Ask Gadling: You develop a serious illness while traveling
The very thought of acquiring a serious illness or injury while traveling strikes fear into the hearts of even the most stalwart adventurers. Speaking from personal experience, it’s terrifying to find yourself alone (or not) in dodgy accomodations, in a remote area of a developing country, with a raging fever and/or an uncontrollable case of the runs or other unsavory symptoms. Which isn’t to say the same ailments suffered in the comfort of a five-star hotel in Paris are a picnic, either. Any way you slice it, getting sick in a foreign country sucks.
And sometimes, despite taking precautions, you fall ill anyway, as I can attest. It can be a matter of circumstance (That water my guide “boiled” in a bamboo culm on a Thai Hilltribe trek? Yeah, I pretty much saw the resulting case of dysentery coming), or just bad luck. I’ve been on my own during most of my unfortunate on-the-road maladies. Between my experiences and those of fellow travelers, I’ve accumulated some wisdom over the years for dealing with sudden-onset illness in less-than-ideal circumstances.
For the purposes of this article, I’m not going to include injuries, pre-existing conditions, or focus on food poisoning, which was well-covered in a previous Ask Gadling post by Melanie. I also want to stress that we’re not medical professionals here at Gadling, myself included. For the technical stuff, I turned to Dr. John Szumowski, Clinical Fellow of University of Washington Medical Center’s Division of Allergy and Infectious Disease.
After the jump, tips on prevention, what to do when illness strikes, and how to get yourself home in the event of a full-blown medical emergency.
All travelers should get flu and tetanus shots. If you’re a frequent world traveler, get vaccinated for hepatitis A, typhoid, and polio. Depending upon where you’re traveling, you may require a Yellow Fever or Japanese Encephalitis vaccine, or malaria prophylaxis.
I used to think a rabies vaccination was overkill until I saw a fellow traveler get seriously nipped by a puppy we were playing with in a remote village near the Myanmar border. The deathly silence that followed was sufficient motivation. Adds Dr. Szumowski, “It’s still important to remember that excellent wound-care and post-bite medical evaluation are necessary, even if a person has had prior rabies pre-exposure vaccination.” The International Society of Travel Medicine has a list of global travel medicine clinics.
I also carry an EpiPen, because you never know what could trigger anaphylaxis while you’re abroad. It also bears mentioning that you can develop a life-threatening allergy to something previously benign. A chef I know went into anaphylactic shock after tasting one of his dishes containing taro root, even though he’d been cooking with it for over 20 years.
If you get sick
Stay calm, and assess your symtoms
It’s easy to get carried away and assume the worst, but odds are your sudden fever isn’t malaria.
Try to identify the source of infection or illness
Know when to seek professional medical assistance
In general, says Dr. Szumowski, some symptoms or exposures that should prompt “expeditious” medical evaluation include:
high fevers (over 101ºF, especially if sustained or accompanied by shaking or drenching sweats)
bloody diarrhea
inability to keep food or liquids down in situation of significant vomiting or diarrhea
confusion or severe headache
severe cough, especially if accompanied by shortness of breath
animal bite or other animal-related attack
Tips for self-care
If you’re vomiting or have diarrhea, stay hydrated with (purified/bottled water), and Gatorade or other electrolyte beverages. If you absolutely have to travel, take Imodium as an anti-diarrheal.
Eat bland foods
Remember the BRAT diet for gastrointestinal upset: rice, bananas, applesauce, and toast.
Control your fever
To lower a high fever, take the recommended dosages of acetaminophen (Tylenol) or ibuprofen (Advil).
Wear ID
Wear a medical alert bracelet for serious conditions, allergies, etc., Write down your condition in your destination country’s language in both your phrasebook, and place a card in your passport.
Know when to self-diagnose
Sometimes, you find yourself in a position where you have no other option. That said, this is something you want to avoid for obvious reasons. Says Dr. Szumowski, “Self-diagnosis and treatment can be appropriate for less serious conditions such as traveler’s diarrhea, but it is important not to delay evaluation by a medical professional for more serious illness [see warning signs above]. If someone chooses to self-treat, it’s important to be aware of potential for counterfeit medications locally.”
What if the only available hospital/clinic/doctor’s office is seriously sketchy?
If you’re in a situation where the medical facility is primitive/lacking in sanitation, you’ve got a tough call on your hands.
I posed this question to Dr. Szumowski. He says, “It depends on the acuity and seriousness of the condition. In general, evaluation and treatment in a facility with adequately-trained staff and more comprehensive resources is preferable whenever possible–this may mean seeking evaluation in the capital, at a private hospital, or even returning home. Aside from limited diagnostics and medications, smaller/less-resourced facilities may have inadequate sanitary practices (e.g. reuse of equipment) and screening of blood products, raising the risk of contracting pathogens such as hepatitis C or HIV. Therefore, having evacuation insurance is advisable, especially for extended travels in the developing world.”
In other words, you may be shit out of luck. But this is why you’re reading this article–so you can be prepared for all kinds of situations! Read on.
OTC antibiotics
In many countries, you can buy OTC antibiotics, and indeed, this may be your only option, but heed Dr. Szumowski’s warning, above. Caveat emptor.
If you need to be evacuated, the U.S. government offers financial assistance and/or repatriation loans. The American Citizens Service and Crisis Management (ACS) is linked to U.S. embassies and consulates all over the globe. It’s a good idea to enroll in the U.S. Department of State’s “Smart Traveler Enrollment Program (formerly known as “Traveler Registration)” if you’re traveling for a long period of time, to a high-risk region, or doing any extreme adventure activities.
Travel prepared
Get antibiotic prescriptions (and carry copies with you) from your primary care doctor or internist, or visit a travel medicine clinic, and pack them in you travel first-aid kit (You don’t have one? REI has some great options). Some people also carry sterile latex gloves and hypodermic needles with them. If you’re diabetic or have another condition that requires injections, this makes sense, provided you have a note from your medical provider. For everyone else, this is a personal choice that comes down to, “How comfortable are you with the knowledge that you’re carrying drug paraphernalia?” If you backpack, travel in places with notoriously corrupt law enforcement, or countries like, say, Malaysia, you may want to hedge your bets.
Email yourself and family or a trusted friend copies of medical insurance, itinerary, and a list of medications, and doctors.
Consider traveler’s insurance.
If the worst happens
In the highly unlikely event you do come home with a mystery disease that isn’t responding to medical treatment, get to a specialist, asap. Depending upon where you’ve been, this may be an infectious disease or tropical medicine doctor, a dermatologist or rheumatologist who specializes in tropical medicine, etc.. You may need to travel–out of state–to find the right specialist. Find someone who has first-hand experience traveling/training or practicing in developing countries, and in diagnosing diseases not found in the U.S.. It may even be best to try and seek medical treatment in the country where you became ill (even if that means a return trip).
Unfortunately, I can speak with authority this subject, because I’m in my 22nd month of diagnostics following a trip to South America. If you do find yourself harboring a travel-related (or not) disease that defies diagnosis, you must be your own advocate. No one is more invested in your health than you are, and doctors are human. They may make mistakes, despite their best intentions. Seek not just a second, but a third opinion, from at least two different medical facilities.
And finally, don’t let anything in this article scare you and put you off travel. Odds are, you’ll come home with nothing more than great memories, and the eagerness to plan your next trip. I know I can’t wait.
Merriam-Webster defines a tourist as, “one who makes a tour for pleasure or culture.” I would stretch that definition to include business travelers, assuming they have a bit of leisure time.
Here at Gadling, our goal is to encourage travel and exploration, even if it’s in your hometown. For the purposes of this article, however, I’m referring to non-domestic travel. And no matter how hard you try, even if you live in a foreign country and speak the language fluently, natives always know you’re a tourist or not one of them.
I believe that being a tourist generally entails asking a lot of questions out of curiousity or general inquiry, and making the occasional cultural gaffe. But there are many compelling reasons why you should squelch the urge to behave like the stereotypical tourist: the Ugly American, say, or a culturally clueless wanderer. Without getting into semantics or the murky, pretentious waters of “traveler” versus “tourist.” I’ll be the first to admit that I’m not always the ideal traveler. There are times when I’m frustrated, pissed off, or discombobulated. But one of the reasons I travel is that I like to challenge myself, and get out of my comfort zone. Once I remind myself of that, I’m able to relax, and usually, find the humor in a situation.
Advantages to not acting like a tourist
Safety. Just like at home, if you look like you know where you’re going–even if you don’t–you’re less likely to become a target for crime or harassment. We’ve all had to whip out a map or guidebook, no matter how surreptitiously. There’s nothing wrong with that: just don’t flaunt it. Most people are genuinely helpful, but if I need assistance, I prefer to choose my source if the circumstances are remotely sketchy.
A more rewarding cultural experience. This isn’t to say an incredible trip is impossible for aloha-wear-clad package tourists who never leave the confines of their hotel property, or independent travelers who consult Generic Guidebook at every step. But straying from the beaten path, being culturally aware, and allowing things to happen serendipitously are a lot easier when you have low-key dress and demeanor, and an open mind.
You’ll enjoy yourself more. Intense cultural experiences aren’t always pleasant (the time I was the only butt-naked Westerner in a very local’s-only Moroccan hammam was, shall we say, awkward). But as a rule, being open to such experiences allows you to feel less like an outsider, and provides a window into how other people live, eat, socialize, fall in love, celebrate, and mourn. There’s a fine line between being a participant and a cultural voyeur, however, and doing a bit of pre-trip research will go far in helping you avoid crossing it.
Dress appropriately. This generally applies more to women than men, but in general, why would you want to draw unwanted attention to yourself? Leave the frat shirts, booty shorts, and low-cut tank tops at home. While this is a basic personal safety issue, it’s also about cultural respect. It’s tacky and offensive for a Western woman to sunbathe topless in Southern Thailand (which has a sizeable Muslim population), but it can be seriously problematic for her to show too much skin or not wear a headscarf in certain rural areas of the Middle East.
Lend a hand. While some might see this as uber-touristy (if not outright patronizing), I often bring useful items with me to certain countries. Whether it’s colored pencils or clothing for kids, basic medical necessities, or fresh produce, the fact is, isolated and impoverished people are often grateful for assistance. I won’t bring or distribute items without doing a bit of research to see if it’s acceptable/what communities are in need of.
Eat as the locals do, or at least pretend. For me, street food and dining in a private home are the greatest joys of travel. But not everyone feels that way, and sometimes, even I find myself confronted by a glass or plate of something so repulsive/high-risk, I can’t bring myself to partake. To refuse an offering can often cause disgrace or mortal offense to your host, so if at all possible, fake it. That banana chicha, fermented by a heaping dose of my (likely tubercular) host’s saliva? Yeah, I didn’t really drink that.
Wear your poker face. I’ve often been told I have an expressive face (usually not as a compliment). When I’m traveling abroad, I have to work overtime to not show emotions when confronted with a cultural foible or other situation that amuses or offends my American sensibilities. And while losing your temper can occasionally work in your favor, remember that in many parts of the world–most notably, Asia–it’s seen as a major character flaw. Take a deep breath, simmer down, and please don’t unleash the “But I’m an American!” card.
Rules to follow as a tourist
Be humble and gracious. You may find the local diet, standard of living, and treatment of women appalling, but you needn’t need show it.
Be respectful. You’re the foreigner speaking a crazy language.
Don’t be a victim. Use common sense, and don’t go looking for trouble. If it finds you anyway, try resolve the situation in a non-confrontational way, or do what you need to do to protect yourself. In a worst case scenario, call your nearest embassy or consulate.
Be prepared. Always have a Plan B, whether it’s money, copies of your passport and medical insurance, or taking out travel insurance. Email yourself and family or a friend copies of all important documents, including lists of emergency contacts, doctors, and collect numbers for banks and credit card companies.
Be grateful. No matter what kind of amazing adventures I have, and no matter how much my nationality/government/deeply ingrained personal and cultural shortcomings may embarrass me, I’m profoundly appreciative that being an American grants me the quality of life and civil liberties I possess.
Ask Gadling: You’re out of money in a foreign country
by Laurel Miller on Sep 14, 2010
Even the most intrepid adventure traveler dreads the thought of running out of money while in a foreign country. The fact that this situation usually occurs under dire circumstances only compounds the anxiety and frustration that result from a depleted bank account.
The only time I’ve ever run completely out of funds was on 9/11. I’d been working at a friend’s London restaurant for a month, and sleeping in her spare room. I took two weeks off to visit Spain and Portugal, before flying back into Heathrow to catch my flight home. I arrived in Lisbon my last day, on the fumes of my savings, relieved to be headed home the following morning. I had just enough money left for a dorm bed in a hostel, a couple of bread rolls, and (possibly) cab fare to the airport.
I was in a cheese shop, having a fractured bilingual conversation with the shopkeeper, when I noticed his employees in a huddle, shooting glances my way. As I departed, I felt the shopkeeper’s hand on my arm, and that’s how I found out the World Trade Center–and life as Americans knew it–was no more. I headed back to the hostel in a daze, and spent the next two hours slumped in front of the television, in shock. It quickly became clear I wasn’t going anywhere, and my lack of funds was going to be a bigger problem than I’d anticipated.
On that darkest of days, I was lucky. A savior in the form of a Dutch backpacker loaned me fifty dollars. Actually, he forced it upon me, because he saw me watching the news and quickly assessed my situation. When I was able to get back to London a couple of days later, I picked up the money my parents had wired to a bank, and spent the next week working at the restaurant and crashing on the futon.
Get a cash advance on your debit card. I called my bank, Wells Fargo, and asked them if I could do this in an emergency. I was told that I should go into the nearest bank and request a cash advance, but that it’s entirely up to that institution, as well as your personal bank, as to whether receiving funds is possible. Still, this is the easiest, most obvious first step, assuming your card hasn’t been stolen. On a separate, but related, note, always inform your bank and credit card lenders that you will be traveling overseas, to prevent a security hold.
Most banks/credit card lenders have an “outside the U.S./collect call” number on their website or on the back of your card. Email them to yourself, and write them down on a slip of paper you carry someplace other than your wallet (in case you’re mugged, which is the most common reason travelers find themselves sans money). Actually, it’s best to make two copies of emergency numbers, so you can carry one on your person.
The below numbers are general non-U.S. collect call; many financial institutions also have toll-free numbers by country code listed on their sites.
Visa:1-443-641-2004.
Mastercard: 1-636-722-7111.
Capital One: 001-804-934-2001.
Bank of America: 1-302-738-5719.
Wells Fargo: Access codes vary by country; click here for listing.
Get a cash advance on your credit card, if you have one (it’s best to carry one for major emergencies anyway, even if it’s nearly maxed out). Also, be sure to check your credit card lender’s policies on emergency travel assistance, lost/stolen luggage reimbursement, etc. It may save you money or negate your having to purchase travel insurance, which is always a good idea for long-term or adventure travelers.
Having someone wire money bank-to-bank is the most secure method of receiving emergency funds. Barring that, international wire transfer services are available through Western Union (1-800-325-6000), and Western Union’s Custom House. Depending upon the provider, funds can be received between one hour to three days after wiring, and service charges will vary.
If you’ve got a family member or friend you can trust with your checking or savings account number, have them keep it on file so they can make an emergency deposit, if necessary.
Some companies, like Visa, offer prepaid TravelMoney cards. These can be used in an ATM like a debit card, but function like traveler’s checks. They may also be reloadable (i.e. reuseable), and feature lost/stolen luggage reimbursement, and travel and emergency assistance services (Visa offers “24-hour translation assistance, medical and legal referrals, emergency trip arrangements, and emergency messages to relatives.”). Be aware that this pertains to assistance and referral only; it’s your dime for any fees incurred from actual services rendered. Remember, too, that while ATM’s are fairly ubiquitous throughout the world, you can’t always rely upon finding one.
The drawbacks with prepaid cards is that they’re easily lost, stolen, or chewed up by an ATM (one reason I carry three–really–ATM cards when I travel. Portugal also taught me that lesson. Admittedly, it’s more cards to potentially have stolen, but I hedge my bets). They’re also expensive to activate and load, and there can be high foreign currency exchange rate fees.
You can stash traveler’s checks in your luggage, but it’s risky if your bags are lost, stolen, or rifled through in your accommodation (always lock zippers and remove valuables when you leave the room). I don’t even leave my daypack, which contains my passport, ATM and credit cards, camera, etc., in the room when I shower at a hostel. Call me paranoid, but I’d rather bathe with my bag than return to find my bunkmate has cleaned me out.
If you’ve exhausted all other options, are seriously ill or injured, or in a natural disaster, it’s time to bust out the big guns. The U.S. government offers financial assistance and/or repatriation loans. The American Citizen’s Services & Crisis Management (ACS) is linked to U.S. embassies and consulates all over the world. Find the office nearest you, and ask for help. According to the U.S. Department of State, ACS will contact your family, friends, or business associates to raise private funds.
The U.S. repatriation program is federally-funded, and helps destitute or ill Americans return to the States. Again, this is for serious emergencies, if no other option is available. There are strict requirements for eligibility, and you must apply from the American Consulate or Embassy nearest you at the time.
Don’t forget to register yourself with the U.S. Department of State if you’re traveling anywhere sketchy, or engaging in high-risk activities (no, unprotected sex doesn’t count).
ACS’s domestic number (of use if you’re the one who needs to help out a fellow traveler) is 1-888-407-4747. Outside of the U.S., dial the country code, +202-501-4444.
There is, as they say, a time and place for everything. And sometimes, ladies, that occurs when you’re traveling. I encourage anyone who travels to a foreign country to learn a few key phrases and learn a bit about the place, in order to avoid cultural faux pas. Even something as innocuous as patting a child on the head in Thailand is considered a grievous offense, because the head is considered the the highest (and thus most sacred) part of the body.
It’s also bad form to lose your temper in Asia and other parts of the world, because it goes against cultural mores. But what to do when your safety is threatened, or if you’re being relentlessly hit upon?
It’s for this reason that I’ve developed what I like to call “safety vernacular” in a variety of languages. While I speak Spanish, I only know the aforementioned key phrases in other tongues: “please,” “thank you,” “what’s your name,” “where’s the bathroom?” But I also know how to swear like a banshee, and employ the varying degrees of “Get lost” that range from polite to, “If you don’t get out of my face now, you’re going to lose your testicles.”Now, you’re probably asking, “Is that really necessary?” Yes, it is. And it just may save your life.
What you say, and how you say it — as well as how you physically react — depends upon where you’re traveling. Sometimes it’s best to just ignore your harasser and move on. You don’t want to make a bad situation worse by responding aggressively in a country where women simply don’t act that way/where it could further encourage or antagonize your would-be attacker or paramour. And please, follow your guidebook’s advice on appropriate dress — not only will it help you blend in (inasmuch as that’s possible); it’s also a matter of cultural respect. Leave the Daisy Dukes at home, and pack a bra. While it doesn’t help in the vernacular department, a great book for cultural advice is Behave Yourself! The essential guide to international etiquette, by Michael Powell.
Let’s take Tokyo’s Metro. It’s infamous for acts of chikan, or frotteurism, and foreigners aren’t exempt. Please note this doesn’t mean all Japanese men are evil perverts, or that riding the subway in Japan means you’re going to get felt up. But put it this way: it’s become such an issue that some railway companies in Japan designate women-only cars during peak hours.
Anyway. Japan is a country where it’s imperative not to “lose face.” Screaming at a frotteur and smacking him across the face, while perhaps the appropriate response, isn’t going to fly. Instead, find a guidebook that will tell you how best to deal with the situation, as well as provide you with a handy phrase to thwart it. “Eve-teasing” is a similar form of public harassment prevalent in India, as are open, leering stares. The best way to handle it is to ignore the stares, seek the company of other (local) women on public transit, or to call out your harasser in a crowd — public humiliation is very effective in India.
On how phrasebooks can help
It is for these situations that I swear by Lonely Planet Phrasebooks. They’re published in just about every language a traveler would require: Swahili to Southeast Asian hill tribe dialects; Basque to Mongolian. Not only do these little books offer cultural tidbits, but they’re packed with appropriate emergency phrases ranging from “Help!” “I’ve been raped,” and “How do I find the ____ embassy?” to sections on “Dating and Romance,” “Cultural Differences,” and “Specific Needs” travel. The various authors also have a great sense of (albeit dark) humor.
For example: the Spanish Phrasebook (Spain/Basque) offers these two gems: Por favor, deje de molestarme (Please stop hassling me), and Estoy aqui con mi esposo (I’m here with my husband). There are also phrases for “Do you have a condom?” and, “I might be in a wheelchair, but I’m not stupid!” See, very handy. The Portuguese Phrasebook also contains, in the “Making Love/Afterwards” section, “Would you like a cigarette?” and, “I think you should leave now.”
And some real-world examples…
But we’re talking safety here, and not the kind a condom can protect you from (although do take some with you; you really don’t want to be purchasing them in developing nations with less-regulated testing standards). In Italy and Latin America, the local women have no problem telling annoying men where to get off, and you should follow suit. I always make a point of saying I have a husband (it’s somewhat more effective than “boyfriend,” and I learned my lesson the one time I said I was a lesbian to a pesky Italian in a bar. “Aah!” he cried with delight, “Leccamento il fico! (“licking the fig”).”)
So there you have it. Don’t go looking for trouble, but don’t invite trouble by looking (and acting) like a victim. A little pre-trip research, and keeping your wits about you on the road will go a long way toward ensuring you come home with nothing more than great memories and all of your valuables.
by Jamie Rhein on Dec 30, 2007
Here are two travel resolutions that have to do with letting people in on your plans, at least the basic idea of what you are up to. They may seem like they’ll cramp your free spirit, hit-the-road on a whim style if you’re that kind of person, but these are the details that could save people at home some headache and give you a heads up if there has been a problem while you are away.
When I watched Chris McCandless burn all of his identificiation and not let people know where he was heading when he went off on his going it alone adventure as depicted in the movie Into the Wild, I thought, “Ya know, not the best plan.” I understood the sentiment, but still, not the best plan. Therefore, here are my two don’t be like Chris McCandless resolutions.
Resolution 1: When you are traveling, let people know you are going and for about how long.
A few years back I found out from a relative that my dad was trotting off to Europe or some such place and he had yet to mention it to me. He’s a big boy and can travel wherever and whenever he wants for sure, but I called him up to find out how I might be able to reach him in case there was an emergency. Ever since that day when I reminded him that we need to know when he’s traveling, he’s been good about filling me in. At least I know when he’s leaving and coming back and, if he has it, one contact number.
Also, if I had called him while he was away and he never answered, I’d get worried. We don’t live near each other. I’d rather know he’s out of town then wrack my brain figuring out how to get in touch with him or if something bad has happened when actually he’s drinking a glass of red wine in the south of France.
Likewise, most of the time when we travel, we let our families know where we’re going and when we will be back and our contact information in case they have to contact us.
Although I’ve never had to contact anyone because of an emergency, years ago a friend of mine had to contact me because my apartment was broken into. This caused me to cut my trip short by a couple of days since I wasn’t particularly comfortable letting him handle a broken window and my missing belongings from a couple thousand miles away.
Resolution #2. Leave important documents with someone and instructions just in case there is a medical emergency
My mom is big on telling me just where her documents are whenever she goes anywhere. Everything is written down in an elaborate list even. She’s done this for years despite my eye rolling. However, it’s not a bad idea. She’s also one to carry around a list of the medications she takes in case she has to go to the hospital, which could be resolution #3. She did have an emergency this past February and the list saved the ER folks time and energy.