Chapter 2The Pre-Travel ConsultationCounseling & Advice for Travelers
Obtaining Health Care Abroad for the Ill Traveler
The quality and availability of proper medical care abroad may be variable. Before departure, travelers should consider how they would access adequate health care during their trip, should a medical problem arise. Many insurance plans provide coverage for emergency health care while abroad, but travelers should check with their carriers to confirm what coverage is offered and what requirements exist. At a minimum, travelers will need to provide copies of bills and invoices to initiate reimbursement. Travelers should also be aware that emergency health coverage does not usually cover emergency evacuation or the costs of altered itineraries. Travelers may purchase specific policies to cover these expenses (see below).
LOCATING ADEQUATE HEALTH CARE PROVIDERS AND FACILITIES ABROAD
Before going abroad, travelers should identify adequate health care providers and facilities at their destination. This is especially true for travelers with preexisting or complicated medical issues. Travelers who require regular dialysis need to arrange appointments at an adequate clinical site before arriving at their destination. Similarly, pregnant travelers should identify reliable health facilities before going abroad.
The following resources list health care providers and facilities around the world:
- The Department of State (www.usembassy.gov) can help travelers locate medical services and notify friends, family, or employer of an emergency.
- The International Society of Travel Medicine (ISTM) maintains a directory of health care professionals with expertise in travel medicine in almost 50 countries worldwide. Search these clinics at 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 provide care to members while abroad. Membership is free, although donations are suggested. Search for clinics at http://www.iamat.org/doctors_clinics.cfm.
- The Joint Commission International (JCI) aims to improve patient safety through accreditation and certification of health care facilities worldwide. Facilities that are accredited through JCI demonstrate a standard level of quality. A list of these facilities can be found at http://www.jointcommissioninternational.org/JCI-Accredited-Organizations.
- Embassies and consulates in other countries, hotel doctors, and credit card companies (especially those with special privileges) may also provide information.
- Supplemental medical insurance plans acquired prior to travel will often enable access to local providers in many countries through a 24-hour emergency hotline.
For more information on medical insurance, see the next section in this chapter, Travel Insurance, Travel Health Insurance, & Medical Evacuation Insurance.
In addition to identifying quality health care, travelers, especially those with chronic or complicated medical issues, should know all the names of their chronic conditions and allergies, their blood type, and current medications (including generic names), ideally in the local language. Travelers should also wear medical identification jewelry (such as a MedicAlert bracelet), if appropriate.
AVOID TRAVEL WHEN SICK
Travelers should evaluate their health before travel to ensure that they are healthy enough for their itinerary and should avoid travel if they become ill before or during their trip. Some airlines check for visibly sick passengers in the waiting area and during boarding. If a passenger looks visibly ill, the airline may prohibit that person from boarding. Travelers may be reluctant to postpone or cancel a trip when ill because of their financial investment in a trip, among other factors.
Encouraging travelers, especially those with chronic or complicated health conditions, to purchase trip cancellation insurance, which will protect some or all of the investment in a trip, may increase compliance with this recommendation.
DRUGS AND OTHER PHARMACEUTICALS
The quality of drugs and medical products abroad cannot be guaranteed, as they may not meet US standards or could be counterfeit (see Perspectives: Pharmaceutical Quality & Counterfeit Drugs earlier in this chapter). To minimize risks associated with substandard drugs and pharmaceuticals, travelers should:
• Bring with them all the medicines that they think they will need, including pain relievers and antidiarrheal medication.
• Use caution when buying medications abroad, especially those that do not require a prescription. In many developing countries, a variety of drugs can be purchased without a prescription.
• Insist that a new needle and syringe be used when receiving an injection. Travelers who know beforehand that they will require injections during their trip can bring their own injection supplies (see the Travel Health Kits section earlier in this chapter).
• Carry an epinephrine autoinjector, if needed, in carry-on luggage and include a letter from the prescribing physician that explains the allergy and a copy of the prescription.
A medical emergency abroad, such as a motor vehicle accident or trauma, could result in need for a blood transfusion. 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. Although it is difficult to ensure access to safe blood, there are a few measures travelers can take to increase their chances of having a safe blood transfusion in the event of a medical emergency:
- Avoid blood transfusions as much as possible, particularly in developing countries. Travelers should receive a blood transfusion only in life-or-death situations.
- If a blood transfusion is required, travelers should make every effort to ensure that the blood has been screened for transmissible diseases, including HIV. Although this is difficult to do at the point of service, travelers who plan ahead and locate medical services before traveling will increase their chances of obtaining higher-quality care abroad.
- Travelers may consider registering with agencies such as the Blood Care Foundation that attempt to rapidly deliver reliable blood products to members while abroad (http://www.bloodcare.org.uk/blood-transfusions-abroad.html).
All travelers should consider being immunized against hepatitis B virus before travel, especially those who travel frequently to developing countries, those whose itinerary indicates spending a prolonged period in developing countries, and those whose activities (such as adventure travel) put them at higher risk for serious injury.
- Kolars JC. Rules of the road: a consumer’s guide for travelers seeking health care in foreign lands. J Travel Med. 2002 Jul–Aug; 9(4):198–201.
- World Health Organization. Blood safety [fact sheet no. 279]. Geneva: World Health Organization; 2011 [cited 2012 Sep 18]. Available from: http://www.who.int/worldblooddonorday/media/who_blood_safety_factsheet_2011.pdf.
- World Health Organization. Medicines: spurious/falsely-labelled/ falsified/counterfeit (SFFC) medicines [fact sheet no. 275]. Geneva: World Health Organization; 2012 [cited 2012 Sep 18]. Available from: http://www.who.int/mediacentre/factsheets/fs275/en/.