Trip Preparation

Key Points:

When traveling overseas, you should:

• Consider visiting a travel clinic prior to departure. Travel clinics can provide specialized immunizations and prescriptions for medications, as well as providing essential advice about how to prevent or treat illness abroad.

• Learn about the availability and quality of health care available at your destination.

• Know how to obtain the names of qualified, English-speaking doctors and which facilities provide the best care at their destination.

• Purchase a travel health policy that directly pays doctors and hospitals abroad and that also coordinates and pays for emergency medical evacuation.

• Carry standby antibiotics to treat travelers’ diarrhea, and bring at least a basic first aid kit.

• Have available copies of key portions of your medical records (e.g., a recent ECG) and a list of their medications, if health problems are a concern.

• See a physician immediately if a fever develops during a trip to the tropics or soon after your return. Malaria is a medical emergency you may need to consider.

What's New?

• Travelers should consider carrying the nonabsorbable antibiotic rifaximin (Xifaxan) to treat travelers' diarrhea (TD). It is effective against E. coli, the most common cause of TD.

• Prophylactic treatment with rifaximin 600 mg/d for 14 days safely and effectively reduced the risk of developing travelers' diarrhea in US travelers to Mexico.  Rifaximin is effective against enterotoxigenic E. coli (ETEC) and enteroaggressive E. coli (EAEC) and has also shown effectiveness in the prevention of shigellosis.

• The non-DEET repellent picaridin is now available in a 20% formulation and is comparable to DEET for protecting against mosquito bites that transmit malaria and other infectious tropical diseases. It has more favorable cosmetic properties than DEET and will not damage synthetic materials, such as plastic.

• Traveler-ER is a USB device (flash drive) that securely stores copies of your medical records and does not rely on a central data base.

• Starting in May 2009, Portable Oxygen Concentrators must be allowed on all flights originating or ending in the United States. This will require all airlines operating in the US, including foreign airlines, to allow the use of approved POCs on-board and in-flight.

When preparing for your trip, list the countries you will be visiting (in order) and the length of time you plan to spend in each one. There are four questions you need to answer about your trip, which will determine the degree of detail needed in planning ahead.

What is My Destination?

You should ask yourself the following questions: What illnesses are prevalent in the region I will be visiting? What is the general level of sanitation? How competent, and close by, is medical care? How harsh is the climate? How safe are the roads? Is the country politically stable?

Also, remember that a trip to Western Europe, for example, doesn’t require as much preparation as an extended stay in a remote village in a less developed region. Because some countries and cities are much safer than others, be careful not to overdo precautions. You don’t need a typhoid shot if you are going to London or Tokyo, nor do you necessarily need a whole series of immunizations if you’re taking a brief trip to a less developed country but staying exclusively in a deluxe hotel in a large city. For updated information on country-by-country disease risks, consult the World Medical Guide section of this book.

What Will I Be Doing?

Staying in rural areas of less developed countries puts you at greater risk of contact with unsanitary food and drink and usually brings greater exposure to disease-carrying insects. (However, some diseases, such as dengue fever, are also transmitted in urban areas. There is also the risk of malaria in most cities in sub-Saharan Africa.)

Traveling on a tour and staying only in air-conditioned, deluxe hotels, typically carries less risk than traveling in rural areas off the usual tourist routes. Planning an adventure or wilderness itinerary with exposure to extremes of heat, cold, or altitude also takes additional preparation, as does trekking or camping in a remote area far from medical care. Driving a car, motorcycle, or moped in a less developed country may be quite hazardous as motor vehicle accidents account for most preventable fatalities among travelers. Higher risk activities also include swimming in unfamiliar, possibly treacherous, waters, or wading/rafting in freshwater ponds, lakes, or streams. Engaging in casual, unprotected sex is another potential health problem. Therefore, a close analysis of your activities is critical in helping you avoid illness and injury.

How Long Will I Be There?

A brief trip usually means less exposure to diseases and less opportunity for an accident. Longer trips increase the likelihoods of side trips and excursions that may place you at an unforeseen risk, perhaps for a mosquito-transmitted disease such as malaria. Longer travel may also cause you to discontinue prophylactic antimalarial medication, abandon safe food and drink practices, or neglect insect protection measures. Long-stay travel also brings with it the risk of “culture shock” and the need to know more about local customs, traditions, and history. Therefore, if you will be working overseas, you must also consider what psychological stresses you, and perhaps your family, will experience while adjusting to life abroad and what resources you will need beforehand to help make a smooth adjustment.

What Should I Bring?

Your itinerary, the climatic conditions you expect to encounter, the duration of your trip, and the disease risks in the countries you will be visiting all influence what you should bring. For example, many travelers to tropical and subtropical regions neglect to take precautions against insect bites necessary to prevent malaria and other insect-transmitted diseases. Be sure you have the necessary supplies (DEET repellents, permethrin insecticide, mosquito netting) described in Chapter 8. Your health status may also require you to take additional precautions.

When traveling overseas, take an ample supply of any medication that you use regularly, as well as copies of your prescriptions and the generic names of the medications; brand names are usually different overseas. Do not carry a mixture of pills in unmarked vials. To avoid problems with customs officers who might suspect that your pills are recreational drugs or illegal narcotics, keep each medication in its labeled original container. Note: Certain countries deny entry to HIV-positive travelers. If you are HIV-positive, be prudent when packing your medications.

Carry legally prescribed narcotics and controlled drugs (tranquilizers, sleeping pills, etc.) only if medically necessary. If you are a diabetic taking insulin and carrying needles and syringes, you may also arouse suspicion at customs checkpoints. Obtain a letter on a professional letterhead from your doctor certifying the need for these medications and certifying your diagnosis and treatment. The same applies if you will be carrying needles and syringes in an HIV/hepatitis prevention kit.

Preparation Checklists

Use the following checklists as general guidelines and modify them according to your itinerary and specific travel and health needs. A nylon or canvas pack (e.g., the Wallaby Trip Kit by Eagle Creek) or a first aid kit are useful for carrying medications and other healthcare items. Any medical kit containing sharp objects, such as scissors or a scalpel, should be in your checked baggage to avoid possible confiscation at an airline security checkpoint. Medications and other items needed en route should always be carried on your person.

Medical and Personal Care Items

• An adequate supply of your prescription medications—Carry copies of your prescriptions by generic names. Determine how much of each medication you will need for the duration of your trip, and if you will need refills. Check local availability of medications, but know that regionally manufactured drugs may be substandard or counterfeit. The illicit market in bogus, copied, relabeled, adulterated, and look-alike drugs is burgeoning; therefore, be careful. It may be prudent to bring enough medications for your entire trip—or make arrangements for additional drugs to be shipped to you from home.

• Antibiotics for treating travelers’ diarrhea—Fluoroquinolone antibiotics are currently the most effective drugs and include levofloxacin (Levaquin) and ciprofloxacin (Cipro).

• Azithromycin (Zithromax) is the best alternative treatment for travelers' diarrhea. It is the drug of choice for treating travelers' diarrhea in children. Rifaxamin is a new antibiotic effective against E. coli (ETEC-see Chapter 6). Ciprofloxacin and azithromycin are available in liquid forms for children.

• Antibiotics for self-treatment of other infections—The fluoroquinolone levofloxacin (or ciprofloxacin or moxifloxacin) and azithromycin are good choices but no one drug covers every illness. The fluoroquinolones are effective against acute bacterial bronchitis, community-acquired pneumonia, urinary tract infections, typhoid fever, skin infections (cellulitis), and nongonococcal urethritis. Fluoroquinolones may not be effective against methicillin-resistant staph aureus (MRSA) skin infections and are no longer recommended for treating gonorrhea. Azithromycin is a good choice for respiratory infections and is also effective against typhoid and cholera.

• Azithromycin is effective against sexually-transmitted diseases. A single 2-g dose of azithromycin is as effective against uncomplicated gonorrhea as a 250-mg dose of ceftriaxone (but has more gastrointestinal side effects). Azithromycin is also first-line treatment for chlamydia infections.

• Cefixime is now available in a 400 mg tablet. A single 400-mg oral dose is effective for the treatment of uncomplicated gonorrhea. The combination of 400 mg single-dose cefixime and single 1-g dose azithromycin is virtually 100% effective against mixed gonorrhea/chamydia infections. Travelers who contemplate possible unprotected sexual exposure may wish to carry these drugs for self-treatment.

• Loperamide (Imodium-AD, Diamode)—Use to treat mild to moderate travelers’ diarrhea, or use in combination with an antibiotic to treat more severe diarrhea.

• Antimalarial drugs—Recommended especially if you are going to sub-Saharan Africa—an area where falciparum malaria is a major threat (see Chapter 7). These drugs are usually taken for prophylaxis; occasionally, they are carried for self-treatment.

• Medical kit—At a minimum, carry a basic first-aid kit that contains a thermometer, Band-Aids, gauze pads, 1 or 2 roller gauzes, antibiotic ointment, scissors, and tape. Blister pads (Spenco, moleskin) should be included. The size of the medical kit depends on the number of travelers, length of stay, and the availability of local health care. Some travelers (especially those with multinational corporations) also carry kits with suture supplies and intravenous fluids.

• Sterile needle/syringe kit—Recommended when traveling to countries where hepatitis B, hepatitis C and HIV can be transmitted by nonsterile medical injections or surgical procedures.

• Water filtration/purification supplies—MicroPūr tablets, Katadyn filter, and the Exstream water purification bottle are popular.

• Oral rehydration salts (e.g., CeraLyte)—Use to treat dehydration caused by severe diarrhea. A 1- liter plastic bottle is adequate for storing water or rehydration solution.

• Epinephrine kit—If you have a history of severe bee sting reactions or severe food or drug allergies, have your doctor prescribe an emergency epinephrine self-injection kit (EpiPen). Be sure you know how to use it before you leave.

• Analgesics, such as ibuprofen (e.g., Motrin, Advil) or acetaminophen (Tylenol)—Acetaminophen with codeine, or with hydrocodone (Vicodin), also has antidiarrheal properties. Aspirin can lose potency when exposed to humidity and heat. Acetaminophen is not affected by these conditions.

• Antacids—Maalox or Mylanta are useful.

• Pepto-Bismol—Useful for the prevention and treatment of diarrhea (Chapter 6).

• Cathartics and/or stool softeners. Constipation can be a problem in elderly travelers.

• Motion/sea sickness drugs—TransDerm Scōp patch (for sea sickness on cruises); SCŌPACE (scopolamine tablets), Dramamine, and Phenergan are shorter-acting agents.

• Drugs to prevent or treat altitude illness (see Chapter 15)—These should be considered when ascending above 8,000 feet.

• Jet lag—Sleeping pills, e.g., triazolam (Halcion) are helpful for some people who find insomnia the most troublesome symptom of jet lag. Zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta) are alternatives. Melatonin has limited effectiveness, and is not approved by the FDA for this indication.

• Contact lens wearers—Antibiotic eye drops containing a fluoroquinolone (levofloxacin or ciprofloxacin) for treating an infected corneal ulcer should be carried. Untreated bacterial infections can cause corneal scarring.

• Hand sanitizer gel or disinfecting skin towelettes—These are convenient when soap and water are not available. Good hand hygiene helps prevent the transmission of travelers’ diarrhea; hand sanitizers also kill viruses that spread respiratory infections.

• Nasal decongestant spray—Afrin or Neo-Synephrine.

• EarPlanes—Pressure-regulating earplugs will reduce pain associated with air travel. Especially recommended if you have trouble clearing your nasal passages during flight.

• Antihistamine tablets—Useful for allergic reactions and rhinitis (hay fever). Zyrtec and Claritin-D are long acting and less sedating. Check with your pharmacist about any possible drug interactions with medications you may be already taking for a chronic condition.

• VōSol solution (2% acetic acid)—This prevents or treats swimmer’s ear.

• Corticosteroid cream, such as Cortaid or Topicort—The steroid creams available by prescription are more effective for treating rashes than the over-the-counter products.

• Antifungal foot powder—Lotrisone and Tinactin are good choices. These are essential when traveling in the heat and humidity of the tropics.

• Antifungal tablets—A single, oral 150-mg tablet of fluconazole (Diflucan) will eradicate a vaginal yeast infection. (These infections can result from using an antibiotic.)

• Extra pair of prescription glasses or contact lenses—Bring a copy of lens prescription.

• Other useful items:

• Other useful items: Tweezers (good for tick and splinter removal), small knife, scissors, or Swiss Army knife (keep out of carry-on luggage). Large safety pins often come in handy.

For Rain, Sun, Heat, and Insects

• Hat, sunglasses, umbrella

• Sunscreens—Broad-spectrum sunscreen, minimum SPF 30.

• Insect repellent—Important when traveling to a country where insect-transmitted diseases, such as malaria, are a threat. Travelers should use a skin repellent that contains at least 30% DEET. A good choice is Ultrathon, which provides 12-hour protection against mosquitoes, as well as ticks and biting flies.

• Clothing insecticide—Permethrin is an insecticide that kills insects that touch the treated fabric (e.g., clothing, gear, tents, mosquito nets). Against ticks, it is more effective than DEET. When used in combination with a DEET repellent (as is done by the U.S. military), up to 100% protection against mosquito and tick bites can be achieved.

• Mosquito bed net (preferably permethrin-treated)

• Insecticide spray (e.g., Raid Flying Insect Spray) to rid sleeping quarters of night-biting insects

Medical kits and other supplies: Sources include Travel Medicine, Inc., 369 Pleasant Street, Northampton, MA 01060, 800-TRAVMED (800-872-8633); on-line catalog www.travmed.com and Chinook Medical Gear, Durango, CO (800-766-1365). On-line catalog www.chinookmed.com

Checking the Weather at Your Destination

Global Weather Information: http://weather.yahoo.com/

Wilderness Travel

Adequate pre-trip planning is essential. If you’re on an adventure itinerary, determine what exposure you will have to heat, cold, or altitude. If you are on a trek, most tour organizers will advise you of what to bring, but you may need to consult experts in outdoor/wilderness travel to determine if what is recommended is truly adequate. A Comprehensive Guide to Wilderness & Travel Medicine, 3rd ed., AMK Publishers, Oakland, CA 2000, by Eric A. Weiss, M.D., is a recommended resource and can be ordered from the publisher (Adventure Medical Kits: 800-324-3517) or amazon.com.

Checklist for campers, hikers, and trekkers—You need to anticipate sudden changes in weather, in particular, high winds, rain, and temperature drops. For your comfort and safety, be sure always to carry an outer shell or parka that is waterproof and breathable, fleece vest or jacket, cap and gloves. Multiple layers of clothing should be worn in more extreme conditions. Review the following checklist for additional items your trip may require.

Can I Bring It with Me?

The Transportation Security Administration (TSA) has guidelines for carry-on items here.

Shipping my Luggage and Other Stuff

You may want to unburden yourself of bringing heavy, bulky suitcases, sports equipment, or other items with you. There are several companies who will ship ahead for you:

http://www.sportsexpress.com/

http://www.luggageconcierge.com/

Travel Documents You May Need

Passports—The Bureau of Consular Affairs’ website (http://www.travel.state.gov) provides comprehensive information about applying for, or renewing, a passport or visa. Passport application forms can be downloaded from this site.

• Passport Express, 800-841-6778 (www.americanpassport.com)
• Passport Plus, New York, NY, 212-759-5540 or 800-367-1818 (www.passportplus.net)
• Passport and Visa Expeditors, Washington, DC, 800-237-3270
• Travisa, Washington, DC, 202-463-6166 or 800-222-2589 (www.travisa.com)
• TravelSeeker (www.passportnow.com). Lists numerous online companies that can expedite getting a new or renewed passport.

Lost Passport Overseas

Q. WHAT SHOULD A U.S. CITIZENS DO IF THEIR PASSPORT IS LOST OR STOLEN ABROAD?
A. Contact the nearest U.S. embassy or consulate for assistance. Phone numbers for U.S. embassies and consulates are also available in our Consular Information Sheets and Key Officers handbook. You will need to speak to the American Citizens Services unit of the Consular Section. If you are scheduled to leave the foreign country shortly, please provide the Consular Section with details regarding your departure schedule. Every effort will be made to assist you quickly. You will also be directed to where you can obtain the required passport photos.

If you are notified by a relative or friend that their U.S. passport has been lost/stolen, you may wish to contact Overseas Citizens Services , (202) 647-5225 at the U.S. Department of State in Washington, D.C. providing as much information about possible about the person's who needs passport services abroad. This will assist us in trying to verify the person's previous passport, clearing the person's name through the Department Passport Name Check System, and relaying this information to the U.S. embassy or consulate. Your relative/friend must apply for a new passport at the nearest U.S. embassy or consulate.

Q. WHAT ARE THE REQUIREMENTS TO OBTAIN A REPLACEMENT PASSPORT?
A. You will need to complete a new passport application . The consular officer taking an application for replacement of a lost, stolen, or misplaced passport must be reasonably satisfied as to your identity and citizenship before issuing the replacement. In virtually all cases this can be done through examination of whatever citizenship and identity documents are available, conversations with the applicant, close observation of demeanor and replies to questions asked, and discussions with the applicant’s traveling companions or contacts in the United States. Please note the new requirements for passports for minors under the age of 14 and how this will change the way passport applications for minors are handled abroad.

Q. WHAT INFORMATION WILL I NEED TO PROVIDE THE CONSULAR OFFICER?
A. You will be asked for certain information to assist in verifying your citizenship:

Personal Data: (including, but not limited to)

• your name

• date of birth

• place of birth

• passport number (if available)

• date and place where your passport was issued

If you can provide the U.S. embassy or consulate with a photocopy of your passport identification page, that will make getting a new passport easier since your citizenship and identity information would be more readily available.

Affidavit Regarding Loss/Theft of the Passport/Police Report:
When you report the loss, theft, or misplacement of your passport you must execute an affidavit fully describing the circumstances under which it was lost, stolen. U.S. Department of State form DS-64 may be used for this purpose, or you may simply execute a sworn statement before the consular officer describing what happened. A police report is not mandatory but may be required when the embassy/consulate believes a problem may exist such as possible fraud. An applicant eligible to receive a passport should not be placed in circumstances to miss a plane or unreasonably delay travel to obtain a police report.

Citizenship Verification and Name Clearance:
The U.S. embassy/consulate will confirm your previous passport issuance through the Passport Verification System. The consular section will also attempt to clear your name through the U.S. Department of State name check system to ensure there is nothing preventing issuance of a U.S. passport to you (for example: outstanding arrest warrant, court order, etc.)

Proof of Identity:
You will also be asked for some proof of your identity. If all your personal papers were lost or stolen with your passport, your identity can be established in a number of ways. In most cases the problem of identity is resolved quickly. It should be noted, however, that if there is any indication of possible fraud the consular officer may request additional documentation or other information.

Information From Consular Interview: The consular officer may be satisfied as to your identity based on the interview with you, or may require other information.

Identifying Witness: Persons traveling with a group or with friends, family or associates in the foreign country can have such a person execute an affidavit of an identifying witness before the consular officer. An identifying witness does not have to be a U.S. citizen.

Information From Family, Friends or Associates in the United States: If you are traveling alone and do not know anyone in the foreign country who can attest to your identity, your family, friends, or associates in the U.S. may contact the consular officer by phone or fax confirming your identity. This is usually quite informal. In emergency situations, your contacts may also communicate with the U.S. Department of State, that Overseas Citizens Services , (202) 647-5225.

Information From Previous Passport Records: If necessary, information about your identity may be obtained from your previous passport application which may have to be retrieved by Overseas Citizens Services , (202) 647-5225, in the U.S. Department of State from the Federal Records Center which is located outside of Washington, D.C.

Q. WILL THE REPLACEMENT PASSPORT BE ISSUED FOR THE FULL 10-YEAR VALIDITY PERIOD FOR AN ADULT?
A. Replacements for lost passports are normally issued for the full 10-year period of validity for adults. Occasionally, cases will arise in which the consular officer has some lingering doubt because of statements made by the applicant, or other circumstances, but is still reasonably satisfied as to identity and citizenship. If there is not time to request and receive the Department’s verification, a passport limited to 3 months may be issued. Limited passports may also be issued in cases in which an applicant has, by mistake, packed the passport with luggage being sent to another location, left the passport at home, perhaps in another country, but has to travel immediately, lost or been robbed of multiple passports in a short timespan, etc. When issuing a limited passport in an emergency situation, consular officers will carefully explain to the applicant that the passport is limited for the duration of the present trip only. When the applicant returns to the United States and wishes to travel again internationally, the applicant will have to apply for a replacement passport and pay the regular fee.

Q. ARE FEES CHARGED FOR REPLACEMENT OF LOST/STOLEN PASSPORTS ABROAD?
A. The normal passport fees are collected from applicants for replacement passports. Applicants will be asked to provide names of persons they feel would be able to assist them financially if there is sufficient time. See our information about Financial Assistance to U.S. citizens abroad and Learn About Sending Money Overseas to U.S. Citizen in an Emergency.

However, if: the applicant’s money and documents have been lost or stolen, or the applicant is a victim of a disaster and the applicant does not have and cannot reasonably be expected to obtain money to pay the fees before continuing travel, no passport fee will be charged and a limited validity passport will be issued. When the person applies for a full validity passport on their return to the United States the regular passport fee will be charged for the replacement passport. See the U.S. Department of State Schedule of Fees, 22 CFR 22.1

·     Visas—The best source to obtain up-to-date visa requirements for travel to other countries is the website of the Bureau of Consular Affairs (http://travel.state.gov/travel/tips/brochures/brochures_1229.html).

After verifying the need for a visa, contact the embassy or consulate of the country or countries of your destination to verify information regarding the documents you will need and the processing time required. You can also use one of the passport expeditor companies listed on the previous page to file the application. Go to their websites to view the process and fees.

·    HIV testing requirements for entry into foreign countries—Not all HIV testing requirements are found on the U.S. Department of State website, or the requirements may have changed, so check with the embassy or consulate of the country that you plan to visit to verify the requirement for entry, if any. The HIV test is usually required only for those applying for a foreign work permit, prolonged residence, or immigration—not for tourist visits of less than 1 to 3 months. Tests done in the United States or Canada may not be accepted..

·    International Certificate of Vaccination (Yellow Card)—Yellow fever vaccinations must be given at official Yellow Fever Vaccination Centers (e.g., a travel clinic, local health department) as designated by respective state health departments. The international certificate of vaccination (the Yellow Card-pictured below) must be validated with the “Uniform Stamp” and signed by the physician or the physician’s designee. The Centers for Disease Control and Prevention website (www.cdc.gov/travel) lists all the authorized Yellow Fever Vaccination Centers within the United States, by state, that are licensed to administer the yellow fever vaccine and the certificate of vaccination.

You need to have in your possession a validated International Certificate of Vaccination when entering countries that require proof of yellow fever vaccination. Some countries in sub-Saharan Africa require ALL travelers to have a valid Certificate, but for most countries the requirement is only if you are arriving from an infected area or from any country in the yellow fever endemic zones. The Certificate of Vaccination becomes valid 10 days after the immunization is administered. Be sure to take this lag period into account. You should carry the yellow card with your passport.

• Date and dose of all vaccinations received for foreign travel
• Medical exemption from receipt of required vaccinations
• Personal health history
• Drug allergies
• Current medications
• Prescriptions for eyeglasses or contact lenses

Note: Currently no country “officially” requires cholera vaccination as a condition of entry. Local authorities in some (usually sub-Saharan) countries, however, may require documentation of vaccination. This tactic may be used to extract a bribe to waive the “requirement.” Depending on your itinerary (and because the cholera vaccine is no longer available in the United States), you may have your health-care provider state on your Yellow Card “Exempt from cholera vaccine” and have the exemption stamped and signed. Note: There is no section for cholera vaccination on the new Yellow Cards. Some travel clinics routinely state that the vaccine is contraindicated; in some cases the clinic will create a cholera stamped area while being sure that the traveler knows that they did not receive the injection.

·    Extra photos—Obtain at least eight (8) additional 2¢¢ ´ 2¢¢ photos when applying for your passport or visa(s). These extra photos will come in handy if you need additional visas or an international driver’s permit or if you need to replace a lost passport or other document.

·    Personal health records—Consider carrying photocopies of your health and hospital records, recent electrocardiogram (ECG), laboratory test results, list of current medications, allergies, etc. Or, you may wish to subscribe to a service that can assemble all of your pertinent medical records, store them in a computer, and fax or e-mail them anywhere in the world within minutes. Contact Global Med-Net (800-650-SAVE) for further information. Another resource is Traveler-ER. They sell a USB device that stores emergency contact and personal health information and which does not, for security reasons, rely on any central database.

·    Travel health insurance—It is always a good idea to purchase a travel insurance policy (Chapter 18). These policies pay overseas doctors and hospitals at the time of the visit, and they also cover emergency medical transport. Check your existing health insurance policy to see what benefits are provided in case of illness overseas. Normally, only emergencies are covered. Medicare does not pay for out-of-country illnesses or accidents, so anyone with Medicare should also have MediGap coverage.

·    Doctors and hospitals abroad—The International Association for Assistance to Travelers (IAMAT) publishes a booklet listing hospitals and English-speaking physicians overseas. 417 Center Street, Lewiston, NY 14092; 716-754-4883. The Destinations Section of this website has extensive country listings of doctors and hospitals, with many website addresses.

·    Medic Alert bracelet—If you have a serious or chronic medical condition, a history of severe drug allergy, etc., you should consider wearing a Medic Alert bracelet. Call 1-800-ID-ALERT to order.

·    Prescription drugs abroad—Worldwide delivery of non-controlled (non-narcotic) medications sent via Federal Express or DHL. Contact: Global RX, 4024 Carrington Lane, Efland, NC 27243; Tel: 919-304-4278; Fax: 919-304-4405; E-mail: info@globalrx.com; www.globalrx.com

·    Divers Alert Network (DAN)—For non-emergency medical questions and general information, scuba divers can call (919) 684-2948 for DAN’S Dive Safety and Medical Information Line. (Website: www.diversalertnetwork.org). For scuba diving emergencies, DAN’S Diving Emergency Hotline is (919) 684-4DAN (4326) or (919) 684-8111. These lines are open to all divers.

·    Telephone number and e-mail address of your personal physician or medical group

·    Foreign language telephone assistance—When dealing with medical problems long distance, there may be language barriers. Call AT&T’s Language Line at 800-628-8486 for assistance. The service costs vary per minute, depending on the language being interpreted.

·    Traveler’s checks—Make a photocopy of the numbers. Leave the photocopy at home and carry with you the list of numbers that you get with the checks. Copy the date and place of purchase and where to call if the checks are lost or stolen.

·    Credit cards—Know your charge card credit limits. U.S. citizens have been arrested in some countries for exceeding credit limits. Keep a copy of your card numbers in case they are lost or stolen. Report the loss immediately.

·    Money—ATM facilities in other countries are becoming more prevalent; they offer convenience and usually the best exchange rates. Foreign banks usually will advance cash against your credit card. Be sure you have your PIN number.

·    Birth certificate and photo ID—These documents can sometimes be used in lieu of a passport for entry into certain countries. They’re also useful to have if you lose your passport. If you are living overseas or getting married in a foreign country, be sure to have these documents with you.

·    Green card for resident aliens—Don’t leave home without it.

·    Doctor’s letter—You may want a doctor’s letter describing and authorizing the prescription medications you will be taking on your trip, including needles/syringes if you are a diabetic. The letter should contain the generic names of the medications and the dosages.

·    International driver’s permit—This is available at any AAA office. When applying you’ll need two passport-sized photos (they can take the photos), your driver’s license, and $15 for the fee. The international driver’s permit is printed in nine languages and serves as a translation for your license, which is valid in many countries. Note: You also need to take your regular driver's with you when you drive abroad. A few countries (China, Egypt, Nepal) do not allow tourists to drive.

·    Notarized parental consent—Necessary when a minor child is traveling with the noncustodial parent. This permission letter may even be required when one parent is traveling internationally alone with his/her child. You may not be able to board the aircraft or enter a country (e.g., Mexico) without this document. 

 ·    Mobile phones overseas—Unless you have a multi-band GSM phone, your own mobile phone (cellphone)) is probably useless overseas, so you may want to buy or rent a phone for your trip. A low-cost option is buying a cheap, prepaid phone on arrival. You can also buy a phone before departure, or at your destination, whose SIM card can be reloaded with airtime purchased locally. Good resources for mobile phones overseas include Telestial (www.telestial.com) and Cellular Abroad (www.cellularabroad.com). NOTE: Camera phones are not allowed in Saudi Arabia and their use in some other countries may arouse suspicion.

Guidelines for Using Cellphones Abroad

(Source: The New York Times July 2010)

Avoiding a Large Phone Bill When Traveling