Author: TravelHealth-UK

Plan Ahead

It is important to think through your trip. Research your destination carefully and think through the practicalities of how long you plan to be away, and what kind of activities you plan to take part in – will you be more or less active than you normally are at home? And what about food, do you easily adapt to other foods or will you have a hard time finding something you like to eat?

• Visit your GP or diabetic advisor in good time to sort out your supplies and equipment –
• A letter from your GP confirming you are a diabetic, and why you have needles in your possession, would be a good idea!
• Make sure you get a prescription for your medication, enough for the trip and a bit more.
• Purchasing a diabetic identity bracelet gives some travellers the piece of mind they need when travelling, as does having medications listed for emergency situations.
• Immunisations and anti-malaria medication are usually safe for the diabetic, and should be discussed with your doctor.
• Insurance is best sorted out as soon as possible and the wise traveller will shop around. It is important to mention your diabetes as a pre-existing condition. Ask at Diabetes UK if you need help in finding a good policy. Excellent guides can also be purchased at Diabetes UK, giving you specific country prescription regulations. As well as good insurance, you will also need an EHIC if you are travelling within Europe.

Travelling with Insulin

• When you travel by air it is not always necessary to order “diabetic meals”. Check your carbohydrate intake regularly and, if required, top-up with snacks on the journey.
• When travelling by air don’t be afraid to ask a flight attendant for more food or a slice of bread if you need it. When you are about to eat on a flight, don’t take your insulin until you see the food coming down the isle – all kinds of things can cause a hold up or delay in it getting to you!
• If you are travelling into unknown territories, take plenty of snacks, especially if you are backpacking and are unsure of your final destination details. The journey might take longer than you planned, and the McDonalds you thought would be on every corner, might not be there!
• Always keep your insulin with you at all times. Insulin should always be carried in your hand luggage, out of direct sunlight or freezing conditions – such as an aeroplane hold! If your insulin comes in U-100 check the conversion rate in countries where it comes in U-40 or U-80. It will be essential in this situation to get new syringes to avoid dosage mistakes. Travel to tropical regions of the world will require you keeping the insulin in a cold pack, or in a cool place, maybe next to a cold water bottle.
• Heat will affect the rate at which insulin is absorbed. In the heat, insulin is absorbed quicker. It is therefore important to monitor your levels in hot weather and adjust your diet as required.
• In a cold climate insulin is absorbed slower. Also if you find yourself cold and shivering it is possible to use up energy and lower your blood sugar levels. Monitor your blood sugar levels in extreme conditions and never let your insulin freeze.
• Adjust your insulin times when you reach your destination – you will have already discussed this with your diabetic adviser but just to remind you:
• When travelling WEST lengthen the gap between insulin doses or add extra food with an extra dose until adjusted. When travelling EAST shorten the gap and reduce dosages. Always check your blood sugar at regular intervals when you cross time zones, as you might need to adjust your dosages. Remember perfect control might not be possible in the first few days, but keep working at it.

Arriving at your Destination

Finally arriving at your destination is a very exciting time – make sure you have pre-booked a hotel for the first few nights if you are backpacking, so that you have time to readjust to your surroundings before setting off.

It is inevitable that on some days you might not feel yourself, either because you are adjusting to different food, or because you have caught a local stomach upset which has left you a little green! Traveller’s diarrhoea is often a case of “when” rather than “if” in most tropical destinations, and careful attention should be given to food and water. It is important to monitor your blood sugar levels carefully while you are sick. Maintain a good level of carbohydrate content in your diet and don’t delay seeing a doctor if the problem continues or if you are worried about your condition.

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

Plan Ahead

Visit your GP or specialist nurse as soon as you can to get repeat prescriptions — get enough for the trip and a bit extra. To make it easier when you go through customs, get your GP to write a letter if you need to carry equipment or needles with you.

Malaria and Vaccinations

Disabilities do not stop you taking malaria medication or having vaccinations if they are recommended for your destination, unless you have contra-indications to them. Sort these out with your Travel Health Specialist as soon as possible.

Transport Needs

Plan ahead – inform the airline or travel operators of your needs. They are used to providing special chairs, seats or meals, so do not feel you are ‘putting them out’ – it is their job to help you and make your trip as safe and comfortable as possible.

Choose your method of transport with care, and when flying, go with the most direct route so that you are not left trying to change flights at numerous locations around the world. Discuss with the airline if you will need any assistance.

Look into international organisations that can help with your particular needs. A search of the Internet can bring up all kinds of organisations — there is even an organisation dedicated to providing a dialysis network in certain countries. Choose good insurance with a company that is aware of your condition. If you are travelling with a companion, make sure they are aware of their role in helping you prior to leaving.

If you have a hearing disability, inform the flight attendant so that alternative safety instructions can be given to you.

Returning Home

When you return home, see your GP for a medical check up, especially if you have been ill while away.

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

Vaccinations

Many countries require vaccination, some of which may not be advisable to have during the first trimester of pregnancy. If it is essential that you travel to a destination where Yellow Fever vaccination is required, talk to your doctor about a certificate of exemption.

Malaria

If it is essential that you travel to a malarial area, medication may be required. Discuss with your Doctor the most suitable medication for you at this time. Folic acid supplements are sometimes recommended with certain anti-malarial tablets.

Insurance

Make sure that your insurance covers your ‘pre-existing’ condition, should any unforeseen problems arise.

The Journey

If you will be immobile while travelling, such as on a coach or in a plane, it is important to recognise the added risk of DVT. If you have more risk factors aside from pregnancy, you should see your doctor before you travel and discuss prevention.

Try to exercise at least every hour on long journeys. Exercise the calf muscles by rotating your ankles, or making use of the commercially available exercise equipment.

It is important that you do not wear clothing that will cause a restriction of circulation.

Wear loose clothing. Especially when flying – due to the change in atmospheric pressure in a plane parts of your body can expand due to increased gas!

Avoid dehydration. In the dry environment of a plane, it is a well-documented fact that too much alcohol, tea and coffee on flights can add to the problem of dehydration. It is therefore very important to remain hydrated during a long flight by drinking plenty of water and fruit juices.

At your Destination

If you are planning an extended stay abroad, remember that some airlines will not allow you to fly after 36 weeks on domestic flights, and 34-35 weeks on international routes.

Care should be taken in avoiding stomach problems by watching what you eat and drink. Advice should also be considered in relation to sun care, sexual health and preventing bites, especially in high risk malarial destinations.

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

A Medical Tourist is a person who travels abroad for specific medical treatment or alternative therapy to restore their health as well as allow them to experience local culture. Among the most popular treatments are dental and cosmetic surgeries.

Why do people go overseas for medical care?

The Medical Tourism Survey found that more than 50,000 people travelled from the UK to an overseas destination for medical treatment at a cost of £161 million in early 2007. From those going overseas from the UK, concerns about increasing rates of MRSA, long NHS waiting lists and the promise of cheap medical treatment abroad were main reasons.

What Medical Tourism is not…

Medical tourism does not include those patients who have requested permission from their existing health commission for treatment in Europe. There are currently two ways to get treated overseas under the NHS.

European Union regulations of article 49

Under these guidelines a patient can receive treatment in another European country as long as it is the same as they would have had in the UK. Treatment can be at a private hospital or a state funded hospital. Patients will need to pay for the treatment received up front when they are treated. As long as the care is approved they can seek reimbursement, but this might not be the total cost of treatment. Reimbursement is however not automatic and requires approval from a patients own healthcare trust prior to treatment. Under these circumstances a patient is not covered on a European Health Insurance Card (EHIC)

E112 Form

This route allows you to have treatment in another state funded sector hospital within Europe (EEA) and Switzerland. You will need to make payments in the same way that a local person seeking treatment would – this usually involves a percentage of the costs up front. Payment for the remainder of the treatment is made via the NHS and if there is a difference based on your up front costs you can seek reimbursement.

For each of these routes permission must be sought from your local Primary Care Trust or GP first. The Department of Health website gives a full list of conditions and guidelines.

What Travel Health advice do you need if you decide to go overseas for independent medical treatment?

All economic predictions suggest that medical tourism will increase over the next few years. It is essential if you decide this is the best option for you that you are properly prepared and receive safe care.

Insurance

Medical tourists should be aware that a regular travel insurance policy used for holidays and business trips will not cover you when going overseas for medical treatment. This also means not having cover in the event of anything going wrong with their surgery or, in most cases, even for lost luggage. This is due to a blanket clause on most policies stating that cover is no longer valid if the “primary purpose” of the trip is to receive medical treatment. If you are considering going overseas it is important to think through what you will do should something go wrong with the surgery and discuss this with your insurance provider and relatives before you travel.

Immunisation and Malaria Advice

Advice should still be given by your doctor or travel clinic nurse for the destination you are going to visit. You will also need to consider the recuperation period after treatment and your health risks. For countries where blood borne diseases such as Hepatitis B are endemic it is worth considering vaccination. It is important to remember that disease and malarial mosquitoes have no respect for hospital boundaries. Even in the holiday period after treatment you could be vulnerable to local infections and potential respiratory problems following surgery.

Blood Group

Make sure you know your blood group and for some parts of the world research and discuss with your treatment supplier how you will be able to access a safe supply of blood.

Fitness to Fly

You will need to ensure that you are fit not only to fly to your destination but back again. Certain types of surgery will require longer recuperation and you should allow plenty of recovery time prior to the return journey. Most abdominal or ear surgery requires a ten day wait prior to flying without complications, whereas keyhole surgery recommends a four to five day wait. You should also discuss with your GP the prevention of DVT and consider your risk factors.

NHS on Return?

If you are planning on going overseas as a medical tourist it is a good idea to discuss your pending treatment with your GP and consider if you will be able to receive any follow up treatment in the UK on return. Important follow up care is not included in a health tourism package. The importance of returning with detailed medical notes is essential if you are to receive continuity of care.

More Information and Resources

If you have insurance concerns prior to travel you should contact the British Insurance Brokers association on 0901 8140015 for advice.

Medical Tourism: Your Complete Guide to Low-Cost Dental, Cosmetic, Medical Care & Surgery Overseas by Paul Gahlinger (2008) is a complete reference to treatment overseas

The Complete Medical Tourist by David Hancock (2006) gives an overview of treatment overseas looking at costs, locations, procedures and sightseeing.

NOTE: We have not included any links to Health Tourism companies in the above article, but do have advertisement links on this page to raise revenue for updating the site – it is essential that you research any Health Tourism Company offering such a service.

It is important to remember that you are in a potentially vulnerable position and you should do your homework before considering such a venture. It is also essential that you visit your health care provider or GP to discuss your plans.

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

From the corporate Business Traveller to the low budget sole trader, health shows no respect for status or expense accounts. There are no stereotypical Business Travellers.

BusinessTravelHealth.com seeks to recognise your diverse needs as a Business Traveller. It offers a practical common sense approach to meeting those needs through good preparation and access to information. It identifies the different mindsets with which individuals travel and seeks to provide you with advice and motivation to protect your health wherever the wind may take you…

Health Advice for Business Travellers

This section suggests practical ways to maintain your health while you are away from home. Not all health incidents relate to disease — there is the matter of preventing accidents, issues of personal safety, dealing with travel stress, and more…

Disease Prevention

Illness affects most business travellers on one trip or another. If you travel to tropical destinations, the diseases may be less familiar than if you travel within the western world, but the risks remain.

With only 5% of all travel related health risks preventable by vaccination, it is essential to understand how the prevent getting sick. This section provides insight into the diseases at your destination, as well as how to prevent infection with practical precautions.

Resources and Tools

There are a large number of very useful tools available to the business traveller to help prepare for a trip. We have compiled a selection of books, articles and useful online tools that are well worth a click.

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

Check your Weight

The number of overweight males in the United Kingdom has continued to rise over the last 20 years, and you are at risk of health problems if you are overweight. Discuss with your Doctor what would be a suitable weight and, if required, make an effort to reduce your weight slowly.

When travelling, try to eat at regular meal times in your destination country. Avoid grabbing snacks inbetween meals. Eating a good breakfast at local time will set you up for the day and help avoid the eleven o’clock hunger pangs.

If the food is self-service, just cut down on your portions. Eating a little less food over a period of time will eventually reap rewards.

Check your Alcohol Consumption

Recognise that in many ways, alcohol is a drug and should be treated with respect. A weekly limit of alcohol should not go above 28 units, although a healthy limit should remain below 21 units per week. This amounts to about 3 glasses of wine or 2 pints of beer each day. Too much alcohol can have an adverse effect on your health — as well as causing impotence and a lower sex drive, it can cause damage to the liver, brain and heart muscle.

Alcohol can have a positive effect and has been seen to help reduce cholesterol levels when used in moderation. Red wine has been shown to have benefits when drunk with a meal.

In a study looking at alcohol related accidents abroad, it was noted that more accidents are caused by drunken pedestrians than drivers — if you must drink while you are away, make sure you have booked a reputable taxi company to pick you up and return you to your hotel afterwards.

Check how much you are smoking

If you smoke, you will be well aware of your increased risk of heart disease, lung cancer, respiratory disorders and general health. “No smoking” on most flights now gives the smoker an excellent excuse to give up.

If you do want to give up smoking, discuss this with your doctor and make sure you get full support and medication as an option. If you continue to smoke and this is making you unbearable to travel with, get advice from your Doctor. Many incidences of air rage are a direct result of people being stressed, as they are unable to smoke on long flights.

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

Safety and Security

While sexual equality has meant that women are gain to the same rights as the male in the West, sadly this is not the same in all the countries of the world. Personal research into the area you are going to is essential, especially when travelling to Eastern cultures. It is important that you observe the culture around you, observing how the other women dress and behave, especially if you are planning on staying for a longer period of time.

For the woman travelling alone, a pair of dark sunglasses in some countries will not go amiss. Avoid eye contact with strangers, especially when travelling alone on public transport. Never behave in a way that will attract unwanted members of the opposite sex and beware of the clothing customs in the country you are visiting.

When travelling alone, always leave a schedule with someone at home and check in at prearranged times. When planning what to take with you on a trip, it is advisable to leave behind any expensive jewellery or objects and clothing that will draw attention to yourself.

Personal Health Issues

Remember that travelling can disrupt a normal menstrual cycle. The stress of preparation and tiredness that comes with jet lag and other issues surrounding the trip, can mean that your periods could be late or, in some circumstances, stop altogether. If you are worried that you are late and there is a risk of pregnancy, it is best to do a test. However if there is no risk of this, it could be considered a side effect of travel.

Some women, especially when travelling to the far corners of the globe, prefer to suppress their periods for the time they are away. This is possible to do if you are on certain kinds of pill or wanting to use them for your trip. In each situation, you should discuss the issue with your Family Planning expert or TravelHealth Specialist. This would also be a good time to check that you are up to date with your smear test.

If you are planning on having a period while you are away and are travelling outside of the Western World, it would be wise to take supplies with you. If travelling to remote areas where disposal could be a problem, a supply of small disposable bags and a tub of baby wipes should get you through.

Some women suffer from bladder problems, especially after having children, and are thus tempted not to drink too much when travelling. It is important in a hot climate to drink plenty of non-alcoholic fluid to avoid dehydration.

Urine infections and thrush are common among women travelling, especially when taking certain kinds of malaria tablets. If you suffer on a regular basis at home, ask your doctor if you can take some medication with you, along with a tube of canesten or your regular thrush treatment pack

In the relaxed environment of a far off country, the issues of contraception might come up — pre-plan and think ahead. If you are likely to have casual sex, always carry kite mark condoms with you in your purse, even if you are on the pill. If you are taking the oral contraceptive pill along with Doxycycline for more than 2 weeks, discuss your contraception with your regular Family Planning Specialist. Remember that traveller’s diarrhoea can interrupt the absorption of the pill, thus leaving you with an inadequate level of protection. If this is the case, a barrier method should be used as well. Discuss this with your Travel Health Specialist or Family Planning clinic before you go.

When crossing time zones, plan ahead when to take your oral contraceptive pill, keeping in mind that a break of more than 24 hours between doses will lead to inadequate protection and the possibility of breakthrough bleeding.

In today’s society the female traveller has a whole host of opportunities before her and should not be deterred from scaling the highest peaks. With good pre-planning and careful thought it can be a rewarding experience, as well as a safe one.

 

Vaccinations

Consult your doctor or TravelHealth Advisor several weeks before you leave. It is important to discuss every aspect of your trip, such as where you are going, for how long and how you plan to travel. Vaccinations may be required to help prevent infections during your holiday. In addition to routine holiday vaccinations, you might need to have a flu vaccination, especially if you are going on a cruise. Your doctor will be able to order flu vaccine at any time of the year.

Medications

Make sure that your GP or TravelHealth Practitioner is aware of any medication you take before they prescribe vaccinations for your trip. Reactions may cause reduced effectiveness or even serious side effects. If you visit an independent Travel Clinic for malaria tablets, remember that they will not have a copy of your existing medical history, so take along with you a list of your medication.

If you regularly take medication, make sure you take enough to last you until after you return from your trip — and be prepared for any delays. Also write down all medication you take and keep this information on your person in case of emergency.

Malaria tablets may be required for some destinations. Consult your General Practitioner especially if you are already on regular medication.

Always carry your medication in your hand luggage, and ask your GP to write a letter explaining the nature of your medication. If you are travelling to Asia, check with the embassy of the country you are visiting for regulations on bringing medication into the country.

Special Arrangements

If you have a pre-existing illness or disability, you may need to make special arrangements for travel or accommodation. Contact your tour operator and hotel to discuss your requirements and make sure that they have the facilities you need to travel in comfort.

If you need to keep medications cool, ask your travel agent for a room with a fridge. Make provision to keep your medication cool during the journey. It is important that you follow the instructions you received with your medication, as temperature may affect how well the medicine works.

If your medication requires to be taken at regular intervals, it may be worth getting some specific advice. Unusual increase in regular activity can change the rate at which some medications are absorbed. It is also important to allow for delays and different time zones when calculating your schedule. Your practice nurse can assist you with this.

Insurance

Check that the insurance offered by your travel company covers your requirements — you may need to take out additional insurance if the cover is not sufficient. Be thorough when completing the forms, as failure to declare a health problem may invalidate your insurance.

If you are travelling in Europe, be sure to complete form EHIC, available from your post office. This will need to be validated by your post office before you leave.

Arriving at your Destination

Make yourself familiar with the medical facilities of your chosen destination. Make sure you know the emergency numbers for your locality and know where to get help if you get into trouble.

Safety rules for food and drink are very important — ensure that you are aware of the precautions you need to take to eat and drink safely.

Ensure that you drink adequate amounts of non-alcoholic fluid to prevent dehydration.

Insect bites and minor cuts and grazes may take longer to heal in a hot climate. Take a small first aid kit to ensure you can keep a wound clean and dry whilst away. Seek medical advice if you are concerned.

Diarrhoea is a problem for many travellers. This is of particular concern for the mature traveller, and you may need specialist advice. Discuss what action you should take in the event of the onset of diarrhoea with your Doctor or TravelHealth Advisor.

Returning Home

It may be appropriate to have a health check with your Doctor or Practice Nurse. This becomes important if you have been ill whilst on holiday — repeat or additional medications might be needed to treat illness acquired abroad.

It is also important to take it easy and rest after your trip. Travelling can be stressful and you may require time to readjust to being home.

Useful Contact Addresses

Royal Association for Disability and Rehabilitation

12 City Forum, 250 City Rd, London EC1V 8AF.

Tel: 020 7250 3222.

Provide leaflets and booklets specifically for those with a disability. They also produce travel guides for the UK and beyond. A telephone help line is also available to address individual travel questions.

Diabetes UK

110 Queen Ann St, London W1M 0BD.

Tel: 020 7323 1531.

Provide leaflets and booklets that may be of value to the diabetic traveller. A telephone help line gives individual advice to anyone with questions regarding travel and their diabetic care.

Age Concern

Freepost, Ashburton, Devon TQ13 7ZZ.

Tel: 0800 00 99 66.

Produce leaflets covering many areas of interest to travellers over 50, those more specific to travel are fact sheet 4 and fact sheet 26. The fact sheets are free and comprehensive. A telephone help line is also available.

Age Concern Travel Insurance

Telephone: 0845 601 2234

Age Concern provides travel insurance cover without any age limitations. They are also able to provide cover for travellers with pre-existing conditions

British Heart Foundation

14 Fitzharding St, London, W1H 4DH.

Tel: 020 7935 0185.

Produce a fact sheet that addresses air travel following heart attack or surgery. A telephone help line is also available.

 

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

• Think through your trip before you go to anticipate every eventuality and be prepared!
• Think ahead of your child to prevent accidents – many countries do not have the same health and safety regulations you have at home.
• Take medication with you if you are unfamiliar with local medicines – child paracetamol, rehydration fluid, travel sickness medicine etc.
• Also take a copy of your repeat prescription if your child is on any medication should you need more medication while away, play safe and get enough from you Doctor before you leave.
• When travelling across time zones try to get your child adjusted as quickly as possible to the time with plenty of fresh air and meals at local times on arrival.

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

While most parents will agree that is impossible to have a totally stress free holiday with young children – being organised can help alleviate some of the stress…

Planning Ahead

Plan all necessary travel vaccinations for the trip well in advance to avoid stress, making sure that all childhood vaccinations are up to date prior to leaving.

Try to avoid taking young children to malarious areas while they are very young as some malaria medication is unsuitable for young children. Discuss this with your doctor if your trip is unavoidable.

The Journey

Plan ahead — think through your child’s normal schedule and try to keep to it if possible while you are travelling. This means feeding at their normal time, naps and other activities. Get your child into a daily routine AFTER arriving at your chosen destination – not during the trip.

Plan for travel sickness — bags, medication from your pharmacist or Doctor and a change of clothing. Some medications for children contain sedative properties – a good idea for a very long journey.

Keep everything your child needs for the trip in your hand luggage — no special toys in the suitcase!

During the trip give children activities at sensible intervals — not all the toys at once. Spread the entertainment out so you don’t run out of ideas after the first hour! Carry plenty of food and drink for the journey – sensible light snack food is good – hungry children don’t travel well.

Arriving at your Destination

Think ahead of your child to prevent accidents – many countries do not have the same health and safety regulations you have at home.

Take medication with you if you are unfamiliar with local medicines – child paracetamol, rehydration fluid, travel sickness medicine etc.

Also take a copy of your repeat prescription if your child is on any medication, should you need more medication while away. Play safe and get enough from you Doctor before you leave.

When travelling across time zones, try to get your child adjusted as quickly as possible to the time with plenty of fresh air and meals at local times on arrival.

Lower your expectations – remember this is a holiday and you need to have fun too!

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.