Apr 12, 2021

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Humans Are a Traveling Species

It turns out when we evolved about 100,000 years ago, when we stood up instead of swinging from trees or walking on our knuckles, we actually developed a way of moving that was incredibly calorically efficient. We had to change our muscles in our rear, we had to change our angles of our ankle, we actually put our shoulders back, our head was more erect, and we looked forward. So not only could we see around us, we were curious as a species, we could stand up and walk, and we traveled all over the world.

The great apes don't really leave home, but humans have been leaving home to go places since we called ourselves Homo sapiens. And we traveled because maybe for new resources or new food sources, or to get stuff that we wanted, like chocolate, and pretty shells, and stuff, and feathers, and things that we wanted. And wherever we went, we took our diseases with us, and whenever we found ourselves in a new place, we met new diseases there. So now that we travel all over the world easily, we spread our diseases all over the planet. We are a traveling species.

With us in the studio is Theresa "Terri" Sofarelli. She is physician assistant, and she spent a lot of her time talking to and taking care of people who are going to travel.


Healthy Traveling

I'm going to tell you a little travel story in that when I was in college... this is at the University of Colorado. It was very popular to go to Mexico during spring break, and I did, and I knew that you could get sick. So I drank out of bottles and I made sure my food was cooked, and I wanted to make sure I stayed healthy. But sure as shoot, as soon as I got back, I got Montezuma's Revenge.

Dr. Jones: I didn't even think about going to a traveler's clinic or asking, even when I was in medical school, "What can I do to prevent this and what can I do if I get it?" So talk about how you help people prepare for wherever they might be going.

Terri: What we offer in our travel clinic is a combination of things from pre-travel consult to post-travel consults if people come back sick. So in a pre-travel consult, we'll review a patient's medical history, their medications, what activities they plan to do abroad, look at their vaccine history and make recommendations on vaccines, make recommendations on malaria prophylaxis, certain activities to avoid. And also, we give them information on where to receive medical help abroad ... [and] our travel clinic is also one of the GeoSentinel sites.

We're one of 60 travel clinics around the world that collects data on return travelers, and we submit that information to the CDC to help them know when a new arising disease is occurring. And our site is unique in the sense that we've got the most number of long-term expatriate travelers coming back to our clinic. And that would include the LDS missionaries returning. Whereas a site from Kathmandu, for example, would mostly be seeing travelers coming into their clinic from out of the country for acute problems.

Dr. Jones: I think that as traveling species who goes places, we want to be well when we get there. And whether we're going for social reasons, or emotional reasons, or for whatever reason, we want to be well over there. We do want to be sick while we're there. We don't want to be sick when we get back.

Terri: So for the person that does travel abroad and comes back with any kind of unique symptoms, specifically a fever or chills, I would strongly encourage them to see a travel medicine expert, whether it's at the University of Utah or abroad.

There is a organization called ISTM, which stands for the International Society of Tropical Medicine, and they list all travel medicine providers. And this is important because if somebody with a fever goes into maybe the urgent care, or the ER, or primary care doc, and they don't tell them that they've been traveling, they might get diagnosed with a viral infection where they could have malaria, for example, which can be deadly.


Social Traveling

There are internet brides, people that might meet through an agency where they connect people, or there are people who want to be a Facebook friend that you don't know, and then you hook up through Facebook and you want to see them.

Terri: So a couple years ago, one of our travel nurses noticed that a lot of the patients coming in for pre-travel consultation actually going to visit their internet fiancés [...] We realized that out of about, 4,000, we found probably about 40 people that were traveling to visit internet fiancés and about half were women, half were men.

And so we collected data on where they were going, how long they were staying for, and where they were traveling to meet these fiancés and realized that this was a special population that was at higher risk for problems than other travelers.

Women were usually single, they had never been married, and they were usually traveling to Africa. So we wanted to make sure we spoke to them about protecting themselves against STIs or unprotected pregnancies, being a victim of assault or victims of fraud.

Dr. Jones: The thought of traveling to meet your fiancé sounds... to me, that sounds a little risky, and you've confirmed that.

Terri: We felt like it was more risky for the women traveling because they would usually have open-ended itinerary and plan to stay with their future husband and the family of the husband, whereas the men that were traveling planned a closed-end trip with the intent to bring the bride back to United States and get married here. And that seemed safer.

Dr. Jones: Did you find out of those who went, how many came back with a bride or a groom?

Terri: We didn't do follow-up on them, but we did find though that some of the brides and grooms that would come back would leave their new partner at a certain timeframe, and that was usually related to once they got their green card at 3 months, they would leave their new partner, or after 2 years once they got residency, or even after 10 years when they got their citizenship.

Dr. Jones: That's only just slightly illegal.


Travel with a Smart Conscious

I've been watching the news and seeing all these spring break parties, particularly in Mexico and Miami, with young people who were going places that they can go during the COVID pandemic. But they all go out there and nobody is in their tiny bikini with a mask that's bigger than their bikini. They're drinking stuff that makes them have bad judgment, and there they are in a super spreader event.

Dr. Jones: Have you been making any conversations with people about going during the COVID epidemic?

Terri: We are seeing an increase in our pre-travel consults for travel abroad. People have been anxious to get traveling again. We will look up a patient's travel destination and see that actually the CDC and the World Health Organization are commonly advising travelers not to go to these destinations unless it's deemed necessary. So a spring break to Mexico isn't deemed necessary [but] the country of Mexico has no regulations for travelers coming in right now.

But something to think about for everyone traveling is that when we travel from high-resource country to a low-resource country, we could be bringing the COVID disease to that area. We could be bringing a resistant strain. And they're resource-poor countries. They might not be able to accommodate or treat you appropriately. They might not be able to treat the locals if you get them sick. So we could be putting a burden on those local communities.


The Emotional Need to Travel

For me and for many people, we haven't seen our families. I have a real emotional need. I want to see my family. And people say it's not necessary, but it's necessary. I'm getting old. I might not see them again, and I just want to see them. Luckily, they all live in the United States. But for people who have family overseas, that's been a real burden for folks not to be able to go visit. That's part of the emotional domain. They feel cut off from their family.

Terri: I've been seeing that also. People do want to travel to see their family, whether it's just to see them to reconnect or for a special event, whether it's a graduation, retirement, birth of a new child. I think it's important for our mental health too to be able to connect with their family.

Dr. Jones: And funerals. I think having had a number of friends whose parents have died from COVID, but they can't have the kind of in-person funeral. A funeral is a gathering of souls and of bodies, and to be emotional together, and tell funny stories. And Zoom just doesn't cut it.


The Finanical Aspect of Traveling

I'm thinking about people who travel for financial reasons in the sense of the financial domain. Some people travel because it's required for their work. All the traveling that I did growing up was because my father would get a job and we would just move to another country or another place. And there are people called road warriors.

Terri: I would call myself one of them.

Dr. Jones: Oh, you're a road warrior? Do you travel for work?

Terri: I travel for work and for fun [...] Another factor with the low-budget traveler historically is a little bit higher risk for infections because they are usually traveling similar to the locals where they could be on the bus, they could be staying at lower-end hotels, or be camping. So we have different education for that traveler versus someone who's going to an all-inclusive resort and having everything paid for and high-end food.

Dr. Jones: Well, I have to say that I have a fondness for street food wherever I travel, whether it's Asia or South America. I think the very best food is when you're on your feet walking through a town and you get street food. And I understand the risks involved in eating street food.

Terri: I used to eat street food. In Costa Rica, I lived with a family, ate whatever they prepared. But like I said earlier, I did get sick from that. And eating from street food, you have to just realize that the vendors usually don't have access to running water and food. Their plates that they're serving you on might not be clean. So it's a great place to get Hepatitis A and typhoid.

Dr. Jones: And amoebas.

Terri: And amoebas, yes. But if you don't eat the local food, then you're not necessarily engaging in the culture as you'd like to. So it's a hard call.


Know Where You're Traveling

Thinking about engaging in the culture brings us to the intellectual domain. Many people travel. When I talked about when we stood up and we looked around and we are very curious as a species, we want to learn something new. And going someplace to learn something new, or see some new geography and learn about it. But when you're going someplace new, you have to learn something about the culture and there are things that you probably ought to know before you arrive.

Dr. Jones: Do you help people with some cultural awareness or give them some places to go that they can start reading about behaviors that are inappropriate?

Terri: We used to give out a handout from an organization called CultureGrams, and that would list every country and different social norms, the dos and don'ts. I don't believe we give that anymore, but that I thought was invaluable information. I personally learned in Costa Rica, for example, that if a woman goes to the bar, sits at a bar seat by herself, that means she's a prostitute.

Dr. Jones: Oh, good. That's good to know.

Terri: Yeah. And I unfortunately sat at a bar once. Or if you spend time with a single male alone that that means that you're interested in them, or that...

Dr. Jones: Looking for business.

Terri: Looking for business. So it was things like that. CultureGrams would also discussed that if you were a guest in someone's home, what would be appropriate to bring or not to bring? Or, for example, if you were going to Asia, they don't recommend sitting with your feet facing someone.

Terri: We also hand out a travel book that we've created at the University. And the very last page, it has essentially 10 recommendations on how to be a gracious visitor to that country. And that does include trying to reduce your environmental impact there.

So for people who are going to go on backpacking or trekking, sometimes they'll think that they can just buy all the water they need and then just toss the plastic bottle somewhere. But a lot of countries with poor resources don't have the ability to discard that plastic. And when you go on treks, whether it's Machu Picchu, you will see a lot of garbage that trekkers have left behind.


Travel, but Remember to Take Care of Your Surroundings

International travel often, in fact, it always has a significant environmental impact because of whatever method you used to get there, whether it's planes or trains, which have a big environmental impact. And then, of course, the stuff you carry and the stuff you leave behind in environmentally sensitive places. I think of the Galapagos as being a very popular place to visit, but we've made significant inroads, unfortunately, into the quality of the environment for the animals there.

Terri: And also, traveling to communities that haven't seen many people from the outside also affects the culture and the community.

Dr. Jones: Yes. We were traveling in Indonesia to some islands that had not seen any white people, Caucasian-Europeans, since maybe World War II. And some people in dugouts came out to the ship that we were on, and they had leprosy. So leprosy was still active in that community. And our ship's doc said although we weren't likely to get leprosy, he wouldn't let us off the boat. And they were very curious and, of course, we were all very curious, but we didn't want to do anything to harm them or for them to harm us.

So we bring our diseases with us and we pick up some from where we go. I think that's important in terms of our health.


Traveling is a Spirital Journey

I think of the Santiago as a long walking trip in Europe for people who take this walk, and there are spiritual conversations and churches along the way. For many people, a spiritual journey is a walking journey. People who traveled into the desert, and we think of our great prophets who walked into the desert to have insight into themselves. And of course, our very own culture has many examples of that.

People are looking to fulfill a spiritual mission or they're looking perhaps for spiritual enlightenment, and the very nature of just walking ends up being a spiritual practice. So people may travel either short distances or long distances in physical space to make some travel in emotional and spiritual space.

Terri: I don't know where this fits in, but including myself, I enjoy traveling for high adventure sports. For some people, that's a religion. To go rock climbing, ice climbing, skiing, mountaineering, scuba diving in places around the world is a form of religion in my mind.

Dr. Jones: I think so, and they're looking for a very... they do something that's very hard. Any time we do something that's very hard, it's transformative. And some people go to climb big mountains is what I think of. Climbing big mountains becomes a religious experience because it takes you out of the quotidian, the ordinariness of your day. And if you can't build it into your daily life where you are... I think of Emily Dickinson, who never traveled, or Thoreau, who said you didn't need to travel and you could get all of your inner work done where you are. But for many people, that's not quite what they're looking for and they do their inner work by doing some outer work.

Terri: I agree with that. I've traveled to some of the bigger mountain ranges around the world, and for those that don't travel, they don't understand why I would need to go see Everest or go see the Andes when I've got my own mountains in United States. So it's a hard question to answer.

Dr. Jones: I think it's a matter of phrasing what your heart... helping other people understand what your heart wants and why this is actually something that's very powerful for you.


Health Haiku

All senses turned up
Travel with your feet and heart
To see something new

For Patients