GERM
00:00:10.480 – 00:00:11.520
Bat haiyo ne? My name is Germ.

WORM
00:00:11.520 – 00:00:12.400
I’m Worm.

GERM
00:00:12.560 – 00:00:28.480
Welcome to episode 86 of the Germ and Worm Travel health podcast. There’s a rat in me toilet. What am I gonna do? It’s a big planet. See it in Good Health. I’m Dr. Paul Pottinger, also called Germ. I’m a professor of infectious diseases at the University of Washington in Seattle.

WORM
00:00:28.770 – 00:00:36.450
I’m Dr. Chris Sanford, also known as Worm, Associate professor in the Departments of Family Medicine and Global Health, also at the University of Washington.

GERM
00:00:36.610 – 00:01:26.910
Chris, this is our job: to answer questions as they come. And. And here they are for today. Rats in the toilets of Seattle. Is this really a thing? Spoiler alert. Maybe so. Health and safety concerns when traveling to Myanmar. Should I be screened for tuberculosis after I take an international trip? And a new vaccine for Nipah virus infection. Is it ready for prime time?

A reminder to our listeners, Please contact with your own travel health questions, your stories, and your tips for success or requests for clarification about something we say here on the podcast. Just get us on our website, germandworm.com or drop us an email germandwormmail.com before we start, here is our medical disclaimer.

This podcast is designed to inform, inspire, and entertain, but you should not use this podcast as clinical care. Before you travel. Please see a qualified healthcare professional for recommendations specific to you and your itinerary.

WORM
00:01:28.900 – 00:01:50.100
Paul, this next question is for you. There was recent flooding in Washington state, particularly around where we are, King county and Snohomish county in western Washington.

The public health department put out notices about potentially rats coming up into toilets and what to do if that happens. Is that an Internet joke or is that a real thing?

GERM
00:01:50.660 – 00:04:12.570
The two are not mutually exclusive. So first of all, to honor the victims of the flooding, we really do have historic, unprecedented flooding here in the King county area.

And that’s for a bunch of reasons. It’s climate change, it’s bad rain, it’s neglect of our levee system. It’s a whole bunch of things that came together.

I did not see this aspect coming, which was, you know, there could be a rat in me toilet. So here in Seattle, we’re not a big city. We’re a couple million people, top left corner of the country. And I don’t mind when we get some.

Some national press. It’s usually good. This is not good.

And what happened here was we have some concern that during the flood that rats in the area, which may be there all the time anyway, they get swept into rivers and viaducts and causeways and they May end up trying to survive. I mean, they’re mammals, after all.

And one thing that they can do is apparently, theoretically, this is possible that they could, in order to survive, crawl up the sewer system. This may actually lead to rats being able to get through that s. Trap at the bottom of your toilet and end up in your toilet bowl.

No, it’s not a joke, although it’s. It’s horrific in its proportions and its implications.

But the concern from public health authorities and sanitation experts is that this could happen.

You could theoretically lift the toilet lid if you keep it shut at home in the first place and see a rat swimming around in the toilet trying to get its way out. Now, most toilets, it turns out, are smooth and slippery, and it’s not easy for a rat to actually get out of the toilet.

But it’s not exactly what you want to see when you. When you consider the thing you’re supposed to do in the toilet. This is not expected. So apparently it is theoretically possible.

Apparently it has happened. And because there’s so much flooding, they’ve told the citizens of Seattle and surrounding areas what to do.

And what you should do, apparently, is flush it back down. I mean, I. This is what we’ve been advised to do. Flush the toilet. Let’s close the lid, flush the toilet.

And if that doesn’t take care of it, consider squirting some dish soap in there. That may lubricate the system and help the rat slither back down into the sewage system.

And if that doesn’t work, they’ve advised you, call a pest control person. Now, I have not heard tell of the pest control industry in Seattle going ballistic off the walls doing this.

I’m not sure this has actually happened, but it is at least a theoretical concern. What do you think, Chris?

WORM
00:04:13.130 – 00:04:51.510
I can see why this caught the national attention. Can you imagine? This sounds awful. You’re trying to have a private moment and you feel a little nibble on your posterior. I mean, this sounds awful.

And actually, I don’t think it’s 100% hypothetical. When the New York Times read this, a number of readers put in comments which are always interesting to read.

And apparently some wrote, yeah, this in New York City. This happened to me 30 years ago, and I still remember the exact moment. So this is rare, but it’s not entirely made up.

As Paul said, stay calm, Put the lid down, flush, Put in some dish soap, get professional help. Don’t freak out.

GERM
00:04:52.030 – 00:05:58.390
The chance of being bitten on the buttock by one of these beasts is extremely small for the reasons we talked about. So if this does happen, your house does not have to be torched to the ground under conflagration of fire. It is just a toilet after all.

To be clear, if you are bitten or scratched by a rat, that is different. You do need to see a doctor because rats can carry certain infections. But if it’s just one in the toilet, that wouldn’t make me freak out.

Your toilet is usually dirtier than that anyway. And, and I think this is unlikely to happen. And it’s not just Seattle. Thank you for emphasizing that New York City is way ahead of us on this.

Actually, anywhere in the world where there is frequent flooding and such, this could happen. So we’re glad to join the legions of people who have a rat in me toilet.

And if this happens to me, I promise I will share this with you here on German Worm. Okay, Chris, question to you from an anonymous writer who says I’m scheduled to travel to Myanmar to to visit a friend who lives there.

My first time to Myanmar, but I just read that their public health system is in shambles. Honestly, do you think I should reschedule?

WORM
00:05:59.030 – 00:07:15.630
Thank you for the question.

When I’m considering going to a potentially tumultuous country, one of the first places I check out is the U.S. department of State Travel Advisory System. And out of the roughly 190, 200 countries in the world, about 20 are level four. And level four is do not travel.

And unfortunately, Myanmar is on that list. There was a coup d’ etat there in 2021. Basically, the military took over the government. And since then it’s been very tumultuous.

And the public health system, which wasn’t great in the first place, has deteriorated. Also, there have been detention of foreign citizens, primarily journalists, but also some other people.

I think for you to visit a friend there, I would wait until the country is more stable. I don’t think it’s a place for tourism now. I think there’s a certain threshold beyond which you might be a burden in some way on the system.

You might have something untoward. If something untoward happened, whether it was a legal problem, detention, or an illness, there would be insufficient support.

So everyone has their own level of risk, and some people are going to go there to visit family or what have you. But for me, given that your trip is optional, I would give it a pass until things chill out a bit.

GERM
00:07:16.310 – 00:08:39.630
I mean, I agree, I don’t always agree with the current administration’s feelings about international travel or international affairs in general. This one, I think is true. And if you do read this article, which I suspect prompted the question from this nice person here in the New York Times.

What they’re describing is just a collapse of public health system and the health system in general.

Not just public health, but also clinical care, where doctors not only in Myanmar, but also in the bordering country of Thailand are just swamped with doing refugee work, work with trying to take care of people who are dealing with a number of critical issues. Infections that they haven’t seen in a long time, like cholera, explosions of malaria, whooping cough, pertussis.

They’re just getting swamped by this because there’s chaos. Anytime there’s civil war, there’s chaos. And of course it’s the people who suffer.

And that’s because there’s no longer that sanitation infrastructure. Things are a mess.

I’m just thinking about from a health perspective, when it comes to personal safety and political repression, journalists being jailed arbitrarily, etc, it’s bad. Right now. Things are bad in Myanmar. The questioner has said that they want to visit a friend.

Look, if that’s for a short trip for a reason, that they must go for medical mission or something like this, I mean, it can be done. But if this is just a trip that should be done optionally, I am with you, Chris. We don’t usually tell folks what to do, do we? I guess we’re not.

WORM
00:08:39.710 – 00:08:40.670
Well, we never do.

GERM
00:08:40.750 – 00:09:07.930
We never do. And… I would not do this.

And caring about all of our listeners, I hope that they will consider rescheduling and I’m thinking about their friends who are there hoping that they are safe and prosperous as well, the people of Myanmar. I’ve never visited this country. I would love to. It sounds absolutely fascinating. There’s so many things going on.

I have that on my list, but not right now. I would not personally feel safe doing so for both political safety and of course, infectious health reasons.

WORM
00:09:08.010 – 00:09:22.170
Yeah, I had the good fortune to go there some decades ago. Let’s see, this was 1998. Lovely country. Monks, temples, lovely countryside, lovely people. That was a long time ago.

I hope to go there again, but it’s not going to be this year.

GERM
00:09:22.450 – 00:09:24.730
Well, maybe you and I could go together. I’d love to have you show me around.

WORM
00:09:24.730 – 00:09:47.650
Yeah, yeah, yeah. All right. Paul, coming to you, I’ve read a new article that there’s a vaccine for Nipah virus infection.

Do you trust the new vaccine and should I consider getting it? And is it really ready for prime time?

GERM
00:09:48.250 – 00:13:17.780
Hey, thanks so much. So Nipah virus, we’ve talked about this briefly, I think back on episode 69 where we talked about folks in South Asia catching Nipah virus.

It’s a virus that actually can be communicated to people through the consumption of home brewed palm wine. Why does that happen?

Well, it turns out that bats, especially fruit bats, they tend to carry this virus, the Nipah virus, and they also love hanging out in palm trees. And that’s where palm wine comes from.

And I think the bats can either through their feces, their snot, their urine, somehow they tend to put these viral particles into the palm trees, which is how it gets to palm wine and then into people. There are probably other ways to catch it.

In fact, in that context, there was one person who actually contracted Nipah virus, a child who had not consumed palm wine. So it can come through other sources and other routes in nature. That’s a problem because Nipah virus can be very dangerous.

This is a virus that triggers an inflammation of the meninges and the brain, meningitis and, or meningoencephalitis. And this is a very inflammatory response by the human immune system to a virus that just does not belong. It is very foreign.

It’s quite different from most of the other viruses that we may already have immunity to. And so sort of like the bad old days with the original ancestral Covid, where people got so very sick. So too here with Nipah virus.

So people do die this way in South Asia. It’s a real shame.

And so that’s why I was so excited to read recently a news release by CIDRAP about a new phase 1 randomized clinical trial of a new Nipah virus vaccine, which apparently engenders a nice immune response. Now, this was published in the peer reviewed literature in a very reputable journal called the Lancet.

And what researchers did was they gave people this experimental vaccine, a dose, and then they looked to see what kind of antibody response they made. Right, Chris, this is the classic thing for a phase one to do.

Not only is it safe and tolerable, but also does it generate the antibody response that we would hope to see. And so people who were given two doses of this vaccine, yes, they did produce antibodies within a month of getting their shot.

And the vaccine compared to a placebo really made a huge difference in terms of boosting that immune response much, much better than the placebo group. And no one was hospitalized, no one died who received this vaccine. It did seem to be safe and well tolerated.

And so you knowing that there have been outbreaks in South Asia in particular, also in Malaysia, Singapore, Bangladesh and India with a high mortality rate. This is exciting to us. The questioner is asked whether it’s ready for primetime. It is definitely not ready for primetime. This is phase one.

And as you recall, in fda, current legitimate FDA parlance, we have four phases of approval. So this is the first of those four phases and that’s exciting.

I’m very hopeful that this will lead to phase two studies and that this will show in larger numbers to be both effective and safe. But we’re not there yet. And so to this questioner, if you are traveling to South Asia, should you worry about Nipah virus?

Look, it’s a bad infection, but it is quite rare.

And I think the thing to do, as we’ve talked about before, aside from all your usual personal protective measures, this is yet another reason why I do think you should avoid consuming home brewed palm wine when you’re in that part of the country, especially in the wintertime. That’s when we tend to see more of these outbreaks. Chris, your thoughts about Nipah virus, the vaccine or otherwise?

WORM
00:13:17.860 – 00:13:38.960
You bet. I’m glad to see this encouraging study. As you say, it’s not yet on the market. Should this be released?

Should it do well and be efficacious and not have a lot of side effects and make it to the general market?

Probably like a lot of vaccines, this is going to be more important for the folks who live there and have ongoing exposure than for folks who only have very occasional exposure.

GERM
00:13:39.520 – 00:14:07.670
Yeah. So stay tuned. Let’s keep our eyes peeled and keep our ears to the ground.

Let’s look for the literature that shows how this is going to advance and we’ll bring it back as we learn more. Chris, question to you. I love this one.

The anonymous questioner says, do I need to worry about tuberculosis when I visit countries where TB is common? And should I be screened after my trip overseas?

WORM
00:14:08.310 – 00:16:32.140
Yeah. Thank you for this. First, a little bit of background. Tb, it’s a bacterial illness. It’s common around the world, particularly in low income countries.

You’ve probably heard of it if you read much 19th century literature. They called it consumption because people tended to lose weight and waste away.

Began to get really common in Europe in the 1600s as people started living together more got more urban. Hit a peak in the 1800s and actually in the 1800s in places like Europe, it caused as many as one death in four. So it was super common.

There’s still a lot of people who have active infections and it actually kills around the planet. Over a million people every year, about 1.2 million people, making it the number one leading cause of death from infectious disease.

It spreads through the air, so by coughing and such, and primarily it affects the lungs. So most TB disease is pulmonary, but it can affect any organ in the body and we call this other location tb, extrapulmonary tb.

The risk of travelers is low. The risk is high if you live with somebody long term who has active tb, but actually it’s rare for a traveler to get it.

Your risk is a little higher if you’re a healthcare professional. And earlier in my career I was screened every year as an MD for tb. I got a skin test.

But subsequent studies showed that even in healthcare professionals who were at higher than average risk of getting this screening wasn’t really cost effective. So some years ago they stopped that annual screening. In terms of, do you need to be worried about it?

Not really, unless you’re living with someone for months to years who has active tb.

So if you’re just a ordinary traveler or tourist, your risk is fairly minuscule of picking this up or your next question, should you be screened after your trip? As a general rule, no. Again, several decades ago we used to screen for TB after longer trips with a skin test or a blood test.

We don’t tend to do this now. And of course that’s assuming you’re asymptomatic.

If you have a prolonged cough, sure, if you cough for a week after a trip and it goes away, maybe it’s a head cold. But if you’re coughing, say for more than three weeks after a trip. Yeah. See a doc and maybe consider getting some testing.

Now, this leads us to the thing that’s relevant to travelers, which is a vaccine. And I think I’m going to let Paul talk a little bit about where we are with vaccines and who gets benefit.

GERM
00:16:33.020 – 00:19:20.490
Currently, what we really need for this most incredibly common infection is a strong, durable, effective vaccine. And there is work in this area.

To be clear, we have a vaccine today called bcg, the Bacille Calmett-Guerin, Calmette and Guerin built this a long time ago. It’s not even totally clear where this particular strain of TB came from.

So there is a TB vaccine and that has been shown over many years to give partial protection in young infants and newborns to reduce their chance of developing a very serious complication, which is called TB meningitis. So it’s given routinely across planet Earth. Not in my country, the United States, but most everywhere else.

When you’re born into A country where there is a high rate of community acquired TB newborns get this BCG vaccine and it works to reduce the chance of this devastating central nervous system infection. However, that durability is not continued beyond childhood. People still catch TB after they received bcg.

It just tends to happen a little bit later in life and they tend to have a lower risk of central nervous system infection. So.

So we do not routinely give this vaccine in the United States, even to people who are traveling overseas, because it really is a pediatric vaccine. Right, Chris? We need a shot to give to everybody, everybody alive who could get one shot and get rid of this infection that does not exist.

There is exciting development scientifically in people who are really tilting at this windmill trying to make that happen. Stay tuned. I am actually optimistic that that may happen in my lifetime. It’s possible. It has been an incredibly difficult thing to do.

There is no guarantee that we will get there. And certainly today that unfortunately does not exist. If someone’s traveling internationally and they come back.

You mentioned this, I think correctly. You know, do we routinely recommend people be screened? No, we do not.

But when might you ask your doctor about being screened if your immune system is low, if you’re someone who, for example, is living with hiv, or if you are planning to go on to or currently are receiving immunomodulatory treatment, especially that family of drugs against tnf, the TNF blockers. That’s a high risk for tb because TNF is what keeps the TB under control.

So yeah, you can most definitely catch this infection overseas. If you come back sick, tell your doctor I was overseas, they should think about tb.

And if you are someone who’s at high risk of bad complications of tb, then that’s something to talk about, by the way, before you go and also after you come back. With those exceptions, most folks should usually not worry too much about tb.

But I’m glad this person asked about it and it’s something that we take seriously and boy, your travel health medicine specialist should really help you. Think about this in the case of before you go and after you return.

WORM
00:19:22.970 – 00:19:30.570
Paul, this comes to you from Jordan in Hamilton, Ontario, Canada. Should I get evacuation insurance?

GERM
00:19:31.930 – 00:22:00.400
Yeah. Thanks, Jordan. As far as I know, Hamilton is still not totally third world. I think you could probably get to a hospital just fine. No, just kidding.

So the answer is it depends, right? Depends what you’re up to, where are you going to go and what are you going to do.

Evacuation implies that you’re overseas and that you’re sick and you need to get back to your country of origin. And there are reasons why people should think about this. Reason number one would be you’re going someplace very far flung, very far afield.

And without that insurance, getting home in the case of a traumatic accident, an injury or something would be very difficult. So maybe that helps to facilitate the speed of getting home. Maybe it also helps to just cover the exorbitant, crazy, crazy cost.

And Chris, I’ll ask you in a minute for what your experience is with the cost of this, but to me, you know, working with some families over the years, 30 to 50,000 US dollars to be repatriated through an air ambulance. I mean, no problem, easy that it would cost that much, if not more. So there are cases in which this can actually save you a lot of money.

And if you’re going to do a high risk activity, you’re thinking about this. But the other reason to think about this is just for medical issues.

For someone who’s living at high risk of a cardiac issue, someone who’s got a history of vascular disease, chronic lung disease, you name it.

For someone who is dealing with chronic medical issues, they may want to be able to return to their country of origin very quickly as well, even if they’re not going to be zorbing, shredding the nar or whatever, mountaineering and such. So both of those are reasonable reasons. Jordan in Hamilton, Ontario, to think about doing this. So I.

For example, my hobby, as I think we’ve mentioned here before, is mountain climbing. And when I’m on a large international mountaineering expedition, I usually do bring evacuation insurance. That was very helpful for me.

For example, in 2015 when there was a big earthquake in Nepal and I was about halfway up Mount Everest, that was a way to fly to safety. The truth is, I would have flown to safety anyway, but this really helped me cover the cost. So that was an investment well done.

And I’ve seen that be helpful to people before. On the other hand, I don’t always do that. I’ll give you an example. Next week I’m gonna climb, or try to climb Pico de Orizaba.

That’s the third highest mountain in North America and the tallest in Mexico.

I’m doing that with friends and family and I do not have evacuation insurance for that because Orizaba is close to Mexico City and Mexico City you can get to anywhere internationally. So I think you can be choosy about this. Depends on what you plan to do and where you plan to do it. What’s your philosophy about this, please?

WORM
00:22:00.400 – 00:23:25.690
Well, I think it’s always reasonable to get it as per your personal preference. But as you say, it’s more important if you’re going longer duration and more remote and more isolated and lower quality of healthcare.

And it’s low priority if you’re going to a high income nation. So if I was going to London for a week, I wouldn’t get it. There’s good medical care in London, for example.

But suppose I was hiking or trekking for a month in Kenya or Peru or Laos. I’d probably get it because suppose I had bad luck and my automobile crashed and I fractured my femur, my thigh bone.

Well, that often involves surgery and pins to reset it. And I’d probably want to be flown to a different country for the surgery. And I’ve even heard of air ambulances costing 50 or even $100,000.

And they’ll fly you, but they’ll want the money. And so just doing the math, it really saves a lot of money to get the insurance a good place to buy the insurance.

There’s this really nifty website called squaremouth.com spelled just like it sounds. And it’s basically a clearinghouse for a large number of different plans for medical and trip and evacuation insurance.

You can compare plans you put in your duration where you’re going. They’ll spit out a price and it’s not that bad. As I recall, I’ve paid like $125 for three and a half weeks of coverage, something like that.

I’ve never actually used it, but I’ve talked to people who’ve had. And they were really glad that they had it.

GERM
00:23:25.850 – 00:25:11.770
Yeah. And I think that number, the cost can go up depending on the planned itinerary.

So for me, you know, you have to tell them, don’t, don’t try to believe me. If you try to lie to them or minimize your itinerary, they will not pay. So I mean, I told him I was climbing Mount Everest.

My, I would think I was about 10 times higher than what you just mentioned a moment ago, but it’s still worth it, put it that way. So thanks for asking about this. If folks out there have good or bad experiences with travel, evacuation, insurance, let us know. Just drop us a line: Germandworm@gmail.com. Okay. Along similar lines, I want to ask you about this, Chris.

From myself, I get this question a lot about communication and planet wide communication. All the gizmos and options that are out there. It’s becoming more complex. What should people do?

So back in the old days, it was pretty Straightforward. If you were going to travel internationally and you wanted to stay in touch with people, you would bring a satellite phone, sat phone.

That was called the Iridium phone. There were others, but basically it was Iridium.

And it’s this thing that looks like a 1980s mobile phone, this gigantic cordless phone type of thing with a big rigid antenna. And by the way, that’s still there. And I have used those. A friend of mine was kind enough to lend me his on Mount Everest.

So I was able to call home, talk to my wife and tell her, hey, there’s been an earthquake, but I’m okay. Like that. That was worth it in that moment. But now things are more complex, right?

Because there’s Internet access, there’s services that’ll do that, there’s SOS options.

There’s even, of course, the newest iPhones, which have their own satellite communication and allow you to, well, to text with people at will from anywhere in the world. So I just want to chat with you about this. What’s your philosophy about staying in touch with people and communication options?

WORM
00:25:12.490 – 00:27:12.250
First, let me make the larger point that when you read online that a certain product will make you safer when you travel. My first thought, and I think I’m usually right, is that if you buy this thing, it’ll make a profit for the company that makes it.

And it’s a really good marketing pitch that it’ll make you safer. And it may or may not, but a lot of them don’t. So if someone appeals to your fear, don’t feel that you have to do it to be even safer.

Now, on this topic specifically, well, first, let me go back a little bit. Let me talk about sort of what’s what. So Garmin uses the Iridium satellite network for its inreach devices.

And Starlink, which is different, offers broadband Internet, but it’s not currently integrated with Garmin. So basically, you pay a fee, you get more Internet or satellite access.

The plus is, of course, you can get in touch with whoever from all over the planet. The con is you got to carry more gear, you have to pay a fee, and to some extent, this will take you out of the moment.

Some of us enjoy being isolated. Of course, I enjoy being isolated less if there’s a medical crisis, and I really want to get in touch with someone.

So again, there’s no one size fits all. In general, I like to take fewer gizmos with me. So, for example, I don’t have a smartwatch. I don’t like being reminded of things on my wrist.

I Would say, as with evacuation insurance, this is very low priority, approaching zero if you’re in a place with good wi fi.

So if you’re going to a developed country which has good Internet, this is like really unimportant if you’re going really remote, especially if you’re doing something adventurous like climbing a mountain mountain where somebody might fall down and break their ankle or worse then yeah, it could be a great thing to have. So my approach to this, I don’t tend to be as adventurous in mountain climbing as Paul.

I’m not signed up for any of these, but I certainly would consider it if I was going off the beaten path for a prolonged duration. So Paul, on mountains, who has what and what do you carry?

GERM
00:27:12.490 – 00:29:14.000
Yeah, I mean, I carry multiple ways to try to stay in touch. Mountaineering or just being in the backcountry in general, you know, it’s hard enough to stay safe.

What I want to be able to do is to be in touch at my choosing. So you’re right, actually, I think being out there and being offline, off grid, it’s one of the great attractions to the wilderness.

I mean, it’s why I do it in large part. But if I get hurt, I don’t want to die out there.

I just, I don’t want to die and have somebody find my cougar chewed femur down 20 years down the line. I want to stay alive. I got things to do, so I got reasons to live.

So I like to have the option to say, hey, one of the party members is in trouble, let’s get help. And I think that’s so for me personally, it’s a two, two part system. There is the Garmin. I use the Garmin inreach the Mini.

And now there’s an even newer flavor of the Mini. It’s so small and it’s smaller than a deck of cards for sure. And that gives you both the ability to text, but also to just push a button.

You’re having trouble with your communications, you’re injured, you push a button. That’s the SOS button and someone will know where you are.

And you can have a concierge type experience to be extracted or at least for someone to have a fight and chance for search and rescue. I also have the Apple Watch, the Ultra or Extreme, whatever they call it, the big fancy one. And with that I can do satellite texting as well.

Indeed, iPhones can do this too. So I’ll use that for example, at night in camp just to tell my family, hey, I’m Good. I’m in camp, I’m having a nice dinner, whatever the case is.

That’s because I’m in the mountains and I think that’s helpful. For me, personally, I like that combination. Currently, I’m both Garmin and Apple. Whether I’ll continue with the Garmin, I don’t know.

I mean, the Apple system is so good. I like it, but it’s more fiddly. You do have to point it at the satellite. You have to track it with your. With your eye and your body.

You have to move that device. If I have a broken wrist or something, boy, it’d be nice to have an SOS button.

That’s why I continue to use the Garmin, formerly called Delorme, but now called the Garmin system. So if you’re going to be out there really far afield, something to look at.

WORM
00:29:14.320 – 00:29:57.170
Yeah, I don’t, as I say, travel with one of these, but one exception. I recently spent six days on the middle fork of the Salmon river in Idaho, and I did not carry one of these devices, but our guides did.

And actually on our trip with our little collection of six boats, nobody got hurt. They didn’t have to do it. But just two boats ahead of us, there were a couple of emergencies.

That one guy hit a rock and broke ribs and had to be medevaced out. Another woman, who was about 70, stood up in a hot pool, passed out, fell forward, hit her head, actually broke some vertebrae in her neck.

Had to be medevaced out. So on that boat, it was really good that they had one of these satellite devices with the guides.

So again, in the backcountry, as Paul says, this can really be a lifesaver.

GERM
00:29:57.330 – 00:30:42.450
Hot springs. They’ll kill you. I hope that person did. O. Everyone, thanks for sticking with us through episode 86 of Germ and Worm.

As always, we welcome your questions on Travel Health. Just send them to us or your tips for travel success. Suggested corrections.

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WORM
00:30:42.450 – 00:30:45.450
I’m Worm. It’s a big planet. See it in good health and we’ll.

GERM
00:30:45.450 – 00:31:06.760
See you next time. This podcast is designed to inform, inspire and entertain.

However, this podcast does not establish a doctor patient relationship and therefore it should not replace your conversation with a qualified healthcare professional, please see one before your next adventure. The opinions in this podcast are Dr. Sanford’s and Dr. Pottinger’s alone and do not necessarily represent the opinions of the University of Washington or UW Medicine.