Preparing for International Travel, Part 1

by Dr Gordon Coates

(To download this article as a free ebook, click HERE)

Disclaimers, Warnings and Acknowledgements

Please see the disclaimers, warnings and acknowledgements relating to the whole series, as stated in the first article of the series, Travel Health Series - Introduction.

Please note that the early articles in this series will be very general in nature. They will therefore, inevitably, leave many questions unanswered. Later articles in the series will provide more detail about selected aspects of Travel Health.

Series Context

In the second article of this Travel Health series, I discussed Fitness for International Travel. Once you have determined that travel is feasible from that point of view, the next step is to make the necessary preparations to ensure that your trip is a safe and enjoyable experience.

As the topic is a large one, I will not try to cover all the preparations in one article. In the present article, I will only introduce three important aspects of preparation, each of which is very relevant to your physical wellbeing during and after travel. I will do this under the headings Service and Repairs, Jabs and Tabs, and Insurance, and in this article I will only discuss the general principles relating to each of those topics.

Service and Repairs

The idea of pre-travel service and repairs is quickly covered in principle, though it may take you a little longer to complete in practice, especially if some repairs are necessary. Quite simply, medical and dental treatment is much easier to arrange at home. It may sometimes also be cheaper. In the case of travel to developing countries, it is also very much safer to be treated at home. Even very minor examinations and treatments involve potential risks, including (but by no means limited to) the transmission of potentially fatal blood-borne infections. Most such risks would be minimised, or even excluded from the realm of reasonable possibility, in a developed country.

In other words, having a medical and dental checkup a few months before you leave, and having any necessary procedures performed well before your departure, might save your holiday from turning into a very irritating and inconvenient experience. Conceivably, it might even save your life. Considering that the procedures would need to be done sooner or later in any case, it makes very good sense to treat yourself at least as well as you would treat your car – by attending to "service and repairs" before embarking on any long trip!

Jabs and Tabs

Susceptibility to many serious infections can be very much reduced by prior immunisation/vaccination - hence the "jabs" part of this heading. [Although vaccination originally meant smallpox immunisation, using vaccinia virus, it has gradually come to mean the use of any preparation containing dead or attenuated microorganisms, in order to confer immunity to a disease. In other words, "vaccination" and "immunisation" now mean exactly the same thing.]

In other cases, considerable protection can be afforded by taking "prophylactic" (preventive) medication - hence the "tabs" part of the heading above. This is often one important part (though very far from being the whole) of the prevention of malaria (which will be discussed in a future article in this series). It is also, though less often, used for the prevention of various other illnesses.

In a few cases, medication, together with instructions for its correct use, may be carried by the traveller for use if and when symptoms suggest that a particular infection is probably present. (This requires self-diagnosis, which is very unreliable, but is sometimes the best compromise when medical advice is not available.)

Note that medications and their accompanying documentation must always be declared at Customs, whether en route or returning home. Also, some medications may be illegal in some countries, even if they were medically prescribed and their possession is supported by medical documentation. It is therefore necessary to check with the relevant embassies or consulates before departure, if intending to carry medications, whether they will be in unaccompanied baggage or carried in the cabin.

Incidentally, needles are usually not allowed inside aircraft cabins, though an exception may be made in some cases if it has been arranged in advance for the treatment of an illness such as diabetes. (Simply protesting that failure to receive necessary medication during the flight might prove fatal may sound like a logical alternative, but such protests often fall on deaf ears where airline security regulations are concerned.)

Importantly, none of the precautions referred to above is a substitute for avoiding exposure to dangerous microorganisms wherever possible, which will be the subject of various future articles in this series. However, immunisations and preventive or therapeutic medications are extremely valuable in some situations.

More details about particular "jabs" and "tabs" will also be the subject of future articles in this series. In the present article, I will not go into any detail about either topic. Instead, my main emphasis will be on the general principles which determine the optimal utilisation of these very important resources.

Vaccinations often require two or more doses of vaccine separated by an interval of some weeks, and immunity may not develop fully for some weeks after the last dose. Medications may need to be tested before your departure, to see if you can safely take them during the trip. They may also need to be commenced some time before you leave (as well as being continued for some time after you return).

For these reasons, it is essential to find out in good time what "jabs and tabs" are advisable, so that the best possible preventive measures can be taken, and will have time to become fully effective, before the risk of exposure to the infections concerned commences.

Although shorter times can sometimes be sufficient, it is best to start the "jabs and tabs" process about eight weeks prior to departure. If you have never been immunised against polio, or if you are going "off the beaten track", make that twelve weeks prior to departure. However, if such time intervals are not feasible, do not despair. Useful, though usually not optimal, protection can often be achieved at quite short notice.

In addition to the need to allow sufficient time, there are three very important things to remember about "jabs and tabs":

• what is advisable is frequently not the same as what is available for protection against the potential risks
• what is advisable is frequently not the same as what is required for entry to a particular country
• what is advisable is frequently not the same as it was the last time you went to the country in question

To get this right, you really need the help of a doctor with a special interest in Travel Medicine. This includes some family doctors, but by no means all of them. Therefore, you need to start by choosing a doctor…

Almost all general practitioners (child and family physicians) will happily give travel advice and vaccinations – but it will often be very different from that provided by a Travel Medicine specialist! Therefore, you should only go to your usual doctor for this advice if he or she has a special interest in Travel Medicine, accompanied by appropriate expertise.

Expert advice is especially important if you are going to Africa, Asia, South America or anywhere else where dangerous diseases flourish and public health infrastructure does not. That, of course, includes a very high proportion of the most interesting travel destinations!

Your usual doctor may be able to refer you to a good travel clinic, or you may prefer to find one in the phone book or on the web. My recent Google search for "travel health" yielded over a million results, while limiting the search to one country, Australia, reduced the number to about 45,000…

Fortunately, though, the major travel clinics mostly appeared on the first few pages of results. Another approach would be to consult the list by country at the International Society of Travel Medicine (ISTM) website, http://www.istm.org. Although this only lists ISTM members, most major clinics fall into that category, so the list is quite useful.

If you do consult a Travel Medicine practitioner, be sure to take along a summary of your medical history, including past medical and surgical events, any current problems, any regular or occasional medications, and any allergies you know of. This is necessary simply because the most important factor to consider when providing travel advice is the most variable factor of all – the individual traveller.

If you would like to get an idea in advance of what might be advised, the "Travelers' Health" page at http://wwwnc.cdc.gov/travel has a "Destinations" link which takes you to a long list of possible destinations and provides basic information about whichever ones you choose. Importantly, this is not an alternative to getting good medical advice about your needs. It simply gives you an idea of what is likely to be on the menu.

For example, a traveller intending to spend a month camping in a rural area might need most or all of the measures listed, and perhaps some others that were not listed. On the other hand, a traveller spending two nights in a five star hotel in a modern city in the same country might need only a few of the measures listed, or sometimes none. No two cases are the same!

Insurance

There are many risks for which financial assistance and/or compensation can be purchased. In the present context, of course, I am considering travel insurance, and especially travel health insurance. Discussion of the documentation relating to the insurance you purchase belongs, strictly speaking, in a future article - as do baggage insurance and trip cancellation insurance.

However, especially in the case of health insurance, adequate cover may become highly relevant to your personal wellbeing, or even your survival. Therefore, I have decided to discuss health insurance here, along with the preparations discussed above (which are, of course, aimed at reducing the likelihood of needing it!)

The Australian Department of Foreign Affairs and Trade offers some useful advice about travel insurance, which I will paraphrase here. When organising your insurance, make sure that you will be covered for all medical expenses, specifically including pre-existing medical conditions, hospitalisations and medical evacuations. Shop around for a policy that both meets all your needs and covers you for the whole time that you will be away. If you plan to participate in adventure tourism, or sports such as scuba diving or parasailing, discuss these plans with your insurance provider and ensure that your policy covers the activities fully.

However, perhaps you are wondering whether you really need to insure against possibilities that you hope will never happen. If so, here are a few interesting points to ponder. (The examples given are based on 2007 prices in Australian dollars, so you should adjust them accordingly.)

• Daily hospitalisation costs in Southeast Asia regularly exceed $800
• A stay in a general ward in Noumea's main hospital was estimated to cost a minimum of $1,500 per day
• In the Intensive Care Unit of the same hospital, that daily charge started at an estimated $3,000
• The return of a deceased person's remains from Europe to Australia was estimated to cost in excess of $10,000
• The cost of medical evacuation of a critically ill person to a developed country can easily reach $100,000, and may sometimes be more than $300,000.

Reciprocal health care agreements may cover some costs in some circumstances, but they do not cover you while you are en route, and they do not cover evacuation expenses. It may also be necessary to register in advance of the need for medical treatment, to qualify for reciprocal cover, even though the need for treatment is usually unexpected. Various documents, including proof of entitlement to health care at home (even if that is universal) may be required during the registration process, and the cover provided may not be retrospective.

For all of the above reasons, travel insurance to cover the costs of illness or injury during a trip is really essential, no matter how fervently you hope never to claim against it. Travel agents can usually arrange such insurance, for which they usually receive a fee from the insurer involved. Alternatively, you could source it independently.

If you are young and healthy, it won't cost too much. If your health is not so good, it will naturally cost more – but then, in that case, you are also more likely to need it! You can arrange various other sorts of insurance, such as baggage insurance, at the same time if you wish.

In conclusion, here is a special message for teenagers and young adults. You feel indestructible, right? Fair enough – that feeling is so common that it is considered normal, even though it is not logical. However, microorganisms see you just the same way that they see people younger or older than yourself. They see you as food. Injuries, of course, do not see you at all – they just happen, usually when least expected. Therefore, I advise you to take the same precautions as other people, even though they may seem ridiculous in your own case. After all, you might as well survive your trip, as well as enjoying it!

Links

Some Useful Travel Health Websites

Partial Bibliography for the Travel Health Series

Declaration of Interest

Dr Coates receives no financial or other incentives from any travel-associated bodies.

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Next:
Preparing for International Travel, Part 2