Alla Kirsch, M.D. loves to travel and, having traveled around the world, is now waiting on cheap flights to the moon. She is passionate about everything she does, including her practice in family medicine. As a strong believer in proper medical preparation, immunizations and prescriptions for any trip, she is dedicating herself to educating travelers and physicians on the need for pre-travel medical consultations. In 2008, she co-founded Travel Clinics of America to make travel medicine accessible to everyone through their primary care physicians.
Cheapflights: What should a first-time traveler to an international destination do to prepare?
Alla Kirsch, M.D.: My first suggestion for all travelers is to start preparing as soon as they make their plans. Time may be needed to get visas, travel vaccines, and even to learn a few words in the local language.
For travelers going on a vacation, my suggestion would be to carefully research the destination. I think it is important to take the time to figure out what makes the country unique and learn about the local customs, traditions and people. Then I would start learning about the specific places to visit and if travel there presents any unusual physical or health demands.
As a physician, I believe a consultation with a travel medicine specialist is a must before a first international trip. Business travelers in particular may not be familiar with health risks abroad and falsely assume that stay in 5-star hotels protects them.
All travelers should make sure they have an up-to-date passport and any necessary visas, of course, but I also recommend looking into international driver’s license if you are planning to drive. Although often overlooked, I would advise purchasing travel medical insurance, which is invaluable not only in case of an emergency but also for getting help in dealing with an injury or illness. Medicare and many of the commercial insurances do not reimburse medical expenses incurred abroad.
CF: Are there special considerations one should take when traveling within the U.S.?
AK: As a physician, my main focus when consulting travelers is on health risks. Fortunately, there are few unique health risks when traveling domestically. If you use common sense and maintain proper hygiene, you should be fine.
One piece of advice I give all travelers is to pack all essentials in carry-on luggage in case checked baggage does not arrive. My list of essentials includes prescription and nonprescription medications, an extra pair of glasses or contacts, and written prescriptions in case you need to get refills. Also, don’t forget to check with your medical insurance if you are covered in other states.
CF: What are some of the most common travel-related diseases and ailments and how can they be prevented?
The most common travel-related diseases and ailments are the same as at home: colds and rashes. Cardiovascular problems are also high on the list. A consultation with your regular doctor before a trip may be prudent to make sure that you are fit for travel.
Travelers tend to take more risks than they would at home and therefore are more likely to get injured. It has been well documented that travelers engage in more casual sex and are at risk for HIV, hepatitis B, syphilis and other STI’s. Motor vehicles accidents are high on the list of injuries due to poor road conditions and varying traffic laws from country to country. Travelers need to be very careful when crossing streets to avoid being hit by cars and other moving vehicles.
Traveler’s diarrhea or Montezuma’s revenge occurs in up to 60 percent of people traveling through developing countries for 2 weeks or more. Good hand hygiene and making careful food and beverage choices decrease the chances of getting ill.
Foreign mosquitoes may expose travelers to malaria, dengue, Japanese encephalitis and other diseases. To protect themselves, travelers need proper immunizations and prescription medications, and to learn the correct way to use DEET-containing bug repellants.
Be aware that every region has unique diseases and risks that should be accounted for in advance, which is why I urge all travelers to see a travel doctor for advice and immunizations.
CF: For parents traveling with children, are there additional special precautions to take to stay healthy?
AK: We take proper child restraints for granted in this country but they may not be available abroad. Bring your own car seat which you can use on the plane and in a rented car. Roads in developing countries are often bumpy and combined with the fact that kids are more prone to motion sickness, car travel may be less than smooth. To decrease symptoms of motion sickness symptoms, teach children to look ahead and far at the horizon when riding in a car. You can also minimize symptoms by choosing to sit in the front of the bus or over the wings on the plane.
Pets abroad may not have had their immunizations and are potential rabies transmitters. I would encourage parents to keep their children from interacting with domesticated or wild animals and teach them to report any animal scratches or bites. To prevent rabies, it is very important to get immediate medical care in case of an animal bite.
CF: Do you have a routine for staying healthy when you travel?
AK: It starts before I travel. I always make sure I’m up to date on any necessary immunizations. If I am traveling to a destination that has malaria, I start taking my anti-malarial medication and make sure I keep up with it during and after the trip. While traveling, I am really careful with washing my hands and trying to stay away from people who are coughing and sneezing. I am religious with using sunscreens and bug repellants. I make sure I drink lots of safe water especially if I am in hot or cold climates. Admittedly, although I know and try to follow all the rules for safe food and water, I frequently make mistakes. Remembering prior episodes, I make sure that I take along Cipro, an antibiotic which is quite effective in self-treating traveler’s diarrhea.
CF: In terms of your own travel habits, what kinds of destinations do you prefer?
AK: Personally, I love to take active vacations in places off the beaten path, staying in small independent hotels and eating where the locals eat. I am not big on traveling in big groups and prefer to travel with a friends or family members who have similar interests. In new places, I typically hire reputable local guides and ask lots of questions to learn not only the history but also the traditions and customs. Although I have traveled through much of Europe, I have recently started to travel to South and Central America.
CF: What is an absolute must on your packing list?
AK: A second pair of glasses. Once when I was in California, my glasses broke and I was left with wearing sunglasses until the next day. Not fun. Now I always travel with a spare pair.
CF: What’s your routine before you fly?
AK: I try to get to the airport early so I can check bags and relax at the gate stress-free. I make sure that I have my headphones and my iPod is fully charged, so I can listen to music and drown out the noise.
As a doctor, I worry about blood clots, so on long flights, I prefer an aisle seat which makes it easier to move around the cabin. Staying well hydrated also decreases risk of clots, so after I go through security, I purchase a large bottle of water.
CF: Any tips on researching a new destination before taking off?
AK: There are so many places on the web that one can tap into for information. But from the medical point of view, great places to research safety at the travel destinations are the websites for the Department of State, World Health Organization and Centers for Disease Control and Prevention. I also like to know what clothes to bring, so I always check out a weather-forecasting site.
CF: How do you discover local or off-the-beaten-path places?
AK: I always search for places on websites where travelers post their experiences. If many people recommend a specific local guide, I try to connect with him. Once I have a basic plan of where I’ll be going, I contact local hotels and companies at my destination and ask for their advice. I’ve put together great trips by asking local people. For me, there is something exciting everywhere.
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