出門不生病 你需要做到這些
On a recent trip to Tanzania with four grandsons, my most important task (beside protecting them from the jaws of a lion or leopard) was to keep them, and myself, in good health. It would not have been much fun to be stuck in a tent next to the commode or flattened on a cot while the rest of the gang viewed a dazzling array of wild animals from the safety of a Land Rover.
最近，我帶着四個孫子到坦桑尼亞旅行。行程中，我最重要的任務（除了從獅子或豹子的利爪下保護他們之外）就是保障他們和我自己的身體健康。當別的遊客都乘坐路虎安全地欣賞各色各樣的野生動物之時，你卻被困在帶座椅式便桶的帳篷裏甚至臥牀不起，肯定不是什麼愉快的經歷。
Although I came prepared for the worst, I did everything I could to make our trip the best. And I’m happy to report, no one got sick and we all had a great time.
雖然也要準備好去應對可能發生的最糟糕的事件，但我首先是竭盡所能地想讓我們能享受一場美好的旅行。現在，我可以很高興地報告大家，我們當中沒有一個人生病，每個人都玩得很開心。
When I described the steps I took to friends and physicians, they urged me to write about them. So here goes, along with a host of other helpful travel hints from well-informed professional sources.
我向朋友和醫生們說起我所採取的措施，他們都力勸我把它們寫下來。所以，我們這就開始吧，以下內容中還包含我從其他見多識廣的專業人士處得到的許多有用的旅行注意事項。
No. 1: I reminded my grandsons daily, any water you drink or use to brush your teeth must come from a sealed bottle that you open. Ice wasn’t an issue in the bush, but that too should be prepared from bottled water. When you take a shower or swim in a pool, keep your mouth shut. (This warning was particularly pertinent for one grandson who always sings in the shower.)
第一：我每天都提醒我的孫子，只有自己親手啓封的密封瓶裝水纔可以飲用或用於刷牙。在叢林中不存在冰的問題，但要用冰的話，也應該利用瓶裝水製備。洗澡或在游泳池中游泳時要保持閉嘴。（這條警告特別適用於我一個喜歡在淋浴時唱歌的孫子。）
No. 2: Before every meal, we each chewed one pink tablet of bismuth subsalicylate (sold as Pepto-Bismol and various store brands).
第二：每次吃飯前，我們每人都要咀嚼一片粉色的次水楊酸鉍片（商品名爲Pepto-Bismol或其他品名不等）。
I have used this preventive since first reading about it in 1980 in The Journal of the American Medical Association in a study led by Dr. Herbert L. DuPont, an infectious Disease and travel medicine specialist at the University of Texas, Houston. The study described how using these tablets greatly reduced the risk of traveler’s diarrhea among American students traveling to Mexico. In a subsequent study published in 1987, Dr. DuPont and colleagues reported that two tablets chewed four times a day reduced the risk of developing diarrhea by 65 percent. (Each tablet contained the standard dose, 262 milligrams of bismuth subsalicylate.)
自從我第一次讀到這一點後，我就一直在採取這一預防措施。那還是1980年《美國醫學協會雜誌》(Journal of the American Medical Association)上德克薩斯大學（University of Texas，位於休斯頓）的傳染病和旅行醫學專家赫伯特·L·杜邦(Herbert L. DuPont)博士領導的一項研究。它介紹了在到墨西哥旅行的美國學生中，使用這些藥片如何大大降低了旅行者的腹瀉風險。在1987年發表的一項後續研究中，杜邦博士及其同事報告說，每天四次、每次咀嚼兩片該藥片可將腹瀉風險減少65%（每片含標準劑量的次水楊酸鉍，即262毫克）。
I have relied on these tablets, albeit in a lesser dose because I’m a lot smaller than average, during trips to Vietnam, Thailand, Peru, Indonesia, India and Nepal, and never got sick despite eating salads and peeled fruit, which one is warned to avoid. In fact, in India and Nepal, my traveling companion, who also took the tablets, and I were the only ones who stayed healthy even though the others in our group assiduously avoided those no-no foods and we did not.
在赴越南、泰國、祕魯、印度尼西亞、印度和尼泊爾的旅行期間，我一直依賴這些藥片（雖然使用的劑量較小，因爲我的體型遠小於普通人）。儘管我食用了沙拉和去皮的水果（有人警告我提示要避免食用此類食物），也從來沒有生過病。事實上，在印度和尼泊爾，我和一位堅持服用這些藥片的旅伴是我們那個旅行團中唯一保持健康的人——哪怕其他人都竭力不去碰那些禁忌食物，而我們並沒有忌口。
So for the five of us going to Tanzania, I packed 15 tablets for each day of our trip — and no one experienced the slightest gastrointestinal upset. That wasn’t the case, though, for most of the others on our itinerary. However, if you choose to try this preventive, I suggest you check first with your doctor and perhaps consider using Dr. DuPont’s larger dosage.
因此，爲了我們五人的坦桑尼亞之行，我按照每天15片的劑量準備了藥片，結果，沒有一個人出現過絲毫的腸胃不適。同行的其他人卻大多沒有這麼幸運。不過，要是你選擇嘗試這種預防措施，我還是建議你先去拜訪一下醫生，或考慮使用杜邦博士推薦的較大劑量。
Without a preventive, which is no guarantee against food-borne illness, stick to “safe food” that is cooked and served hot, and fruits and vegetables you have washed in bottled water and peeled yourself. Never eat undercooked foods — eggs, meat, fish or poultry — or any food sold by street vendors.
預防性用藥並不能保證你不會感染食源性疾病，而在沒有預防性用藥的情況下，你應該只吃那些“安全食品”，即煮熟並趁熱食用的食品，以及你自己去皮、用瓶裝水洗淨的水果和蔬菜。絕對不要食用沒煮熟的雞蛋、肉、魚或禽肉等或街頭攤販出售的任何食品。
Reduce your exposure to germs by washing your hands often, and always before eating. A hand sanitizer with at least 60 percent alcohol can be used if soap and water are unavailable.
經常洗手，尤其是在進食前，以減少你對病菌的暴露。如果沒有肥皂和水，也可以使用至少含60%酒精的洗手液。
I took no chances, especially since I was responsible for four children. I had an emergency supply of Lomotil (for digestive problems) and azithromycin (Zithromax Z-pak, for infections) just in case.
我不會抱着僥倖心理去冒任何險，當我要爲四個孩子的安全負責時尤其如此。我備有應急的地芬諾酯（Lomotil，治療消化問題）和阿奇黴素（治療感染）以防萬一。
No. 3 (really No. 1 chronologically): I made sure we were all up-to-date on routine vaccines — measles-mumps-rubella, varicella (chickenpox), diphtheria-tetanus-pertussis, polio and an annual flu shot — and added two (for hepatitis A and typhoid) that the Centers for Disease Control and Prevention recommends for travelers to Tanzania. You can review recommendations for other destinations on the C.D.C. website at We also each filled prescriptions for generic Malarone (atovaquone proguanil) to prevent malaria, and I checked daily to be sure the boys remembered to take it.
第三（如果按時間順序排列，其實這應該是第一點）：我確保大家都接種了最新的常規疫苗：麻疹-腮腺炎-風疹、水痘、白喉-破傷風-百日咳、脊髓灰質炎和每年的流感疫苗，還補充接種了美國疾病控制和預防中心(Centers for Disease Control and Prevention, C.D.C.)建議到坦桑尼亞旅遊的遊客接種的兩種疫苗：甲肝和傷寒。您可以從C.D.C.的網站上查看針對其他目的地的建議。我還讓醫生爲我們每個人都處方了足量的阿託伐醌/氯胍來預防瘧疾，並每天檢查孩子們有沒有按時服藥。
I also packed an ample supply of sunscreen, insect repellent with 20 percent or more of DEET, and a first-aid kit of hydrocortisone cream, antibiotic ointment and a variety of bandages, though happily the latter two were never needed. For one grandson prone to motion sickness, I took some meclizine as well.
我還準備了充足的防曬霜、至少含20%DEET（避蚊胺）的驅昆蟲劑以及一個包含氫化可的鬆軟膏、抗生素軟膏和各種繃帶的急救包，不過我們很高興後兩者從來沒派上過用場。有一個孫子容易暈車，所以我也帶了些美克洛嗪。
As the oldest traveler in the group (and the shortest now that my youngest grandson, at age 11, has passed me), I am acutely aware of the risk of blood clots when flying long distances. I always book an aisle seat so I can get up every hour or so and walk around for a minute. It also helps to move your legs and flex your ankles frequently. You might also wear graduated compression stockings on very long trips. Similar precautions apply to long car or train trips.
作爲旅行團中最年長的成員（也是最矮的一個，因爲我最小的孫子[11歲]已經超過了我），我對長途飛行中的血栓風險有深刻的認識。我總是預訂靠過道的座位，這樣我就可以每隔一小時左右站起來走動一會兒。這樣的安排還有助於經常活動雙腿和屈伸腳踝。你也可以在長途旅行時穿着預防下肢靜脈曲張的彈力襪。類似的預防措施也適用於長途的汽車或火車旅行。
Although the risk of clots is generally very small, they can be life-threatening. At greatest risk are people over 40, those who are obese or pregnant or have limited mobility (for example, because of a leg cast) or who have a personal or family history of clots. Estrogen-containing medications also raise the risk; I usually take one of those, raloxifene, prescribed to protect my bones. But it can increase the risk of a clot, so I stop taking three days before a plane trip of four or more hours. For more information, check the C.D.C. advisory on blood clots and travel, and talk to your doctor.
雖然一般而言，血栓風險很小，但它們可能會危及生命。40歲以上、肥胖、懷孕或行動不便（比如一條腿打了石膏）以及有血栓病史或家族史的人風險最大。含有雌激素的藥物也會增加血栓風險。我平時會服用一種此類藥物——雷洛昔芬來保護我的骨骼，但既然它可能增加血栓風險，我會在至少四小時的飛行前三天停止服用該藥物。欲瞭解更多信息，請查看C.D.C.關於血栓和旅行的建議，並諮詢你的醫生。
Even when traveling alone, I always purchase travel health and medical evacuation insurance because, well, you never know. People on my various trips have broken bones or become seriously ill and had to return home mid-trip. Two men died while snorkeling on separate trips of mine.
即使是在獨自旅行的時候，我也總是會購買旅遊健康與醫療保險，畢竟——你知道——世事難料。在我的各種旅行經歷中，就見過有人因骨折或生了重病而不得不中途打道回府。在我獨自旅行的時候，也遇上過2次男子在浮潛時死亡的案例。
Consider carrying a card that lists your blood type, any chronic illnesses or serious allergies and the generic names of prescription medicines you take. Bring some extra doses in case of travel delays.
請考慮攜帶一張卡片，列出你的血型、慢性疾病或嚴重過敏史，以及你正使用的處方藥的通用名。請適當多帶一些藥物，以防行程延誤。
Other worthy precautions: To avoid nasty parasitic diseases like schistosomiasis, do not swim or wade in fresh water in developing countries or wherever the sanitation is poor. Pools should be chlorinated. However adorable an animal (domestic or wild) may be, keep your distance. Do not touch or feed any animal you don’t know. Some carry rabies. Should you get bitten or scratched by an animal, wash the wound immediately with soap and clean water and, if at all possible, get to a doctor quickly.
其他值得注意的事項：爲了避免血吸蟲病等嚴重的寄生蟲病，請不要在發展中國家或任何衛生條件差的地方的淡水中游泳或涉水。游泳池應經過加氯消毒。無論動物（家養或野生）有多可愛，都請保持距離。請勿觸摸或飼餵你不認識的任何動物。有些動物可能攜帶狂犬病病毒。萬一被動物咬傷或抓傷，應立即用肥皂和清水清洗傷口，如果可能的話，儘快去看醫生。
If you expect to be at a high altitude (8,000 feet or higher), consult your doctor about medicine to prevent altitude sickness, which can take more than the starch out of a person. I was glad I did when traveling to Cusco, Peru (11,154 feet) and climbing in the Sacred Valley of the Incas (9,000 feet). The recommended preventive is acetazolamide (generic version of Diamox).
如果你計劃前往高海拔（8000英尺[約合2348米]或更高），請諮詢醫生如何用藥預防高原反應——萬一發生高原反應，可就不單單是讓人垂頭喪氣這麼簡單了。我很慶幸我在前往祕魯的庫斯科市（11154英尺[約合3400米]）以及攀爬印加聖谷（Sacred Valley of the Incas，9000英尺[約合2743米]）時做了這些預防措施。推薦的預防藥物是乙酰唑胺。
