A Little Discussion… Health and Travel Sickness in Long-term Travel

One of the scariest obstacles to international travel is often the health question. In my planning stages for my own round the world trip I fretted over the health side of the equation because it was the big unknown. Beyond vaccinating myself, stocking my medical kit, and buying really good travel insurance, the rest was out of my control, and I really like maintaining control. Alongside the common questions I’ve covered these past few months in my ongoing series about facing fears and obstacles to travel, the health topic is a big one. It crops up in many reader emails as pre-planning questions, but I have also wrestled with guilt from time to time because there is no promise of health. Over the years, several long-time readers emailed me about their health battles after setting out on their big trip overseas.

Thatbyinnyu Temple temple in the background in Bagan, Burma (Myanmar)

Though I was sick every day of our Myanmar trip, I wouldn’t trade those memories of traveling with my niece for all the world. :)

While my travel planning resource page tackles a lot of the basic questions, it doesn’t factor in the emotional toll that health can take on you while traveling. I discussed fears of physical dangers earlier this summer, but the health topic is one I have thought about how to approach for many months. At the most basic level, it’s more dangerous on your health to travel than stay home. And in the other fears I discussed, that was either not the case, or the risks were relatively equal. But with the type of travel I undertake, it’s often to remote areas without medical access and with serious diseases—areas where I willingly put myself at more of a health risk than staying put in a place with quick and easy hospital access.

I state this so clearly out of respect for the adventurous travelers who have ventured out on trips and faced their own obstacles and stumbles. For the woman who emailed me for advice after she took off on her first trip to India, only to fly home weeks later with a persistent and lasting battle with giardia for more than ten months (she ended each email with the assertion she would resume her trip once better though!). And for others who emailed me saying they felt like they did something wrong because they got sick right away, or robbed on the first day of travel, or lonely on day two.

Travel is not always glamorous and though I believe it’s worth the trade-off, it’s best to have a healthy respect for the issues so you take the right precautions. First let’s look at a rundown of what I’ve faced since I left in 2008, perspectives on the long-term effect on my health, and then a long list of tips and resources to keep you safe and healthy on the road.

The Sickness Rundown

Shiva on the Ganges River

Shiva watching over the Ganges River–my first sight of  Rishikesh after battling food poisoning on the night train.

Leaving to travel I knew I had general health on my side—I ate a healthy vegetarian diet, hiked reluctantly but often, and rarely faced serious illness. My only Achilles heel is a bizarre and varied list of allergies to things that bite/sting. Not too bad, and so, let’s look at the serious and not-so-serious things my immune system was up to over the past five years:

  • Laryngitis: It was November 2008, mere weeks into my round the world trip, and my Florida-girl sensibilities couldn’t handle the biting cold of Australia’s south coast. I completely lost my voice for five days after losing my week-long battle with a hellacious cold.
  • Head lice: Not sickness per se, but not ideal thanks to a very suspect hostel in Melbourne, Australia.
  • Dysentery: My most severe illness in my life; I likely acquired it from the fresh fruit smoothies rampant in Luang Prabang, Laos or from the fresh veggies I ate there as well. I described it in more depth here, but suffice to say it worsened so rapidly because of the nonexistent healthcare infrastructure in the country, and the fact that I was in a remote region when I realized it wasn’t just a casual bout of traveler’s diarrhea. The key here was hydration, and it’s the only reason I lived through it (hydration and charcoal tablets to be precise).
  • Food poisoning: Complements of a luke-warm plate of vegetables from a street stall in McLeod Ganj, India in 2009. The illness struck hours later and lasted throughout my overnight train; I spent the dark dawn hours balanced over the open hole in the train bathroom depositing my dinner onto the whooshing train-tracks as we sped toward Rishikesh. It was awesome.
  • Allergic reaction:  After hiking around Croatia’s national parks and sustaining a tick bite, I found myself with hives and bumps that would not respond to Benadryl—after pantomiming with a pharmacist in Bosnia who spoke no English, she gave me an amazing wonder-cream I still use to this day.
  • Allergic reaction: I don’t know what caused my severe allergic reaction in Belize in 2010, but I found myself covered in hives and my throat started closing. The local doctor then poked my arms/hands so many times trying to find a vein for the shot that I passed out; when I woke up he had managed it with a jab to the buttocks. 12+ hours later, with my symptoms still serious and since I didn’t know what was causing the allergic reaction, I left Belize and all returned to normal.
  • Scabies: A delightful gift from what I thought was a nice guesthouse in Guatemala. Words can not express how awful and itchy scabies is. On the funny side, I baffled the pharmacist when I asked, in Spanish, for scabicide. Our animated argument lasted at least five minutes, it included all locals passing by, and all insisted that there was no way I had scabies. I did. She finally handed over the bottle, at which point I spent two days dealing with the fun process of washing every single thing I own and coating myself in poison from neck-to-toe.
  • Motorbike accident: I crashed my motorbike on a bridge in Laos and sustained a good deal of road-rash as well as a serious muffler burn on my ankle that sent me into shock. Luang Prabang has a very basic hospital now that bandaged me up and sent me on my way. I wrote a bit here more about the danger of traffic accidents and travel.
  • Giardia: My second most severe illness and this one was also contracted in Laos; it took effect on my birthday in 2011. I thought I had food poisoning at my birthday dinner with friends in Thailand, but weeks later as Ana and I traveled through Myanmar I realized I had some hallmark symptoms of giardia, which include really lovely sulfur burps. I could not find the medicine for giardia, metronidazole, while in Myanmar so I waited it out for three more weeks until I returned to Thailand. At that point the Thai doctors had a conniption fit over my weight loss and ran heaps of tests and heaps of medicine before they would call me “fixed.”
  • Worms: There is every chance that I carried worms for a year before I figured out why I couldn’t gain the weight back from my bout with giardia. It was my friends Bessie and Kyle, who had lived in Myanmar, who pointed out in February of this year that I sounded like I was still carrying worms/parasites. Good call, I was.

And now, after that last bout with de-worming and antibiotics, which I took while I was in Mexico earlier this year, I am finally feeling really good. I am healthy in a way I haven’t been for years. I am fairly positive that I am parasite-free, and I am so good, in fact, that my best friend convinced me to train for a marathon in January. :)

The Toll on My Health

My cat, Sylar, also called Baby Kitty despite being huge now.

My cat, Sylar, also called Baby Kitty despite being huge now. And despite my allergies I deal with it because he’s too cute for us to send away. :)

I haven’t come out of these past five years unscathed, but this varied list of ailments doesn’t make me fear travel. Quite the opposite, most of these I listed I forgot about until I made this list because once the illness passes I am back to enjoying being on the road, hearing new stories, and meeting new people. I am pretty big on being prepared, and then accepting that you can’t do much in life beyond that.

I am a planner and a preparer, I carry a well-stocked medical kit—double stocked when my niece Ana traveled with me—and my kit has helped me and dozens of other travelers I met along the way who needed help. And that’s a biggie, I ask for help and have played the pantomime game with pharmacists all over the world to find the medicine I needed.

Before traveling, my only known allergies were mild reactions to stinging/biting things (as I child I was very allergic to fleas), and a mild cat allergy. Over the years all my allergies worsened, with the most notable change after dysentery, when I took a huge course of strong antibiotics and I was underweight and undernourished for months after it. On the other side of that illness I have much more severe allergies to the mundane things like seasonal allergies and hay-fever—and I’ll know within seconds if you have a cat in your house.

Ana is all smiles with her soup in Hpa-An, Burma.

Ana never got sick on our trip despite her adventurous appetite. Here she gives me a thumbs up for our yummy breakfast in Hpa-An, Myanmar.

And as much as past health helps, it’s as much about luck, experience, and preparedness to stay healthy on the road. And I’ll note time and again that I come out smiling and grateful for the travels and life I’ve led these past five years. Though there is little chance I would have contracted some of these illnesses if I wasn’t on the road, there surely would have been something else cropping up instead.

10 Practical Tips for Travel Sickness

  • Practical Tips for Avoiding Travel SicknessGet your vaccines: Vaccinations are an important part of off-the-beaten path travel and all new travelers should visit their local health clinic for the recommended vaccines. A full list of tips and resources is here.
  • Carry a medical kit: While you can easily buy a travel medical kit to get you started, I recommend customizing it to meet your needs and adding a few things that are often lacking. I noted that oral rehydration salts were a life-saver several times, as was a general antibiotic, and heaps of antihistamines.
  • Buy travel insurance: I have never used my travel insurance but I highly recommend having it just in case, especially if you’re traveling long-term. I use World Nomads or IMG Patriot and generally think one of these two are the best options I have found; my review is here.
  • Read and research: Read up on the places you’re traveling, ask other travelers what precautions they took for the region, and learn what you need about your own health to keep you safe. Read How to Shit Around the World, which wins for the best title ever.
  • Take physical precautions: Your research should tell you the reasonable precautions to take; in many tropical regions mosquito bite prevention is important; consider Deet, malaria medicines, and/or a mosquito net as needed for your specific trip. Wash your hands a lot—more than you ever would back home.
  • Learn about food safety: Carry your own utensils (I carry this spork), and research the ways to spot good street food stalls and restaurants. My friend Jodi wrote the Food Traveler’s Handbook and it’s a great guide that not only helps you delve deeper into a place’s food culture, but she offers heaps of practical tips for food and eating safety.
  • Learn about water safety: Drinking water in developing countries is not always safe. But there are very effective precautions you can take. I used a SteriPEN on the road (my full review here), and something like a LifeStraw could also be effective in ensuring that you’re never stuck without clean drinking water.
  • Stay hydrated: Anything related to diarrhea and vomiting have severe dehydration side effects. Carry oral rehydration salts and focus on drinking electrolytes and minerals when you’re suffering from any bout of diarrhea or vomiting. Proper hydration may be the single thing that stops an illness from turning fatal before you can find medical help. Most outdoors stores (like REI, my favorite) sell oral rehydration salts to stock your medical kit before you leave and it’s also very cheap to refill your supplies on the road in the more developed countries on your route (Thailand had them in every pharmacy, Laos did not).
  • Take preventive measures: Antibiotics wreak havoc on your system and kill all the good bacteria in your body alongside the bad. Take probiotic pills and eat yogurt, kefir, or other foods with live cultures not only during your course of antibiotics, but throughout any region where you’re battling intestinal issues, they really help keep you healthy. Also get enough sleep and eat healthy, which is tricky on the road but helps your recovery time when you do get sick!
  • Ask for help when you need it: This includes seeking medical help, asking locals to help when your condition is serious, and generally communicating. People are kind all over the world, and if you’re in a tough spot you need to let others know about your illness and let them help you find help. I’m not a doctor and so if I feel like things are out of control I have learned to immediately ask for help—between the humidity in tropical regions, risk of infection, and poor sanitation and healthcare, situations can deteriorate quickly. If  you think you’re seriously ill, don’t just self-diagnose on WebMD, go get help.
  • Keep a positive attitude: I noted in the loneliness post that being sick on the road was the loneliest I have ever felt on the road, and maintaining a positive attitude after hugging a toilet for days is tough, but essential to helping you stay healthy and recover faster. You’re not alone and the rest of the traveler’s posting happy photos on Facebook don’t have  a secret recipe for health; all long-term travelers have battled sickness on the road.

Next month I have a whole post coming about tackling toilet time on the road, mostly because it’s seems so infrequently discussed, but I suspect it’s one of those things readers Google while their browser is in incognito mode. It’s important to maintain honesty about travel, and health is one of those things. I’ll be the first to encourage someone to take the leap and travel asap, but with that leap comes the responsibility to stay informed.

With that in mind, is there anything I missed, tips you’ve found for staying healthy on the road or any resources that add to the topic of health and travel sickness for new or worried travelers? 

This post is a part of my monthly series on overcoming fears to travel, check out all the posts here, new ones on the first Tuesday of every month.

Resources to Stay Healthy While You Travel


38 Responses to A Little Discussion… Health and Travel Sickness in Long-term Travel

  1. Sandra September 30, 2017 at 7:23 pm #

    Hey! I recently found your blog and I really love it. While I travel health is definitely my biggest concern! I have a question for you, since you unfortunately had scabies. How did you manage to relax and sleep in other beds after that? I got bed bugs on February and still feel anxious and have trouble sleeping in hostels, etc. Do you have some “preventive measures”? What do you do?

    • Shannon October 1, 2017 at 11:26 am #

      That is a tough question Sandra. The thought is always there once you’ve been subjected to something like bed bugs and scabies. With bed bugs, I am vigilant about checking the bed corners for dried blood droplets and other signs at every single new guesthouse or hostel. I never leave my luggage next to the bed either, just in case. And I read reviews religiously, looking for any mention of it online. If the place has ever had a single whiff of a mention of bed bugs, I don’t say there. I also use a sleep sheet very often if I am every in a place that just feels less clean than I would prefer (although cleanliness is not a guarantee against bed bugs, but does mostly prevent scabies). The bugs feel like such a violation of your space and your person, to wake up the next day and realize they were there, it’s so rough. But they don’t hurt you truly. I tried to remember that in the weeks after I got ride of the scabies mites. They were awful and itchy, and I will take steps to not get them again, but I came through it OK, and could again. The vast majority of beds you encounter will not have the bed bugs, if you research a place ahead of time, and then check your bed and bed frame for signs, then you have truly done all that you can. The rest is unknowable, so I release it and know that I will handle what comes next if I have to. I know that’s not a great answer, but it’s how I’ve had to approach sleeping in so many beds all of these years.

  2. Craig Workman January 9, 2016 at 2:40 pm #

    Hi Shannon! Great Post, however I do have a question. What insurance do you currently carry? I’m going to New Zealand on a 1 year holiday visa. I was going to buy World Nomads but I learned they are not considered creditable insurance in the eyes of the U.S. government. Because they do not meet Affordable Health Care standards for medical insurance,if I went with them I would face a $700 fine from the IRS. I found 2 places that have creditable insurance that will cover me abroad and back in the US but it’s $250/month. Have you heard of this? And do you have a recommendation of a creditable and affordable insurance option? Thanks in advance for you attention to this!

    • Shannon O'Donnell January 9, 2016 at 5:26 pm #

      Hi Craig, that’s a tough situation. In this post I list out two others I’ve used in the past or heard good things about, IMG and HTH, as well as considerations you should think about for the travel insurance side of things: http://alittleadrift.com/2009/12/backpacker-travel-insurance-world-nomads/ . For meeting the ACA standards — I don’t know anything about this. I maintain health insurance here because I am no longer gone for the majority of the year (so I pay for both). You might want to actually talk with your tax accountant about if you will qualify to pay taxes for the calendar year you are gone — you only pay insurance if you are a current resident, and there are loopholes for taxes too if you are off of U.S. soil for a specific time in any calendar year. “U.S. citizens working and living abroad who are outside the states for 330 days or more in a 12-month period are not required to maintain MEC. In this instance, you are deemed to have met the individual mandate. ” Read this: https://www.hthtravelinsurance.com/aca_faqs.cfm. Other thoughts: have you looked at New Zealand health insurance plans? Travel insurance is not usually designed to meet the standards of the ACA, but a health policy from there might. Good luck! Hope some of this helps spark some ideas.

      • Craig Workman January 10, 2016 at 11:01 pm #

        Hey Thanks Shannon! Looks like I’ll be going with IMG. They also provide several months of coverage back in the States as a “readjustment coverage”. So that’s another plus.

        I know these medical plans offer some emergency dental coverage for serious incidents. Did you ever look into coverage for minor things like cleanings and toothaches? I’m having difficulty finding something for this.

        Thanks!

        • Shannon O'Donnell January 10, 2016 at 11:36 pm #

          Minor things that are maintenance checkups are not really included. If you plan to do some travels in other regions, it’s often really cheap. I get my checkups and cleanings in Thailand and Mexico when I pass through. I also just pay the $65 that it costs locally in my hometown for a cleaning before I head out each time. Those sorts of routine visits can usually cost less in other places in the world because they have different healthcare systems.

  3. kay tucker January 13, 2014 at 6:02 pm #

    Great post! Thank you for honestly discussing something that is probably the only thing that makes me a little apprehensive about longterm travel. These worries won’t stop me from exploring and I still intend to travel (hopefully in 6 months). I’m saving money to travel Belize and Jamaica. A blog called ‘sunshine and stilettos’ led me to legal nomads which led me to your blog! Because of these solo female traveler blogs, I feel wonderfully empowered and encouraged to embark on my first solo international trip. I always felt I would find a way but the encouragement from other women definitely helps. Thank you for sharing your adventures and for speaking so frankly about health and safety!

    • kay tucker January 13, 2014 at 6:03 pm #

      *I meant to say Belize/Jamaica is where I will begin…I hope to take a much more extended trip next year ;)

    • Shannon O'Donnell January 14, 2014 at 11:43 pm #

      Hi Kay! So glad you found the site helpful and what a wonderful and fun chain that brought you here. Congrats on the decision to head out soon, there are always going to be fear points, but getting started and just seeing what it’s like for yourself is the best way to assuage it. There are heaps of things I stressed over before I left and the vast majority never manifested in my travels. If you’re aware and cautious of the few common issues, you’ll have an amazing trip! Don’t hesitate to let me know if there is ever anything I can do to help. Safe travels :)

  4. Theresa Caruso September 26, 2013 at 3:41 pm #

    This is a wonderful post. You have truly persevered throughout your adventures, only to come out on top! As a travel agent, I often run into people who avoid traveling too far “off the grid” because they’re afraid of getting sick. I know they’re missing out on some incredible experiences. With the suggestions you’ve got here, I’m sure I will be able to convince more people to try out some extraordinary vacations.

    • Shannon O'Donnell September 27, 2013 at 10:19 am #

      Thanks for weighing in and sharing your own thoughts, as a travel agent do you help steer them to something they might like but be a bit outside their normal zone (because of those health fears), or do most people come in with a clear idea?

      • Theresa Caruso October 8, 2013 at 9:03 am #

        I definitely try and steer my clients towards something a bit outside their comfort zone, but I try to sandwich it between things I know will put them completely at ease. Most of them enjoy adventure and come in with a general understanding that they will need some kind of vaccination and preparation when going “off the grid”, they just don’t know what.

        • Shannon O'Donnell October 8, 2013 at 9:07 am #

          Ah, that sounds like the perfect way to ease them into stretching just enough to have a truly memorable vacation :)

  5. Tripobox September 4, 2013 at 10:09 am #

    Wow, you’ve been through a lot. Great tips though, and I love that you’ve mentioned how important a positive attitude is as well as good planning and preparation. This is the perfect article to bookmark for future travels :) I’m in Barcelona at the moment but I may go further off the grid in the next year! Thanks, Lucy (Tripobox)

    • Shannon O'Donnell September 4, 2013 at 10:44 am #

      Thanks Lucy! When you decide to drop off the grid, don’t hesitate to shoot me an email if there is ever anything I can help with! :)

  6. Jacquie Mathers @ MFW August 25, 2013 at 5:59 pm #

    I just discovered your blog, absolutely love your advice you’re so in depth! Great article, sounds like horrible luck, but definitely makes me push myself to become better prepared, x

    • Shannon O'Donnell August 25, 2013 at 10:40 pm #

      Thanks Jacquie! Don’t hesitate to shoot me an email if there is anything I can help you with as you prepare for your own travels!! :)

  7. TravAddict August 21, 2013 at 6:55 pm #

    Wow, you have had some terrible experiences with illness while traveleing, but also some great advice on how to deal with it. Great post

    • Shannon O'Donnell August 22, 2013 at 10:41 am #

      Thanks, travel has highs and lows but I’ve always found it worth it :)

  8. Claire @ Vegetating Earth August 18, 2013 at 2:49 pm #

    This is an excellent post. I am both a worrier and a planner and illness is one of the unavoidable things about travel (that you can only prepare so much for). It’s great that you forgot about many of them; that actually makes me feel much less worried!

    • Shannon O'Donnell August 19, 2013 at 1:31 pm #

      A little bit of worry will keep you safe, but beyond that enjoy and you really do accept and move on from most of the minor setbacks. Safe travels Claire! :)

  9. Phil August 17, 2013 at 2:22 pm #

    Hey SHannon, Great post. I think it’s helpful when travelers can reference personal experiences when talking about travel health issues. And that’s quite a list!! Mine is somewhat similar and I would definitely put amoebic dysentery and malaria up there when I reflect on the depths of misery that I’ve dealt with while traveling. One thing I would add in the practical tips section is handwashing. It’s perhaps the most effective weapon when it comes to disease prevention and yet a lot of people overlook it.

    • Shannon O'Donnell August 18, 2013 at 6:57 pm #

      So, so true Phil, I’m adding that tip and a link to your site into the post now as you are right, it’s one of the easiest ways to mitigate the bad germs all over the place as you travel. Sorry to hear that you had malaria (and dysentery of course, holy hell is that a terrible one).

  10. Jane Has A Backpack August 15, 2013 at 8:01 pm #

    Great that those didn’t stop you from travelling! Being sick can’t be prevented while on the road, especially if you are not well-adjusted on a particular place. Learning from your experience, those tips may come in handy as well. Thanks.

    • Shannon O'Donnell August 15, 2013 at 11:31 pm #

      The well-adjusted part is definitely true, if you’I’m in a region for long enough I found that I sort of run through the common bugs and stay healthier over time. Glad the tips seem on-target from your own travels Jane, and thanks for weighing in here! :)

  11. simon August 14, 2013 at 10:48 am #

    This was really useful, thanks

  12. Abdul Razzak August 13, 2013 at 4:48 pm #

    I do a lot of work travel as well as personal travel and I can completely relate to this post. It can sometimes completely take a toll on your health even with the most luxurious travel mode or regardless even if you are staying in the most luxurious hotels. It has actually happened to me many times that I have travelled through business class, one of the best hotels, hardly took any overload and still felt like very relentless or tired. Managing your schedules, eating habits, medicines proper rest while travelling is very very important and your post here gives some great knowledge to take away from here. Thanks!

    • Shannon O'Donnell August 15, 2013 at 11:33 pm #

      Thanks for sharing your own experiences here Abdul, I don’t do a lot of the higher-end travel, but I know the time on flights, sleep disruptions and different foods can really stress your system and make you more vulnerable no matter how you travel. Glad the post resonated and held true against your own travels as well, thanks for weighing in! :)

  13. Andi Perullo August 13, 2013 at 3:18 pm #

    OMG and I thought *I* had had really awful health issues while on the road! You poor thing!!!! I love how it hasn’t stopped you from traveling though!

    • Shannon O'Donnell August 15, 2013 at 11:12 pm #

      Aw thanks Andi, I was just reading your post about being a Chinese Medicine Doctor and surely that helped a bit I hope as you are traveling? Do you bring any special things with you if you’re going somewhere a bit more remote?

      • Andi Perullo August 16, 2013 at 9:46 am #

        Oh yes, I have a little “medicine chest” I bring with me. It’s filled with goodies from both Western and Chinese Medicine. I think TCM has generally kept me healthy while traveling, because I think I have a weaker immune system than most people.

        • Shannon O'Donnell August 16, 2013 at 10:18 am #

          Sorry to hear that about your immune system, if we ever make it to that coffee we need to get somewhere in the world I’d love to hear more about the TCM :)

  14. Heather August 13, 2013 at 12:11 pm #

    Illness can be an unfortunate side effect of travel, but it’s not enough of one to make me stay home. Although fear of spending another night on the toilet has led me to be a lot more cautious in what I eat. If something looks under cooked – particularly eggs – I won’t eat it.

    • Shannon O'Donnell August 15, 2013 at 11:12 pm #

      Ugh! The runny eggs really get me when I travel too — I just can’t do it when the whites are still clear. I am with you on that.

  15. Amanda @ Adventure Year August 13, 2013 at 10:29 am #

    This is such a good post and a GREAT resource. I got sick when I was traveling in Dublin. Thankfully, it wasn’t a trip-ending sickness. It did, however, contain frustrated tears and confusion about what to do. Antibiotics probably would have been a great help. I’m planning a big trip now, and I’ll have to keep this page in mind!

    • Shannon O'Donnell August 15, 2013 at 11:01 pm #

      So glad to hear you kept going after the Dublin sickness, and good luck on your big trip planning, let me know if there is anything I can ever help with. :)

  16. Kate August 13, 2013 at 9:56 am #

    This is brilliant! My first time out with friends (no parents/guide/group, etc.) I was in Peru and drank a bad bottle of water. Stuff coming out of every hole, often all at once – awful. Gatorade (and cipro) probably saved my life. Came back with ulcerative colitis, which I’ll have probably until I die or get my colon out.

    Currently planning a RTW trip and can’t wait to see how it goes!

    • Shannon O'Donnell August 15, 2013 at 10:50 pm #

      Oh, that Peru experience sounds terrible — like you the gatorade and cipro were what the big difference for me making it through it. Congrats on your RTW and let me know if there is ever anything I can do to help!

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