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Your Health and Safety Abroad

Health Planning

Take Note: The most common problem to foreign travelers is "over medicating." We've provided this detailed information to stimulate thought, not provide evidence or rationale for a traveling pharmacy. In most cases, your body's normal defenses, common sense and plenty of rest will provide faster relief.

When you're setting off on your own for an extended period of time, it's important to take a few basic precautions to insure your health. Here's a pre departure checklist from Robert Kohls' book, Survival Kit for Overseas Living:

  Make an appointment to see your doctor at least three months ahead of departure for a physical and required or recommended immunizations. If you have a health condition which requires routine attention, prepare to deal with the condition overseas. Bring a doctor's statement with you describing your medical problem, prescriptions for drugs you may require, other treatment information regarding your problem, and a very clear explanation about any drugs or medical paraphernalia that you are carrying with you.  
  Find out from your public health service if gamma globulin shots, a preventative measure against hepatitis, are recommended for the country or region where you plan to travel. Request copies of medical records that would be important to the treatment of problems you might encounter overseas: X-rays, EKGs, a record of your blood type, prescriptions written in a generic form, dental records, and a letter describing any special health problems. Make a duplicate copy of this information and keep (whatever is practical) in two places, one on your person and one in your luggage.
Remember that U.S. prescription
  Remember that U.S. prescriptions cannot be honored overseas. Take additional prescribed drugs with you and be sure that you have a doctor's letter describing, in generic trade and dosage terms, what these drugs are and how they are used. Sometimes prescription drugs in the U.S. can be bought over the counter in other countries. Beware, however, of buying potent drugs over the counter. Always ask careful questions about what you're purchasing.  
  Bring eyeglass prescriptions and extra glasses or contact lenses. Consider bringing some extra cleaning solution with you, as it can be many times more expensive abroad.  
  Bring a medical kit. Standard items which may be useful include adhesive tape, cotton swabs, gauze, Band-Aids, sterile cleaners, and antibacterial ointment. Depending upon the country, it might be useful to have water purification tablets, salt tablets, skin lotion and moisturizer, insect repellent, antihistamines, painkillers, disinfectant, small scissors, tweezers, thermometer and something for insect bite reactions.  
  Learn how to find a doctor overseas. If you are with a health insurance program, a Member Services department might be able to help. The school or center you're attending (administrators, teachers) and family or hotel you're staying at will have favored physicians. Large international hotels refer English speaking doctors, or you can check with the U.S. consulate or embassy. IAMAT, the International Association for Medical Assistance to Travelers, provides a list of English speaking doctors all over the world. There is no fee, but donations to this nonprofit organization are welcomed.  
  Keep all medications in your hand luggage. Checked baggage can be subject to extreme temperature variations and may be lost.  
  Eating Safe Foods... When abroad, consider food safe to eat if it is served steaming hot and is thoroughly cooked (not cooked, cooled, and moderately reheated). Other things considered safe include that which you can peel (oranges, avocados, etc.); processed beverages which you pop open (bottled water, carbonated soda, beer, etc.); piping hot coffee and tea. Exercise your judgment on other foods: those sitting at room temperature, and/or uncovered, foods requiring refrigeration, foods sitting out in the open sun (such as items in an open air market).  

The U.S. Department of Health and Human Services Centers for Disease Control publishes Health Information for International Travelers, a yearly update on health vaccinations and other health issues. Other pamphlets are Before you Travel, Health Concerns for International Travel, and Self-Care.

International SOS - - Provider of medical, personal, and travel assistance to students / scholars studying abroad. Membership includes pre-trip medical advice and referrals as well as coordination of complex medical evacuations. For more information visit

Practical Health Care Suggestions

Edited from a compilation by Marianne Rev, M.D.

Many foreigners experience some stomach upset and diarrhea when traveling - particularly when visiting tropical, less developed, or rural areas. The reason for this is not completely understood, but it is thought to be secondary to a change in the type and quantity of the bacteria that normally inhabit our gastrointestinal system. The change in climate, types of food, stresses of traveling, as well as being in a strange environment, are probably all contributing factors.

1. How You Can Avoid Getting Significant Diarrhea

    1. Drink purified water (bottled, boiled, or treated with "Halazone") if in an area where tap water is questionable.
2. Make sure you ask for drinks without ice (may not be made from purified water).
3. Use iodine tables or "Iodo" for soaking vegetables and fruits that cannot be peeled, for at least fifteen minutes. (Liquid "Iodo" is better than tablets - no dissolving time.) Purified water does not alone kill microorganisms on fruits, vegetables, etc. (Don't drink water with high "Iodo" content!)
4. Avoid, at all cost, ready-made custards and foods made with mayonnaise (e.g. potato and chicken salads, cream cheese, etc.) as they are the most common transmitters of food poisoning (salmonella, staphylococcus). Avoid eating from stands where meats and dairy products are kept in the open in the heat of the sun for long periods of time.

2. What to do When You Have Diarrhea

Stop eating!!! Give your body a rest! You can live for a couple of months without solid food, but you can only live 24-36 hours without water (or fluids of some sort). When you have diarrhea, your body is losing lots of water and certain salts--the chief one being potassium. Try the following feeding suggestions for at least 3 days.
First day: Clear fluids alone. Examples: water, clear soup, weak lemon or plain tea, flat ginger ale, Coca Cola or Pepsi. Pop is especially good because of its salt content (sodium, chloride, and potassium). Allow the gas to escape before drinking, it's easier for the body to handle. NO MILK!
Second day: You may add dry toast, mashed potatoes (without milk or butter), baby foods (e.g. mashed bananas, etc.).
Third day: You may add boiled meats, cooked vegetables, and cooked fruit. Milk, other dairy products, fresh fruit, fresh vegetables, and fried foods should be the last foods to be added.

3. When You Should See a Qualified Doctor/Paramedic?

If you have any of the following symptoms:

1. Severe abdominal pain (especially if localized in one area).
2. Repeated vomiting, along with diarrhea.
3. Severe diarrhea that is blood stained, or passing of blood and mucus.
4. Accompaniment of fever for more than 24 hours.
5. Diarrhea that doesn't subside after 4-5 days of the above-mentioned conservative treatment.

Health Care Hints for Home & Away

• Avoid "Entero-Vioform" and "chloramphenicol." Entero-vioform is a constipating agent that has been removed from the North American market several years ago because it has been proven to have potentially dangerous neurological side effects.
• If you need injections, request that a disposable syringe be used.
• Avoid blood transfusions unless critically necessary. Plasma or glucose are less likely to be contaminated.
• Wear shoes or sandals at all times! Many protozoa, fungi, and worms enter the body through the skin. These parasitic organisms are common in most areas of the world. Don't go barefoot!

Colds and sore throats are common. When should you be concerned?

    1.When you have accompanying fever lasting more than 24 hours.
2. When you have swollen glands around your jaws, ears, and/or neck.
3. When you have severe sore throat lasting more than a few days.
4. When you have accompanying earache, loss or diminution of hearing, or discharge from ear(s).
5. When you have accompanying painful and very tender sinus(es), and/or redness over sinus(es).
6. When you have accompanying moderate to severe muscular and joint pains.
7. When you have an accompanying red rash that is worse in body creases (e.g., at the elbow or back of the knees).
8. When you have accompanying cough with increased and abnormal colored sputum.

If you have any of the above reasons for being concerned, you should see a qualified doctor or paramedic as you will require a physical examination, some lab tests (throat culture and possibly a blood test), and antibiotics. Different antibiotics are required depending on location and clinical picture of the infection as well as on any individual drug allergies.

How to Deal with the Heat

Adjust Gradually to the Sun:If you're in the mountains (or close to the equator) you may be closer to the sun than in many parts of the U .S. and Canada. Your body will feel the effects of the sun more and with in a shorter time.

What to do:

    1. Cover your head
2. Wear sunglasses if your eyes are in direct sunlight or are exposed to reflections of the sun on sand and water for a long time.
3. Get used to direct sunlight gradually. If you are keen on tanning, but have sensitive and fair skin, use a total sunscreen initially. Any agent with 5% para-aminobenzoic acid in 50% ethyl alcohol is a good sunscreen agent (e.g. "PRESUN"). Another good one is any agent with 10% sulisobenzone (e.g. "UVAL"). Lie in the sun for 10-15 minutes per day, initially, and increase by 10-15 minutes every couple of days. Too much sun is not good for your skin!! As well drying, chronic overexposure greatly increases your risk of developing skin cancer.

Some Common Heat and Sun-Related Ailments


1. Cool water and cool soaks applied to the affected areas
2. Baking soda (soda bicarbonate): 8 tsp. to a liter of water; apply paste to affected areas; may be repeated as needed.
3. "Solarcaine" lotion (0.5% benzocaine), a mild topical (skin) anesthetic. Note skin sensitivity to benzocaine may occur.

Ultraviolet burns to the cornea of the eye may be caused by overexposure to direct sunlight. About 12 hours after the injurious exposure, there are symptoms of extreme pain in the eye, especially in well-lit areas. See a doctor immediately! Until then, take some pain reliever by mouth (e.g. aspirin, Tylenol, etc.) and rest in a darkened room with eyes closed.

Heat Exhaustion or Prostration: Symptoms: weakness, dizziness, confusion, headache, with or without muscle cramps. Underlying Problem: salt depletion and dehydration. Treatment: cool environment, elevate feet, massage legs, drink 1-2 liters of water with 2 grams of salt in it. ( 1 oz. = 30 cc. = 28 gms.)

Heat Stroke (Sunstroke): Symptoms: sudden loss of consciousness, high fever, cessation of sweating, signs of shock, hot and dry skin (may be preceded by headache, dizziness, nausea, convulsions, visual disturbances). Underlying Problem: failure of heat regulating mechanisms of body. Emergency treatment-- MUST REDUCE HIGH TEMPERATURE! Place in a shady cool place, remove clothing, sprinkle with water, then fan as soon as possible, immerse in cold water or use ice packs, massage extremities (legs and arms) vigorously to maintain circulation, may require oxygen. Get a doctor immediately, or, even better, take the person to the nearest hospital emergency room! After a heat stroke, one must avoid immediate re-exposure to heat. Hypersensitivity to high temperatures may remain for a considerable time.

Heat Cramps:Symptoms: painful spasm of muscles of abdomen and extremities, with possible twitching. Underlying problem: salt depletion. Treatment: 1 gm. salt every 1/2 to 1 hour with large amounts of water by mouth usually relieves attacks promptly. Mace patient in a cool place and massage sore muscles. Rest should be continued for 1-3 days depending on the severity of the attack.

Acclimatization: You will find that in the initial weeks of your stay in places of high altitude you will tire more easily, require more sleep and become short of breath more easily. This will pass after a few weeks, once your body has made adjustments to the lower oxygen tensions.

It is strongly suggested that you check with your physician or public health service before traveling. Consider areas you may visit on side trips as well as your primary destination. Tetanus vaccinations are always recommended (even at home). Check with health authorities well in advance before you go, as you may need to take preventatives starting weeks before you set out.

Your Health is in YOUR Hands, too!!

Most people don't get sick when traveling - and many who do get sick induce it upon themselves. Exercise restraint.

1. Get plenty of rest (more than you get at home as you'll probably be more active).
2. Drink liquids. If you can take the bottle top off or peel it, you can drink or eat it most anywhere in the world. Dehydration is no fun.
3. Avoid excesses of alcohol and food, at least until your body starts to adjust to its new environment.
4. Plan ahead and build flexibility into your travel itinerary. Reducing emotional stress as well as physical stress will enable you to adjust more quickly to your new surroundings - and maximize the probabilities for a healthy, enjoyable trip.

Health Insurance Abroad

Having health insurance abroad is as important if not more important than having it here in the US. You have just as much chance of getting sick in another country as you do in the US.

Here are some tips:

  If you have insurance through a company in the US, contact that company to determine whether or not the coverage extends to foreign countries or if you can extend your current coverage while you are abroad. Take note of the deductibles and any other procedural information that would be involved with making an insurance claim from abroad.  
  More often than not, YOU will be required to pay the medical costs upfront in the country were you receive care. Your health insurance will reimburse you later. In some countries a hospital may not treat you if you cannot pay for at least a portion of the services up front. Therefore itís recommended that you bring a credit card with a high limit to cover any unexpected medical costs.  

Save receipts, and submit the receipts to your insurance company upon your return for reimbursement. Also, your policy may not include medical evacuation or repatriation. Think about this before you travel. Medical emergencies seldom happen, but when they do it's best to be prepared.