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Reflections on Risking a Safari in Kenya and Tips for Safe Travel to Exotic Places when Fighting CLL

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By Brian Koffman, MD and CLL Patient

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Was it a good idea to go on a photo safari all over Kenya?

The safest, and maybe the smartest course is to stay put.

Or maybe risk a relaxing trip to the beach for the weekend.

Many fellow CLLers have asked about the trip wondering if it they too could take such a safari or any other exotic trip such as Peru or Vietnam or a million other wonder-filled places that are always beckoning. Is it safe or is it foolhardy?

Consider the pre-trip facts for this one:

It would take two full days with lay overs in Qatar, I would fly across 10 time zones to land in Nairobi, AKA Ni-robbery, a high crime city in Kenya, a country that the State department says is dangerous to visit due to crime and terrorism and overwhelming poverty.

There is a terrible shortage of good medical care with way too few doctors and supplies.

I would travel from Nairobi for seven hours or more on dangerous two lane highways, or barely maintained one lane gravel roads, through shallow river beds and deep rocky pits in rumbling Land Cruisers with red dust flying and bones shaking. This experience is what is jokingly called an African massage. We finally crossed the equator to arrive at a tent camp in the middle of nowhere. We would do the same road trips again and again. You don’t take want to take these roads if you have back or neck pain that might flare-up.

There are airstrips (not airports, but airstrips where the pilot may have to buzz the runway to get the zebras off the tarmac before landing) near most of the places where tourists like me go to see the wildlife.

When you have a compromised immune system and a blood cancer, is a trip such as this a clear sign of….

  • Craziness? Maybe.
  • Risk-taking behavior? Of course.
  • Saying no to cancer saying no to me? You bet.
  • A carefully calculated gamble that turned out amazingly well? Absolutely.

This was a fantastic trip and I loved every day of it. I felt safe and healthy and fully alive.

So here’s my advice to others. If your doctors say OK, do it. And don’t believe all that you read.

I still bought travel insurance that waived the pre-existing conditions. This is easy to do if you buy it soon after you make your first payment for the trip. It wasn’t the cheapest plan because it included coverage for an expensive emergency MEDI-VAC flight if I needed to get to a good hospital back home or in London. Shop around.

With a proper safari company (we used the wonderful team from As You Like It Safaris whom I highly recommend) we were well cared for from the moment we stepped into the arrival lounge at the airport.

We were met at the airport and whisked away to the elegant colonial era Muthaiga Country Club for lunch. Nairobi traffic is infamous and street hawkers actually hang on to the car at every stop, which are frequent and lengthy, but we never felt threatened. And we didn’t buy anything.

Most western hotels in Nairobi have airport-like security with barriers for the cars entering and x-ray machines and metal detectors in order to enter the lobby.

New foods in a foreign country are one of the joys of travel and Kenya was no exception.

I stayed away from salads and fresh juices but most fellow safarians ate everything and did fine. All my water was boiled or bottled (listen for the click), even for brushing my teeth. Repeat: even for brushing my teeth. It takes real concentration not to run my toothbrush under the tap and rinse instead with bottled water.

Food was great- fresh and well-spiced- mostly Indian for me, but it was easier to be vegan in Kenya than in Louisiana or most of Texas.

I got all my shots. Unlike Tanzania, Kenya does not require the live Yellow Fever vaccination that would have made the trip a non-starter. I was up to date on typhoid (the shots, not the live oral form), tetanus, hepatitis A and B.

Just in case, I brought a whole pharmacy. I brought antibiotics (Cipro and Zithromax and used none), GI meds (Pepto and Imodium-AD and used none), pain meds, ointments and creams (and used none), hand sanitizer, sunscreen, and a full extra week of my ibrutinib and all my other meds in case flights were delayed.

I had a note from my doctor listing all my meds.

Due to the time change, I switched to take my morning meds in the evening and vice versa to keep the intervals between doses on the travel days with the 10 hour time change. Ibrutinib only binds the BTK sites for about 24 hours and I didn’t want to stretch that out too much.

I took Malarone with no side effects to protect against malaria, wore long pants and long sleeve shirts treated with permethrin, and used high-dose DEET twice daily during game drives. I got a total of two mosquito bites in the whole two weeks. I wore a hat and a buff for the sun and the dust.

Others took nothing and survived, with no sign of a parasitic infection. Not everyone handles anti-malarials well. They are notorious for causing wild dreams and psychiatric issues and occasional nausea and other gut issues. I did fine.

The tent camps where we stayed in the bush were marvelous and often quite luxurious. Except for the mischievous monkeys that want to steal anything and everything, it was comforting and safe. Power might be intermittent and run off a diesel generator or solar power, but we were out in the savannah.

The night sounds were loud, melodic and startling. I could have done without the smells from the hippo pool.

But where else would I get a Maasai warrior walking me to my tent to guard against the wandering hippos or a Samburu villager with a sling shot keeping away the monkeys and mongooses away from our food when we dined by the river while watching the Nile crocodiles bask in the sun or the elephants cross the shallows?

Folks left iPads and expensive cameras lying out and returned to find them untouched hours later.

The Serena chain of hotels in the National Parks and Reserves were all first class- clean, beautifully designed with gorgeous views, good food and great service.

All the Kenyans we met were friendly and helpful. Guides/drivers can make or break the trip and ours were encyclopedic in their knowledge of the local flora and fauna and wise in the ways of keeping us safe and comfortable, as well as kind and generous.

The wildlife doesn’t disappoint. Seeing a lion stalk and kill a wildebeest or watching them mate (it is female-initiated, very, very quick and oft repeated every 15 minutes or so for about 3 days), or a leopard or cheetah mom with her cubs or an elephant family care for their young, or a gerenuk get up on its hind legs to sample some high up tasty leaves or more colorful birds than I can remember or giraffes spreading their legs widely to reach down for a drink or the giant Nile crocodile that look like they snuck into the river straight from the Jurassic period or all the vultures and Marabou storks fighting over a carcass or flamingos turning the sky pink when they all take flight together or countless herds of zebras and gazelles and oryx and cape buffalo and impalas living together has made me never want to go to a zoo again.

All animals need lots of room and many need their families to live a normal life.

Plus, I didn’t get mauled by a big cat (don’t step out of the land cruiser- they can move fast) or gored by a buffalo or crushed by an elephant or bitten in half by a hippo. Hippos kill the most Africans with their huge mouths. And they don’t even eat meat. Never stand between a hippo and the river where it is heading.

So here is my advice for an exotic trip

  1. Get your doc’s OK.
  2. Don’t go where there are active diseases for which there is no protective meds or killed vaccines and that can be a problem for those us with depressed immunity. An example might be a Dengue outbreak in southeast Asia
  3. Check the CDC’s helpful site for each country before planning and before leaving: http://wwwnc.cdc.gov/travel/destinations/list/
  4. Buy good travel insurance.
  5. Bring more meds than you think you’ll ever need including an extra week of everything. And bring a note from your doctor even though I have never been asked for one.
  6. Don’t forget all the creams and ointments.
  7. Don’t drink the water- even to brush your teeth!
  8. Be careful around salads and fresh fruit.
  9. Use tons of hand sanitizer all the time and consider an N95 mask on the plane or in any crowd where folks are coughing or sick.
  10. If you can afford it, upgrade and fly first or business class. Studies have shown that the lucky passengers in those less crowded sections get less infections post-flight
  11. Don’t get eaten by a Nile crocodile or bitten by a hippo.
  12. Go and enjoy! 

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Dr. Brian Koffman, a well-known doctor, educator and clinical professor turned patient has dedicated himself to teaching and helping the CLL community since his diagnosis in 2005. He serves as the unpaid medical director of the CLL Society Inc.

Originally published in The CLL Tribune Q3 2016.