Staying Healthy While Traveling or Living Abroad

You do a great job of managing your hemophilia at home, at school, and on the job. But what happens when you travel? Whether you’re planning a short vacation or are moving overseas to study or work abroad, you need to plan ahead to make sure you stay healthy on the road.

Different countries have different healthcare systems, and what you are used to at home may not be what you find when you’re abroad. Access to that healthcare is not always as accessible as you’re used to either. If you’re planning to live abroad for any length of time, George Eves, founder of Expat Info Desk (www.expatinfodesk.com), a comprehensive online information resource for expats worldwide, offers the following tips for safeguarding your health while overseas:

• Reputation. Although it may be tempting to sign up for the cheapest healthcare coverage available, that’s not always the best approach to take. It’s prudent to do some research into the reputation of the insurer in order to identify any potential issues that may occur. “Don’t be afraid to ask other expats which insurers they use and their opinions of their coverage,” says Eves.
• Your lifestyle. Make sure you have the right plan to suit your lifestyle. If you participate in sporting activities, then you need to ensure that the policy will cover you for any accidents that may occur. Ask the insurer to provide full details of what sports are covered, and to what extent you are covered.
• Methods by which claims will be handled and paid. The majority of international healthcare insurers currently have a direct billing process in place so that hospital or medical fees will be settled directly between the hospital and the insurer, without the insured needing to pay and then claim the money back later. “If you do not have significant savings or access to large amounts of money, then you will certainly need such an insurer, as hospital bills can run into tens of thousands of dollars,” says Eves.
• Customer service. Ideally, you need a provider that offers round-the-clock support, 365 days a year, as emergencies can occur at any time. “You need to be confident that you can quickly and easily speak to someone who can advise you,” Eves says.
• The current status of your health. Many insurance providers exclude coverage for any health conditions, like hemophilia, that are already in existence. If you have ongoing health problems, then you may need additional coverage for these. “Many insurers will not provide coverage for any chronic conditions,” Eves cautions. “Be open with the insurer and disclose all information when seeking a quotation as you need to be 100 percent sure that your needs can be met and will be covered.”
• Hospital inclusion. Ideally, expatriates should use health insurance that allows them, or their doctor, the freedom to decide which hospital or clinic they will be treated in. This may be important if you encounter any conditions that require care at specialized institutions. “You want to be assured that you can access the best care for your needs,” says Eves.

You may not be planning a long-term move abroad, but even a short visit overseas requires vigilance if you’re traveling with a chronic condition, says Dr. Robert Quigley, Regional Medical Director of the Americas Region for International SOS Assistance, Inc. (www.internationalsos.com), the largest medical assistance company in the world with 25 worldwide call centers to meet the needs of travelers with medical concerns and emergencies.

A medical assistance company such as International SOS differs not only from your existing health insurance coverage but also from supplementary travel health insurance policies. A medical assistance company provides “soup to nuts” healthcare assistance, whether you have a simple question, need help finding a doctor who speaks the same language you do, require hospitalization, or need to return to your home country for treatment.

International SOS primarily serves business travelers and expats, but also offers assistance to short-stay travelers as well. If you know when and where you’ll be traveling, Quigley recommends that you call in to advise them of your travel plans and fill them in on your medical history.

If you’re a spontaneous bleeder, for example, the blood products you rely on at home may not be available—or as closely regulated—in other countries. “Depending on your medical history, we may even caution you not to go to certain places,” says Quigley.

It’s important to do your homework prior to traveling, Quigley adds. Emergency contact numbers differ from country to country; in Germany, you would dial 112, in the US, you would dial #911, while in the UK you have to dial #999. In some countries, if you don’t have cash in hand, a hospital will not treat you. And in many parts of the world, hospitals don’t meet the same standard of care required of hospitals in the developed world.

“It’s important to know as much as you can before you go,” says Quigley, “so you are not caught unaware or unprepared should an emergency arise.”

Quigley also warns about guarding against risky behavior while traveling. “Just because you’re no longer in familiar surroundings doesn’t mean the same cautions don’t apply,” he says, pointing out that substance abuse, unprotected sexual encounters, and activities that would put you at risk for a bleed at home still hold true while traveling.

In short, though, while traveling with a chronic illness may require more planning, as long as you have consulted with your physicians, are carrying adequate supplies, take appropriate safeguards to minimize your risk of injury, and have a medical back-up plan to assist you, there’s no reason you can’t safely travel throughout the world.

Carrying Medications Abroad

It’s not just those with hemophilia who need to bring along medication or medical supplies when they cross international borders. But the rules about prescription and non-prescription (or "over the counter") medications are different in each country, says Dr. Robert Quigley of International SOS Assistance. A drug that is common in your home country may be prohibited in your destination. Or your destination may require a doctor's note explaining your need for the drug.

Travelers who violate medication transport rules may face serious consequences, even if the violation was unintentional. Drugs can be confiscated, and in some cases, criminal charges may be involved. Fortunately, these problems can be prevented with a bit of preparatory work before departure, says Quigley, who offers these recommendations:

Before you travel

Make a list of all the medications you take on a regular basis. Include prescription and non-prescription drugs, such as pain relievers, antacids and vitamins.

Select which ones you will bring with you. Learn their actual scientific names, as brand names differ from country to country. For example, Dafalgan, Panadol and Tylenol are all names for the drug acetaminophen/paracetamol.

For each medicine you will carry, perform these steps:

• Gather an ample supply to last your entire trip, with a few spares if possible.
• Keep all drugs in their original packaging.
• Contact your embassy to determine whether any drugs on your list are restricted in your destination(s). For example, if you will travel to China, contact the Chinese embassy or consulate in your home country and ask about medication restrictions.
• Make a copy of the prescription, if it is a prescription drug.
• Have your healthcare provider write a note describing the medicine and why you need it. It's best to get this on letterhead paper.
• Translate the note into English and the language of your destination(s).

When deciding how strictly to follow the above protocol, consider how strongly you need the medication. It is an inconvenience if your headache medicine is confiscated during travel. It is a serious health crisis if authorities confiscate a drug you take every day to manage hemophilia, diabetes, HIV, or another chronic illness.

Also note that the protocol steps are more critical if you are carrying an injectable drug or a controlled medication, such as a narcotic.

Carrying medications

Keep all medication in its original packaging. Pack a copy of your prescription with the drug. Place in your hand (carry on) luggage so that it stays with you the entire time. If this is a problem due to liquid restrictions or syringes, consult the transit crew for advice on where to store the medicine.

Some travelers also pack extra medication in their checked luggage, in case their hand luggage is lost or stolen.

Obtaining drugs abroad

Drugs sold around the world are not always rigorously inspected, or manufactured using high-quality methods. Counterfeit drugs are a global problem. Some facilities may sell expired medicines, or products that have been ruined by improper storage. Since standards vary widely, it is best to pack enough medication to last the entire time you are away. Travelers should also pack a basic drug/first aid kit for every trip. 

What if you lose your medication? Or become ill while abroad and need a painkiller, anti-nausea pill, or some other treatment? Ideally, you should contact a travel assistance company for professional advice about reliable sources of medication. Sometimes, they can arrange to have medications from your home country delivered to you.

If it is impossible to contact your assistance company, consider consulting your home country's embassy at your destination. Staff may be able to direct you towards a reliable drug provider. Other sources of advice include the tourist information bureau, a respectable hotelier, or some other tourist-oriented businessperson.

Coming home

Some travelers forget that their home country also has medication rules and restrictions in place! If you have purchased medication abroad, check with authorities in your home country before returning. Ensure that the medicine you are carrying is permitted. If you are unsure, it may be best to discard the drug rather than attempt to bring it back with you.

Plan a healthy trip by following this checklist provided by International SOS (www.internationalsos.com).

TRAVELER'S CHECK LIST	Packed
First Aid Kit
Adhesive bandages (or gauze with tape)
Alcohol swabs
Antiseptic (e.g. povidone-iodine)
Bandage rolls (for sprains, etc.)
Scissors
Thermometer
Tweezers
Personal Items
Feminine hygiene products
Birth control/condoms
Laxative
General Items
Antiseptic hand wipes
Candle and matches
Electrical plug adaptor/voltage transformer
Flashlight and batteries
Insect repellant with DEET
Mosquito netting
Spare glasses, sunglasses, contact lenses, solutions, etc.
Sunscreen
Water purification (iodine, chlorine, filter)
Medicines
Antibiotics for travelers diarrhea (e.g. cipro or azithromycin)
Antifungal ointment or powder
Sleeping tablets (if required for jetlag)
Antidiarrheal medication (e.g. loperamide)
Moisturizing cream / soothing cream for bites
Oral rehydration solution (ORS) for diarrhea/dehydration
Pain relievers
Prescription medications (in original bottle, carry actual prescription or letter from doctor, take in hand luggage, take enough for entire trip)
Vitamins
Documents
Airline tickets
Driver’s license
Credit cards/travelers checks
Passports
Medical summary
Passport photos
Travel insurance documentation
Visas