It’s much easier to cope with medical emergencies at home than in a foreign country. You speak the language. You can call 911. You won’t have these options in many parts of the world. In certain areas, it might not even be easy to find a doctor. What you need to know…
GET travel insurance
Emergency rooms in the US treat everyone. In many parts of the world, you will not get treated unless you can pay for it. And there’s no guarantee that your health insurance at home will reimburse you.
I advise everyone to get travel medical insurance — and to keep the card with you at all times. Most policies cost only a few dollars a day. Make sure that yours covers the cost of evacuation to the nearest modern medical facility and then back home.
Most large insurance companies offer travel policies. Better: A policy from a company that specializes in travel, such as International SOS. In an emergency, policyholders can get 24-hour information on local hospitals and specialists and medical translation services.
Important: See a travel doctor before heading to remote locations. He/she can write a prescription for medications that you might need while traveling, such as antibiotics or antimalarial drugs. You also will be advised to get the necessary vaccinations, particularly against hepatitis.
Bring medical records
You might not be able to discuss your medical history with a doctor should you be seriously ill or injured. A wallet-size list that includes all of your pertinent medical information, such as drug allergies, underlying health problems and all the medications and supplements that you’re taking, could save your life.
I also advise travelers with health issues to bring copies of medical tests — for example, a recent electrocardiogram if you have heart disease.
Bring extra meds
If you’re taking medications for a chronic condition, bring more than you think you will need in case you’re delayed getting back to the US. In certain parts of the world, counterfeit medications are rampant, especially for the treatment of malaria in Africa and Asia.
Bring your own medication in its original container, along with a copy of the paper prescription. If you are carrying syringes to treat diabetes, carry a note from your doctor explaining this.
Be aware that just taking a paper prescription for a drug is not enough. Certain countries will not dispense medications based on a US prescription, especially if it’s for a controlled substance, such as a sleep aid or an anxiety drug. And it’s not easy to determine the policy in a particular country.
It also is important to know the generic name of the drug you are taking because brand names vary widely.
To Find a doctor
In most countries, if you stay at a large hotel, all you need to do is ask at the front desk for an English-speaking doctor. Every major hotel has a staff physician or can recommend one.
You also can try the nearest US consulate or embassy — many have lists of doctors. Or you can contact the International Association for Medical Assistance to Travellers (716-754-4883, www.iamat.org), a nonprofit group that provides listings of English-speaking doctors and clinics around the world. It also provides information about vaccinations and discounted rates on consultations with member doctors. You can join for free, but donations are accepted.
the Traveler’s Curse
Diarrhea is the most common malady that afflicts travelers. (People who come from other countries to the US also tend to get it.) It’s unlikely to be serious for those who are otherwise in good health.
Exception: Diarrhea that continues for more than a few days or is accompanied by muscle aches, fever and/or blood and/or mucus in the stool can be very serious. Severe diarrhea caused by an intestinal infection can cause dehydration. Without treatment, dehydration can be life-threatening, particularly for the elderly or people with health problems.
First step: If you can’t see a doctor, replenish fluids with oral rehydration liquids — they’re available in grocery stores and pharmacies around the world. In addition to water, these liquids provide salt, potassium and sugar. Or you can substitute diluted Coca-Cola.
Next: You can take the antibiotic ciprofloxacin (Cipro). A typical dose is 500 mg twice a day for one to three days. Consider getting this drug at home before you leave and bringing it with you. An alternative antibiotic is azithromycin, which is more appropriate for children, pregnant women and people traveling to southeast Asia, where ciprofloxacin is not always effective. Ask your doctor what dose is right for you.
NO transfusions OR SHOTS
The blood supply generally is safe in the US. But in many parts of the developing world, there’s no guarantee that blood won’t be contaminated with HIV or hepatitis. My advice…
Don’t accept a blood transfusion in a developing country (assuming that you’re aware of what’s happening) unless the doctor is able to convince you or a loved one that it is needed to save your life.
Know your blood type. It gives you the option of getting a blood donation from a low-risk friend or fellow traveler.
Ask to be transferred to a big city that has a major medical center, where blood is more likely to be screened and infection-free.
Getting an injection in a developing country can be just as risky as getting a transfusion. Some travelers come home with hepatitis after getting an injection with an unsterilized, secondhand needle. Avoid injections unless you have no other choice.
Be aware of malaria
Malaria still is among the most common diseases worldwide. There are more than 200 million cases of malaria each year. The actor George Clooney contracted the disease on a recent trip to Sudan. Nearly one million people die from the disease annually.
Ask your doctor about chemoprophylaxis, taking medication to prevent (rather than treat) an illness. Chloroquine is the drug of choice for preventing and treating malaria in certain areas of the world, such as Central America, Haiti and the Dominican Republic. In most other areas, chloroquine isn’t effective and doxycycline or other drugs are used instead.
The Web site of the Centers for Disease Control and Prevention (www.cdc.gov/malaria/map) shows where malaria occurs and the recommended medications for different areas.
Know the symptoms: Patients who get a fever after traveling to a risky area are assumed to have malaria until it’s proved otherwise. Other symptoms may include headache, chills and muscle aches. Get tested immediately. Other tropical infections, such as dengue fever, typhoid fever and hepatitis, have symptoms similar to malaria.
Important: If a blood test is negative, but the fever doesn’t go away, repeat the test in 12 to 24 hours. It’s common for the first malaria test to fail to detect parasites in the blood. If you have malaria, parasites should show up in the second test. People have died when they failed to treat malaria after getting one negative blood smear.
Don’t pet dogs OR MONKEYS
Don’t worry too much about snakes, scorpions and poisonous spiders. These certainly are present in remote areas, but only a minority of bites and stings require emergency treatment. Taking an antihistamine, such as Benadryl, can help prevent anaphylaxis, a dangerous reaction to the venom. Do this if a bite or sting becomes swollen, red or itchy.
The fact is, dog and monkey bites are a more serious concern. Many undeveloped countries are full of stray animals, many of which may have rabies. There is a pre-exposure rabies vaccine, but it is quite expensive, so it’s recommended only for high-risk travelers such as Peace Corps workers in India or Africa.
If you do get bitten: Wash the bite for at least 20 minutes with soap and running water. Extended washing reduces the risk for infection. Then see a doctor immediately.
