Dr. Mary-Louise Scully, Tropical Disease Specialist: To know her is to love her

If you have ever traveled to sub-Sahara Africa or cruised the Peruvian Amazon River (as I have) or other parts South America, chances are you consulted – or should have consulted – Dr. Mary-Louise Scully at the clinic formerly known as Sansum (now part of Sutter Health).

I first met Dr. Scully prior to one of the BEST trips of my life – a river cruise with Aqua Expeditions along a Peruvian section of the Amazon River. At that time, I spent $500 before my feet even left town, for malaria medications and yellow fever, hepatitis A, typhoid and other needed vaccines, per the good doc. My trip was fantastic – and I never got sick. On a side note, I did take along the great NY Times best-selling book The River of Doubt: Theodore Roosevelt’s Darkest Journey by Candice Millard about explorer/adventurer/President Teddy Roosevelt’s Amazon expeditions in Brazil – and had I read it beforehand, I DOUBT I would have signed on for the voyage. 

I had the opportunity to hear Dr. Scully speak at the Santa Barbara Club, thanks to Montecito Bank & Trust’s travel expert/tour leader extraordinaire Maria McCall (who has a host of travel stories to share) for one of the MClub’s “Lunch and Learn” events on January 20^th. A full house of MB&T’s members enjoyed the informative talk followed by questions, cheerfully answered with the good doctor’s recommendations.

Dr. Scully, director of the Travel & Tropical Medicine Center, is a self-proclaimed “Yank,” raised in Connecticut. She received her BA from Smith College, her MD from Rush Medical College, Illinois, and completed her Internal Medicine residency and Infectious Disease fellowship at Yale University and Yale New Haven Hospital. For 11 years, she was a member of the Clinical Faculty at Yale New Haven Hospital and worked at the Yale International Health and Travel Clinic before, lucky for us, moving to Santa Barbara in 2002 and joining Sansum Clinic, now Sutter Health, in 2003.

Here’s a quick overview of what we learned. However, I heartily recommend you make an appointment with Dr. Scully anytime you are planning travel to exotic lands that may put your health at risk. Travel insurance was also discussed, along with what to pack in your carry-on to be ready on the “run,” including diarrhea medicine. 

I am NOT a doctor, so please consult Dr. Scully or your own physician and check the latest reports on the CDC website’s Travel tab for recommendations. www.nc.cdc.gov/travel 

Beware and prepare when traveling to lands where you could contract Malaria, Yellow Fever, Dengue, Zika or Chikungunya

Dr. Scully began her lesson with an African proverb – not surprising since her global volunteer work has included two trips to Chad, Africa, with Chad Relief Foundation/ Fund for Refugee Initiatives. The proverb says, “If you think you are too small to make a difference, try sleeping with a mosquito.”

Yellow Fever

Rules of thumb change all the time: but at this writing, you don’t need a yellow fever vaccination (to avoid an Ebola-type death from the disease) for Tanzania, but you still do for Kenya and Uganda. Yellow fever killed 10% of Philadelphia’s population in the 1790s and was also prevalent during the building of the Panama Canal. It’s a “live attenuated” vaccine, with potential side effects in persons with a weakened immune system or of older age, so Dr. Scully carefully weighs the risks versus the benefits when deciding with the patient what is best for them. In the past, the vaccine was “boosted” every ten years, but recommendations have been updated to reflect “lifetime protection” once vaccinated. Exceptions to the lifetime protection would be if traveling into an area with an active Yellow Fever outbreak, west African countries, and if working in the Peace Corps. When a traveler undergoing chemotherapy can’t get the vaccine, for example (or is experiencing another immune system deficit), Dr. Scully will provide an official medical contraindication letter, to allow that patient to travel into countries with Yellow Fever requirements.

Malaria

There are five human varieties of malaria, the deadliest being Plasmodium falciparum. Malaria is still present in 85 countries, including parts of South America, India, Southeast Asia, Indonesia and sub-Saharan Africa. That being said, Dr. Scully noted that if you are just “popping into Angor Wat and staying at Raffles hotel” in 2026, you do not need anti-malaria pills as many parts of southeast Asia have been successful at eliminating malaria. Most commonly used for malaria prevention is Malarone (Atovaquone / Proguanil) as it has few if any side effects. Another alternative is Doxycycline though some people can be more sensitive to sun exposure while on it. Many people may remember an old prophylactic medicine, Mefloquine or Larium, that did have neuropsychiatric side effects like insomnia and nightmares; but is rarely ever used these days. It is, though, the only FDA approved medication for pregnant women (!) and they are thus advised not to travel into areas of malaria risk. 

The Three Amigos: Dengue, Zika, and Chikungunya (which translates to “that which contorts, or bends up”)

These three viruses are present throughout much of the tropical world, transmitted by the Aedes mosquito, which is primarily a daytime biter. Dengue is a big problem globally and at present there is only a licensed Dengue vaccine in Europe, where such vaccination is typically prioritized for travelers, but not for people who live in endemic areas. Right now, Cuba is in the midst of a Chikungunya outbreak with an estimated 38,000 cases. The new Vimkunya vaccine for Chikungunya would be advised for travel right now to Cuba.

The best way to prevent all insect transmitted disease is either a 30% Deet or 20% Picardan repellant applied to exposed skin, and permethrin on clothing and gear. For evening biting mosquitoes (malaria, West Nile, Japanese encephalitis) sleeping under bed netting at night can be effective. As Dr. Scully likes to remind in rhyme: “If you don’t get bit, you don’t get sick.”

Montezuma’s Revenge and Delhi Belly

There’s a reason the all-time travelers favorite is called the runs, also clinically known as Traveler’s Diarrhea. The CDC jingle goes: “Boil it, Cook it, Peel it, or Skip it.”

In San Miquel de Allende, my friends living there wash their produce in a special disinfectant solution. Sadly, Dr. Scully advises street food can carry higher risk. One of my most delicious and memorable meals I’ve had on my travels was curried goat and fried plantains served on a piece of paper for the princely sum of about one dollar, by a street vendor in Haiti. I have no memory of getting ill.

Eighty percent of traveler’s diarrhea is bacterial, so in addition to packing Imodium or chewable Pepto-Bismol for mild symptoms, Dr. Scully will prescribe an antibiotic Azithromycin for more serious diarrhea symptoms. She stressed how we now appreciate the degree to which our beneficial “gut microbiome” is decimated by antibiotics, so hoping the antibiotic won’t be needed. But when infected in a foreign land, the hit taken by the microbiome is likely better than ending up needing medical care for IV fluids in a foreign land. What’s perhaps new, Dr. Scully advises, is the antibiotic “less is more” approach (versus old school antibiotic carpet bombing). These days you can stop the antibiotic once you are feeling better.

There’s No Place Like Home – And What to Pack!

For many who are sick at home (or on the road) with the current strain of Influenza A (H3N2) subclade K vaccine mismatch, it’s good to get a prescription for Tamiflu and bring test kits (COVID and flu are now in one swab) along on your trip and test early. Tamiflu works best for influenza if started within 24-48 hours of symptom onset.

In March I’m heading to Japan, which has had a really bad year of flu. I’ll be calling Dr. Scully or my equally wonderful primary physician, Dr. Beamer, both at Sutter, for a Tamiflu prescription.

Seasick or Motion Sickness? 

Zofran works well for nausea and vomiting, such as that we get with Norovirus, the infamous cruise ship virus. Many patients find it works also extremely well for motion or sea sickness. 

River cruises are GREAT if you suffer from seasickness – nice and smooth. I first saw Dr. Scully before my fantastic and memorable May of 2013 Aqua Expeditions cruise on the Peruvian Amazon (Aqua has expanded river cruising to Vietnam and Cambodia, as well as ocean-faring expeditions in Indonesia, the Seychelles and beyond). Dr. Scully showed me a map at the time and predicted the spread of yellow fever in Brazil. The map she projected on the screen over a decade later confirmed her predictions! 

I am not a doctor and I am only conveying what I learned (which was a lot) at the MB&T Lunch and Learn, so please check for yourselves with your own physician, or especially Dr. Scully who, in addition to her clinical practice of Infectious Diseases and Tropical Medicine, is the past chair of the Professional Education committee of the International Society of Travel Medicine (ISTM). She has completed a six-year term as a member of the American Board of Internal Medicine (ABIM) Infectious Disease subspecialty exam committee. She also served over a decade as an Associate Editor for the Journal of Travel Medicine. 

Last, But Not Least

1. Look for your yellow vaccination card that you should be keeping with your passport: you can get it updated to reflect your most recent immunizations.

2. How about N95 masks while traveling? Dr. Scully recommends at minimum wearing one at the beginning of your flight – before the HEPA filters are turned on in flight (we all know how hard it is to eat with a mask on!) and likewise when landing and then disembarking, as well as in any large crowds.

We travelers are lucky to have Dr. Scully in our community. Thank you, Dr. Scully, for all you do to make sure our community stays safe when traveling!

If you are not a member of Montecito Bank & Trust’s “MClub” you might want to join ($250K bank deposit balances required). You won’t want to miss upcoming “Lunch and Learn” events with a SB Zoo tour, a visit to the National Search Dog Foundation, and more. Travel tours are also on the docket, but you’ll need to ask a member of the club for more info or just join and be part of the fun.