Chapter 6 Health Care Abroad
Travel Health Kits
Regardless of their destination, international travelers should assemble and carry a travel health kit. Travelers should tailor the contents to their specific needs, the type and length of travel, and their destination(s). Kits can be assembled at home or purchased at a local store, pharmacy, or online. Travel health kits can help to ensure travelers have supplies they need to
- Manage preexisting medical conditions and treat any exacerbations of these conditions.
- Prevent illness and injury related to traveling.
- Take care of minor health problems as they occur.
By bringing medications from home, travelers can avoid having to purchase them at their destination. See Perspectives: Avoiding Poorly Regulated Medicines and Medical Products during Travel in this chapter for information about the risks associated with purchasing medications abroad. Even when the quality is reliable, the medications people are accustomed to taking at home may be sold under different names or with different ingredients and dosage units in other countries, presenting additional challenges.
TRAVELING WITH MEDICATIONS
International travelers should carry all medications in their original containers with clear labels that easily identify the contents. Patient name and dosing regimen information should be included. Although travelers may prefer packing their medications into small bags, pillboxes, or daily-dose containers, officials at ports of entry may require a formal and proper identification of all medications.
Travelers should carry copies of all prescriptions, including their generic names, preferably translated into the local language of the destination. For controlled substances and injectable medications, travelers should carry a note on letterhead stationery from the prescribing clinician or travel clinic. Translating the letter into the local language at the destination and attaching this translation to the original document may prove helpful if the document is needed during the trip. Some countries do not permit certain medications. If there is a question about these restrictions, particularly regarding controlled substances, travelers should contact the embassy or consulate of the destination country.
A travel health kit is useful only when easily accessible. It should be carried with the traveler at all times (such as in a carry-on bag), although sharp objects (like scissors and fine splinter tweezers) must remain in checked luggage. Travelers should make sure that any liquid or gel-based items packed in the carry-on bags do not exceed size limits. Exceptions are made for certain medical reasons; check the Transportation Security Administration for US outbound and inbound travel (call toll-free at 866-289-9673 Monday-Friday 8 am to 11 pm, weekends and holidays 9 am to 8 pm, or email TSA-ContactCenter@dhs.gov) and the embassy or consulate of the destination country for their restrictions.
SUPPLIES FOR PREEXISTING MEDICAL CONDITIONS
Travelers with preexisting medical conditions should carry enough medication for the duration of their trip and an extra supply, in case the trip extends for any reason. If additional supplies or medications are needed to manage exacerbations of existing medical conditions, these should be carried as well. Consult with the clinician managing the traveler’s preexisting medical conditions for the best plan of action (see Chapter 5, Travelers with Chronic Illnesses).
People with preexisting conditions, such as diabetes or allergies, should consider wearing an alert bracelet, making sure this information (in English and preferably translated into the local language of the destination) is also on a card in their wallet and with their other travel documents.
GENERAL TRAVEL HEALTH KIT SUPPLIES
The following is a list of items that travelers should consider when assembling a basic travel health kit. See Chapters 5 and 9 for additional suggestions of contents for travelers with preexisting health conditions or specific reasons for travel.
Prescription Medications and Supplies
- Medications taken on a regular basis at home
- Antibiotics for self-treatment of moderate to severe diarrhea1
- Medication to prevent malaria, if needed
- Medication to prevent or treat altitude illness, if needed
- Prescription glasses/contact lenses (consider packing an extra pair of each, in case lenses are damaged)
- Epinephrine auto-injectors (such as an EpiPen 2-Pak), especially if history of severe allergic reaction or anaphylaxis; smaller-dose packages are available for children2
- Diabetes testing supplies and insulin
- Needles or syringes, if needed for injectable medication. Needles and syringes can be difficult to purchase in some locations, so take more than what is needed for the length of the trip. These items will require a letter from the prescribing clinician on letterhead stationery.
- Medical alert bracelet or necklace
1 For factors to consider when deciding whether to use an antibiotic for self-treatment of moderate to severe travelers’ diarrhea, see Chapter 2, Perspectives: Antibiotics in Travelers’ Diarrhea—Balancing the Risks & Benefits.
2 Travelers with known, severe allergies should carry injectable epinephrine and antihistamines with them at all times, including during air, sea, and land travel. Travelers with a history of severe allergic reactions should consider bringing along a short course of oral steroid medication (prescription required from doctor) and antihistamines as additional treatment of a severe allergic reaction. For additional information, see Chapter 5, Travelers with Chronic Illnesses, Box 5-02, Highly allergic travelers.
- Medications taken on a regular basis at home
- Treatment for pain or fever (one or more of the following, or an alternative):
- Treatment for stomach upset or diarrhea:
- Antidiarrheal medication (such as loperamide [Imodium] or bismuth subsalicylate [Pepto-Bismol])
- Packets of oral rehydration salts for dehydration
- Mild laxative
- Treatment for mild upper respiratory tract conditions:
- Decongestant, alone or in combination with antihistamine
- Cough suppressant or expectorant
- Cough drops
- Anti–motion sickness medication
- Mild sedative or sleep aid
- Saline eye drops
- Saline nose drops or spray
Basic First Aid Items
- Disposable latex-free gloves (≥2 pairs)
- Adhesive bandages, multiple sizes
- Adhesive tape
- Antiseptic wound cleanser
- Cotton swabs
- Antifungal and antibacterial spray or creams
- 1% hydrocortisone cream
- Anti-itch gel or cream for insect bites and stings
- Moleskin or molefoam for blister prevention and treatment
- Digital thermometer
- Safety pins
- Elastic/compression bandage wrap for sprains and strains
- Triangular bandage to wrap injuries and to make an arm or shoulder sling
1 If traveling by air, travelers should pack these sharp items in checked baggage, since airport or airline security may confiscate them if packed in carry-on bags. Small bandage scissors with rounded tips may be available for purchase in certain stores or online.
- For travel in remote areas, consider a commercial suture kit
- First aid quick reference card
Supplies to Prevent Illness or Injury
- Antibacterial hand wipes or an alcohol-based hand sanitizer, containing ≥60% alcohol
- Insect repellents for skin and clothing (see Chapter 3, Mosquitoes, Ticks & Other Arthropods for recommended types)
- Bed net (if needed, for protection against insect bites while sleeping)
- Sunscreen (≥15 SPF with UVA and UVB protection)
- Water purification tablets (if visiting remote areas, camping, or staying in areas where access to clean water is limited)
- Latex condoms
- Ear plugs
- Personal safety equipment (such as child safety seats and bicycle helmets)
Travelers should both carry the following documents and leave copies with a family member or close contact who will remain in the United States, in case of an emergency.
- Proof of vaccination on an International Certificate of Vaccination or Prophylaxis (ICVP) card or medical waiver (if vaccinations are required)
- Copies of all prescriptions for medications, eye glasses/contacts, and other medical supplies (including generic names and preferably translated into the local language of the destination)
- Documentation of preexisting conditions, such as diabetes or allergies (in English and preferably translated into the local language of the destination)
- Health insurance, supplemental travel health insurance, medical evacuation insurance, and travel insurance information (carry contact information for all insurance providers and copies of claim forms)
- Contact card to be carried with the traveler at all times, including street addresses, phone numbers, and email addresses of the following:
- Family member or close contact remaining in the United States
- Health care provider(s) at home
- Place(s) of lodging at the destination(s)
- Hospitals or clinics (including emergency services) in your destination(s)
- US embassy or consulate in the destination country or countries
See the Obtaining Health Care Abroad section in this chapter for information about how to locate local health care and embassy or consulate contacts.
COMMERCIAL MEDICAL KITS
Commercial medical kits are available for a wide range of circumstances, from basic first aid to advanced emergency life support. A number of companies manufacture advanced medical kits for adventure travelers, customizing them based on specific travel needs. In addition, specialty kits are available for travelers managing diabetes, dealing with dental emergencies, and participating in aquatic activities. Many pharmacy, grocery, retail, and outdoor sporting goods stores, as well as online retailers, sell their own basic first aid kits. Travelers who choose to purchase a preassembled kit should review the contents of the kit carefully to ensure that it has everything needed; any necessary additional items can be added.
- Goodyer L. Travel medical kits. In: Keystone JS, Freedman DO, Kozarsky PE, Connor BA, Nothdurft HD, editors. Travel Medicine. 3rd ed. Philadelphia: Saunders Elsevier; 2013. pp. 63–6.
- Harper LA, Bettinger J, Dismukes R, Kozarsky PE. Evaluation of the Coca-Cola company travel health kit. J Travel Med. 2002 Sep–Oct;9(5):244–6.
- Rose SR, Keystone JS. Chapter 2, trip preparation. In: Rose SR, Keystone JS, editors. International Travel Health Guide. 2019 online ed. Northampton: Travel Medicine; 2019. Available from: www.travmed.com/pages/health-guide-chapter-2-trip-preparation.