People often ask us about health-related issues, so here are some answers.

Health Insurance: Since we are from the US, with an immensely expensive and burdensome healthcare system, we felt that we had to carry health insurance that would cover us there. Although we might be able to cover expenses for most types of events in the other countries of our journey, a single week in a hospital in the US can easily bankrupt anyone. So we carry normal (expensive) major medical, high deductible ($10,000) health insurance that would cover us if we had to go limping home for a major chronic illness or something. But that insurance doesn't cover us outside the US, so if we had a serious accident or something, we could end up without coverage. So we also bought health insurance that covers us outside the US (cheaper by far). Our monthly expenses for health insurance are probably the biggest expense of the trip.

Note that "Trip insurance" is not worth much for a trip of this size, since it is not renewable and typically has pretty serious limitations. It's oriented to people going on vacation, not to people living abroad. What we needed (and most travellers will need) is the type of insurance that expatriates buy. The folks at Global Insurance Net make a specialty of this type of insurance, and we were pleased with their expertise and service.

Health Care: We've been pretty pleased with healthcare everywhere we've been. It's much easier to obtain and far cheaper than in the US, and of very similar quality, in general. We've been in for dental cleanings and checkups, parasite tests and treatments, chest itch, and all the little things you might have over the course of a couple of years. All care has been good. We haven't had any serious episodes needing serious care except the whooping cough, and that developed while we were in the US. And our care there wasn't really all that good. Lab tests and such are far easier in most countries here. When we've suspected that we have parasites (digestive issues that don't go away) we've either gone to the doctor or straight to the lab with a sample. You don't need a doctor involved - you can take a stool sample to the lab, get it done, and know the answer. Then you can take that to the doctor (or just to the pharmacist) and get the drug required. Or, of course, you can go straight to the pharmacist and just get the drug and skip the test in the first place. Our parasite consult with the doctor plus lab test plus drugs in Nicaragua cost a total of about US$15.

Note that getting parasites is really just one of the things that can happen occasionally in the third world. It's not something to get too excited about. You do the test (if you want) and take the drug. All very simple.

Heath: We've been generally healthy, gracias a Dios. We got the whooping cough in Guatemala and then recovered from it in the US. We recommend to all adults the vaccination which is now available. We've had occasional stomach distress, but only a few times did it put us down for a day or two.

We take vitamins. We have a theory that I get a little depressed or discouraged without them. Anyway, when I start taking them again I seem to get better. We eat things that are cooked and hot, when we can, or dry. We avoid green salads, and generally leave them on the plate when they're served. We have eaten all the food in all the countries we've been through, and like it all. We also ride pretty moderately, and take a rest day every 3-5 days, sometimes more than one day. Staying rested and not getting exhausted helps with the health issues.

All in all, we've had a wonderful health situation (wasting all that insurance money - but that's what we'd rather do).

Vaccinations: The Center for Disease Control has loads of recommendation on what you should do travelling in every place on earth. We took everything they recommended, including Yellow Fever, Hepatitis A&B, Typhoid, etc. We also got the 3-part Rabies shots, which were quite expensive. And we wish we had gotten the Whooping Cough vaccine for adults. We didn't know about it at the time. But we got Whooping Cough in Guatemala and it put us out of commission for 3 months.

One of the more difficult issues is malaria prophylaxis. (Read the docs on Malaria drugs and prevention at the CDC page.) There is no immunization for malaria and it can be a very bad thing. From Mexico through Panama, you can take chloroquine, which is a weekly pill sold under the brand name Aralen. It is widely available, cheap in every pharmacy, and has no side effects. A great thing. However, you only need it in areas that are below 800 meters in elevation or so, so we didn't take it when we were at 2000+ meters in Mexico, for example. However, south of Panama the malaria is chloroquine resistant, meaning that you should be taking other drugs. And all the drugs have side-effects. And they're not so easily available. The best one is not even available outside the US and Europe, and is terribly expensive. We ended up deciding to try to stay high in the mountains (above about 800 meters) and not do the drugs. But we haven't seen many mosquitoes so far in South America at all on the route we've taken.

One note: In Mexico all of the vaccinations are free. So instead of paying US$450/each for our vaccinations we could have gotten them free. We did get our third Hepatitis B vaccination there, for free. So it's worth considering going this route.

Altitude Sickness: We were quite concerned about altitude sickness as we crossed Peru over the last couple of weeks. We crested at 4700 meters, and that may be our high point for the trip, but we'll be at 4300 and 4400 several times yet, and that's almost the same.

Nancy is quite sensitive to altitude and was very worried about it. Randy grew up at over 2300 meters and was less worried. We took it quite easy, making sure we didn't climb to an elevation more than 1000 meters higher each day. We spent 2 or 3 days around 4000 meters before going over the pass. Nancy felt like it was a big challenge but did not have any of the classic symptoms of altitude sickness. She felt weak and worked hard, but didn't get "sick".

We have both tried chewing coca leaves, a time-honored way to deal with stress at altitude. Nancy feels like it really helps her, but it's annoying that the leaves get stuck in your gums. I tried it and think it's OK but probably won't do it again. Nancy has also fixed a water bottle full of "mate de coca", coca tea, several days, and feels like that helps too.

We bought some medicine in the pharmacy also, but didn't really understand its use or possible effects, so we didn't use it.

The biggest advice, of course: Go up slowly. Go up gently. Take time to acclimate. If you get actual altitude sickness (especially HACE or HAPE, cerebral or pulmonary edema) which is possible even at lower elevations like 3000 meters, GO DOWN IMMEDIATELY.