know about her. I might try her out on debriding, suturing, and sticking before making a final decision on those supplies.

Any other thoughts on antibiotics? I thought about cipro for a couple of specific reasons besides its generally wide spectrum, but as I rarely ever use antibiotics myself, was considering other wide spectrum antibiotics. You're probably right - cipro might make the most sense.

Roger on the Ex Stream XR - already told her that either that or the Sawyer must be in her daypack-that-is-always-with-her for subtle "right now" safe drinking water. I'm looking at the Sawyer, but the Ex Stream is my certain bet for that role.

RE: Steri Pen and MIOX - you have too many toys <grin>. I remember your reviews of both of those. I HAVE been toying with the idea of the MIOX for the chemical side of things. How has the thing held up for you? Any durability or performance concerns? NBD for me to send spare batteries with her.

RE Filters - I, too, am a little concerned about making a big fuss about water around her hosts, so I'd like not to be too overt if possible. Due to oocysts I've been thinking filtration from the start. I use a Guide personally, but I have NOT settled on anything wrt filtration device for her. Pocket Filter is a known; First Need is a known (even with quirks); Guide / Hiker Pro is a known; etc. I like the potential of ceramic depth filters and look at the MSRs. But with the Ex Stream XR along, I'm thinking pretty hard about a simple gravity based filter such as Katydn's. No moving parts and she can use the Ex Stream in the meanwhile. Thoughts? BTW, anyone know how the water privatization/de-privatization fiasco has turned out?

RE Inoculations: I already told her to get a different doc - he didn't even follow the State / CDC guidelines. Rabies (!!!) and yellow fever. Yaaargh! She won't be as shot up as I am (no commercial plague available now), but I'll see that she gets better coverage. Sheesh! I about blew my top that he didn't give her Hep inoculations.

RE: raw foods - yup. Been on her about that, but... it's been my experience that things like a salad take down giants. See my comments on preparedness for Traveler's Lament...

RE: TP - Something I take for granted because I always pack it, so I would have missed telling her. Thanks.

RE: Socio/Economic/Governmental advice - priceless; thanks so much.

I really appreciate the reply, Pete - thanks so much. I will have her contact you directly in a couple of months - I'll PM you her name and email (<yawn> - tomorrow)

Best regards,

Tom

Oh - forgot to mention that I have warned her about UV burns (she looks like an AmerInd Princess so she probably will ignore me on that) and I've told her in no uncertain terms to bring controlled release DEET (Ultrathon or Sawyer) and to treat her clothes and bedclothes with pemethrin before she packs up for the trip.

Also got her aimed at Sierra Dawn products for hand laundry and personal hygiene (Campsuds products) - told her no scented soap or shampoo.

Waiting to see what malarial prophy the (new) doc will recommend. since she will be spending time in the Amazon basin, she will need to be on a prophy the whole trip. I'd normally use mefloquinine, but Bolivia isn't a theater I'm familiar with and that stuff can have some side effects. I think chloroquine is officially useless there now - will ask your opinion after I hear what her doc suggests.

Tom

A sleeping bag liner treated with Permitherine is also a good idea for use as personal bedding even in nicer hotels. I don't know if a mosquito net would also be a useful item where she is going.

"...I get so darned busy..."

Ya gotta slow down! Life is too short to be busy at "our" ages...

Sleeping bag liner is a good idea. I have a specific brand/style in mind. Pemethrin treatment is not optional <grin>. Thanks.

Tom

heh - hey, I'm eligible for my second pension now, can you believe it? Having fun working; wish I remembered to goof off more. Working on it this year - baby steps. Feels like I'm getting fat, though.

Besides, I'm concerned that if I slow down, they'll throw dirt over me.

Save some fun and relaxation for me - I'll figure it out one of these days.

The sharps aren't for her to use, but so that if she goes to a medical facility they have sterile sharps with which to work on her. This is a serious concern in the 3rd world (heck, look at what happened recently in Las Vegas with recycled sharps, don't even have to go there for problems <~>).

One thing I didn't notice anyone mentioning is insurance. Most regular medical won't cover out of country. I also strongly suggest you consider medical evacuation insurance as well. This can break the bank if it's required.

Doug - Thanks for the clarification and insurance suggestions!

As I mentioned to Pete, I am looking at the Sawyer water purifier - specifically the SP 135 kit ($113) and the SP 155 kit ($145) for the niece. Claimed 3,000 gallon filter life is probably accurate enough if backwash maintenance is done - I used industrial-sized versions of this sort of filter in the 1993 floods to send water directly to hospital mains (using RAW river water intake) - we post-chlorinated a tiny bit so the water qual guys had something to test for (but it was completely unnecessary except for "shelf life"). The plants came from down under IIRC, but the filters were the same type (but BIG).

The head loss across the filters was minimal, so I believe Sawyer's claims of ease of sipping vs others that require squeezing the bottle to build pressure - and I note they use a polycarbonate bottle, which means no squeeze.

I downloaded the BIG video and watched it off-line.

Links:

http://www.sawyerproducts.com/SP135.htm

http://www.sawyerproducts.com/SP155P.htm

It appears to me that these do NOT use an activated carbon element, so there would be no chemical removal/reduction capability; not sure that would be very important in Bolivia.

Do you have any info / reviews / user opinions you can point me at?

I think Sawyer should send you (or Pete) some of the filters and purifiers to review...

Regards,

Tom

I've got some samples of the Sawyer. They do draw easily compared to others. As always, the problem is that we cannot affordably test to see how truly effective they are. Forced to take their word for it in most cases.

I always take filter life with a very large grain of salt. The advantage is that in most cases where it's not wilderness use, they aren't going to silt up much, so they tend to last longer that usual.

International travel health insurance is highly recommended. My daughter was visiting Fiji in early February and while swimming suffered a deep puncture wound in her foot. A long story short, she spent 4 days in a Fijian hospital (which was free, socialized medicine) but the infection was so severe that she ended up in a hospital in Christchurch, NZ. She endured two surgeries and a skin graft. Twelve days @ $600 a pop plus surgeries would have bankrupted her.

Fortuneately she had purchased the special international health/travel insurance which will cover most of the expense. It included evacuation insurance.

Another suggestion is to make sure your daughter contacts the embassy or nearest consulate. It's important that the embassy know where she will be and how to contact her. For US citizens this can be done online before one leaves or at the embassy or consulate. Dept. of State The US consular officer in Auckland called my daughter in the hospital to check on her progress, sent her reading material, and generally helped ease this father's concerns.

I'll try to get her to post the whole story and pretty pictures (think Blast's finger times 10) after she gets home this week.

Andy - Thank you. Hope your daughter recovers fully. I won't say I look forward to reading more about this incident, but if she writes it up, I will read it to learn from.

Regards,

Tom

Here are a few other items I thought of after my original post;

Feminine hygiene products
Sewing kit
If she wears eyeglasses or contacts, extras of both including contact lens cleaning solution, eyeglass repair kit and copy of her lens prescription
Sunglasses
Duct tape, zip ties and some mid-weight wire for repairs
Cell phone – depending upon her carrier, she may be able to have international coverage. Cell phones have gained huge popularity in many South American countries and it not uncommon to find cell phone use in even some remote areas, since it is easier to install cell phone towers then run landlines. Even if she is unable to use the cell phone while in Bolivia, she can call home while at the airport both coming and going


Packing note: For international travel, most airlines will allow two check-in bags weighing no more then 70lbs, so your niece should have plenty of packing room. She should use both bags (even if she is not hauling 70 lbs of clothing) and divide up her clothing/toiletries between the two, so that if one is lost she still has the other bag (and carry-on) with several complete sets of clothing. My daughter and I generally share one check-in bag for our clothing and use the other 3 for medical/firefighting equipment/supplies. In our carry-on we always include at least 3 days worth of clothing, that way if our check-in luggage is lost or delayed, we always have enough cloths to wear (4 sets - we wear one and have 3 as back-up) and have enough to be able to wash and dry as needed.

I tend to carry more water purifying devices then might normally be needed, as I tend to be the “go-to-person” for everything and anything the team may need, so I have redundant items for key needs. Interestingly, despite traveling with 2-4 doctors and a ton of medical supplies, they almost always come to me for medication and treatment within the team. Practicing medicine in these remote areas is much more like rural or street medicine; many of these doctors practice within hospitals or practices where supplies, equipment and lab tests are readily available. Out in the rural towns and isolated villages, they must depend much more upon their diagnostic skills as opposed to lab tests, etc, which can be challenging.

I would really suggest the MIOX, in addition to using to biologically purify the water, the concentrated solution can be used as a surface disinfect (toilet seats, plates, cups, eating utensils, etc.) and in the diluted form, I would have no hesitation to use to clean cuts and abrasions.

Pete

Agreed - thanks. Most of that was on my (mental) list for her, but now it's written down. No contacts, thank goodness (or glasses).

I have to check on the cell phone - I think one of my acquaintances / classmate may have been who did their cell network / infrastructure - if not, he will probably know about it anyway. I think he sold his company and retired, but it was fairly recently.

Good to go on the MIOX - your advice on that is golden as far as I am concerned. I think the way I see that is I will LOAN her mine ("Oh, honey, our niece REALLY needs to use this on her trip and you know how strapped she is for $ - I only bought it for her...")

That is, after I buy mine... and the good thing is, CR123 batteries are already one of our standard cells in my household. "See, it even uses the SAME batteries as our sooperdooper flashlights..."

My DW is so on to me... good thing for me she tolerates my wierdnesses so well. (And she DID buy me a new tent for Christmas.) Hey - she and I can try out the MIOX in July backpacking in the Collegiate Range!

Passing this on. My sister and her daughter (the traveler) are very grateful for the information I've forwarded from you, Alan, and Doug.

Many Thanks,

Tom

You don’t normally think about it, but reading this thread makes you realize just how well we live in The USA compared to many parts of the World.

How about a hammock?

Can be used for sleeping in, or set up on the flat as a mosquito net:

http://mosquitohammock.com/junglehammock.html

A

Thank you. I thought about this sort of thing (net), but for her trip it's perhaps overkill. At some point she simply cannot lug too much gear.

I am suggesting she bring and use something like a Cocoon Travel sheet, treated with permethrin, for at least her overnights away from the host family. If it turns out that netting is advisable for some or all of her visit, I suspect she can easily purchase one in-country.

See http://www.designsalt.com/index.asp

Also available at http://www.campmor.com

IMHO, an Egyptian Cotton or Silk-Cotton rectangular Travel sheet (or 2), treated with permethrin, would be a great item to pack and use on the trip. Ripstop Silk would be nice, too, but costs more.

Natural color seems to be a good bet.

I have not yet seen the suggested packing list so for now I have no idea if a sleeping bag will be needed for some portions of her visit. The sleeping sheet would be useful and a nice comfort item in all situations, I think. Stuffs very small and weighs very little.

Tom

For the needles and sutures, etc, if she is traveling with friends, they NEED to know about this stuff, why, and where it is. If she's unconscious, she can't tell the medical personnel anything.

Treating water: she could probably explain it away as allergy to something, or medication, couldn't she?

She needs to know how to contact the American Consulate, not just the other way around.

I wouldn't want to be wearing open-toed shoes or sandals.

Sue

It is true that people can get AMS (Altitude Sickness) at 9000', but it would be very rare for it to be fatal at 9000'. Still, stairs will be a pain in the butt for a while.

If you (well, your neice in this case) have the time, aclimating is the way to go, although one could do it in a couple of days. When I climbed Mt. Whitney (14,501') a few years ago, I aclimated over two days without ill affect although three would have been better. When I climbed Taylor Pk (13,000' and some change) last summer, I aclimated over one day only. That was a bit rough since I left from sea level the day before, but I did all right. Note that everyone is different with altitude. Some get it at 10,000', some at 13,000', some at 17,000', etc. It depends on the person and the time allowed for acclimitization. Under 10,000', most people can adapt fairly quickly, although it'll be multiple weeks before they'll feel comfortable playing basketball or something.

A drop of altitude of as little as 1,000' is often enough to ameliorate atltitude sickness.