And You Thought It Couldn’t Get Any Worse

The journeys that take you farthest out of your comfort zone are often the most rewarding. A first, blinding exposure to an entirely new culture can be intoxicating. Few things are more satisfying than mastering a bewildering foreign transport system. And making friends across a seemingly impenetrable language barrier is one of life’s greatest joys.

But to turn a cliché on its head: the greater the reward, the greater the risk. As any veteran traveler will tell you, if it can go wrong, you can bet your last travelers’ check that it will go wrong. So before you set out for adventure in Antigua, glory in the Galapagos, calm in Costa Rica or solace in the Sahara, here are some tips that can spare you one of the many pitfalls that await the ill-prepared pioneer.

Get the information before you go. It really does pay to buy a pocket-sized notebook and put some key information in it before you leave. Make sure you have the number and address of your country’s embassy in the country you’re visiting, as well as details for regional consulates. It’s also a no-brainer to visit the World Federation of Hemophilia’s Passport directory at www.wfh.org—the directory has an extensive, easy to search list of hemophilia treatment centers (HTCs) around the globe. You should also note down numbers for taxi services and police stations. Pick up a map at the first information center you come across when you enter the country so that you can orient yourself, and so you won’t be utterly lost if disaster strikes.

Document your trip (and this doesn’t mean keep a journal). The wise traveler will keep as many as three copies of their itinerary, plane tickets, medical information and passport to hand, and when they reach their destination will stash them in separate locations—for example, the hotel safe, a suitcase and a bag they keep with them at all times. That way, if any documents are lost or stolen, they still have a back-up and some form of identification. If you’re not that prepared and you find yourself in trouble, immediately contact your local embassy or consulate (which is where that aforementioned list comes in handy!). It’s also worth giving copies of key documents to people you trust before you go so that, as a last resort, they can e-mail or fax them to the relevant authorities.

Take Your Treatment. You can’t rely on finding a 24-hour apothecary—or an HTC—when you’re traveling the world. Stuart Rose, MD, FACEP and president of Travel Medicine, Inc., advises keeping the following with you at all times: a sufficient amount of factor (including factor concentrate, sterile water, and reconstitution/transfer device) in its original packaging; all necessary ancillaries, such as butterfly needles, syringes, alcohol wipes, gauze pads, and infusion pads, with extra amounts in case of infiltration, damage, or loss; and a sharps container.

Anne Lowish, RN at MedPro RX, Inc., advises that a kit should include two to four doses, a current order from your doctor, and the name of your hemophilia treatment center and contact person.

“If you’re going abroad, call the airlines at least a week or two in advance to see what you can take on the plane,” Lowish says. “They will allow you to carry factor on board, but the baggage will need to be a certain size and it will be stored at the front of the plane. Make sure you have two copies of your orders—one in the box and one on your person—and be prepared that the airline will open and examine the box. Be sure to pack the box carefully in case of air turbulence.” You should also research whether you need a letter to take your treatment through customs.

Learn to improvise and keep your cool. Forget or run out of infusion? Don’t raise the red flag just yet. If you are not injured, the first thing to do is call a specialty pharmacy to see if the medication can be delivered, Nurse Lowish says. “If they’re unable do so, then call the treatment center.” If you keep your orders and treatment center information with you, “someone can call the center and find out where the closest center is that carries your treatment.”

If you’re faced with a medical team not familiar with your situation, Lowish says to explain that you have a blood disorder that means you bleed longer, not faster. “Tell them that you have medicine and can provide contact information for your hemophilia treatment center for additional information, and that you can mix your own medicine or ask them if they can mix it for you and then give it to you. Every box of factor will have information inside that explains exactly how to mix it, what it should look like, how fast to give it and what to look for in a reaction.”

If all else fails, don’t be afraid to ask for help. (This means surrendering your male pride for a hot minute.) Even if English is barely spoken where you are, chances are you’ll find someone who can direct you where you need to go. And if you don’t, hand signals and gestures work wonders.