Germs are waiting for you on your travels

Dec. 30--Retiree Janice Saltz made plans earlier this year for the trip of a lifetime. She and husband Irwin planned to visit Janice's cousin, a retired U.S. diplomatic officer, and his Thai wife in their Bangkok home and then join the Chinese New Year's celebration in Hong Kong.

Ultimately, it all took place, although not exactly the way Janice had envisioned it. She was sidelined with a stomach bug and took a detour to Kasemrad Hospital, a modern facility in Bangkok.

Saltz had contracted traveler's diarrhea apparently from eating a "bad oyster" in an omelet served in a restaurant in Koh Samui, a Thai island beach town. Saltz spent the one-day journey back to Bangkok -- via airplane, bus and boat -- sleeping, vomiting and coping with diarrhea.

About 30 million trips were taken from the U.S. to destinations outside North America in 2014, according to the U.S. Department of Commerce's Office of Travel & Tourism Industries.

Getting sick or injured while overseas is not uncommon for U.S. travelers, especially in non-Western countries, and can pose serious threats to health. One survey showed that nearly two-thirds suffered everything from minor illnesses, such as colds and stomachaches, to heart attacks, strokes and serious injuries in traffic accidents.

Travelers' financial well-being also is at risk if they don't take proper precautions to avoid illness and to protect their pocketbooks with insurance.

Shirley Stephenson, a nurse practitioner who advises travelers at the Travel Clinic at University of Chicago Medicine, said she breaks down health risks into two categories: "illness related to things we eat and illness related to things that eat us. Food-borne and vector-borne illnesses are common and range from mild, unpleasant symptoms that resolve relatively quickly to life-threatening infections."

Typically Stephenson first discusses risks people never consider in their everyday lives in the U.S., such as monkey bites; chikungunya virus, an increasingly common mosquito-borne disease causing fever and joint pain; and typhoid fever, a bacterial disease spread through contaminated food and water or through close contact with someone who is infected.

Saltz, of Chicago, experienced the most common traveler's health problem: bacterial diarrhea. Stephenson noted that 80 to 90 percent of traveler's diarrhea has a bacterial cause.

Saltz said her doctors at the Thai hospital, who spoke excellent English, discovered in tests that she had the sort of infection oysters spread. She took antibiotics and missed only one day of the Chinese New Year's celebration.

"Food-borne illnesses can happen anywhere but are more common in certain parts of the world," Stephenson warned.

She said the U.S. Centers for Disease Control ranks Asia, the Middle East, Africa, Mexico and Central and South America as high-risk zones for diarrhea. She added that the Travel Clinic commonly prescribes antibiotics to patients traveling in such areas so they don't have to find a doctor.

Stephenson said travelers should ask neighbors and colleagues who have been to a region to get an idea of safe nearby medical facilities. "Be mindful of pre-existing medical conditions, and have a game plan in place if problems arise," she said. "Consider wearing a medical-alert bracelet for conditions that might require acute medical care, such as cardiac conditions or insulin-dependent diabetes."

A list of medications and conditions can help people with chronic conditions when they are far from home, she added.

Travel clinics can provide information to prepare you for a trip along with recommended vaccines and prescriptions. For a list of such clinics, go to wwwnc.cdc.gov/travel/page/find-clinic.

If you get sick abroad, ask a concierge or other staff member at a hostel or hotel about nearby physicians and facilities.

Another option is to look online at the list of physicians and dentists compiled by U.S. embassies and consulates. The U.S. State Department lists names of doctors U.S. citizens found helpful. These are under the "American Citizens Services" heading for an individual country at www.usembassy.gov.

The State Department warns: "Please bear in mind that we cannot refer you to a specific doctor or hospital, nor does being on a U.S. embassy or consulate list mean that we recommend that doctor or hospital. We are not responsible or liable for the professional ability or quality of service you may receive from a doctor or a hospital on a list."

OK. What next?

Insure yourself. Travel insurance comes in a variety of flavors. One kind mainly protects against trip cancellation and lost luggage. It may not cover any medical expenses abroad, so read the policy carefully.

Check with your regular health insurance company to determine what, if any, medical expenses, will be covered overseas.

Medicare does not cover medical expenses abroad, though Medigap insurance may cover some expenses.

Two other types of short-term supplemental travel insurance may help:

--Travel health insurance covers medical expenses to varying degrees. Be sure to keep track of receipts because hospitals and doctors likely will expect payment on the spot, and you will need to be reimbursed when you get home.

--Evacuation insurance covers the expense of getting sick patients to the care they need when it is not available locally. This occurs via a pricey air ambulance or travel escort service.

Travel insurance is available from travel agents and also online sites. The State Department lists some sources: http://travel.state.gov/content/passports/en/go/health/insurance-providers.html

Saltz, 64, and her husband had obtained a traveler's health policy for only $102, and it covered her $555 hospital bill.

Saltz had a much better deal than an acquaintance who had a stroke overseas and did not have a traveler's plan with evacuation coverage and incurred a huge bill that had to be paid out of pocket.

The news isn't all bad. Countries with national health plans may provide low-cost or even no-cost care to tourists.

Dr. Joel Dunnington, a retired radiologist from MD Anderson Cancer Center in Houston, experienced symptoms of a sinus infection while attending a conference on smoking and health in Helsinki a few years ago. A hotel concierge directed him to an urgent-care center, where a lab test was done, and he was prescribed an antibiotic. As a foreign visitor, he was billed only $20.

Another option is travel-assistance programs, such as International SOS, which for a premium offers a network of providers, vetting their training, facilities and fluency in English and similarly checking out hospitals. It also offers air evacuation and escort services, and takes the pulse of local security threats. The Philadelphia-based company runs physician-supported centers that are open around the clock to offer guidance to travelers.

Stephenson views such programs as a boon in underdeveloped or dangerous regions with iffy choices for care and security risks.

"Being extra-cautious or hyper-vigilant is often appropriate when in an unfamiliar area," she said. "Having a resource like this that can offer remote assessment can be very valuable, especially if one is in a more rural area or if one doesn't have friends, family or colleagues in (or familiarity with) the region."

Dr. Robert Quigley, senior vice president of medical assistance at International SOS, which manages travel health emergencies and evacuation, stressed the importance of reading the fine print on travel health policies. He said many travelers, especially on cruise ship adventures, don't really read insurance riders or know what their coverage includes.

"It's critical that you do your homework," he said. "If you imagine the worst-case scenario, make sure that it is all covered with the combined (insurance policies) that you hold. You should be good to go -- and have lots of fun."

Howard Wolinsky is a freelance reporter.

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