They go to have fun, make friends, discover the world, test their abilities and
learn about themselves – and some come back unwell or even rushed to an Israeli
hospital. Every year, hundreds of Israel backpackers – including some
middle-aged adults – return from Third World “paradises” not only with memories
and memorabilia but also with serious tropical diseases due to apathy,
negligence or bad luck.
An infectious diseases specialist and an
educational psychologist teamed up to write a book, in Hebrew, about these
travelers and the malaria, bilharzia, dengue fever, leishmaniasis and other
potentially fatal diseases they pick up.
One hopes they pack up and read
the 248-page, softcover volume along with their maps and travel guides
can stay healthy during their treks in the Far East, Africa and South
Titled Nosaya Samui: Sipureihem Shel
Nos’im Veshel Mahalot
Tropiot Nilvot (A Hidden Traveler: Narratives of Travelers With Tropical
, the NIS 78 book was written by Sheba Medical Center
Schwartz and Dr. Orna Schatz- Oppenheimer and published by Ramot-Tel
University. It makes an interesting, often fascinating read as the
combine their talents to provide a lot of laymen-friendly clinical
intertwined with personal stories of Israeli victims.
The main aim of the
book, they write in the introduction, is to explain the risks of
unfamiliar diseases that even many Israeli doctors have never seen. “For
who intend to go on a journey or trek, worried parents of backpackers,
staffers, company workers involved in the Third World and just those who
curious and enjoy reading – to all these, A Hidden Traveler
opens a window” on
the relatively new field of tropical medicine.
MALARIA, which is derived
from the Italian words mala aria
(because it was thought “bad” or polluted air
caused it), is still one of the most fatal diseases, killing about two
people a year. It was in Israel’s swampland too, and whole settlements
abandoned due to the toll taken by Anopheles
mosquitoes carrying the plasmodium
parasite and spreading the disease. But in 1966, the World Health
declared it eradicated in Israel; since then, it has been diagnosed only
Israelis and foreigners bringing it from abroad.
There are three million
types of mosquitoes in the world, they write, and 400 belong to the Anopheles
family. About 25 of these can carry the parasite and transmit it to
plasmodium parasite come in four types – ovale, malariae, vivax and
but the last two are responsible for 95 percent of all cases.
Alfonse Laveran, a French military doctor, first identified the parasite
in red blood cells of a malaria victim; 27 years later, he received the
Prize for his achievement.
The female Anopheles
needs blood for
the protein “meal” the eggs she lays can feed on. She sucks the blood
hole in the victim’s skin, and if she carries plasmodium, two weeks
first symptoms appear – a high fever, weakness, headache, chills and
pain of the joints and lower limbs. As these symptoms are
doctors may misdiagnose the problem as flu, especially if it occurs in
autumn/winter flu season, the authors note.
IF UNTREATED or
unsuccessfully treated, malaria can result in severe headaches,
attacks, respiratory difficulties, kidney failure, loss of consciousness
then death. Only a specific blood test can confirm the diagnosis – and
unfortunately, in far-off Third World countries, such a test is not
available. It is more difficult to diagnose if the Ovale or Vivax
involved, as it may show some symptoms, then “sleep” in the liver and
months later. This has produced misinformation among trekkers that
be treated, only to reappear later, but there is no scientific basis to
The first effective drug for treating malaria was
identified by the Indians of Peru, who used the bark of a local tree –
or Chinchona – to treat it.
The active ingredient in Peruvian bark is
quinine. It was synthesized at the end of the 19th century and called
and shown effective as an injected drug not only against malaria but
against irregular heartbeat after heart attacks. But as the parasite
resistance to the drug, there has been a constant search for new, safe
effective ones. A drug called mefloquine (Lariam) developed by the US
taken once a week has proven very efficient; it sometimes causes
stomach discomfort and should not be prescribed to people with
disease, especially epilepsy, or psychiatric problems. Two other malaria
are malarone and a Chinese concoction named sweet wormwood.
places where malaria is endemic, one must also take pills to reduce the
infection, but they don’t prevent infection, as they hinder the
development and halt the disease. Many backpackers believe that the
effects are more unpleasant than the disease, but this is untrue,
the book. No protective vaccination has been developed so far, as the
“knows how to escape” from the immune system. Thus the best prevention
wearing long-sleeved shirts and long trousers, using mosquito repellant
sleeping in rooms whose windows are screened (as the bugs bite at
The authors include a chapter taken from a book produced by the
Foreign Ministry about how successful malaria treatment at Sheba Medical
of Isaias Afewerki, the president of Eritrea led to diplomatic relations
In 1993, Afewerki visited disease-infested parts of his country
and took sick with malaria that reached his brain and put him into a
Americans, fearful that Afewerki’s death would end the peace process
Ethiopia, pressed for hospitalization in Israel, despite Muslim
opposition. He was flown to Sheba along with senior ministers and
excellent treatment was provided, and he recovered fully, even chatting
then-foreign minister Shimon Peres. He was able to return home in an
Aircraft Industry jet, and liked it so much that he bought it on the
he suffered a rare complication due to the severity of his illness, he
to Israel for a checkup and was successfully treated. In May 1993, two
after his second visit, diplomatic relations between Eritrea and Israel
MICHAL, a 30-year-old Israeli who took very ill with malaria in
India, gives a frank interview while in an Israeli hospital. A graphic
she decided to leave her routine and trek with a boyfriend and alone.
patients’ personal stories are printed in italics, with the authors
helpful commentary on the medical aspects.
She had been away for many
months and returned for her birthday, but spent it in an Israeli
feeling awful. She had diarrhea, ringing in her ears and low blood sugar
addition to the better-known symptoms of malaria.
“I presume it will be
much more difficult to return to India after I got sick there,” she
it was an incredible experience and I’m sure I will return.
What is clear
is that one has to be very aware that the minute one’s temperature rises
can still travel, get on a train or a plane or hire a jeep for NIS 600
1,000 and get to a hospital... and not some clinic.”
Drora, a divorced
woman in her 50s, is not the typical Israeli trekker. She spends many
traveling alone, making friends with people her children’s age and
doing meditation in ashrams. Suddenly she felt she was losing her
though the number of red blood cells in her body had dropped, malaria
diagnosed. She became so apathetic that her daughter had to fly in to
home. Yellow from the decomposition of blood cells, she was covered up
plane going home so as not to frighten other passengers. She could
breathe when she arrived at the hospital, and was immediately admitted
intensive care. Drora thought she was dying – but was not alarmed. Only
friend visited her and demanded that she fight the disease did Drora
An Israeli who lived in Angola buying raw diamonds from local
dealers and living in a well-guarded villa got malaria for the fourth
the last was very severe, harming his kidneys. Even though he was
there, doctors didn’t know what type of parasite was involved and gave
on a trial-and-error basis. Fortunately, he got back to Israel in time,
kidney function recovered. But he decided not to live in Africa any
Bilharzia is a tropical disease known scientifically as
schistosomiasis, produced by the trematoda worm that lives in water
with human excrement.
The worm, only 12 to 14 millimeters long, passes
through the skin to internal organs. The eggs are eliminated in the
stool and, when they meet up with a certain type of snail, breed inside
excreted. A month after they enter the human body, the victim develops a
fever as an allergic reaction to the worms. When eggs are released by
the disease spreads, producing itching, burning and blood in the urine.
patients are misdiagnosed with a tumor. The eggs can wander into the
men and genitals of women, causing more problems. A drug called
(Biltricide) is recommended when the worms reach adulthood.
existed here in the 1920s, apparently brought by pilgrims, Beduin and
who came from Egypt. In some Arab villages, nearly everybody was
bathing in the Yarkon was enough to infect 170 pupils in 1928. But
the heavy organic pollution that developed in the Yarkon killed off the
and the cycle of infection was halted. Eventually, it disappeared from
country, only to appear in Israeli travelers and foreigners.
30-year-old student, went to Africa for over a year and picked up
while bathing in a Malawi lake. She retells her experiences as a single
travelling to Uganda and other countries, with the local married women
protecting her from macho males. Feeling unwell, she returned to Israel
suffered greatly. “It was really scary; I was weak and couldn’t do
It took months until she was correctly diagnosed and treated
by a tropical disease expert, who asked for photos and a full
what she did during her travels. Finally, she recovered.
Dengue fever is
spread by Aedes aegypti
mosquitoes, their bites causing high fever, joint and
muscle pain and sever headache. It is common in the Caribbean, Far East
Latin America but less so in Africa. The import by the US and European
of cheap tires from the Far East led to the mosquitoes’ “import” as they
in their wet hollows. The most serious type of the disease is dengue
fever, which is often fatal. There is no vaccine or specific drug;
given supportive care to recover.
Leishmaniasis is spread by the bite of
the sand fly and is common in the Middle East, known in Israel as the
Jericho because of the rash. But other types affect not only the skin
internal organs, membranes and cartilage. Various drugs are available,
on the type, but the body can sustain serious permanent damage.
conclusion of the book, Schwartz and Schatz-Oppenheimer note that every
some 100,000 Israelis visit Thailand and 50,000 go to India. Latin
also popular, with 55,000 trekkers, and 20,000 more go to Africa.
hygienic conditions do not deter them.
Israeli doctors who treat
returning trekkers are frustrated by the fact that the supply of drugs
minimal as companies have to go through much red tape to be
tested, approved and registered; in addition, “only” hundreds of
Israelis a year
need them. With an inadequate supply of drugs, treatment that would have
only a few days drags on.
As the Third World is brought closer by
travelers, a change in thinking is required, the authors conclude. “From
personal stories we have presented in the book, it is clear that
used to exist in far-off regions of the world are coming here quickly.
exposes some hidden travelers’ diseases that have become visible guests
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