Jason High, an insurance agent from Newton, Kansas, has spent his career assessing risk, but nothing could have prepared him for the medical journey he started in April 2017.
During a seven-day cruise in the Caribbean that he earned for being a top agent at his company, High and his wife, Racquel, decided to rent a moped when the ship docked on the island of Antigua. He drove and she sat behind him.
“We were driving to the beach and we went from being on smaller streets to kind of a highway,” High recalled. “When we got on the main road, we swerved to miss another car and we hit a curb and flew and hit a light pole that came down and hit my knee and then my femur bone went through my pelvis.”
Travelers from the United States may be accustomed to certain standards of safety that other countries do not meet.
“Whatever safety systems exist in the U.S. are not going to be there in other countries,” said Herbert L. DuPont, M.D., director of the Center for Infectious Diseases at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health. “There are no railings in dangerous areas where you may fall, there are breaks in the sidewalks, wires that hang at eye level. … There are hazards all the time. We have to exercise care in a way we don’t in this country and be careful and go slow—and that is preventive medicine.”
• • Buy travel insurance • •
Between 18 and 24 percent of deaths among travelers in foreign countries are caused by injuries, compared to only 2 percent of deaths caused by infectious diseases, according to estimates from the Centers for Disease Control and Prevention (CDC). Experts hypothesize that the increased injury toll for travelers can be attributed to multiple factors—unfamiliar and risky environments, differences in language and communications, less stringent product safety and vehicle standards, unfamiliar rules and regulations, as well as a carefree holiday or vacation spirit leading to more risk-taking behavior.
“A lot of times people travel abroad in order to do certain activities, such as mountain climbing or base-jumping or parasailing,” said Richina Bicette, M.D., assistant professor of emergency medicine at Baylor College of Medicine. “Those are all very dangerous activities. They look fun, but we aren’t really sure what the regulations are overseas. Usually they are not regulated by a government. They are locals who have created a business, so there is no way to make sure you will be as safe as you are in the U.S.”
High’s injuries were severe. After the accident, he was taken to one of the largest hospitals on the island.
“The hospital wanted $1,000 before they would let me see a doctor,” High said. “A surgeon who traveled between the islands was at [the hospital] that day. Immediately, he could see my knee was about six inches offset from the other one and he said, ‘We have to get this reset right now because your leg or any of your joints can only be out for two hours before the blood vessels die and the bone ends up dying.’”
After resetting High’s leg, the surgeon delivered a stern warning.
“The doctor that set my leg told me that I needed to do everything I could to get out of this hospital to have the surgery,” High said. “He told me that if I had the surgery there, I would die.”
But the price to get home was a staggering $47,000.
Fortunately, when High’s company booked the trip, they also bought travel insurance.
“To be evacuated back to the U.S. is extremely expensive,” DuPont said. “If you have one of these $40, $50, $100 travel insurance plans, all of that will be covered. It feels like insurance should be a requirement for all U.S. travelers.”
About 30 hours after the crash, High and his wife were picked up by an air ambulance and flown back to the U.S., where High had surgery.
“The trip insurance reimbursed us for everything,” High said. “I think at one time, I estimated the total cost was $315,000 for the surgery—flight and everything. Your trip insurance pays for everything out of the country and then once I was back here, my insurance took over for the rest. For the flight and everything in Antigua, it was about $70,000.”
Travel insurance is the No. 1 recommendation DuPont and Bicette make for travelers.
“It is usually pennies on the dollar for whatever you are paying for the trip and it can save you a ton of money and headache in the long run,” Bicette said. “When you are in the states, and you live in Texas but are traveling to New York and you get hurt and you have to seek medical care, your insurance will cover the cost even if you’re not in your home state of residence. If you’re abroad, that is usually not so much of a guarantee and people don’t oftentimes know that.”
Travelers can purchase travel insurance when booking flights, or separately, through a provider.
“The cost varies depending on the trip you take, but that cost includes all medical costs and evacuation insurance to get you back to the U.S. once you’re stabilized,” DuPont said. “It sounds expensive to a traveler, but to a traveler who uses it, it’s an amazing cost savings.”
• • Get informed, get vaccinated • •
Travel experts warn that for certain destinations, accessing care can be challenging. DuPont recommends joining the International Association for Medical Assistance to Travellers (www.iamat.org), a Canadian nonprofit that provides travel health information and access to a network of English-speaking doctors around the world.
“If you’re in a hotel, they usually have people that work with the hotels that you can summon to you,” DuPont said. “You can also call the U.S. consulate in the city you are in and they have a list of doctors who take care of U.S. people living there. If all else fails, go to a university hospital. Everywhere you go in the world, people are required, by law, to see you.”
In addition to the risk of injury, travelers might encounter other health-related situations, including contracting a disease or succumbing to food poisoning.
“Measles is highly, highly contagious—so contagious that you don’t actually need to come in contact with someone that has measles to get it,” Bicette said. “For example, say someone that has measles was in a hotel room before you got there and they were coughing and sneezing. Those respiratory droplets will still be there even if the person is gone and you may still be at risk.”
The best way to protect oneself from measles is by getting vaccinated with the measles-mumps-rubella vaccine. The CDC recommends getting vaccinated at least two weeks before departing on a trip. Even if travelers are within two weeks of a trip, they should still get vaccinated.
The Centers for Disease Control and
Prevention (CDC) recommends protecting
against measles before international travel.
Plan to be vaccinated at least two weeks
before departure with the measles-mumps-rubella
(MMR) vaccine. The CDC does
not recommend measles vaccine for
infants younger than 6 months
• • Eat food dry, peeled or hot • •
To mitigate the risk of food poisoning, Bicette suggests avoiding street food and DuPont swears by a “dry, peeled, hot” rule.
“We have done research on this over the years and the foods that are safe are very simple,” DuPont said. “They are dry foods—the bacteria that cause disease need moisture, so anything dry is safe. That is bread, toast—safe. Anything that is steaming hot—if you see steam coming from food, it is safe. If you peel something, it is safe. For example, a melon at a breakfast buffet, that is safe because the contamination is on the surface. If you stick with dry, hot, peeled, you’ll never get sick.”
The UT Physicians International Travel Medicine Center, a once-a-week clinic offered at McGovern School of Medicine at UTHealth, prepares travelers by offering pre-travel exams, vaccinations, contact information for U.S. embassies and consulates, and follow-up care.
“Our patients come in because they want to stay healthy while they travel,” said Maria Reyes, RN, a travel medicine nurse with UT Physicians. “We check vital signs, make sure their blood pressure is OK, their heart rate is OK and they’re not running a temperature, and check their weight. We go through their medications, provide vaccinations if they are needed.”
DuPont said in regard to preventive medicines, the most important is malaria prophylaxis if you’re going to a malaria endemic area, which includes parts of Africa, South Asia and Central and South America.
Anti-diarrheal medicine is also a must for many travelers.
“Malaria kills people; diarrhea makes them feel like they’re going to die,” DuPont said. “Arming yourself with medication for diarrhea is important if you’re going to an area in Latin America, Asia or Africa. If you’re going to Europe, Australia, Japan, New Zealand, no problem. But if you’re going to these other areas, you need to bring something to protect you from illness.”
Being prepared is the key to a safe and healthy trip.
“You can’t live in a perpetual state of fear or you will never be able to experience life,” Bicette said. “Always consider your safety when traveling, always have bail out plans, make sure someone knows where you are every step of the way, make sure you have a way to contact people at home and that they can contact you.”
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