Travel Essentials: Illness Abroad

A traveler going abroad with any pre-existing medical problems should carry a letter from the attending physician describing the medical condition and any prescription medications, including the generic names of prescribed drugs. Any medications being carried overseas should be left in their original containers, be clearly labeled, and be carried in hand luggage. Travelers should check with the embassy of the country they are visiting to make sure any required medications are not considered to be illegal narcotics.

Healthcare Coverage

Obtaining medical treatment and hospital care abroad can be expensive, and medical evacuation can be extremely costly. Note that your medical insurance/healthcare program may not be accepted outside your home country. If your health insurance policy or state healthcare program provides coverage abroad, remember to carry your proof of insurance/coverage (and a claim form if applicable). Many health insurance companies and state healthcare programs will pay "customary and reasonable" hospital costs abroad, but find out before you travel.

If your medical insurance or health service does not cover you in the country you are visiting, it is a good idea to consider purchasing a short-term policy that does. There are health insurance policies designed specifically to cover travel. Many travel agents and private companies offer insurance plans that will cover health care expenses incurred overseas, including emergency services such as medical evacuations, which very few standard insurance companies and state health services will cover. Remember to do your homework, however, and find out what your travel insurance policy will cover and what exclusions the policy has.

If You Become Sick or Injured While Traveling

See a doctor right away if you:

• Have diarrhea and a high fever (above 102° F/38.9°C)
• Have bloody diarrhea
• Are visiting a malaria-risk area and become sick with a fever or flu-like illness
• Are bitten or scratched by an animal
• Have been in a car accident
• Have been seriously injured
• Are sexually assaulted

If you are sick on an airplane, tell a crew member as soon as possible. If you are coughing, you may be asked to wear a surgical mask or to cover your mouth and nose. If your illness is serious, the crew may move you to a different part of the plane or, if necessary, redirect the airplane and arrange for you to exit at the nearest airport to receive medical care.

If you are sick on a cruise ship, tell a crew member as soon as possible. Cruise ships usually have a small medical facility on board where you may be treated. If your illness is serious, the medical staff may stabilize your condition and move you to a hospital on land for further treatment.

If you experience mild diarrhea, a common problem for many travelers, drink plenty of safe (bottled, boiled, or treated) water, weak tea, or other safe fluids to replace lost body fluids and avoid dehydration. Avoiding dehydration is most important in hot climates and for children. Some travelers have found relief with probiotics (active cultures of beneficial bacteria), found in yogurt with active and live cultures or in supplements. Most episodes of diarrhea will clear up in a few days. For severe cases, you may want to use oral rehydration solutions or salts, or contact a healthcare professional.

Contact your local embassy or consulate if you think you may need assistance. If a foreign citizen becomes seriously ill or injured abroad, a consular officer can assist in locating medical services and informing family or friends. If necessary, a consular officer can also assist in the transfer of funds from family or friends in the home country. Note that hospital bills, medical evacuation expenses, and all medical expenses are the responsibility of the traveler.

Embassies and consulates maintain lists of physicians and medical facilities for distribution to citizens needing medical care. Note that your foreign ministry cannot attest to the professional ability or reputation of, or the quality of services provided by, the medical professionals, medical facilities, or air ambulance services whose names appear on such lists.

Emergency Care Abroad

The quality and availability of proper emergency medical care abroad may be variable. In situations requiring a blood transfusion, the safety of blood products often cannot be guaranteed. Not all countries have accurate, reliable, and systematic screening of blood donations for infectious agents, and the risk of transfusion-related transmission of disease is therefore increased.

An early 21st century World Health Organization (WHO) Global Database on Blood Safety report supports this:

• 40 countries reported they did not test all donated blood for HIV, hepatitis B and C viruses, and syphilis.
• 39 countries reported that, due to unavailable testing supplies, blood was released for clinical use without testing for transfusion-transmissible infections.

Due to this increased risk, travelers in developing countries should only receive a blood transfusion in life-and-death situations for which there may be no other options. When a situation requires blood transfusion, travelers should make every effort to ensure that the blood has been screened for transmissible diseases.

All travelers should consider being immunized against hepatitis B virus before their trip. Immunization is especially recommended to those who travel frequently to developing countries, who plan to spend a prolonged period of time in developing countries, or whose high-risk activities or extreme sports put them at higher risk for serious injury.

Accreditation of International Healthcare Facilities

The quality of healthcare from foreign medical centers can be variable, particularly in developing countries. To ensure a higher quality of care abroad, Joint Commission International attempts to continuously improve the safety and quality of care in the international community through the provision of education and consultation services and international accreditation. A list of accredited international healthcare facilities is available at: www.jointcommissioninternational.org.

Drugs/Pharmaceuticals Abroad

The quality of drugs and medical products abroad cannot be guaranteed, as they may not meet international standards or could be counterfeit. Travelers are advised to:

• Bring with them all the drugs and medicines that they think they will need, including pain relievers, antidiarrheal medication, and, if applicable, antimalarials.
• Exercise caution when buying medications (especially those that do not require a prescription) abroad. In many developing countries, virtually any drug can be purchased without prescription.
• Travelers who may require injections abroad should bring their own injection supplies. In the absence of your own supplies, ask if the equipment is disposable and insist that a new needle and syringe be used.>

More Information

The International Society of Travel Medicine (ISTM) maintains a directory of healthcare professionals with expertise in travel medicine in almost 50 countries worldwide. To access the directory, see www.istm.org.

The International Association for Medical Assistance to Travelers (IAMAT) maintains an international network of physicians, hospitals, and clinics that have agreed to treat IAMAT members in need of medical care while abroad. Membership is free, although a donation to support IAMAT efforts is suggested. Members receive a directory of participating physicians and medical centers and have access to a variety of travel-related information. For more information, see www.iamat.org.

The World Health Organization (WHO) is the directing and coordinating authority for health within the United Nations system. The WHO website offers information about various health topics, country health profiles, data and statistics, and health-related publications. Visit the website at www.who.int.

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