Tips for a safe trip

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VOL 106 / NO 1 / JULY 1999 / POSTGRADUATE MEDICINE

Most people look forward to the fun and excitement of travel, and it's easy to forget that travel can--and often does--trigger headaches, stomachaches, exhaustion, and other potentially serious health problems. Planning, flexibility, humor, and a positive attitude are key ingredients to healthy travel.

Avoiding the last-minute rush plays a big part in safe and healthy travel. Little things, such as obtaining your passport well ahead of time and visiting your doctor at least a month before your trip, can greatly reduce the stress that tires you out before you ever leave home. Early in your planning, think about the things that are likely to worry you while you travel. Does your health insurance cover foreign travel? If not, what are your options? Do you have an extra pair of eyeglasses or contact lenses for backup? If you have a health-related problem, ask your doctor for a letter on clinic letterhead outlining your medical history and current medications. Wear a medical identification tag or bracelet to help others help you. If you need an inhaler or use a controlled substance to treat a health problem, get a letter from your doctor explaining why this device or medication is needed.

Shots, medications, and prescriptions

Depending on your destination and length of stay, find out if your immunizations are adequate and up-to-date. Check to see if hepatitis A, hepatitis B, or other immunizations are a good idea for the area you'll be visiting. You may also need antimalarial drugs for some parts of the world. If you take medication regularly, carry at least twice the amount you expect to need. Pack a full supply in a carry-on bag and another full supply in checked luggage (or a companion's carry-on if temperature is important). Prepare your own personal first-aid kit, and check with your doctor or nurse to see if you have everything you might need. If possible, avoid medications you have not used before, so you won't risk unknown side effects.

Uncomfortable flights and jet lag

Flights that last 6 hours or more can cause swelling (edema) of the ankles and feet. To avoid this, walk around and stretch often during your flight. If you are concerned about travel-related sinus or ear problems, take an oral or nasal decongestant 30 to 40 minutes before departure time.

Jet lag is common and can lead to agitation, insomnia, poor concentration, and generalized fatigue. To help reduce the risk, avoid alcoholic and carbonated drinks before and during a flight, drink plenty of water or fruit juice every day throughout your trip, and try to plan for some relaxation time when you arrive at your destination. Switch to the new eating and sleeping times as quickly as possible.

Motion and altitude sickness

Several over-the-counter oral medications relieve motion sickness, and wrist bands or medicated skin patches work well for some people. The secret is to have them along if you need them.

Altitude sickness can ruin a ski or hiking trip. If possible, spend a day or so at an intermediate altitude to help you adjust. Again, plan ahead and ask your doctor about medicines that prevent altitude sickness.

Food and water worries

About 6 of every 10 foreign travelers have trouble with diarrhea. Food and water are the most common causes. Be especially careful about cold buffets, salads, chilled desserts, and milk and milk products that are not pasteurized. Avoid seafood, beef, pork, and sausages that are uncooked, undercooked, smoked, pickled, or salted. Before you eat at a restaurant, check out the restroom; if it's dirty, the food preparation procedures might be risky as well.

Water supplies in European and other industrialized countries are usually safe, but if you are not sure, use bottled water that is properly sealed. Personal water filters are not recommended, because they do not eliminate viruses. Hot tea, hot coffee, carbonated beverages, beer, wine, and fresh fruit juices are probably safe, but mixed drinks containing water or ice might be risky. Contrary to popular belief, alcohol in drinks does not kill germs.

Diarrhea sometimes can be prevented by taking 2 oz or two tablets of bismuth subsalicylate (Pepto-Bismol) four times a day.

Sunburn, insects, and swimming hazards

Protective clothing, sunscreens, and insect repellents are essential in many parts of the world. Always use a sunscreen with an SPF of 15 or higher, even if you think the sun is not very hot or the sky is overcast. Ask your doctor about insect repellents, particularly if you are traveling with children.

Swimming in freshwater lakes, ponds, rivers, or streams can be dangerous in some countries. Chlorinated pools and salt water are generally safe, but beware of jellyfish, Portuguese man-of-war, and other marine creatures that can cause injury.

Attitude and humor are important factors in staying well. So relax and enjoy your adventures. Even the nuisances of travel make great memories eventually.

This information is not a substitute for medical treatment.

Safety precautions for travelers

Be aware of health and safety risks wherever and whenever you travel. The following tips are especially important.

• Travel with valuables in carry-on luggage. Carry copies of your passport, itinerary, and airline tickets separately in case the originals are lost.
• Do not wear expensive jewelry.
• Carry money and credit cards in a front pocket or money belt, and wear a passport pouch tucked under clothing at all times.
• Avoid displaying large sums of money. Use traveler's checks, but keep a small amount of local currency available for emergencies.
• Dress appropriately--not to attract attention.
• Avoid high-risk behaviors, including tattooing, acupuncture, dental procedures, and sexual encounters with strangers.

The leading cause of health problems among travelers is motor vehicle accidents, and the most important precaution is using seat belts. Walking also may be hazardous, particularly if cars use the opposite side of the road.

If you need help finding medical care, your hotel concierge and English-language newspapers can be good resources. For special concerns, ask your travel agent or physician about how to find healthcare abroad. You may also want to check with the International Association for Medical Assistance to Travellers, 714 Center St, Lewiston, NY 14092, phone 716-754-4883.

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