Basic Pre-Travel Preparation

Our first advice to international travelers is that they have a complete physical and dental exam before they travel. If possible, have this done by a travel medicine specialist. We outline the reasons for this in a separate article and can refer you to such a specialist in your area.

Next, check your health insurance. Many insurance companies will not cover you abroad so you may need to buy special insurance. This is often available through your travel agent or Travel Medicine Clinic. Even with insurance, if you should need care overseas the providers will not be prepared to process your insurance claim. They will expect cash at the time of service.

If you expect to need a doctor overseas we can often provide you with a referral to an appropriate specialist. There is also an organization which you can join which can find you an English-speaking doctor abroad. They are The International Association for Medical Assistance to Travellers (IAMAT). 716-754-4883 in the U.S. or 416-652-0137 in Canada. In an emergency your best bet might be to ask advice from the American Embassy. Remember that we are available 24 hours a day by telephone, fax or e-mail to assist you in finding a physician or arranging medical evacuation when necessary.

If you take prescription medications, take along enough for the whole trip. Also take a note from your doctor (on his/her letterhead) explaining your need for them, and extra prescriptions written in generic terms. Likewise, take an extra pair of glasses or contact lenses and the prescription for them. Such notes and prescriptions are also available through our office.

Always keep up to date on routine immunizations. These include tetanus, diphtheria, mumps, measles, rubella and polio. Many people add pneumonia and flu vaccine to the list There's a new hepatitis A vaccine most think is a good idea for everyone to have as well.

As for special immunizations and medications you will need for your trip, current recommendations are as follows.....Cholera shots are of such limited benefit that they are recommended only for people with major stomach problems (e.g have had stomach surgery or are on large doses of anti-acid medication) or who will be far from medical care for months at a time. Recommendations change frequently, however, so again we advise direct consultation with a travel medicine specialist.

There are a few medicines we might suggest you take along. When we lead tours we find that the ones commonly needed are for the every-day ailments--stomach upset, headache, sprains, cold, sore throat, cough (the latter especially after long plane flights with dry air). So we pack antacids, cold and cough remedies, throat discs, and pain remedies like ibuprofen. With the changes in environment and toilet habits women also frequently get urinary infections and vaginal yeast infections. There are some inexpensive prescriptions and good over-the-counter preparations for those. A note about birth control pills. Travel often causes some unpredictable spotting, which is harmless. But skipping pills or combining them with antibiotics and some other medications can reduce their effectiveness, so you may want to consider using a backup method of contraception.

You may get a lot of advice regarding jet lag. The simple measures the best. The symptoms we call "jet lag" are really due to more than just changing time zones. The stress of a long trip, too little sleep along the way, dehydration from the dry air in the plane and a host of other factors all play their part. Try to drink so much fluids that you have to make frequent bathroom trips. Also avoid alcohol, caffeine and most of the food, choosing rather to sleep as much as possible on the long leg of the trip. If possible, choose a flight that arrives at night so you can go straight to bed and then get up on local time. If you have to arrive in the daytime, immediately start living by the new schedule. A one-time dose of a sleeping pill your first night there may also help.

There is a jet-lag diet that is recommended but it is too time-consuming and complicated for most people to remember. Ditto with scheduled exposure to daylight or other bright lights. Simply being outdoors as much as possible during my first couple of days helps as much as anything.

Melatonin is getting a lot of attention. Scientifically, it makes sense. The placebo-controlled studies show that it is better than sugar pills if taken according to a strict multi-dose regimen. But just popping a few melatonin capsules is statistically no better than sugar pills regardless of the dose. Considering what we DON'T know about melatonin, many physicians are still avoiding it.

One health measure most commonly forgotten by travelers is traffic safety and crime prevention. The State Department has some good brochures on this which you may wish to read, such as "A Safe Trip Abroad" (U.S. Government Printing Office, Washington, D.C. 20402.) They are also often available through our office. We also subscribe to computer lists which instantly alert us to particular areas of risk. Research and advice regarding current safety issues is part of our standard consultation.

Unfortunately, one of the more frequent causes of illness in travelers is sexually transmitted disease. Studies show that about one in four international travelers will have a new sexual partner during the trip. In today's medical climate, I cannot advise strongly enough against this, but since many people ignore the advice I try to at least remind everyone to use reliable contraception and condoms.

Be careful what you eat and drink. All drinks, including water, should be bottled or boiled. And all food thoroughly cooked and served hot. Don't add ice cubes unless you know they were made with boiled water. And remember to use boiled water to brush your teeth. It is best not to eat food from street vendors regardless how enticing it looks and smells.

Remember to dress so as to protect yourself from insects--especially in the evening and early morning, in tall grass, marshes or forest. Malaria, Lyme disease, dengue fever and several other diseases are spread by insects. But they are easily preventable with basic measures. A good insect repellent containing DEET or picardin should be used on exposed areas. And make sure your bedroom is screened or you have a mosquito net. (see our catalog for supplies)

The sun's rays are a lot more direct in the tropics than in temperate climates so sunburn is a common ailment. Sunscreens are your best protection but ecologists worry that large amounts may damage coral and other aquatic life, so consider other measures. For instance, stay out of the sun between 10 a.m. and 2 p.m. Also, wear a wide-brimmed hat and use lip balm. At the beach or while snorkelling, wear a T-shirt, hat and sunglasses (and footwear to protect against coral and other sharp objects.) There are various parasitic diseases than are spread through river water so confine your swimming to the ocean or chlorinated pools.

A few more comments.

Remember to pack your sense of humor. Delays and mishaps are part of travel. If you expect them as simply part of the adventure, you will enjoy your trip more and your hosts will enjoy you.

Meanwhile, don't overpack your schedule. Casual days of intimately enjoying a few sites are much more memorable than a hurried blur of tourist rush.

And finally, don't worry too much about health or anything else. Relax and enjoy the trip!