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Travel with Kids in Third World Countries
I'm wondering if anyone has any new insights into safety while traveling/living with a young child (4.5 years old, still under 40 pounds) in a third world country. My son will be with me in Dakar, Senegal for 7 weeks and I'm mostly concerned about automobile safety given that most vehicles there won't have functioning seatbelts. I'm also trying to find some magic child safety seat that will work on the airplane, in whatever cars do have seatbelts AND is light enough to carry around airports and through a week of travel in Europe on trains in the middle of winter. I have a seat that works well on airplanes now, but it is very heavy and awkward to carry around. I've called around, but none of the stores seem to have much to offer. (By the way, I haven't found much of anything helpful on the web. There is a site, which is interesting, but basically repeats the less than satisfactory information given on the FAA site about child safety on airplanes, http://www.airsafe.com/kidsafe.htm)
I also have some concerns about health - particularly malaria (even tho' he seems to be especially sweet to mosquitos, I don't want my son to be taking prophylactic doses of Meflaquine/Larium) , and food-bourne illnesses. I am aware of all the standard precautions, have checked out the CDC page and am going to Senegal at a time of year when malaria isn't that prevalent, but any hints/advice would be greatly appreciated.
I hate giving advice but I will share my experience. I was a Peace Corps volunteer in Cameroon, West Africa for 2.5 years, in the early 90's. During that time, I had malaria three times even though I was taking chloroquin and fansidar prophylactically. By the time I left Cameroon, there were resistant strains to both these drugs. While I was in Africa , three volunteers DIED of malaria in the continent. I used to be much more knowledgeable about the various strains than I am now, but PLEASE PLEASE do not take a child to sub-Saharan Africa without prophylactics. If you do not want to give him drugs, then I would say don't take him. No amount of separation anxiety can be as lethal as a bad case of malaria.
As far as car seat, I would say, take one anyway. I have traveled extensively in West Africa and I agree that transportation safety is nonexistent, but it cant hurt. Dysentery is sure to happen unless you really live in a vacuum and dont go near fresh fruit or produce. It does pass though. I am sure your doctor can prescribe something for it. All that said, I hope you have a good time! I love it there.
I haven't been to Senegal, but if it's anything like Cameroon, you'll be lucky to get a SEAT on local transportation (private taxis, bus-like vans, etc), let alone a place for a carseat or a seatbelt. This varies by location, of course, but the further out "in the bush" you are, the more likely they will cram as many people as possible into the car, meaning your son will probably be on your lap. Also, the drivers in some areas will try to get you into their car by grabbing at anything you're carrying, so a clumsy carseat (on top of whatever luggage you have AND your small child) could be a real nightmare. I'm sure it varies by what you're doing there and who you're with. I was a Peace Corps volunteer, so we saw essentially what the local population saw. I'm sure it would be different if you have escorts or business companions or anything like that, or if you're spending a lot of money (a lot to them, not necessarily to you). As for the malaria, most of us got it at least once (in a roughly 2 yr period) even while on Mefloquine. I agree that you probably shouldn't give it to your child, especially if it's just for a short visit. Anopheles (the malaria mosquito) only bites at night (say 4:30 pm and later), so keep you and your child well-protected at those times (maybe mosquito repellent would do the trick when you're up and about; definitely nets over sleeping areas help cut down on problems). There's not really enough known on the effects of Mefloquine to feel good giving it to a growing child... even adults have reported some pretty bizarre problems. It doesn't sound like it's worth the risk in your case. If either of you DO get malaria (another problem is that Mefloquine can muffle the symptoms, causing misdiagnosis), there are treatments that seem to be pretty effective. The real problem is getting it and ignoring it, but I think it would be tough to miss the symptoms normally (fever that cycles is the prime one). Good luck!
I've read about an inflatable carseat that I think still meets safety regulations. I think it was in the book ``Baby Bargains.''
I've been to Dakar and elsewhere in Senegal myself. You may be right to fear the lacking seatbelt issue, though I wouldn't be so sure. Dakar is very cospmopolitan and there is huge population of professional foreigners. Many taxis are likely to be Mercedes, since those are common in Europe and Dakar's connection to France is significant. I took buses, so I can't be sure.
I realize the malaria medication is a tough choice, but I just wanted to encourage you to talk to as many people as possible before deciding to forgo malaria prophylaxis. There is most definitely quinine-resistant malaria in Senegal today, as is the case in many of the malaria-plagued places of the world today. You can get forms of malaria there that stick with you so that years later, suddenly, a person has malaria again. And if you come down with malaria, you have to take the same type of medicine but in very huge doses, plus you are suffering. Probably you know all this already and are making the best choice, but my own experience was that I didn't take medication before I went (as you're supposed to), largely because I was afraid of all the side effects I'd heard about. And while it wasn't very humid, I still got occasional mosquito bites and then would become very scared. What if this is the one? Finally, someone I met told me I was a nut not to take the drugs and I started right away and had no side effects, even taking two kinds. And I didn't get sick at all.
Have a great time! It's a fascinating place of gorgeous people - on every sidewalk there seems to be a parade of bright colors and beautiful clothes. Do be wary in the central market where things can easily be stolen off you. and do get out of the city!
In 1984 I went with a male friend to Tanzania. We were both taking chloroquin and fansidar as malarial prophylactics, but get this -- we were on the same doses, even though he outweighed me by forty pounds or more. In travelling from Dar to Moshi, we were bitten extensively by mosquitos -- I counted 89 bites between the wrist and elbow of my left forearm (while waiting around the next afternoon in Moshi). I did not come down with malaria, but he DID. So, and here's the "advice" part so ignore it if you like... not only should you make sure your child has prophylaxis or leave him/her home, but you should make sure the dosages all of you get are appropriate for your own size. Also, get all recommended vaccinations, and never drink anything that has not been sterilized -- order your coffee as "kahawa na maziwa moto" (with boiled milk) if you can't take it black (but it's great in Tanzania and Kenya, so do try it ;-), order your coca cola sealed in the bottle -- if you have to have it cold, put the bottle into ice, and WIPE the opening thoroughly before drinking it. No "orange squash" if you value your health, no cut fruits, take water purification tablets along for the water in hotels, etc., and take along pepto bismol tablets or some other such to be chewed to prevent the runs. That worked well for us -- he only got malaria, and neither of us got anything else although we were in Tanzania and Kenya for eight weeks, and not staying in the fanciest hotels, either (well, except once in Nairobi!). Another friend of mine picked up some intestinal bug and has never gotten rid of it -- she still has an occasional bout. And, all that aside, have a GREAT time! The people are wonderful, despite often having to cope with difficult circumstances.
Regarding the use of prophylaxis for malaria: most European doctors do NOT prescribe prophylaxis, partly for the reason that if we rich foreigners keep on routinely using the drugs of last resort their efficacy will be destroyed for everyone. Rather, the strategy is to respond very quickly to symptoms. If you will be far from medical help, you should carry the medications with you. My impression is that Mefloquine/Lariam is NOT cleared for young kids (please check this), at least as a prophylactic. I think chloroquine is considered safe enough that you COULD give it to your son as a prophylactic. I would try to find out as much as you can (doctors there will know more than here) about the symptoms & treatments of malaria in young children. The best thing, of course, is, as suggested to protect against mosquitoes in the evening & night (though daytime species carry dengue fever! - don't know if this disease occurs in SEnegal...) Good luck & please keep us posted w/ any new info you come across (I, too, am contemplating taking a small one to Sub-Saharan Africa & the
Here are a few more suggestions for travel in Third World countries (these may sound a little paranoid, but it's probably worthwhile to be more safe than sorry):
Consider bringing your own hypdermic needles, sterile syringe, and a note from your doctor explaining why you have them. In case you or your child needs an injection while there, do NOT rely on the clinic or doctor traeting you having sterile supplies.
Know your blood types.
Bring oral rehydration powder with you, too. The packets are light, small, and fairly cheap. If you don't use it, you can give it to people who live there, who probably will. (Dehydration from diarrhea is a very serious problem in children in 3rd world nations.)
PeptoBismol was mentioned before... it should be on your "must bring" list.
If you are going to be WAY out in the wilds and want to be as utterly safe as you can be, think about a few sterile hospital gloves and maybe even an IV drip.
There's a great book called "Travel with Children" by Maureen Wheeler. It's part of the Lonely Planet series, and I highly recommended it for "adventure" travelers. She's been amazing places with her kids, and her suggestions are quite detailed and useful. (BTW, I'm the author of a book on traveling with babies and small children called "Baby Maneuvers." It's for parents whose kids are under five. And... there's one chapter focusing on overseas and adventure travel.)
A note: all this preparation sounds really scary, but once it's done, you'll be free to enjoy and experience. I think it sounds terrific!
I have an adult acquaintance who took Lariam years ago and is still suffering from the side effects. She initiated a class-action lawsuit against the manufacturer. Ask for her story: LariamUSA AT aol.com
Here is a snip on Lariam (mefloquine) she provided me from the British "GUIDELINES FOR THE PREVENTION OF MALARIA IN TRAVELLERS FROM THE UNITED KINGDOM" by D J Bradley and D C Warhurst on behalf of an expert group of doctors, nurses, and pharmacists (19 Sept 1997):
Increased awareness of distressing adverse neuropsychiatric reactions to mefloquine, a highly protective antimalarial, indicates caution in its use unless there is a high risk of acquiring malaria that is highly resistant to chloroquine. In practice, this means considering carefully whether to use it for short visits to places where the risk is moderate. It is important to observe contraindications to the use of specific antimalarials, and especially not to give mefloquine to people with a history of epilepsy or psychiatric illness, including depression. Chloroquine is relatively contraindicated in people who have had fits [seizures]. Doxycyline is being used cautiously more often for those unable to take these drugs and going to high risk areas, but it does carry some risk of photosensitization. The preferred chemoprophylaxis for areas without chloroquine resistance is chloroquine. Those unable to take chloroquine should take proguanil. [NOTE: Proguanil or Paludrine, though not available in the U.S., can be purchased over-the-counter in most non-U.S. international airports.]
I have travelled to the Senegal in July/August eight years ago. So, all I know refers to the transportation and living conditions at that time. The situation might have changed since then. Generally, there was a big difference in the standard of life between Dakar and the rest of the country particularly the inland. After having travelled around in Mali and the Senegal I did not find that Dakar was really a "third world" place.
Sanitary conditions: were great, water was treated and drinkable (outside of Dakkar nothing was guaranteed).
Mosquitos: I took Lariam. Good is however to avoid Mosquitos, dress acoordingly in the evening, close windows, no lights, spray if neccessary. In Dakar I stayed in a house near the Medina with windows and everything. I do not recall any Mosquito problems there. To my view, in the City itself the risk is relatively low.
Transportation: Regular buses were fairly safe in Dakar. They were not less reliable as most busses that I have seen running in the Bay area. The same was true for taxis. You may want to avoid the colorful and funny-looking minibusses in the City (I forgot their name). They were fast, but very unsafe, badly maintained, e.g. brakes didn't work well, and frequently involved in accidents. Also local people often avoided them. For longer trips in the inside country I recommend checking over the taxi and choosing the most reliable one. It happened several times to me that the taxi broke down somewhere on a road, and we had to wait a couple of hours until the driver had finally managed to self-repair his vehicle. The drivers are also able to pile up people in the car to a point that it gets extremely uncomfortable. Also, try to avoid any Peugeot 4 x 4 without closable windows, or for else dress well. I got once in a violent sand wind and another time I got a terrible sore throat. I read somewhere that colds are the most common illnesses of tourists in Africa. Anyhow, as long as you are staying in Dakar, I don't think there is much to worry. There are a lot of Frenchmen who are really fond of living there. --Petra
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