What To Do When Sick Abroad

Introduction

While abroad, travelers might seek medical care for a wide range of unanticipated conditions, ranging from minor ailments or injuries to major medical or surgical problems. Most worrisome are emergencies that require sophisticated medical or surgical management. This chapter provides recommendations on ways to make obtaining health care when abroad safer and more reliable.

Not all insurance plans cover emergency health care when traveling abroad, so travelers should check with their insurance carriers before departure to confirm the terms of their coverage and to identify additional coverage requirements (see Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance chapter). Most standard health plans (e.g., employment-based health insurance plans) might not cover the full cost of emergency medical care or medical evacuation. Travel-specific health insurance plans vary widely and might not cover the full cost of emergency care, medical evacuation, or itinerary alterations needed to receive medical care during travel. Supplemental coverage policies may cover these expenses, but they often exclude coverage of preexisting conditions. When traveling for work, research, or formal education, travelers should determine whether their sponsoring organization provides travel health insurance.

Supplemental medical insurance plans purchased before traveling often furnish access to pre-selected local healthcare professionals through a 24-hour emergency hotline or provide a list of approved healthcare professionals. Some plans provide medical assistance via a nurse- or physician-backed support center. Travelers should be prepared to pay out of pocket when services are rendered and, in some instances, even before care is received. In such situations, travelers may later submit copies of bills and invoices to their insurers to initiate reimbursement.

Locating healthcare facilities and professionals abroad

The level and availability of medical care around the world varies by country and even within countries. During pre-travel preparation, travelers should consider how they will access health care during their trip should a medical problem or emergency arise (Box 5.2.1). Encourage travelers likely to need health care (e.g., those with serious chronic conditions or who require medications that are not widely available) to research thoroughly and identify potential healthcare professionals and facilities at their destination (see Travelers with Chronic Illnesses chapter). For example, people who require regular dialysis treatments need to arrange appointments in advance at a site with appropriate equipment. Pregnant travelers should know the names and locations of reliable obstetric medical centers (see Pregnant Travelers chapter). Travelers should be aware that more choices are generally available in urban areas than in rural or remote locations. Alternatively, telemedicine encounters during which travelers can access their U.S.-based healthcare professionals remotely might be an option for an individual traveler but will require careful preparation and planning (see Telemedicine When Abroad discussion later in this chapter).

Travelers, particularly those with preexisting or complicated medical issues, should know and have documented in a doctor's letter the names of their conditions, any allergies, their blood type, and current medications and doses. Include generic names of all medications because trade names vary widely. Furthermore, standard dose regimens may vary by country. If possible, this list should be in the local language of the travel destination. Travelers also should carry copies of prescriptions, including for glasses and contact lenses, and consider wearing medical identification jewelry (e.g., a medical alert bracelet), as appropriate. Travelers should check with the embassies of the intended country destinations to ensure that current medications are permitted (see Traveling with Prohibited or Restricted Medications chapter). Many mobile phone applications enable travelers to upload their medical records, prescriptions, electrocardiograms, radiographs, and other information for ready access when needed. Remind travelers to request documentation of any medical care received during travel, including a list of medications received. Upon returning home, the traveler should share this information with healthcare professionals, including their primary healthcare professional or any specialists required for ongoing care of their recent medical issue. Because some travelers have returned home with novel antimicrobial-resistant infections, it is important that returned travelers inform healthcare professionals of their overseas healthcare encounter if it happened within the last 12 months.

Box 5.2.2 includes a list of suggested resources international travelers can use to help identify healthcare professionals and facilities around the world.

Box 5.2.1

Box 5.2.2

Notes

The Centers for Disease Control and Prevention does not endorse any healthcare professional or medical insurance company, and accreditation does not necessarily ensure a good outcome.

Telemedicine when abroad

With expanding digital communication globally, many travelers can seek medical guidance from their established healthcare professionals while traveling. Telemedicine communications can be in real-time (or synchronous). For example, an interactive video session between patient and healthcare professional can create a virtual health encounter resembling an in-office encounter. Other real-time encounters may be as simple as a voice-only telephone call or an exchange of text messages.

Trying to schedule a real-time virtual encounter across time zones is often impractical. This may lead to asynchronous encounters that have the expected delays that are part of routine email exchanges. Asynchronous encounters rely mostly on written communication, although patients may provide useful photographs or video attachments (Box 5.2.3).

Although medical encounters like this may seem simple and straightforward, they are not. Myriad technical, legal, ethical, financial, remunerative, licensure, security, privacy, and documentation issues surround telemedicine. Engaging in telemedicine requires compliance with state and federal privacy and security laws. The Health Insurance Portability and Accountability Act (HIPAA) concentrates on measures to ensure patient privacy and information security. Each state has its own telemedicine laws and regulations, most of which address reimbursement issues (e.g., informing healthcare professionals and insurance carriers which telemedicine services are reimbursed) but not the practice of telemedicine. Therefore, healthcare professionals must perform due diligence to ensure that they conduct telemedicine encounters in accordance with the laws and regulations applicable in their local jurisdiction. In addition, the destination country may have specific legal requirements regarding digital transfer of personal health data.

Travelers may wish to consult their primary healthcare professionals to determine if telemedicine is an option. Since the COVID-19 pandemic, most U.S.-based healthcare professionals have incorporated telehealth into their practices. Many health systems and electronic health records now include patient portals and other HIPAA-compliant methods to facilitate communication.

Box 5.2.3

Avoiding travel when ill

Advise travelers to self-evaluate before leaving home and to avoid or postpone travel if acutely ill with fever or other signs or symptoms of a communicable disease. Traveling while ill increases the likelihood that a person will require exposure to unfamiliar and potentially inadequately equipped healthcare systems. Furthermore, traveling while ill risks transmitting illness to travel partners, other passengers, or crew members. Moreover, some airlines and some countries ask travelers to complete a brief health questionnaire before embarkation or upon arrival. Local health authorities might conduct body temperature checks anywhere in the airport, including the waiting area and while boarding; passengers who fail such screenings might be prohibited from boarding their flight. Because people are often reluctant to postpone or cancel travel, trip cancellation insurance can protect some (or all) of their investment and increase compliance with the recommendation to avoid travel when ill (see Travel Insurance, Travel Health Insurance, and Medical Evacuation Insurance chapter).

Drugs and other pharmaceuticals

The quality of drugs and medical products acquired abroad might not meet the same regulated standards established by the U.S. Food and Drug Administration. Worse yet, drugs could be counterfeit and contain no or substandard amount of active ingredients or could contain harmful or adulterated ingredients. Likewise, vaccines and other products (e.g., condoms, disinfectants, insecticide-treated mosquito nets, face masks or respirators, water purification devices) can have quality problems or be counterfeit. The World Health Organization estimates that 10% of medical products in low- and middle-income countries are substandard or falsified. Travelers whose original supply of medication is used up, lost, stolen, or damaged should take steps to ensure that replacement medicines are safe and effective (Box 5.2.4).

Box 5.2.4

To minimize risks associated with substandard drugs and pharmaceuticals, travelers should bring enough medicine for the entire trip and include an additional supply in case of trip delays. Travelers should carry all medications in the original labeled containers in their carry-on luggage, not in their checked baggage. This also applies to travelers who might require an epinephrine auto-injector to treat known severe, potentially life-threatening allergies (see Severely Allergic Travelers chapter). For epinephrine autoinjectors, travelers should carry a letter from the prescribing physician explaining their allergies and a copy of the written prescription.

Travelers who require regular injections (e.g., for insulin-dependent diabetes) can bring their own supplies but also should bring a healthcare professional's letter stating the need for this equipment. If travelers require injections while abroad, they should insist that healthcare professionals use new needles and syringes.

Blood safety

A medical emergency abroad (e.g., a motor vehicle crash, other trauma) could require a lifesaving transfusion of whole blood or blood components (e.g., platelets, fresh frozen plasma). Not all countries accurately, reliably, and systematically screen blood donations for infectious agents, which puts recipients at risk for transfusion-associated infections. Consequently, all travelers should consider receiving hepatitis B virus immunization before travel (see Vaccination and Immunoprophylaxis—General Principles chapter). Hepatitis B vaccination is especially important for travelers who frequently visit or have long-term stays in low- or middle-income countries; travelers who have underlying medical conditions that increase their risk of requiring blood products while traveling; and travelers whose activities (e.g., riding motorcycles, adventure travel) put them at increased risk for serious injury (see Adventure Travel chapter).

Some simple measures can increase the likelihood of a safe blood transfusion. For instance, the traveler (or a companion, if the traveler is incapacitated) can ask about blood supply screening practices for transfusion-associated infections, including HIV. It may be difficult to obtain information on the safety of the blood supply during an emergency or at the point of service; travelers with known medical conditions that might require transfusions can identify medical service professionals at their destination before travel to increase their chances of obtaining higher-quality care. Travelers may also register with agencies (e.g., the Blood Care Foundation) that attempt to provide rapid and reliable delivery of blood products to members at international locations.