By John Wogan
July 02, 2019
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The Dominican Republic has made headlines recently, and not in a good way. The Caribbean country — which draws in over 2 million visitors from the U.S. each year, making it one of the biggest tourist markets in the region — has experienced an alarming trend in the past year: 10 Americans have died while on vacation here in the past year. The circumstances of each case is still undetermined, and the incidents have understandably left many travelers concerned about booking a trip to the country. The New York Times and the Washington Post reported that a few of the deceased (whose ages range from 41 to 67) died from heart and respiratory failure, though toxicology reports are currently being analyzed, and investigations are ongoing. The Dominican tourism minister, Francisco Javier García, insists that it is safe for tourists, and there’s no warning from the U.S. State Department regarding the incidents. (The F.B.I. is helping the country’s national police to investigate.)

While it’s easy (and understandable) to be alarmed by the news coming out of the D.R., the vast majority of American tourists have visited in the last year without incident, and the Caribbean in general remains one of the safest parts of the world in which to travel. (28 million people visit every year, who are largely unaffected by crime or other danger.) Still, all of this is a reminder that even on a beach vacation, where all you want to do is swim, eat, drink, and relax in the sun, it’s worth thinking about your safety.

For tips on the key practices for eliminating risk while traveling, we spoke with John Gobbels, a former critical care nurse who was also the Clinical Director for STAT MedEvac in Pittsburgh (the air ambulance arm of the renowned University of Pittsburgh Medical Center). He’s the current Vice President and Chief Operating Officer of Medjet, which is one of the leading travel protection and medical transport companies in the country. We asked Gobbels for his thoughts on how to minimize risk on your next trip.

Q: A few of the deaths in the Dominican Republic seemed to be the result of heart failure or respiratory issues. For travelers that may have a history of heart and respiratory problems, what are some key things to think about before and during a trip?

A: “Hot weather can be hard on the heart. The body cools itself in two ways, both of which involve the heart: radiation (moving blood around the body, especially pushing larger volumes closer to the skin), and evaporation (where perspiration helps cool the skin and the blood flowing through it). On a hot day, your body may be trying to circulate two to four times as much blood each minute as it does on a cool day. As you can imagine, this may strain even a healthy cardiovascular system so can be especially problematic for people with already strained, or previously damaged, hearts. Add excessive sweating, which can reduce the potassium and sodium levels (key components in maintaining healthy circulation and body water levels), and a body can quickly fall prey to heat stroke, dysrhythmia (irregular heartbeat), and other serious complications.

“I think awareness is key. While the Caribbean may seem like a common and innocuous place to travel, have a conversation with your doctor prior to going — not just about vaccinations, but also about your overall health, and things that may be of heightened concern in hot/humid environments. Once you get there, take it easy. Staying cool as much as possible, drinking plenty of water, and eating light are ways to help your body cope with the heat.”

Q: Aside from heart and respiratory problems, what other health issues exist that can be affected by hot and humid parts of the world, such as the Caribbean?

A: “In addition to heart and circulation issues, of concern for hot climates might be Parkinsons, Alzheimers, diabetes, prior strokes and other conditions that might have possibly affected the brain’s ability to signal signs of oncoming dehydration.”

Q: Some reports have inferred that alcohol consumption may have played a part in a few of the incidents in the D.R. Are there any guidelines you can recommend in terms of alcohol use?

A: “Caffeinated beverages and alcohol can exacerbate dehydration. Avoiding sugary drinks is also a good idea since it can actually slow the body’s absorption of water. People on medications like beta blockers, diuretics, even some antidepressants and antihistamines that can block sweating, should also be mindful.

“As a general rule, before consuming liquids, whether it be a water bottle you buy from a street or beach vendor, or alcohol from your hotel’s mini bar, always look closely at the cap to make sure there isn’t a gap between the seal ring and the bottle cap, as that would indicate the bottle has been opened. Do not leave drinks unattended, and NEVER accept a drink from a person not known to you, even at the hotel bar.”

Q: What about a hotel’s physical environment? What can guests do to ensure their room is as clean and non-toxic as possible?

A: “You have to remember that hotel rooms are frequently used, shared spaces, and not everything is ‘sanitized’ to the extent one would hope. The floors, comforters, bathroom countertops and other surfaces frequently still have human bacteria and infectious matter on them. Various forms of strep, staph, Bacillus spp, etc. can cause serious gastrointestinal and respiratory problems, even for those with healthy systems. Ventilation systems are breeding grounds for bacteria and molds, and noxious gasses can occasionally be of concern, especially carbon monoxide. While you can’t sterilize a room by yourself, I would suggest avoiding contact as much as possible: Don’t throw clothing and towels on the floor and then reuse them, don’t set your toothbrushes on the counter, remove the comforter or bed coverings when you get there. Basically, be cognizant of contacting surfaces with items you might put near your face. There are some great, easy to pack carbon monoxide alarms you can take with you, especially if it’s an older hotel or you’re staying in an Airbnb which may not be inspected or regulated like hotels. I own one of these for camping but also pack it for other trips.”

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