Staying Healthy Abroad
Published: April 2009
By Christopher R. Cox
From contaminated water to malaria, international travelers confront a wide array of health risks. Here, 10 essential tips that will help you prepare for your next trip.
Nearly half of all visitors to developing countries will get sick during a two-week trip, according to Dr. Phyllis Kozarsky, a travel-health consultant for the Centers for Disease Control and Prevention (CDC). But health problems aren't limited to the these regions, of course; viruses don't recognize borders, and accidents can and do happen anywhere.
"American travelers tend to think of the world as a giant amusement park—that they can have a wonderful experience with little risk," says Dr. Edward T. Ryan, director of the Travelers' Advice and Immunization Center at Boston's Massachusetts General Hospital. " The reality is that the world is a risky place. A well-informed traveler is most likely to come back healthy." Taking these 10 precautions should be as much a part of your trip preparation as buying a plane ticket or booking a hotel.
BEFORE YOU GO
1 Do your homework. Know the health risks of your destination and what immunizations are required by checking the country's Consular Information Sheet on the State Department Web site (www.travel.state.gov). Some countries, such as Uganda, require proof of yellow fever vaccination prior to entry. The CDC site also offers a travelers' health section (www.cdc.gov/travel) and the International Society of Travel Medicine site (www.istm.org) has a link to Outbreak News, a rogues' gallery of "hot zone" diseases compiled by the CDC and the World Health Organization. The list should compel any reader to make a doctor's appointment, ideally at least one month before heading overseas, to ensure routine immunizations are current and to begin specific vaccines or prophylactic drugs, such as antimalarials, if required.
2 Consider a travel-medicine consultation if you're heading to a high-risk area. Although a personal physician can advise on destinations such as Europe, Dr. Jay Keystone, a Toronto-based travel- and tropical-medicine specialist, recommends visiting a travel-health clinic for anything more complex. You can find a comprehensive list of travel clinics on both the CDC and ISTM Web sites. "Family physicians don't have the time to keep up with the risks and outbreaks, disease and drug-resistance patterns, or the newer vaccinations and drugs," says Keystone, who is also the former president of the ISTM.
3 Check your current health insurance policy. It's crucial to have medical insurance that's valid overseas, says Dr. Joan Pfinsgraff, director of health intelligence for iJET, an Annapolis, Maryland, international risk-assessment firm. Since many health care plans don't cover emergency medical evacuation or even basic medical attention overseas, you should consider buying a travel-health insurance policy. The State Department Web site lists companies such as Travelex Insurance Services (www.travelex-insurance.com; 800/228-9792) and Travel Guard International (www.travelguard.com; 800/826-4919) that provide supplemental insurance.
4 Consider purchasing evacuation insurance. Many air-ambulance companies do not repatriate patients to hospitals in their home countries but instead transport them to the nearest acceptable medical facility. However, travel-insurance providers MedjetAssist (www.medjetassist.com) and Global Rescue (www.globalrescue.com) will fly patients to the U.S. hospital of their choice; individual and family policies are available for trips lasting from seven days to one year.
5 Pack a small medical kit. The CDC has a helpful checklist: items such as tweezers, a digital thermometer, antidiarrheal medications, and hydrocortisone cream. Depending on your destination or allergies, you may want to include insect repellent, antimalarial medications, water-purification tablets, prescription pills for skin or parasite infections, and an epinephrine auto-injector. Medex Assistance sells several kits on its site (www.medexassist.com; from $18). Also: bring extra prescription drugs, and carry them in clearly labeled, original containers. It may be hard to find your medications while abroad.
6 Carry your medical history with you at all times. Travelers who suffer from a chronic or preexisting condition should bring a copy of their medical history (which can be stored on a wallet-sized disk or USB drive). Med-InfoChip (877/872-3475; www.medinfochip.com; from $70) sells USB drives that contain prepared forms for information on allergies and medications, medical history, and doctor contacts.
ONCE YOU'RE THERE
7 Don't drink the water. It may seem obvious but it bears repeating: In undeveloped countries, stick with bottled water in sealed containers, even for brushing your teeth, Pfinsgraff advises. (Refilling discarded bottles with tap water is a thriving business in many poor countries, so be sure that the bottles you buy are sealed.) Also, resist the urge to buy food from street vendors and avoid fruit that's already been peeled, salad, and leafy green vegetables. Wash your hands frequently with soap and water or use an antibacterial hand sanitizer.
IF YOU BECOME ILL
8 Seek top-notch medical care. A high-end hotel's concierge should have the names and numbers of reputable physicians, dentists, and clinics. Some hotels, such as the Four Seasons Buenos Aires, have an in-house registered nurse. Many others, such as the Conrad Bangkok, have doctors on call 24 hours a day.
If you buy travel-health insurance, you can get referrals from your provider. Otherwise, the consular-services section of an American Embassy can suggest preferred physicians and facilities. Also, the nonprofit International Association for Medical Assistance to Travellers (www.iamat.org) inspects clinics and has a list of English-speaking, Western-trained physicians around the world. Membership is required, but it's free.
9 Avoid buying medication locally. "A large number of antimalarials and antibiotics available overseas are counterfeit," Kozarsky says. Drugs in many developing countries can be purchased without a prescription, so if you must buy medicine abroad, make sure you get your hotel doctor to okay it. A 2004 study in the journal Tropical Medicine & International Health found that 53 percent of antimalarials purchased in five Asian countries were bogus. Other medications may be adulterated with additional narcotics.
FOLLOW UP AT HOME
10 If you have a fever, seek medical attention. Up to 11 percent of returning travelers can experience febrile illness, according to a study published in the journal of the American Academy of Family Physicians. If you've been to a malarious area, a fever is "a medical emergency,'' Kozarsky says, and you need to see a doctor immediately. The American Society of Tropical Medicine and Hygiene (www.astmh.org) has a list of post-travel experts.
Many prescription and over-the-counter drugs have the same (or similar) brand names as drugs sold overseas—but contain different active ingredients. Here, a few to look out for. —Michelle Andrews
Name + Purpose
Name + Purpose
abnormal heart rhythm
high blood pressure
For the full list, go to www.fda.gov/oc/opacom/reports/confusingnames.html.
First it was mad cow. Then it was SARS. Now the disease that everyone is concerned about is avian flu. If a worldwide pandemic does happen, there could be travel restrictions and enforced quarantines. However, at press time, the Centers for Disease Control and Prevention (CDC) was not recommending that you cancel your travel plans—especially since avian flu was reportedly on the wane in Asian countries. Here's what you need to know if you're headed to one of the 10 countries where an outbreak has occurred.
• Most trip-cancellation insurance plans will cover medical and travel expenses should you catch avian flu while traveling (though no tourist has to date). They will also cover you if your trip is interrupted due to a quarantine or a flight ban in the country you're visiting. But if you cancel your trip ahead of time because you hear about an outbreak of avian flu, most policies won't pay. For that, you need to buy a policy that has a "cancel for any reason" option, which will add 40 to 50 percent to the premium, according to Jim Grace, president of online travel-insurance vendor InsureMyTrip.com. The site has two such policies available, from M. H. Ross and TravelSafe.
• Stay away from live poultry farms and markets—even in urban centers. The virus is passed primarily through poultry feces and blood, but can be transmitted via other secretions too.
• It's safe to eat poultry and eggs, says Christine Pearson, a spokesperson for the CDC, as long as they are cooked thoroughly (at 165 degrees Fahrenheit).
• Finally, if you develop flu-like symptoms while traveling, seek medical care immediately. —M.A.
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Have you ever wondered what would happen if you got sick en route to your destination?Airlines certainly have. For years, most carriers have relied on voice-response telemedicine systems that allow crew members to relay an ill passenger's vital signs and symptoms to doctors on the ground. But some are now adopting a new high-tech version called Tempus.
What it is A shoe boxsized device with a built-in modem that measures and relays passengers' images and vital signs—including blood pressure, pulse, temperature, blood-oxygen level and electrocardiogram information—via the plane's satellite telephone. Data is received at an emergency-response center on the ground, where doctors evaluate the information in order to determine treatment. Who has it Emirates, BMI (formerly British Midways), and, this fall, Virgin Atlantic. —M.A.