Selected Podcast

Staying Healthy When Traveling Out of the Country

What do you do when you get sick in a foreign country? Who can you call?  Where can you go to be seen?

How can you get medicine, and what if you need to go to the hospital?

Are the rules different if I am traveling on business or on vacation?

We'll discuss what you need to know to stay healthy while traveling abroad and what you should do before you leave right here on Conversations with MIT Medical– Care for the Community.
Staying Healthy When Traveling Out of the Country
Featured Speaker:
Dr. Howard Heller, MD, MPH
Dr. Heller is a Physician specializing in Infectious Disease at MIT Medical, Assistant Clinical Professor at Harvard Medical School and member of the Infectious Disease Unit of Massachusetts General Hospital. At MIT Medical he is chairman of infection control. Dr. Heller attended medical school at SUNY Syracuse, did residency training in internal medicine at Memorial Sloan-Kettering Cancer Center and North Shore University Hospital and completed infectious disease fellowship training at SUNY Stony Brook. He is a fellow of the Infectious Disease Society of America and is immediate past President of the Massachusetts Infectious Disease Society.
Transcription:

Melanie Cole (Host): What do you do if you get sick in a foreign country? Who can you call? Where can you go to be seen? These questions can be dizzying and confusing and a little bit frightening. My guest is Dr. Howard Heller. He is a Physician specializing in Infectious Disease at MIT Medical. Welcome to this show, Dr. Heller. Let's talk about staying healthy when traveling out of the country. What do you do to plan in advance, before you're going to leave the country to make sure that you have your bases covered?

Dr. Howard Heller (Guest): I think advanced planning is key. We usually recommend, as soon as people know what their travel plans are and their itineraries, that they look into whether they need any immunizations, any malaria medications, or any other preparations in advance of the trip. The CDC has an excellent website that lets people know that there are specific infections or contagious diseases in the countries that they're going to. MIT Medical has a travel medicine website that also lists a lot of information. We do offer travel clinic services here at MIT Medical. Our patients can come in and have a face-to-face consultation and review what types of immunizations or medications that they might need in the countries that they're going to.

Melanie: They should take a look at their insurance coverage for what might happen while they're in a foreign country, and can they do that on the travel clinic with you, guys?

Dr. Heller: It is something that we review with them. In general, most of the students and employees at MIT have the MIT insurance, which is administered through Blue Cross, and that does cover any emergent thing that happened abroad, whether it's appendicitis or car accident or something less severe, like a sore throat or sinus infection. Patients do have to pay for those services, then they get reimbursed from Blue Cross after they get back. But not all the students are covered under the MIT insurance. Many of the students are still going to be covered under their parent's insurance. So, if they have their coverage through insurance other than MIT, they need to verify that they do have coverage for emergencies abroad.

Melanie: So by checking it out, making sure they have immunizations, going on the CDC websites, seeing where there is infection breakouts, and things that they need to know before they go, what do you take with you when you travel, Dr. Heller? Do you take an antibiotic just in case, because sometimes they're tough to get in another country? Do you take Motrin with you? What do you carry in your little medical bag?

Dr. Heller: I carry the basics, essentials, like ibuprofen. I think anybody who has any underlying medical conditions like asthma needs to bring those medications along with them. Even people who, for example, they've had asthma but have not had an attack in the last two, three years, it's a good idea to bring along the inhaler anyway just in case, because the last thing you want to do when you're having an asthma attack or feeling really sick is to have to run out and find medical care rather than just having your own medicines with you. Depending upon what country you're going to, there might be a high risk of developing diarrheal illness, so for most countries, or at least for many countries, we'd recommend traveling with something like loperamide, which is an antidiarrheal medicine, just to slow things up. If somebody is going to a country where there is a high risk of severe traveler's diarrhea, things like salmonella or cholera, then we would actually give them an antibiotic to take along with them. Those are the basics, but we do review with everybody who comes in if they need other medicines. For example, if they're going to be going to a high altitude, we might recommend medicines to prevent altitude sickness. People who are going on cruise ships or things if they're prone to sea sickness, we might recommend medications for that. A lot of it is common sense. A lot of it is based on somebody's history of what medical problems they've had in the past.

Melanie: How do you advise people? What do you advise them to do if they get sick in a foreign country? If they come down with the flu or just a really bad cold, do they go to a clinic? How do they even find one?

Dr. Heller: That is an excellent question, and it's one thing that we try to spread the word about to all of our patients. MIT actually provides this one full service. It's a company called International SOS. They are a medical assistance company. They're not an insurance company, but they provide medical assistance. They have doctors and nurses available 24/7 by phone. They have offices all over the world. And if somebody gets sick and they're not sure if they need to get medical care or not, you can call International SOS, speak to one of the doctors or nurses, and they will give you medical advice. If the advice is you do need to get medical attention, they will be able to guide you exactly where to go. They know doctors and hospitals all across the globe. They even have their own medical clinics in some of the larger cities in the world, but it's an incredible resource. It's one number to call for all the information you need, so you don't have to start looking at the telephone book or ask around with friends which hospital to go to, which doctor to go to. International SOS has that information. The places where they send you will be places where they have been vetted by International SOS. Nearly all the places will have people who speak English. And they're an incredible resource. If somebody is severely ill, like a major car accident, they will actually send a nurse to meet with you at the hospital, the nurses from International SOS. They guide you through the care. They make sure everything is stable. If somebody needs more intensive medical care, they're the ones who arrange for transport to whatever city you need to get to to get the proper medical care. And also, very importantly, they coordinate with us here at MIT Medical. So any MIT person who contacts International SOS, we find out about it the same day. And so, if somebody is likely to need continuing care after they get back to MIT, or if they need continued hospitalization or stuff like that, we can already start to coordinate it on the MIT side.

Melanie: Are the rules different if they're traveling on business or on vacation?

Dr. Heller: For students, MIT will cover them with International SOS if they are on MIT-related business. If they're on a school-related projected somewhere, MIT will cover that. If they're going on a personal or private vacation, and MIT does not cover it, they can purchase their own coverage directly from International SOS, and it's relatively inexpensive. If somebody is going on an MIT trip, for example, that's a three-month project abroad, and then they're going to tacking on an extra few days or a week afterwards, MIT will cover that part. But if they're clearly taking a longer vacation that's clearly not related to the MIT trip, they should purchase their own coverage. For MIT employees, they are covered both for work-related travel as well as personal travel. And the family members of MIT employees would be covered also as long as they're traveling together with the MIT employee at the time.

Melanie: Dr. Heller, give the listeners your very best advice on staying healthy while they travel, things that they can do both at the airport, on the airplane and in foreign countries and cities, so that maybe they don't pick up what's going around.

Dr. Heller: A lot of it is plain old common sense and the same steps that we talk about all the time about proper hand washing, diet, things like that. That in itself will help to reduce the risk of picking up things like viral infections and the flu. In some parts of the world, we're going to be recommending mosquito repellant, for example, to prevent some mosquito-transmitted infections, like dengue fever. Food precautions, we recommend for certain parts of the world where the level of hygiene or, at least, the sanitation and health department codes are not what we're used to here in the United States. So if somebody's traveling, if they tend to be what we call adventurous eaters, people eating out at street stands, where the hygiene may not be as good, we'd recommend precautions such as not eating uncooked vegetables or fruits, avoiding leafy vegetables. Those are the types of things that we talk about. And when patients need more detail about that, we either give them written information or refer them to the CDC website, where they go into much, much greater descriptions about the precautions: water precautions, insect precautions, things like that.

Melanie: Do you carry sanitizer when you travel abroad, Dr. Heller?

Dr. Heller: I do. Not too obsessive about it, but I do carry it with me just in case.

Melanie: Well, it's a good idea because sometimes there are handwashing stations abroad and they say, "non-potable," so you know you're not supposed to drink that. And so I guess you should also understand what their signs mean and what you're reading when you're over there. In the last minute, please, if you would, just your best advice for staying health when traveling out of the country.

Dr. Heller: Best advice is, for the most part, common sense. But also, keep in mind that one of the greatest sources of illness when people travel is accidents—not malaria, not yellow fever. Those are relatively easily prevented with vaccines and medicines. It's the traffic accidents that are one of the biggest severe problems. So be extra cautious if you're traveling in an area where they don't have the same type of traffic signs, lights, or rules that we are accustomed to here in the United States. Be careful about accidents when you're abroad.

Melanie: Thank you so much, Dr. Howard Heller, Physician specializing in Infectious Disease at MIT. If you want more information, you can go to medweb.mit.edu. You're listening to Conversations with MIT Medical. This is Melanie Cole. Thanks for listening. Have a great day.