Theresa Sommers, Gary W. Brunette

An important aspect of preparing for a trip abroad is to consider the possibility of becoming sick or injured during travel. The following resources and information will be useful to travelers, should they require medical assistance abroad.

Traveling While Ill

Health-care providers should advise their patients about the possible need to avoid traveling if they become ill during their trip. Those with certain health conditions may need to postpone their travel arrangements, including air and public ground transportation. In general, travelers who are ill with a communicable disease that is spread easily to other people should discuss the need for rescheduling travel with their provider.

Travelers should be aware that some airlines check for visibly sick passengers in the waiting area and during boarding. If a waiting passenger looks visibly ill, the airline may prohibit that person from getting on the airplane.

Locating a Health-Care Provider

Several resources are available to American citizens who require medical attention during their travels. The following resources can assist travelers in finding adequate care:

• The U.S. Department of State:
  • A U.S. consular officer can assist in locating appropriate medical services, as well as in notifying friends, family, or employer of an emergency.
  • For more information, see http://travel.state.gov/travel/tips/brochures/brochures_1215.html.
• The International Society of Travel Medicine (ISTM):
  
  • ISTM maintains a directory of health-care professionals with expertise in travel medicine in almost 50 countries worldwide.
  • To access the directory, see www.istm.org.
• The American Society of Tropical Medicine and Hygiene (ASTMH):
  • ASTMH maintains a worldwide directory of providers specializing in tropical medicine, medical parasitology, and travelers’ health.
  • To access the directory, see www.astmh.org.
• International Association for Medical Assistance to Travelers (IAMAT):
  • IAMAT maintains an international network of physicians, hospitals, and clinics who 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 informational brochures.
  • For more information, see www.iamat.org.
• Travel Health Online:
  • This resource maintains a list of travel medicine providers worldwide. Information is obtained from a variety of sources, so the quality of services and the expertise of the providers cannot be guaranteed.
  • For more information, see https://www.tripprep.com.

Travelers may also get information about local health care from embassies and consulates of other countries, hotel doctors, credit card companies, and multinational corporations, which may offer health-care services for their employees. In addition, travelers who obtain evacuation insurance before travel will have access to a 24-hour hotline for help in any medical emergency.

Accreditation of International Health-Care Facilities

The quality of health care 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 health-care facilities is available at the Joint Commission International website (www.jointcommissioninternational.org).

Drugs/Pharmaceuticals Abroad

The quality of drugs and medical products abroad cannot be guaranteed, as they may not meet U.S. standards or could be counterfeit (see Perspectives: Counterfeit Drugs earlier in this chapter). 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). In many developing countries, virtually any drug can be purchased without prescription.
• Travelers who may require an injection(s) abroad should bring their own injection supplies (see the Travel Health Kits section earlier in this chapter).
• Travelers who do not have their own injection supplies yet require an injection should ask if the equipment is disposable and insist that a new needle and syringe be used.

Emergency Care Abroad

The quality and availability of proper emergency medical care abroad may be variable and, 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, which increases the risk of transfusion-related transmission of disease.
• The 2001–2002 WHO Global Database on Blood Safety report supports this view:
  • 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, including HIV.
• All travelers should consider being immunized against hepatitis B virus before their trip, especially—
  • Those who travel frequently to developing countries
  • Travelers whose itinerary indicate spending a prolonged period of time in developing countries
  • Travelers whose activities put them at higher risk for serious injury (e.g., adventure travel).
• There are no medical indications for travelers to take blood with them from their home countries.
• The limited storage period of blood and the need for special equipment negate the feasibility of independent blood banking for individual travelers or small groups. The international shipment of blood for transfusion is practical only when handled by agreement between two responsible organizations, such as national blood transfusion services. This mechanism is not useful for the emergency needs of individual travelers and should not be attempted by private travelers or organizations not operating recognized blood programs.

References

1. World Health Organization. Global database on blood safety report 2001–2002. Available from:   http://www.who.int/bloodsafety/GDBS_Report_2001-2002.pdf (PDF). Geneva: World Health Organization [cited 2008 Jun 30].
2. Kolars JC. Rules of the road: a consumer’s guide for travelers seeking health care in foreign lands. J Travel Med. 2002;9(4):198–201.
3. Joint Commission International. c2002–08 [cited 2008 Jun 30]. Available from: http://www.jointcommissioninternational.org.