Foreign Travel (cont.)
Sexually Transmitted Diseases, Automobile Accidents, and Illegal Drugs
Sex, cars, and drugs: Sexually transmitted diseases, including AIDS, are common in developing countries. The best rule is to abstain from sexual contact with native populations and fellow travelers. Travelers who violate this rule would be wise to carry a supply of condoms.
- Automobile accidents are one of the most common causes of death in travelers. Look both ways before crossing the street, use seatbelts if available, and don't get in the car if the driver is drunk.
- Possession or use of illegal drugs is a very serious offense in most countries. Long prison sentences have been meted out for small amounts of illicit substances.
Travel under special conditions: International travelers often seek adventure.
- Take special precautions when climbing mountains to limit the risk of mountain sickness. Mountain sickness (altitude sickness) can cause headache, nausea, weakness, shortness of breath, and fatigue. In its severe form, brain swelling can cause disorientation, severe headache, bizarre behavior, loss of consciousness, pulmonary edema, or even death. The most effective way to prevent symptoms is to ascend gradually (1,000 feet per day) and to avoid alcoholic beverages and narcotics. Medications are available to reduce the risk of symptoms.
- Scuba diving poses the risk of decompression sickness, such as the bends and puts a strain on the heart. If possible, travelers planning to dive should become certified prior to the trip, because courses at resorts may be shorter and provide less adequate preparation. Divers should follow all safety precautions. People who are out of condition should limit the depth and duration of their dives.
- In general, chronic medical conditions and disabilities do not limit travel if you take sensible precautions. It is best to have a letter from a doctor describing any medical conditions and listing all active medications and doses.
If you have one, a copy of your Personal Health Record should be included. Medical insurance may not pay for care abroad. Travelers should contact their insurance carrier to ascertain their degree of coverage and arrange for extended coverage, if desired. Travelers with significant medical conditions should wear medical alert identification bracelets or necklaces.
- Travelers with disabilities may find limited information on accessibility from the Centers for Disease Control and Prevention or the U.S. Architectural and Transportation Barriers Compliance Board. However, information on conditions in foreign countries is limited. In general, it is best to call ahead to ensure the availability of wheelchairs, specially adapted cars, ground-floor rooms, elevators, and other aids. Have a "plan B" in case the promised aids are not available on arrival. U.S. air carriers and cruise lines are required to make reasonable efforts to allow access by disabled persons.
- Pregnancy should not keep you at home unless you have complications from an unstable medical condition, advanced pregnancy, or impending labor.
- Some activities should be curtailed or eliminated. For example, water skiing and scuba diving pose potential threats to the fetus and should be avoided. Very strenuous activity may cause pre-term labor. Hot tubs should be avoided. Activities that require you to be far from medical care, such as high-altitude hiking, should probably be avoided.
- Air travel is not advised after the 36th week of gestation and for travelers with impending labor. During flight, it is important that pregnant travelers move around to avoid blood clots from developing and to drink adequate amounts of water or other fluids.
- Certain vaccines and medications that are normally recommended for travelers might be prohibited during pregnancy. All pregnant women who plan to travel should consult their doctors.
- In general, children should receive protection against the same diseases as adult travelers. All children should be up to date on routine vaccinations. An accelerated vaccination schedule is available for some of the preventive vaccines and may be useful for children who will spend a long period of time in a developing country. Many vaccines are not effective in very young children. Parents should consult their child's doctor for specific information.
The following items are recommended for a traveler's medical kit:
- Prescription medication: Keep it in the original bottle. Keep it in carry-on luggage. Take along more than enough to last the entire trip. It may also be helpful to carry a copy of the doctor's prescription.
- Foot care products: Bring pads to protect blistered feet from further injury. Consider packing athlete’s foot powder if hiking in tropical or damp areas.
- Cold remedies: cough drops, runny-nose remedy, and tissues.
- Diarrhea remedies: Imodium, Lomotil, or Pepto-Bismol. Talk to your doctor about your travel plans and the possibility of carrying an antibiotic. See Traveler's Diarrhea.
- Pain/fever remedies: aspirin, acetaminophen, or others.
- Motion sickness medicine: over-the-counter remedies or prescription medication such as scopolamine patches.
- Insect repellents: They should contain DEET. Also consider insecticide room sprays and mosquito nets. Permethrin may be applied to clothing and bed nets.
- Skin products: Sunscreen (SPF 15 or higher), lip balm, tropical antibiotic ointment, and topical cortisone cream for rashes and bites.
- First aid and miscellaneous supplies: Bandages, adhesive tape, gauze, tweezers, scissors, pocket knife, needle and thread, safety pins, matches, flashlight, sunglasses, thermometer, laxative, toilet paper, and premoistened towelette.
- For women: Bring sanitary napkins/tampons if traveling to developing countries; medication for vaginal yeast infection.
Numerous exotic diseases await those traveling to developing countries, but some simple precautions and vaccines can minimize the risk.
The most commonly acquired disease is traveler's diarrhea. Hepatitis A,
a more serious disease, affects very few travelers. Typhoid fever, malaria, yellow fever, and meningitis
risks vary based on geographic location visited. The latter diseases are potentially fatal, and the sensible traveler should take precautions against them. Some of these diseases are transmitted by biting insects, others by eating contaminated food or inhaling organisms.
The following list shows ways certain diseases are spread:
- Diseases spread by contaminated food and water: traveler's diarrhea, hepatitis A, typhoid fever, polio, and cholera
- Diseases spread by mosquitoes and other insects: malaria, yellow fever, and Japanese encephalitis
- Diseases spread through coughs and close respiratory contact: meningococcal meningitis, tuberculosis, and influenza
- Disease spread by animals: rabies
Medically Reviewed by a Doctor on 9/10/2014
Mary D. Nettleman, MD, MS, MCAP
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