Adventure Travel Risks - 2012-03-21
Most travel is much safer than it seems. This article looks at how we think about the risks and how to get the most out of your trip.
Perceiving risk accurately
Travel risks are almost never what they first appear to be to the prospective traveller. After the 9/11 hijacking in the US the road toll in the following year went up by about 1,000 as people chose the “safe” option of driving long distance. Likewise many people assume that the biggest dangers in our wilder locations will be wild animals, nasty insects, bad food and dodgy locals. In reality the biggest danger is usually road accidents (like NZ), while dehydration through fear of dodgy water causes more problems than Delhi belly and lack of confidence in dealing with the locals causes more lost opportunities than lost property causes trip disappointments.
So the real risks tend to be the mismatch between the traveller perceptions and reality, which makes writing a risks page really hard. If you don’t think the issue I mention is a risk you will tend to discount it, if I say it is not a significant risk and it’s something you fear, just including it will give you reason to be more fearful - or even not travel. So read these pages thinking hard about your own perceptions of risk.
Opportunity - the flip side of Risk
The official definition of Risk (part of ISO20000) defines it as the effect of uncertainty on outcomes. When we use the word “Risk” we to tend to focus on negative outcomes, so a useful word for the upside of uncertainty is “Opportunity” e.g. “on this trip I might see some of the greatest mountain vistas in the world and be stunned by the majesty and serenity” vs “I might get sick from the altitude”. Working out a fair trade-off between opportunities and risks requires a good understanding of the likelihood of each, the impact of them and most importantly how much control we have over them. Are the mountains likely to provide never to be forgotten moments of serenity? what are chances I will get AMS (Acute Mountain Sickness), how serious is it likely to be? and how much control do I have over both outcomes?
Our minds have learnt to deal with many risks by simply lumping them into two groups, “too dangerous” and “acceptable”. This quick classification is essential for everyday survival, but is not fine enough if we want to gradually stretch our boundaries or enjoy some of the upsides of uncertainty. Driving on New Zealand roads is statistically quite a dangerous activity, but we dramatically improve our personal safety by following a few simple principles: e.g.don;t travel with drunk or overtired drivers, wear a seat belt etc. These principles help us break down activities that are inherently a bit risky into areas that are safer and activities to avoid.
If avoiding drunk drivers is about learning which parts of an activity are dangerous, another learning activity is new skills. Sitting in the navigators seat of a rally car driven by an eperienced rally driver is a vastly different experience to being co-pilot to my daughter on her first gravel sprint races. Experienced travelers not only learn which parts of activities are safe, they also learn skills to deal with more challenging situations.
Reflecting on a lifetime of adventure travel and several years of leading trips, it seems that the biggest uncertainty factor is the attitude of each traveller. Adrenalin junkies might seem the obvious risk, but more holidays get impacted by inappropriate cultural attitudes, wrong expectations and over-cautiousness.
Read a few Trip Advisor reports and you will be surprised at how many South American hotels get slammed by North Americans because their staff don’t speak English, but this is really the tip of the iceberg. Travelling is much more fun when the culture you are visiting is different from your own. Expecting the same service and the same language is bound to create disappointment. A highlight for most of our group on our recent trip to Ecuador was an overnight home-stay in a rural village. It was an insight into the culture that we hugely appreciated, but it was also a challenging night as the cultural and language gap was huge.
Conversely a village stay on research trip in Laos was ruined by a fellow traveller seriously offending half the village before we even arrived. Despite good advice before we left, during a stop on the trail he had insisted on a photo with some of the traditionally dressed woman. He put his arm around them and patted them on the head (both no-nos), then followed up by trying to buy heirloom jewellery from around their necks and generally treating them as inferior. It took several hours hard work in the village by everyone else to restore some trust and respect.
To get the most out of the cultural divide and turn uncertainty to opportunity, the following thoughts help:
- Our culture is not always the best - it’s just the one we know best
- Peoples intelligence is constant across the world, educational opportunities are different
- Most people are genuinely interested in meeting and helping travellers
- be very wary of stereotyping
- keep looking and learning for small but often important customs (e.g. are shoes worn inside?)
Travelling in Turkey in the 1980s we were astounded at how friendly the locals were. We were passed from family to family - with them often insisting we had the best bed in the house, or taking a day off work to show us around. We didn’t know a single Turk before we went and had no introductions or contacts, but we came away with friends we stayed in touch with for 20 years. At the time “Midnight Express”, a movie that is now discredited as a “national hate-film” was all most people new about Turkey and they were generally astounded that we regarded it as the friendliest place we visited. So watch those stereotypes.
Overconfidence is a well known cause of accidents and it is common enough in travel as well. Less obvious is the cost of lack of confidence. In some cases people don’t travel to great places because of misplaced fears, but there are other side effects. Arriving in Kathmandu for the first time it is easy to be overwhelmed by the dust, rubbish, cows in the street and traffic. So much so that I usually have a few people who have to be almost pried out of the hotel for their first street tour. But after a few hours everyone sees it as a fascinating and safe city (if still a polluted one).
Learning when and who to trust is tricky enough in our own culture, but when travellers are faced with a new culture it is easy to revert to stereotypes. That is why con artists dress like westerners and have learnt western ways. Often the most trustworthy are the traditional locals. So when looking to leave a bag with someone leave your prejudice behind first.
In New Zealand there are plenty of opportunities to get an adrenalin buzz in a safe, controlled environment, like bungy jumping, river bugging, guided rafting, abseiling and high ropes courses etc. Travelling in developing countries it is important to remember that Health and Safety is not so well regulated. It pays to assess the safety and competence of operators reasonably carefully and to check their safety record if you can. “What are your most common accidents?” might be a good starter. Paragliding in the Himalayas was a huge high at the end of a magic trip and well worth doing with the reputable company we used. Watching rafters jumping off a rock into a pool known to have obscured obstacles earlier in the trip had been a bit sobering.
Remember - you are ultimately responsible for your own safety.
You are also responsible for making sure you don’t later regret not taking that ride - so keep a cool head and evaluate rationally before deciding.
A big part of the pleasure in travelling is sampling the local menus. However, montezuma’s revenge, or more correctly travellers diarrhoea has ruined many a holiday as travellers succumb to diarrhoea and vomiting, but it is more avoidable and treatable than many realise. Our approach is quite simple and remarkably effective. It consists of:
Water borne bacteria and viruses are the most common cause - so ensure you have a good supply of clean water. This can mean planning ahead as in hot countries you need to drink a lot of water. In towns and cities bottled water is usually safe - but especially in small places the bottle may have be refilled from a tap - so always check the seal. Boiled water is always safe - so hot drinks made with boiling water will be fine. We always take a high quality filter pump and on remoter tips top up every-one's water several times a day. We also encourage everyone to carry some purification tabs - for those just in case moments.
The counter risk is dehydration from avoiding water and we have seen almost as many problems from dehydration as we have from diarrhoea. So always treat the need to drink enough as being as important as drinking good water.
Good personal hygiene
Poor general sanitation spreads more bugs around and a hot climate keeps them active, so there is more need to be careful with hand washing before food prep and meals. Remember to use hand sterilisers or wash hands before eating even a piece of fruit.
vegetarian meals served hot will almost always be safe, however exotic they seem. Fruit peeled with clean hands is also safe, but salads are mostly avoided. Meat and fish that is freshly caught and killed and that is served hot is also generally safe. So I tuck into local fare at markets and restaurants and relish the taste experiments. However I get cautious about stale fish and and meat. In Nepal this tends to mean I am vegetarian except when I have confidence that it is a chicken killed today. In SE Asia I eat fish, insects and whatever meat is on offer at the markets - so long as the stalls are well patronised by the locals. The food on offer in these local markets is often a real taste delight and definitely one of the highlights of travel that should not be missed.
These precautions will not always be enough and there will sometimes be a need for treatment. With the benefit of considerable experience I can recommend the following approach:
Let it Flow
While travelling and tasting new foods your body will react to differences in the mineral content of the water, and changes in diet and exercise. An extra urgent motion or two is not necessarily a sign of a gut infection, or at least one that needs particular attention. So if possible do nothing unless the patient is vomiting or has had more than four watery stools in the last 24 hours. It is surprising how often these things work themselves out as the gut flora adapts. In particular DO NOT immediately begin taking bungers (antimotility drugs like Loperamide) unless you have a challenge like a bus journey.
These can be incredibly effective, but in part because they also kill lots of good bacteria in the gut, they should be avoided until symptoms have reached 4 lose stools within 24 hours.
Often a double dose of azithromycin or norfloxacin taken together with a Loperamide tablet will solve the problem. If not continue with the regular course of bungers and antibiotics.
This plan is effective on 90% of mild to moderate travellers diarrhoea.
The system is not foolproof (nothing is) but it is safer than just eating western style meat meals. It also ensures you enjoy the upside of delicious local fare. However it is surprising how many people get the principle but believe they have a better plan or greater need on the detail. I got really sick on my first trip to the Himalayas (30 years ago) when I couldn’t resist a glass of cold, slightly clorinated water. It was 12 kgs and 6 months before I was right. On group trips to Nepal i get people insisting on the steak “because others are eating it” despite the fact that it has been carried uncovered in open baskets for two weeks up the trail. People also tend to follow their own beliefs on when to pop stoppers and antibiotics - and are distinctly more uncomfortable than they need to be.
A skiing holiday involves a risk of injury that many of us elect to take for the pleasure and satisfaction of being in the mountains on skis. Adventure travel can be as safe or safer than skiing. Just like skiing you can chose to venture off piste inadequately clothed and prepared, with inadequate knowledge of avalanche conditions, or you can ski within your abilities and knowledge.
The following (in approximate order of risk) is a guide that can keep you out of most trouble.
Roads and traffic
The biggest cause of tourist deaths world wide and in almost every country is road accidents. Indeed it is the highest cause of injury related death in most countries (in New Zealand suicide is now twice as frequent as road deaths). In terms of incidents we have observed this is very much top of the list. Options to manage this risk are a bit limited, but the following help:
- fly instead of drive where you are making a long distance connection
- wear a seatbelt in a car and a helmet on a bike or motorbike - regardless of legal requirements
- hire a driver and car rather than self drive in developing countries (it’s often cheaper anyway)
- Don’t drive when tired or alcohol affected.
This may all sound obvious but on a recent motorbike tour of Vietnam our guide was encouraging us to drink at lunch time (we declined) and ride in the afternoon.
Our accident statistics in New Zealand are hugely impacted by drunkenness. I am cautious on Wellington streets late at night and there is no way I would walk through a strange city at night after too many drinks. Likewise approach high adrenalin activities totally sober and avoid alcohol anywhere the circumstances are not “safe”. This all seems obvious but these accidents are far more common than wild animal attacks or violent robberies. Increasingly travel insurance companies are excluding accidents and losses associated with the insured being drunk (not just driving drunk).
At about 5,300m the air density is half that of sea level and so there are half as many oxygen molecules in every litre of air breathed. Despite this it can be very safe trekking at 6,000m and people can get into serious trouble at 4,000m. It is simply a matter of understanding the physiology and psychology of trekkers at altitude. The difference is acclimatisation.
The human body adopts to thinner air in a variety of ways, bigger breaths and thicker blood being two of them, but this adaptation takes time and as importantly varies between individuals.
A general guideline is to ascend no more that 400m a day above about 3000m and no more than 1000m every 4 days. This altitude gain refers to sleeping height - not maximum height reached during the day (which is generally not a problem). Sticking to these rules you are unlikely to have a problem.
Altitude sickness is now called Accute Mountain Sickness (AMS). In its mild form, which many trekkers above 3,500m will experience, it shows up as a headache and maybe nausea (very general symptoms). In its severe form it can and does kill people every year. So the knack is to listen to your body and if you have a headache or nausea be prepared to have an extra night at your current altitude and if that does not fix it go down until symptoms disappear. (If you have a pulse oxometer (now less than $50) you can check your blood oxygen levels for a quick guide to probable acclimatisation.
Problems happen mostly because of egos and group dynamics. Fitness is no indicator of acclimatisation rate, so I have often seen young fit men pushing themselves dangerously because the slightly overweight woman on the trail is going much better than they are. The second group that get affected are those who want to stick with a group at all costs. It may be that they don’t want to let the group down or it may be because they are frightened of being left behind. On a well run trek this should not be an issue as the planned pace will be within recommended ascent rates and guides should be very aware of the issues. But schedules go wrong due to weather and other delays and there can be a big temptation to push on anyway.
Countering this is a tendency for people to read these risk reports and decide the trip is too dangerous, when in fact everyone is doing fine. This is where a guide really earns his or her money. Better run trips have enough guides to ensure those that can’t keep up are safe and small family type parties with a flexible itinerary can just take an extra day.
Same risks as at home, its just that some people seem to think holidays are about leaving responsibilities at home.
Watch an American TV program like CSI and you can sometimes see just how bizarre western society must appear to different cultures. There is no nudity allowed on American TV, but scantily clad women are fine and many of the shows themes are on promiscuous sexual practices. To men brought up in cultures where sex outside marriage is still banned and women always dress modestly, modern western women are an enigma. Combine that with guides skiting about one night flings with western woman and its just amazing that everyone behaves so well. In the west we men are expected to know that short pants or lycra shorts are not an “I’m available” sign, but the message is not always so clearly understood in more conservative cultures. So dress appropriately modestly and women should consider carefully before travelling alone in a culture they don’t know well. We have twice assisted women who had been attacked while travelling alone. Neither were particularly immodestly dressed and both were calm, confident women doing nothing worse than travelling moderately used trails on their own. Both fought off their assailants, but both sustained significant injuries that required stitching.
Wild animals and insects etc
Before we started travelling I was quite concerned about the dangers from large carnivores, snakes and leaches etc. Having travelled extensively I realise how misplaced the concern was. But having said that I have seen nasty near misses from people treating wild animals as friendly.
Generally large carnivores are under such hunting pressure that you are very unlikely to see them in the wild and if they see you they will run away. I suspect that in the US more people shoot themselves accidentally than save their lives by carrying a gun against bears.
Snakes generally want peace and quiet and will stay out of your way. Seeing them becomes a treat.
Leaches have a massive “Icky” factor. The thought of having them on your skin sucking blood is horrible. Brought up on tales of burning leaches off with cigarette, I wondered how we would cope with them as a non-smokers We never saw them until our 3rd or 4th jungle trek and then got caught out by stupidly doing a jungle walk in open sandals giving the hungry leaches a feast. Treatment suggestions include salt, oil (they breath through their skin) and insect repellent, but the most common local treatment is to whip them off at high speed using a leaf between the fingers. Not ideal as it risks leaving the jaws inside the wound. However the exposure taught us lots - they are not as icky as they seem (they are really quite fascinating), treatment is simple, impact is minimal.
Mosquito borne illnesses such as malaria and denque fever do represent real risks, but before reaching for a pill prescription - understand the issues.
Surprisingly, often the best treatment is simply to avoid mosquito bites. Long sleeved shirts, long pants, lots of dimp and good quality mosquito nets are very effective against not only malaria, but a variety of other mosquito borne diseases.
A variety of malarial prophylactics are available that prevent the disease from establishing and these are quickly prescribed by GPs and travel doctors. None are fully effective and before you begin a course, or even choose which treatment, investigate whether the specific areas you are visiting currently have malaria and what is effective against them. Then consider carefully the know side effects (I’ve seen holidays and almost lives wrecked by the psychotic side effects of Larium) and your own ability to take pills on a regular basis (some need to be taken more often and for longer). Where practical, I opt for Doxycycline because of its lower side effects.
Immunisations against viral infections are incredibly effective and you should be up-to-date with as much as practical before you go. You will need to get these administered by a health professional who will cover the ins and outs of each. Many of these you should be up to date with even if you never leave New Zealand - so it may be a good thing to check on your next GPs visit.
The only vaccination that I think is a little contentious is Rabies. The effects are a horrible and painful death that is to be avoided. But rabies is present in many countries in the world including Europe and nowhere is the vaccine given routinely. This is partly because of the level of risk, partly the effectiveness of the vaccine - it needs several repeat shots before being bitten and at least one after being bitten. There is also a course of vaccines that can be given immediately after being bitten.
There is no standard answer as a bus tour in the developed world requires only that you have visas up to date, tarvel insurance and enough money available. An unsupported trip across Antarctica requires a bit more. Assuming you are travelling in a developing nation on a partially structured or fully structured adventure the following guidelines may help your risk management related preparation.
Preparation often ends up focusing too much on what clothing to take and not enough on fitness.
Get them up to date well in advance of departure.
First Aid Kit
If you are trekking somewhere like Nepal you may be several days away from the nearest doctor. So you need access to a significantly more comprehensive medical kit than a standard New Zealand based, trauma focused first aid kit. As trip leaders we carry a wide range of antibiotics and other medicines to treat a wide range of conditions, but on remoter trips we expect our clients to have their own basic supplies of antibiotics they know they tolerate. Tropical conditions generate lots of simply treated skin conditions, so long as you have antibiotics and anti fungal treatments available, so include these. A sterile syringe is also a good idea if there is a danger that you might need treatment at a dodgy facility.
My GP has always been a big help in preparing my fist aid kit but one or two clients have struck GPs unwilling to prescribe antibiotics without symptoms etc. If your GP does not understand travel in medically remote regions, see a Travel Doctor. They have very good kits and advice.
Fitness and Technical skills
There is no need to be a mountaineer, super fit tramper or round Taupo cyclist to enjoy a good bike or trekking holiday. But it does pay to understand your fitness and the requirements of the particular trip. Because I take groups from New Zealand and discuss fitness with each participant I have not had anyone fail to finish a trip. But some Nepalese operators talk about a drop-out rate as high as 30%. While occasionally this is medical issues, the underlying cause is usually lack of hill walking fitness. The well intentioned plans for 6 hours hill walking a week (or whatever) were never quite achieved and then the lack of fitness combined with series of minor ailments and discomforts tip the traveller over the edge from the joys of discovery into a sense of too hard for too little reward.
In addition ensure you have:
- visas, passport and other travel documentation current
- access to appropriate funds while travelling (inc emergency funds)
- travel insurance documents (see separate section)
No one should travel without medical travel insurance. The rest of the world doesn’t have ACC and as a foreigner you are required to pay all your own hospital, medical and evacuation costs. You are unlikely to be admitted to hospital until your credit card or insurance policy is verified. With so many companies now offering policies on-line it is not hard or expensive to organise - just do it. Many organisations like ours demand that everyone has medical travel insurance for good reason - there is no government or fairy god mother to pick up these costs.
Insurance companies offer several extensions to the medical cover, and whether you take these is optional (I quite often don’t). The best value is cancellation insurance. If you can’t travel for one of their defined reasons they will refund your travel costs - so you can do the trip at a more suitable time. As many airlines and travel organisations work on a no refunds for cancelations policy, this can be very worth while as it is often bundled with the medical cover. Just remember to take out the insurance when you make the first payment for the trip. This component of insurance usually includes flight delays and related issues.
Insuring personal possessions is a bit more fraught. You will generally not be covered for carelessness (e.g. putting your bag down beside you without it being attached to you may be careless) and the depreciation rates are often very high. Where I can I take gear I can afford to loose, but having said that, sensible travel behaviour can make the risk of loss as low as being at home in NZ. None of our trips have suffered a significant theft.
Life is risky
Whatever we do in life carries risks. ACC reports that accidents in the home are its most common source of injury with 12 people a week dying as a result. I was recently interviewing a senior ambulance officer and asked him why he rode a motorbike to work and he replied "because I treat a lot of severely hurt people who never take a risk". If you truely research your dream destinations and are prepared to learn and put aside your preconceptions, you can travel to amazing places with little or no greater risk than staying at home and watching other have fun on the TV.
Kayaking in Antarctica
Orcas, katabatic winds, calving glaciers, rolling icebergs - all more manageable risks than they first sound, and a huge amount of fun in the ice.
The buzz from the top was amazing. Technically simple and marginally more dangerous than the drive to the road end.
Operated to international standards we interviewed the operators the night before and decided this was too good to miss. It absolutely was a brilliant experience and a lifetime memory.
They taste a bit like crisps and are eaten like them with a beer. a slightly acquired taste.
The market stalls in laos were very popular with the locals and the food was superb
Penguins are so cute
Watching penguins in a remote rookery in Antarctica was very special and still inspires Frances to pain.
Camping in Antarctica
Another never to be forgotten night. We had to learn glacier travel skills, but to be up here in 24hr day light and stunning views was something to cherish for a lifetime.