Medical advice for the international traveler

Editor’s note: In this weekly column addressing medical and health care issues, doctors from Mercer University’s medical school provide useful and timely information on a variety of topics. Readers with questions for the doctors can email them at groover_ce@mercer.edu.

With winter weather around the corner, many Americans will think about traveling to a warmer climate and some health concerns should be considered.

Much travel to foreign countries involves leaving a “high tech” environment to enter a “lower tech” environment. This means that diagnostic tests, such as x-rays, and therapeutic measures, such as drugs and surgeries, in the country you are visiting may not be as accessible as in America, and it’s important to take precautions. While getting sick or injured is never welcomed, it can be particularly threatening if you are in a country where accessing emergency health care is impossible. Language barriers, distance from hospitals and availability of health care workers might be catastrophic once you have an accident or illness.

Here are a few suggestions to those who may be contemplating a trip to the Caribbean or to Central or South America, or even to more distance destinations such as Asia, or Africa.

First, update immunizations. Vaccines will help you avoid acquiring an illness that may be preventable. This is simple stuff, like taking a flu shot, and updating tetanus. Depending on how primitive your travel conditions will be, it might also involve taking other immunizations. Certainly, staying in an area where the water may not be clean or treated with chlorination may require typhoid and hepatitis A immunizations. Traveling where there may be contact with animals may warrant rabies immunization. The Centers for Disease Control and Prevention is a preferred source for learning more about diseases that are prevalent in countries you will be visiting. That agency gives expert recommendations for immunizations based on the trends of diseases in the past year.

Second, consider malaria prevention when you leave for a tropical country. Malaria is a leading cause of death around the world, and it is carried by mosquitoes that can also cause diseases like dengue and Zika. While the best prevention is to avoid mosquito bites altogether, this is often impossible when there is standing water and warm, rainy weather. Beyond wearing insect repellant and trying to sleep under bed nets, most short-term travelers take a medication to avoid acquisition of malaria from a mosquito bite. Preventive measures are not 100 percent effective, but they do significantly reduce your chances of malaria. Since the illness may lag the mosquito bite by more than a week, the medications are recommended to be continued even after a return home for about a month.

Third, be careful about everything you eat and drink in a less-developed country. Our curiosity about native or ethnic foods may exceed our gut’s ability to digest those foods. Many trips have been spoiled by the onset of vomiting and diarrhea two or three days after arriving at a beautiful destination. In general, following a few simple rules will lessen the chance of a food-borne illness by 80 percent to 90 percent. These include avoiding locally bottled water (bottles are often refilled after initial use), as well as salads, uncooked vegetables, unpasteurized milk and cheeses. In general, raw food is subject to contamination. Also avoid raw or rare meat; shellfish; raw fish/sushi; and raw or undercooked eggs. And please, wash your hands before eating. You can use gelled isopropyl alcohol since safe water is oftentimes unavailable. Hand sanitizer should be your pocket companion on all your trips.

Finally, a word about in-country travel. Often, roads are poor, and vehicles are older and not equipped with airbags or seatbelts. So choose your driver carefully, and always try to do your traveling in daylight when there is good visibility. Your transfers in-country may be the most dangerous part of the journey, since motor vehicle accidents may occur in areas where there are not emergency transports or adequate blood supplies. Some travelers buy insurance that will pay to bring them back to the U.S. if there is illness or accident, but often there is no time to airlift the victims of a trauma after a motor vehicle crash.

So travel prepared. Know your country, and the diseases that are prevalent there. Take your immunizations as suggested by the CDC, and use good judgment when moving around inside the country. Many will not have a health care system like you are accustomed to. Proper planning may be your best bet.

This story was originally published December 13, 2016 at 2:28 PM with the headline "Medical advice for the international traveler."