Staying Healthy Abroad

This item appears on page 36 of the December 2019 issue.
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Jean Sargent of Bainbridge Island, Washington, asked ITN readers for their advice on staying healthy during trips, writing, “What are the best sources for travel health advice? Do you recommend using a travel health service and, if so, how do you choose a good one? What health issues have arisen on trips that you wished you’d been aware of so you could have asked advice from your doctor before leaving home?”

Here are some of the tips that our readers shared.

We have traveled around the world for many years, but Morocco is the only place where we fell ill. That was in 2008. Since then, I never travel without a prescription of Macrobid (Nitrofurantoin) to treat urinary tract infections (UTIs), specifically. My husband is never without his 800mg of Ibuprofen for his bad knee.

A prescription of Cipro (ciprofloxacin) can also treat UTIs, but we use a course of it for the dreaded travelers’ curse, diarrhea.

A prescription of Azithromycin treats bacterial infections such as strep throat, which in my case is always a precursor to a bad cold or the flu. I use a half of a prescription Xanax for sleeping on the way overseas and the other half for the trip home. These are my “don’t leave home without them” remedies.

Now that we have gotten older, we always take out travel insurance, just in case. We use Travel Guard (800/826-5248, www.travelguard.com). Thankfully, we have never had to use it.

Claudia Reed

Las Vegas, NV

The first source for travel health advice is your family physician, who has insight into your health needs, such as if your medications require refrigeration and what precautions to take on long flights.

While preplanning, consult internet sources such as the US Department of State (travel.state.gov), for safety issues for particular regions, and the Centers for Disease Control & Prevention (wwwnc.cdc.gov/travel) regarding vaccination recommendations.

If you want to visit a country with limited medical care or are visiting an area where mosquito-borne illnesses are a threat, by all means you should consult with a travel clinic. Before my husband and I traveled to Myanmar in 2013, we went to the International Traveler’s Medical Service at UConn Health, at the University of Connecticut. (If you are not near a large hospital, ask your physician or seasoned travelers for advice on finding a good travel clinic.)

The education we received at the travel health clinic was invaluable. We received not only appropriate vaccinations but advice on food, water, insect protection and general safety for travel in Myanmar. Additionally, we received a packet of antibiotics appropriate for travelers’ diarrhea.

My one major regret was declining the recommended prophylactic medication for malaria because I was concerned about the side effects. While sailing the Irrawaddy River and touring local villages, I was quite apprehensive about mosquito bites. All of our fellow travelers were taking antimalarial medications. We were most fortunate to return home healthy, but I will never take that chance again.

If you are planning travel to remote regions, I recommend that you take along a few additional weeks’ worth of any prescription medications in their original labeled bottles, in case of unforeseen delays or emergencies. Also, take any over-the-counter medications that you might need, as pharmacies may not be readily available.

I highly recommend travel insurance. Even if you are in excellent health, unforeseen problems may occur. In our travels, we have seen people experience animal bites, heart problems, broken bones, severe coral stings and other unfortunate circumstances which canceled or interrupted some very expensive trips.

The best resource for travel health advice is yourself. Make very realistic assessments of your physical and mobility capabilities before choosing a destination. For example, if you are short of breath while climbing stairs, you probably should not choose a mountainous or high-altitude venture. So be honest with yourself about your personal health issues, and make appropriate travel choices.

Carolyn A. Von Kutzleben

Naples, FL

I highly recommend finding a dedicated travel clinic in your area that can advise you on health risks and recommend immunizations and medications tailored to your itinerary.

Most doctors do not keep up on the rapidly shifting global disease picture, but these clinics do. They can tell you what health risks there are not only in a given country but in a specific area in that country.

For example, malaria may be present in a country but only in certain places. If you are going only to cities, you may not need a malaria prophylaxis.

We use the travel clinic at Baystate Medical Center in Springfield, Massachusetts. Most major regional hospitals should have one.

George C. Kingston

East Longmeadow, MA

Many years ago, when my husband and I were getting ready to travel overseas, we would go to a specialized travel health clinic for shots and prescriptions. For work-related travel, our place of employment had a medical department with a clinic where we could get advice or prescriptions.

Now I mostly use the CDC website wwwnc.cdc.gov/travel/destinations/list to research recommended medications/precautions for our destinations. Then I tell my usual doctor what I want, and he’ll write the prescription, as he knows that my husband and I have taken all these before without problems. Usually, this is for malaria medication, but in 2017, for a trip to Costa Rica, we also got a typhoid vaccine.

The last time we went to a formal travel clinic was in 2015 to get a yellow fever shot; I found the clinic listed on the CDC website. It had been over 10 years since our last shot, and we had lost one of our yellow immunization-record cards. But those shots are now good for a lifetime.

Pauline Ho

Albuquerque, NM

I highly recommend getting materials from the International Association for Medical Assistance to Travellers, or IAMAT (based in Ontario, Can., with an office in Niagara Falls, NY; 716/754-4883, www.iamat.org), a membership organization.

On request, members will be sent a small booklet with a list of English-speaking doctors in many countries, or members can find the list online at www.iamat.org/medical-directory. The doctors volunteer to be part of the IAMAT network; they do not pay a membership fee to be listed.

The booklet also contains a current list of shots and vaccinations needed for various countries. (This information is also available to nonmembers online.)

There is no set membership fee, and donations are tax-deductible. I send a small donation every year and without fail am sent the new booklet. We tear out the pages for the countries we will be visiting and take them with us.

Fortunately, we’ve only had to use it once, in Italy several years ago. My husband, Michael, was feeling sick with an unknown stomach ailment and we became concerned. I looked in the IAMAT booklet for listings in Italy and located a nearby hospital/clinic, and we took a taxi there.

The doctor was wonderful, nothing serious was found, and we paid our very cheap bill.

Marsha Caplan

Boulder, CO

Although I drink only bottled water and eat only cooked food on my trips, I often have had a day of diarrheal distress. I used to wait to see if it would go away in a day or two or take Imodium. If those two measures failed to improve the situation, I would take a course of Cipro, a prescription antibiotic.

On a trip to Tibet, my roommate recommended Pepto-Bismol*. I’m now a believer. I have found that Pepto-Bismol usually takes care of the problem in a day, and it’s easier on my body than the previously mentioned medications. Also, in chewable tablet form, it’s light to carry.

Laurie Friedman

Davis, CA

*Studies show that Pepto-Bismol is an effective preventative if taken before the symptoms of traveler’s diarrhea occur. However, doctors do not recommend Pepto-Bismol as a treatment for traveler’s diarrhea.

Naturally, there are some standard-issue steps we all automatically take to stay healthy while traveling. I will quickly mention a few.

Get the required vaccinations before leaving.

Carry handi-wipes and tissues.

Wash your hands, after using the bathroom and before each meal.

As for water, drink only bottled water.

Personally, I would not eat off street carts.

If you’re traveling to Mexico, be aware that there have been reports of tainted alcohol at some resorts there, so be careful.

Don’t forget to take any prescription medicines with you.

In case you want to call family members, your credit card company, your travel insurance company (and secondary insurance company) or your airline, etc., be sure you know how to call numbers in the US while overseas.

Now, here are some things I learned firsthand when I had a heart attack, spent four nights in the hospital and got a stent implanted in Sanur, Bali, Indonesia, in March 2019.

I was fortunate that I did not have to go looking for a doctor. The hotel I was staying in in Sanur had a doctor with an office on the premises. From now on, traveling overseas, I will ask each of my hotels if they have a doctor on the premises or at least a doctor on call.

The first question they asked at the hospital was “Who is going to pay the bill?” They wanted my insurance information.

Know that Medicare rarely covers medical expenses overseas. There are some exceptions, but, overall, do not expect any coverage by Medicare. Make sure you have secondary travel medical insurance that will cover you on your trip.

On my second day in the hospital, they wanted a certain percentage of the overall bill paid NOW. I had to use my credit card to pay $7,000. They would not accept a check or a bank/wire transfer, only cash or a charge card. So my advice is to have a credit card with a substantial credit allowance, and notify the card company in advance that you will be traveling overseas.

I had Blue Cross Blue Shield (BCBS). The hospital contacted both BCBS and my travel insurance company, and only BCBS responded. Fortunately, I didn’t have to make a claim; BCBS dealt directly with the hospital and covered the majority of my hospital bill (which was huge). The bill was paid before I checked out.

With what BCBS paid plus my $7,000, the bill was overpaid by a few thousand dollars, so the hospital reimbursed me for some of that. I filed a claim with BCBS to get the rest back, and whatever they don’t pay me, I am hoping to reclaim through my travel insurance.

In most cases, you cannot make a claim with your travel insurance until you hear back from your primary insurer. I filed my travel insurance claim in May. The travel insurance company wanted me to file a claim also with Medicare. I filed that claim, and two or three months later Medicare replied that they would provide NO coverage for my overseas claim. Now I’m waiting for the outcome.

This next item was just luck of the draw. My wife and I had been to Bali about six times, using the same driver every time, and he’d become not just a driver/guide but a friend. While I was in the hospital, he and his family made sure my wife was taken care of, picking her up at the hotel and taking her to the hospital and back.

Our friend also helped me when I needed some interpretation. This wasn’t often, as the doctor and most of the staff spoke excellent English. In fact, the hospital (Siloam Hospitals Denpasar in Kuta, Bali), its staff and my doctor all were excellent.

By the way, for everything that you pay for while you’re in the hospital, get receipts plus copies of the medical bills, with an explanation of each bill in English, and make sure each bill is dated and signed.

For my return flight to the States, my doctor did not want me to travel in economy class, so on my discharge summary he recommended business class. Fortunately, my travel insurance paid my claim for the extra cost of the business-class ticket. They probably would not have paid it if the doctor did not write that on the discharge summary.

John Rybczyk

Vero Beach, FL

Please login or subscribe to ITN to read the entire post.

Jean Sargent of Bainbridge Island, Washington, asked ITN readers for their advice on staying healthy during trips, writing, “What are the best sources for travel health advice? Do you recommend using a travel health service and, if so, how do you choose a good one? What health issues have arisen on trips that you wished you’d been aware of so you could have asked advice from your doctor before leaving home?”

Here are some of the tips that our readers shared.

We have traveled around the world for many years, but Morocco is the only place where we fell ill. That was in 2008. Since then, I never travel without a prescription of Macrobid (Nitrofurantoin) to treat urinary tract infections (UTIs), specifically. My husband is never without his 800mg of Ibuprofen for his bad knee.

A prescription of Cipro (ciprofloxacin) can also treat UTIs, but we use a course of it for the dreaded travelers’ curse, diarrhea.

A prescription of Azithromycin treats bacterial infections such as strep throat, which in my case is always a precursor to a bad cold or the flu. I use a half of a prescription Xanax for sleeping on the way overseas and the other half for the trip home. These are my “don’t leave home without them” remedies.

Now that we have gotten older, we always take out travel insurance, just in case. We use Travel Guard (800/826-5248, www.travelguard.com). Thankfully, we have never had to use it.

Claudia Reed

Las Vegas, NV

The first source for travel health advice is your family physician, who has insight into your health needs, such as if your medications require refrigeration and what precautions to take on long flights.

While preplanning, consult internet sources such as the US Department of State (travel.state.gov), for safety issues for particular regions, and the Centers for Disease Control & Prevention (wwwnc.cdc.gov/travel) regarding vaccination recommendations.

If you want to visit a country with limited medical care or are visiting an area where mosquito-borne illnesses are a threat, by all means you should consult with a travel clinic. Before my husband and I traveled to Myanmar in 2013, we went to the International Traveler’s Medical Service at UConn Health, at the University of Connecticut. (If you are not near a large hospital, ask your physician or seasoned travelers for advice on finding a good travel clinic.)

The education we received at the travel health clinic was invaluable. We received not only appropriate vaccinations but advice on food, water, insect protection and general safety for travel in Myanmar. Additionally, we received a packet of antibiotics appropriate for travelers’ diarrhea.

My one major regret was declining the recommended prophylactic medication for malaria because I was concerned about the side effects. While sailing the Irrawaddy River and touring local villages, I was quite apprehensive about mosquito bites. All of our fellow travelers were taking antimalarial medications. We were most fortunate to return home healthy, but I will never take that chance again.

If you are planning travel to remote regions, I recommend that you take along a few additional weeks’ worth of any prescription medications in their original labeled bottles, in case of unforeseen delays or emergencies. Also, take any over-the-counter medications that you might need, as pharmacies may not be readily available.

I highly recommend travel insurance. Even if you are in excellent health, unforeseen problems may occur. In our travels, we have seen people experience animal bites, heart problems, broken bones, severe coral stings and other unfortunate circumstances which canceled or interrupted some very expensive trips.

The best resource for travel health advice is yourself. Make very realistic assessments of your physical and mobility capabilities before choosing a destination. For example, if you are short of breath while climbing stairs, you probably should not choose a mountainous or high-altitude venture. So be honest with yourself about your personal health issues, and make appropriate travel choices.

Carolyn A. Von Kutzleben

Naples, FL

I highly recommend finding a dedicated travel clinic in your area that can advise you on health risks and recommend immunizations and medications tailored to your itinerary.

Most doctors do not keep up on the rapidly shifting global disease picture, but these clinics do. They can tell you what health risks there are not only in a given country but in a specific area in that country.

For example, malaria may be present in a country but only in certain places. If you are going only to cities, you may not need a malaria prophylaxis.

We use the travel clinic at Baystate Medical Center in Springfield, Massachusetts. Most major regional hospitals should have one.

George C. Kingston

East Longmeadow, MA

Many years ago, when my husband and I were getting ready to travel overseas, we would go to a specialized travel health clinic for shots and prescriptions. For work-related travel, our place of employment had a medical department with a clinic where we could get advice or prescriptions.

Now I mostly use the CDC website wwwnc.cdc.gov/travel/destinations/list to research recommended medications/precautions for our destinations. Then I tell my usual doctor what I want, and he’ll write the prescription, as he knows that my husband and I have taken all these before without problems. Usually, this is for malaria medication, but in 2017, for a trip to Costa Rica, we also got a typhoid vaccine.

The last time we went to a formal travel clinic was in 2015 to get a yellow fever shot; I found the clinic listed on the CDC website. It had been over 10 years since our last shot, and we had lost one of our yellow immunization-record cards. But those shots are now good for a lifetime.

Pauline Ho

Albuquerque, NM

I highly recommend getting materials from the International Association for Medical Assistance to Travellers, or IAMAT (based in Ontario, Can., with an office in Niagara Falls, NY; 716/754-4883, www.iamat.org), a membership organization.

On request, members will be sent a small booklet with a list of English-speaking doctors in many countries, or members can find the list online at www.iamat.org/medical-directory. The doctors volunteer to be part of the IAMAT network; they do not pay a membership fee to be listed.

The booklet also contains a current list of shots and vaccinations needed for various countries. (This information is also available to nonmembers online.)

There is no set membership fee, and donations are tax-deductible. I send a small donation every year and without fail am sent the new booklet. We tear out the pages for the countries we will be visiting and take them with us.

Fortunately, we’ve only had to use it once, in Italy several years ago. My husband, Michael, was feeling sick with an unknown stomach ailment and we became concerned. I looked in the IAMAT booklet for listings in Italy and located a nearby hospital/clinic, and we took a taxi there.

The doctor was wonderful, nothing serious was found, and we paid our very cheap bill.

Marsha Caplan

Boulder, CO

Although I drink only bottled water and eat only cooked food on my trips, I often have had a day of diarrheal distress. I used to wait to see if it would go away in a day or two or take Imodium. If those two measures failed to improve the situation, I would take a course of Cipro, a prescription antibiotic.

On a trip to Tibet, my roommate recommended Pepto-Bismol*. I’m now a believer. I have found that Pepto-Bismol usually takes care of the problem in a day, and it’s easier on my body than the previously mentioned medications. Also, in chewable tablet form, it’s light to carry.

Laurie Friedman

Davis, CA

*Studies show that Pepto-Bismol is an effective preventative if taken before the symptoms of traveler’s diarrhea occur. However, doctors do not recommend Pepto-Bismol as a treatment for traveler’s diarrhea.

Naturally, there are some standard-issue steps we all automatically take to stay healthy while traveling. I will quickly mention a few.

Get the required vaccinations before leaving.

Carry handi-wipes and tissues.

Wash your hands, after using the bathroom and before each meal.

As for water, drink only bottled water.

Personally, I would not eat off street carts.

If you’re traveling to Mexico, be aware that there have been reports of tainted alcohol at some resorts there, so be careful.

Don’t forget to take any prescription medicines with you.

In case you want to call family members, your credit card company, your travel insurance company (and secondary insurance company) or your airline, etc., be sure you know how to call numbers in the US while overseas.

Now, here are some things I learned firsthand when I had a heart attack, spent four nights in the hospital and got a stent implanted in Sanur, Bali, Indonesia, in March 2019.

I was fortunate that I did not have to go looking for a doctor. The hotel I was staying in in Sanur had a doctor with an office on the premises. From now on, traveling overseas, I will ask each of my hotels if they have a doctor on the premises or at least a doctor on call.

The first question they asked at the hospital was “Who is going to pay the bill?” They wanted my insurance information.

Know that Medicare rarely covers medical expenses overseas. There are some exceptions, but, overall, do not expect any coverage by Medicare. Make sure you have secondary travel medical insurance that will cover you on your trip.

On my second day in the hospital, they wanted a certain percentage of the overall bill paid NOW. I had to use my credit card to pay $7,000. They would not accept a check or a bank/wire transfer, only cash or a charge card. So my advice is to have a credit card with a substantial credit allowance, and notify the card company in advance that you will be traveling overseas.

I had Blue Cross Blue Shield (BCBS). The hospital contacted both BCBS and my travel insurance company, and only BCBS responded. Fortunately, I didn’t have to make a claim; BCBS dealt directly with the hospital and covered the majority of my hospital bill (which was huge). The bill was paid before I checked out.

With what BCBS paid plus my $7,000, the bill was overpaid by a few thousand dollars, so the hospital reimbursed me for some of that. I filed a claim with BCBS to get the rest back, and whatever they don’t pay me, I am hoping to reclaim through my travel insurance.

In most cases, you cannot make a claim with your travel insurance until you hear back from your primary insurer. I filed my travel insurance claim in May. The travel insurance company wanted me to file a claim also with Medicare. I filed that claim, and two or three months later Medicare replied that they would provide NO coverage for my overseas claim. Now I’m waiting for the outcome.

This next item was just luck of the draw. My wife and I had been to Bali about six times, using the same driver every time, and he’d become not just a driver/guide but a friend. While I was in the hospital, he and his family made sure my wife was taken care of, picking her up at the hotel and taking her to the hospital and back.

Our friend also helped me when I needed some interpretation. This wasn’t often, as the doctor and most of the staff spoke excellent English. In fact, the hospital (Siloam Hospitals Denpasar in Kuta, Bali), its staff and my doctor all were excellent.

By the way, for everything that you pay for while you’re in the hospital, get receipts plus copies of the medical bills, with an explanation of each bill in English, and make sure each bill is dated and signed.

For my return flight to the States, my doctor did not want me to travel in economy class, so on my discharge summary he recommended business class. Fortunately, my travel insurance paid my claim for the extra cost of the business-class ticket. They probably would not have paid it if the doctor did not write that on the discharge summary.

John Rybczyk

Vero Beach, FL