In most developed countries and regions, such as Australia, New Zealand, Japan, and Western Europe, health risks may be no greater than comparable risks while traveling in the United States. On the other hand, in the countries of Africa, Asia, South and Central America, the South Pacific, Middle and Far East, living conditions and standards of sanitation and hygiene can vary greatly, depending on where you are. Some cities in these areas provide safer and healthier envirnoments than outlying rural areas. But the opposite can also be true. The key to survival and good health is, beyond everything else, in knowing what to expect.
Wherever you go, if your travel is limited primarily to tourist areas, there is understandably less risk of exposure to food or water of questionable quality, and thus the risk of disease remains narrow. But as a student, you may travel to cities off the usual tourist routes or live in small villages or rural areas for extended periods of time. In doing so, you of course enrich your education, but you may also run a greater risk of acquiring infectious diseases through exposure to water and food of uncertain quality.
Some Not-Too-Uncommon Diseases: Diarrhea is a common affliction that usually strikes a couple of days after arrival in a new area of the world and seldom lasts longer than about five days. Diarrhea is nature's way of ridding the body of noxious agents; intestinal motility serves as the normal cleansing mechanism of the intestine. The most important way of coping with this disorder is to maintain adequate fluid intake to prevent dehydration. Most cases of diarrhea are self-limited and require only simple replacement of fluids and salts lost in diarrhea stools. Fluids that are readily available, such as canned fruit juices, hot tea, or carbonated drinks, may be used. Your physician may be able to prescribe medication to take along for relief of the symptoms. However, it is strongly recommended that you consult a physician rather than attempt self-medication if your diarrhea condition is severe or does not resolve itself within several days, if there is blood and/or mucus in the stool, if fever occurs with shaking chills, or if there is persistent diarrhea with dehydration.
Tetanus, commonly known as "lockjaw," is an infection of the nervous tissue produced by a contaminated wound or injury. Severe muscle spasms are produced, and if left untreated, tetanus can be fatal. Cleanliness (lots of soap and water to remove contamination of a wound or injury) is one of the most effective weapons to prevent this kind of infection. Tetanus immunization is available, often in combination with the diphtheria vaccine. Tetanus boosters are recommended every ten years after the initial series of three injections administered one month apart.
Hepatitis A (Infectious Hepatitis) is most prevalent in North Africa, the Middle East, and the Caribbean. However, it is possible to contract the disease anywhere (including in the United States) that living conditions are crowded and unsanitary. Hepatitis A is transmitted orally through the ingestion of contaminated food or water; clams, oysters, and other shellfish, especially if eaten raw, are common sources of the disease in contaminated areas. A variety of symptoms are associated with the disease, including fever, loss of appetite, nausea, abdominal pain, and yellowing of the eyes.
Malaria, which is transmitted by the female Anopholine mosquito, is common to parts of the Caribbean, Latin America, Africa, the Middle East, and Asia. Anti-malaria medication is available and is required for those who will be participating in a program in Africa. Instructions on taking the medication must be followed carefully to insure adequate protection; you must usually begin taking the medication prior to your departure, during the entirety of your visit, and for two or three weeks after return to the United States. (The organisms that cause the disease do not invade the red blood cells until about a week or so after the bite of the mosquito.)
Other Infectious Diseases: Certain viral, bacterial, and parasitic infections acquired abroad may not result in any immediately illness. Some diseases (such as malaria) may not produce symptoms for as long as six months to a year after a traveler returns. Should you become ill even well after returning to the United States, you should not hesitate to inform your physician of your travel outside the United States within the 12 months preceding onset of the illness. Knowledge of the possibility of exposure to certain diseases abroad will help the physician arrive at a correct diagnosis.
If you need medications regularly, take an adequate supply with you. Do not buy medications "over the counter" while you are overseas unless you are familiar with the product: "Over the counter" drugs abroad are not regulated by the US Food and Drug Administration.
If you have diabetes, are allergic to penicillin, or have any physical condition that may require emergency care, carry some kind of identification--a tag, bracelet, or card--on your person at all times indicating the specific nature of the problem and spelling out clearly what must or must not be done should you be unable to communicate this information yourself (e.g. in case of unconsciousness).
Prescription medicines should be accompanied by a letter from your physician. This letter should include a description of the problem, the dosage of prescribed medications to assist medical authorities during an emergency, and the generic name(s) of medicine listed.
Any special health needs or medical conditions should be noted on medical history forms you are advised to travel with you. If you are required to take a medicine containing habit-forming or narcotic drugs you should carry a doctor's certificate attesting to that fact. It is also advisable to keep all medicines in their original and labeled containers. To avoid potential problems and because laws may vary from country to country, if you need to carry such medicines you should consult the embassies of the countries you will visit before departing the US (from Gist, published by the Bureau of Public Affairs, Department of State, March 1986).
Should you require medical attention abroad, it may be necessary for you to have sufficient cash on hand to make payment at the time of treatment since the foreign physician and/or hospital may not be able to process medical bills through an American insurance company. In such cases, be sure to obtain a receipt to submit with your insurance claim for reimbursement upon return to the US. It might also be helpful to carry a few blank claim forms with you in case you should need them while abroad.
Protection against cholera and yellow fever are recommended for those going to certain parts of Africa, along with medicine for protection against malaria. Remember that to be effective, these anti-malaria drugs must be taken regularly and in strict accordance with the doctor's instructions. Even though you may be limiting your travel to western Europe, you may still wish to discuss with your personal physician the advisability of receiving certain basic immunizations, like tetanus and typhoid fever. Since you will probably be doing a lot of knocking around overseas, it will be easy to suffer a few minor cuts and abrasions on occasion; it is always a good idea to have protection against tetanus just in case such a wound might become contaminated.
During weekend or post-program travel, you may find yourself in a variety of unfamiliar and possibly remote locations. If you are not fluent in the language of the host country, of course try to seek out an English-speaking doctor if you need medical attention: when it comes to health matters, you will not want to take any chances on a breakdown in communications. American embassies and consulates, many large travel agencies (e.g. Thomas Cook) and a number of the larger hotels abroad will have lists of English-speaking physicians. Some agencies have also been established to assure travelers needing medical care (e.g. with a pre-existing medical problem) a reasonable, preset fee with reputable physicians fluent in English.
If you have a pre-existing medical condition or simply are concerned about health facilities while you are overseas, you must take steps to find out about health care in each countries in which you expect to spend any time. [See below]
Everything you already know about what AIDS is and how it is contracted is as deadly true overseas as it is at home. Knowing this and taking all advised precautions is the only way to protect yourself. AIDS is considerably less an epidemic in some countries than in the U.S., and considerably more in others. Whatever the situation in the country you are going to, you are not more likely to contract AIDS there than here--IF you act sensibly and refrain from unprotected sex and other behaviors and habits with carry the risk of infection. As The World Health Organization states: "AIDS is not spread by daily and routine activities such as sitting next to someone or shaking hands, or working with people. Nor is it spread by insects or insect bites. AIDS is not spread by swimming pools, public transportation, food, cups, glasses, plates, toilets, water, air, touching or hugging, coughing or sneezing." This is as biologically true abroad as it is in your hometown.
However, since you will not know your environment overseas as well as you do at home, or might not be able to control it to the same degree, there are some things you should be concerned about in advance, to prepare yourself for all eventualities.
Knowing Your HIV Status When traveling abroad, be aware that some countries may require HIV antibody tests, a test for antibodies to the human immune-deficiency virus (HIV) that causes AIDS. You should also know that some countries may not have the resources to adequately screen blood or provide sterile needles.
Living overseas in certain areas MAY present greater risks to those who test positive for the HIV virus. Some overseas locations have limited medical facilities that cannot monitor the progress of such infections. Therefore, if you believe you may be infected, knowing your HIV status will help when planning your trip.
If the Country You are Going to Requires an HIV Antibody Test: Some countries now require incoming foreigners, including students, to take the HIV antibody test. Usually this is required for long term stays. Check to see if the country you are going to requires HIV-testing. You may need a "doctor's certificate" showing the results of an HIV antibody test. Consulates in Washington DC and/or New York City carry information on HIV testing as well. If you decide you want to be tested, do so only at a center that offers pre- and post-test counseling. There are many institutions whose primary focus is AIDS counseling. Allow yourself two weeks for the testing process. Finally, consider getting tested twice-first anonymously (which allows you the privacy to decide what you want to do if the result is positive), then again for a doctor's certificate, if needed.
Overseas Blood Transfusions and Blood Products And HIV Screening: While many countries such as the United States, Australia, Canada, Japan, and the western European countries have mandatory screening of donated blood for the AIDS virus, not all do. You should find out before you go from your campus resources, from your local Red Cross and/or western embassies about safe sources of blood overseas. In some locales, ascertaining the availability of HIV-screened blood and blood products may be difficult. Because of obvious uncertainties, consider these precautions: If you are injured or ill while abroad, avoid or postpone any blood transfusion unless it is absolutely necessary. If you do need blood, try to ensure that screened blood is used.
Regardless of the blood screening practices abroad, always try to reduce the risk of serious injury which may require blood transfusions by taking everyday precautions. If you are sexually active, ALWAYS USE A LATEX CONDOM. Take a supply with you as conditions, manufacturing and storage of condoms in other countries may be questionable. Take good care of yourself while traveling! Don't wear yourself down, watch out for excessive exposure to heat, drink plenty of fluids to avoid dehydration, and get plenty of sleep!
Overseas Injections and AIDS: Here in the United States, we may take for granted disposable equipment such as needles and syringes. Be advised that some foreign countries will reuse even disposable equipment. In some countries, if injection is required, you can buy needles and syringes and bring them to the hospital for you own use. Avoid injections unless absolutely necessary. If injections are required, make sure the needles and syringes come straight from a package or have been sterilized with chemicals or by boiling for twenty minutes. When in doubt, ask to see how the equipment has been sterilized.
Caution regarding instrument sterilization applies to all instruments that pierce the skin, including tattooing, acupuncture, ear piercing and dental work.
The Center for Disease Control recommends that "Diabetics or other persons who require routine or frequent injections should carry a supply of syringes and needles sufficient to last their stay abroad." It is not uncommon to bring needles for your own use. However, be aware that carrying needles and syringes without a prescription may be illegal in some countries. Take a note from your doctor if you do need to carry needles and syringes. Some countries have needles and syringes for sale. DO NOT use or allow the use of contaminated, unsterilized syringes or needles for any injections, e.g., illicit drugs, tattooing, acupuncture, or for medical/dental procedures.
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