Chapter 2The Pre-Travel ConsultationCounseling & Advice for Travelers

Theresa E. Sommers

LOCATING A HEALTH CARE PROVIDER ABROAD

It is important for travelers to develop a plan before departure for where and how they will obtain medical assistance during their trip, should the need arise. Several resources provide lists of health care providers and medical facilities that will provide care to travelers. When searching these lists, travelers should consider the languages in which that provider or clinic is proficient.

• The Department of State (www.usembassy.gov) can help travelers locate medical services and notify friends, family, or employer of an emergency.
• The International Society of Travel Medicine (ISTM) (www.istm.org) maintains a directory of health care professionals with expertise in travel medicine in almost 50 countries worldwide.
• The American Society of Tropical Medicine and Hygiene (ASTMH) (www.astmh.org) lists few clinicians outside the United States, so travelers looking for physicians in their destination should also consult other sources. Travelers in need of specialized post-travel care upon return, however, will find this directory useful in finding a tropical medicine expert.
• The International Association for Medical Assistance to Travelers (IAMAT) (www.iamat.org) maintains an international network of physicians, hospitals, and clinics who have agreed to provide care to members while abroad. Membership is free, although donations are suggested.
• Travelers can search the Joint Commission International website (www.jointcommission international.org) to find accredited health care facilities at their destination.
• Travel Health Online (https://www.tripprep.com) maintains a list of travel health providers worldwide. Information is obtained from a variety of sources, so the quality of services and the expertise of the providers cannot be guaranteed.

Travelers may also get information about local health care from embassies and consulates of other countries, hotel doctors, and credit card companies. Travelers who obtain evacuation insurance before travel will have access to a 24-hour hotline that can direct them to medical care or arrange emergency transportation (see the next section in this chapter, Travel Health Insurance and Evacuation Insurance).

PREPARATION BEFORE A TRIP

The quality and availability of medical care abroad may be variable. Travelers should prepare for the possibility of a medical emergency abroad and are encouraged to:

• Evaluate their health prior to the trip to ensure that they are healthy enough to travel and carry out their proposed itinerary.
• Consider travel health or evacuation insurance for their trip.
• Register with the US embassy in their destinations. Travelers can register their trip at https://travelregistration.state.gov/ibrs/ui/.
• Carry a card that identifies, in the local language, blood type, any chronic conditions, serious allergies, and generic names of any medications.
• If appropriate, wear medical identification jewelry (such as a MedicAlert bracelet) for serious medical conditions.
• Find the names of health providers and medical facilities in each location they plan to visit and carry this list with them during travel.

DRUGS AND OTHER PHARMACEUTICALS

The quality of drugs and medical products abroad may not meet US standards or could be counterfeit (see Perspectives: Counterfeit Drugs earlier in this chapter). Travelers should bring with them all the drugs and medicines that they might need, including pain relievers, antidiarrheal medication, and, if applicable, antimalarials. Travelers who may require injections abroad should bring their own injection supplies (see the Travel Health Kits section earlier in this chapter). Travelers who need an injection but do not have their own supplies should insist that a new needle and syringe be used.

BLOOD SAFETY

The safety of blood products in many countries cannot be guaranteed. Not all countries have accurate, reliable, and systematic screening of blood donations for infectious agents, which increases the risk of transfusion-related transmission of disease. Because of the increased risk of bloodborne pathogens, travelers in developing countries should receive a blood transfusion only in life-or-death situations. When a situation requires blood transfusion, travelers should make every effort to ascertain whether the blood has been screened for transmissible diseases, including HIV. Doing so is difficult at the point of service, but travelers who locate medical services before traveling may increase their chances of obtaining higher quality care abroad.

The limited storage period of blood and the need for special equipment negate the feasibility of independent blood banking for individual travelers or small groups. Shipping blood internationally is practical only when handled by agreement between responsible organizations, such as national blood transfusion services. This mechanism is not useful for the emergency needs of individual travelers and should not be attempted by private travelers or organizations not operating recognized blood programs.

BIBLIOGRAPHY

1. Kolars JC. Rules of the road: a consumer’s guide for travelers seeking health care in foreign lands. J Travel Med. 2002 Jul–Aug;9(4):198–201.