A good friend called me once with an interesting request. He was planning a trip with his wife and children to a somewhat unconventional part of the world and was looking for advice as to what to bring and which medical hazards to look out for. In these days of business travel to the third world and adventure travel to exotic locales, this is becoming a more frequent issue.
My first thought was to refer him to a travel clinic. But beyond the proper vaccinations, what advice should I be giving? As it turns out, travelers to rural or remote areas can be faced with one or more of the "Six I's":
1 Insects -- which may transmit malaria, encephalitis, Lyme disease, leishmaniasis, and a multitude of other nasty diseases. Most can be avoided with DEET-containing repellents, but take prophylaxis for malaria when recommended. See the CDC for geographic information and advice.
2 Ingestions -- contaminated food and water. When out in the "country" (even some cities in the third world), don't put it in your mouth unless it has been thoroughly cooked, boiled, or peeled. Water (even ice) should be avoided unless purified.
3 Indiscretions -- mainly of a sexually adventurous nature. Sexually transmitted diseases include HIV. Avoiding contact is best. Using condoms is better than not.
4 Injuries -- due to "accidents." The laws of physics have not been suspended because you are on vacation. Obey all of them, especially the laws of gravity and momentum. Wear seatbelts and life jackets. Don't drive motorbikes if you are not expert at it. If what you are doing seems dangerous, it probably is.
5 Immersion -- in tropical parasite-containing fresh water. Swimming in fresh water in some tropical climes can result in schistosomiasis.
6 Insurance -- Insurance-not just health insurance, but evacuation insurance as well. Beyond checking with your insurer to make sure you are covered, consider evacuation insurance if you will be at sea or in truly remote places. The chances of needing medical evacuation may be small, but the costs if you do can be huge (usually starting at $15,000 and escalating rapidly). Many travel and tour agencies offer it, but I would advise getting your own from a reputable source.
Perhaps the most important item is an adequate supply of any medications that you take on a regular basis. Don't assume you can purchase prescription medications in foreign countries without a doctor visit / local prescription, or even find them at all in remote locales. But DO NOT travel with narcotic medications unless you have a legitimate prescription (bring it with you -- and even then this could be troublesome). Always put your medication in a carryon to avoid the "lost luggage" scenario.
Finally, a medication kit is a good idea and -- depending on your plans -- might include malaria prophylaxis, condoms, and medication to combat traveler's diarrhea and other infections. In addition, a basic first aid kit should have lots of band-aids, a couple ace bandages, disinfectant, and antibiotic ointment.