The Plan

September 8, 2025

The chart on the wall at Passport Health offered a question: “What are the most dangerous animals in the world? It listed them: Mosquitoes (725,000 human deaths/year); other humans (450,000); and so on, including snakes, dogs, tsetse flies, scorpions, crocodiles, down to deer, which kill about 130 people each year by colliding with cars. So don’t hit one!

We were at the place because our Vietnam-Cambodia trip is four months away. You don’t want malaria or Japanese encephalitis, typhoid fever or poliomyetis (polio). You want to avoid rabies, hepatitis, and chikungunya (what’s that?). You want protection.

Information about vaccinations is complicated. You need the injections and/or pills. The family doctor isn’t sure, the pharmacy isn’t sure. Google isn’t sure. A doctor referred us to Passport Health, a private company that has the information and charges for it.

Years ago I went to Nicaragua, Guatemala, and Mexico for work. I don’t recall whether I got some specific vaccinations. Of course I was younger. The standard guidance is “don’t drink the water.” I didn’t but still got sick.

Since the covid pandemic, vaccination has become a nasty political hobbyhorse. Ivy, the nurse we talked to, a former ICU staffer, walked us through our vaccination history, starting with smallpox and polio—we have the childhood scars—to tetanus and MMR (measles, mumps, rubella).  She tapdanced around the covid-19 shot, which incites rightwing outrage. “You don’t have to get it,” she said, probably wondering if we were Republicans.

But the world is a dangerous place. Ticks are out there. Lyme disease, caused by a tick bite, is treatable, but may linger for years if not caught in time. A fellow I know was bitten by a Lone Star tick in the Virginia mountains. He developed alpha-gal syndrome or AGS, an incurable condition that causes hives, nausea, vomiting, diarrhea, and low blood pressure. Victims develop a severe allergy to mammalian foods, beef, pork, lamb, venison, and for some, dairy products.

Then mosquitos. Wherever you are, except in Antarctica and other cold places like Iceland, you find mosquitos. Why did God make them, we sometimes wonder. The literature teaches that 3,700 species of mosquitos exist, which sounds like way too many. Some 700 million people develop mosquito-borne diseases each year, leading to those hundreds of thousands of deaths.

You learn that mosquitos do serve a purpose, as food for other creatures. Because they breed in water, dragonflies and other water-friendly bugs eat them. So do fish, ducks, other birds, bats, toads, and frogs. If mosquitos didn’t exist, those species would have to eat other things.

We know mosquitos are annoying in the backyard or in the woods. They chase your picnic guests inside and ruin your camping trip. They’re everywhere, in the swamps, in the mountains. When my son Michael and I visited Canada’s Northwest Territory, we ventured a walk in the woods. In ten minutes we were driven back to the car, waving our arms.

Our camp was on an island in the middle of a lake. The bugs followed. In our tent at night we hung a smoldering aromatic repellent from the frame. When the flame went out they attacked. Ivy, our Passport Health staff person, talked about the Louisiana bayous, where she’s camped. Just as bad.

The mosquito scenario is scary: yellow fever, Japanese encephalitis, chikungunya, dengue fever, malaria, zika virus. Vaccines are available for yellow fever, chikungunya, and the Japanese encephalitis. But the main defense: don’t get bitten. Use percaridin or permethrin. You can buy clothing treated with permethrin, when you get dressed you’re applying your repellent.

We duck disease one way or another every day. Covid-19 exploded five years ago and as of last month has killed 1.2 million Americans (of 7.1 million fatalities worldwide). Today some folks shrug. They believe the government was lying, making law-abiding citizens wear masks, restricting freedom. 

We march forward. The trip is a project, an adventure, a change from driving the interstate to Tennessee and Virginia.

Some people love Caribbean cruises to those little islands, going ashore and shopping for souvenirs. The locals survive on selling souvenirs; the souvenir shops are mostly owned by the cruise lines.  Most of the time you’re on the ship, eating, drinking, sitting.

We know folks who love European river cruises, up the Rhine, the Danube, the Seine. They see historic cities and stroll cobbled streets. They see cathedrals, museums, castles. They eat great food, drink great beer and wine. Some folks love both the Caribbean and European cruises. Then there’s Alaska. What retired couple hasn’t been or doesn’t want to go?

That bug never bit me. We’re going to Vietnam. Then Cambodia. It’s a long trip, two solid days flying there and two back. We have our reservations and our itinerary.

Lots of Americans make the trip, although not as many as go to Europe. For some it’s a pilgrimage, tinged with emotion. Some three million Americans served in Southeast Asia, depending on how you define the timeframe. Some were there in the mid-1950s.

In March 1965 two Marine infantry battalions landed in Da Nang, the recognized start of America’s Vietnam War. Eight months later in a valley called Ia Drang, the Army’s 7th Cavalry airmobile regiment fought a vicious battle with the North Vietnamese Army, the first major U.S. military engagement since Korea. We learned years later the scope of the nightmare.

I missed Vietnam in ’72 by a couple of months, watching from a Marine base 1,400 miles away. More than 50 years later, the history resonates. We’ll get our shots and the bug spray. We’ll be there.