Ask Gadling: You develop a serious illness while traveling

by Laurel Miller on

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.

[Photo credit: Flickr user MoHotta18]

Before you leave home

Hit the internet
Do a bit of research on emergency medical options for a worst-case scenario. The U.S. Department of State produces a list of American doctors and hospitals in foreign countries.

If you have specific questions (about, say, where to find the best dentists in Europe), Lonely Planet’s Thorn Tree travel forum can be a useful place to get ideas (please do additional research before following any advice). Take the diagnostic-related questions directed to forum members with a heaping grain of salt, and save them for your doctor.

Get vaccinated
Check the CDC’s (Centers for Disease Control and Prevention) website to see what, if any, vaccinations you need before your trip. You can also get updates on things like outbreaks of cholera or bird flu. Be sure you allow ample time before your trip for the protective effects of vaccines to establish themselves. Dr. Szumowski also recommends the CDC’s “Survival Guide to Safe and Healthy Travel” webpage.

View more Ask Gadling: Travel Advice from an Expert or send your question to ask [at] gadling [dot] com.

Keep an immunization card on you (some countries require proof of certain vaccinations) as well as an online record, like Google Health.

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

Stay hydrated
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.

Emergency Measures

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.

[Photo credits: vaccination, Flickr user alvi2047; mosquito, Flickr user tonrulkens; toast, Flickr user snowriderguy; farmacia, Flickr user ibirque; drugs, Flickr user cavale]

Ask Gadling: You missed your flight

by Meg Nesterov on


Even in this day and age of flight delays and cancellations, it’s always not the airline’s fault that you miss your flight. It happens: you oversleep, get stuck in traffic, or just run late on the way to the airport and miss your flight. A few months ago, my husband and I were heading out of Istanbul for the weekend and because of unusually long security lines and non-functional check-in kiosks, our flight closed just before we got to the check-in counter and we missed the flight. Turkish Airlines rebooked and ticketed us on another flight with a small change fee. Recently, some visiting friends missed their flight home though they were *at the gate* due to a last-minute gate change and zero announcements. Despite the fact that other passengers made the same mistake, they paid a change fee plus the fare difference, and they were also flying Turkish Airlines.

So what can you do if you miss your flight?

View more Ask Gadling: Travel Advice from an Expert or send your question to ask [at] gadling [dot] com.
  1. Proceed to the airport check in counter – There used to be an unwritten “flat tire” rule that meant if you got a flat tire en route, you could show up and be put on the next flight with no charge. That rule seems to have gone the way of the free meal in coach, but many airlines may still try to help depending on demand and schedules. If you are on your way but think you will miss the check in cut off time but not the departure time, try calling the airline in case they are able to check you in and then rush you to the gate. Even if you know you will miss your flight, your odds of being rebooked are better if you are physically at the airport than if you go back home or to your hotel. You may even still make the fight if you can (politely, please!) push through security if you tell other passengers you are about to miss your flight.
  2. Use your status if you have it – If you are flying an airline you hold status with, now is the time to call the Gold desk. Flying a full-fare or upper class ticket can also help. This is not to say you should threaten anyone or act self-important, you want to show you are a valuable customer who would greatly appreciate being accommodated. Missed flights are another good case for travel insurance, if you’ve ensured your trip, you may be able to be rebooked for free.
  3. Be calm and flexible – It may not be your fault that your taxi driver took the long way to the airport, but you’re still in the weaker position and at the mercy of the ticketing agent. It won’t help to be difficult or angry. Additionally, being flexible about your routing can help, especially if you’ve missed the last direct flight of the day. Ask about connections or even flights to neighboring cities where you can take a train or drive the rest of the way. The day we missed our flight out of Istanbul to Pristina, we ended up on the next flight – to Prague. Your travel plans may not always be so flexible, but getting a seat on a connecting flight may mean you get home – or on vacation – faster.

Gadling readers: what’s your experience been when you’ve missed a flight? What airlines do you find to be the most accommodating?

Ask Gadling: You have to go home half-way through a prepaid tour or cruise

by McLean Robbins on

For this edition of Ask Gadling, we’ve turned to Lauren Volcheff, the vice president of marketing for Last Minute Travel. Should a guest need to depart half-way through a pre-paid tour or cruise, they should visit the Purser’s Desk or Guest Services desk and ask for help obtaining a “cruise interruption request.” Volcheff says:

A guest can request to debark the ship at a specific port of call at any time during the cruise. The ship will be able to provide insight and walk the guest through the process, provide the necessary paperwork, coordinate with local customs and immigration authorities, and even help with transportation to the airport or hotel, as needed. Passengers will be responsible for associated costs and securing flights back to home country.

Cruise ship passengers should understand that each country’s immigration laws and procedures – not the cruise line – determines how smoothly or complicated the process is for debarking the ship permanently. For instance, some countries will not allow cruise lines to authorize debarkation of passengers, due to visa restrictions.

If a guest needs to leave mid-way through a pre-paid tour, they should consult with the specific regulations of that tour. Certain exceptions – for illness, family emergency, or injury – may be built into the contract.

[Flickr via Bruce Tuten]

Ask Gadling: You don’t have the right plug and there is nowhere to buy one

by McLean Robbins on

This is a simple one – just ask! Your hotel, hostel or tour operator likely has a converter you can borrow. Most have a large supply at the front desk that can be loaned out for the duration of your trip. Better yet, save yourself the hassle and buy a plug with multiple conversion bases. And be aware that Standard European converters don’t work in Italy and Switzerland … this writer learned the hard way on a recent trip overseas.

[Flickr via chrstphre]

Ask Gadling: What to do in a Muslim country during Ramadan

by Sean McLachlan on

Ramadan is a month-long religious festival during which Muslims don’t eat, drink, smoke, or have sex from sunup to sundown. This reminds them what it’s like to be without the things they take for granted, and encourages them to be thankful for what they have. Certain people are excused from fasting, such as children, the sick, the pregnant, menstruating women, and travelers. The rest of the population has to suck it up and get through the day.

Traveling in a Muslim country during Ramadan poses two problems–you can’t eat in public and tourist sights may be closed. In countries such as Turkey and Egypt tourism is such a big draw that major sites will remain open and there are enough restaurants catering to non-Muslims that you’ll be able to eat. In smaller towns, however, you might find the attractions and restaurants closed. Gadling’s Grant Martin was visiting Cairo during Ramadan and found many places had abbreviated hours so the staff could eat at the appropriate times. He also found that while touristy restaurants remained open, some didn’t serve alcohol. Gadling’s Meg Nesterov, who’s living in Istanbul, reported very little changed during the fast.

The big challenge comes in more devout, less visited countries. Back in 1994 while I was crossing Asia, Ramadan started during my last week in Iran and my first three weeks in Pakistan. Pretty much everything shut except for museums in major cities and large archaeological sites such as Mohenjo-daro. Restaurants all closed their doors and I found myself in the odd situation of being an agnostic compelled to observe Ramadan.

So what to do?

Get into the spirit. Ramadan is one of the biggest occasions of the Muslim calendar and you’re there to witness it firsthand. You’ll almost certainly be invited to an iftar, the evening meal right after sunset. Muslims make up for their day of hunger with some seriously good cooking, and it’s traditional to invite a guest. One of my coolest travel memories was an iftar at a home for deaf people in Karachi. We communicated by hand signals the entire evening and one of my hosts gave me a silent tour of the city.

Be flexible with your hours. While shops and restaurants may be shut during the day, they often stay open long into the night.
Visit a mosque. You can rest assured that some of the major sights of any Muslim city will remain open during Ramadan–the mosques. Many are centuries old and are architectural jewels, like this one in New Delhi photographed by user jrodmanjr and uploaded to Gadling’s flickr photostream. Mosques aren’t only a place of worship, they’re a refuge from the heat and bustle of the street, a place where people sit around and chat. This makes them great places to meet locals. I’ve been inside dozens of mosques in many different countries and always found them welcoming. I’ve come across a few in Iran and India that were closed to non-Muslims, but in both countries I found mosques where the worshipers greeted me with friendliness.

Eat if you must. Strangely enough, I found food for sale everywhere in Pakistan and Iran. Nobody was eating, but they were shopping in preparation for breaking the fast. Shopping in daylight hours can be a bit awkward, however. The guy with the rumbling stomach selling oranges in the market knows that Westerner is going to sneak back to his hotel room and gorge himself. I found I couldn’t go the whole day without eating and kept a cache of food back in my room for secret snacks. Out of consideration for the hungry vendors I tried to do my shopping at night.

Know when Ramadan occurs. Ramadan is determined by the Muslim lunar calendar and thus varies from year to year. The exact start depends on when the first sliver of the crescent moon is spotted, which in 2011 Ramadan will be around August 1.

Be understanding. I get grumpy if my lunch is more than an hour late, so I can imagine what I’d be like if I skipped food all day. It must be extra hard for the smokers. Many folks are going to be a bit edgy. By the afternoon they may be lethargic or will have disappeared to take a long nap. Ramadan is a big challenge, so cut them some slack. Just wait until half an hour after sunset, though, and you’ll find everyone in a festive mood.