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Introduction

Traveler health is often the primary focus of people who travel, however the overall safety of the traveler includes health and measures to protect you from harm. Having an understanding of risks and being prepared to address those risks can mitigate harmful or dangerous situations. Get to know the local conditions, political environment, laws, and culture of the places that you will be working. Being aware of your surroundings, practicing safety precautions as a healthcare provider, and having safeguard measures in place prior to travel will minimize unforeseen dangers to security and well-being.

Personal Protection Equipment (PPE)

Check with your host or host organization about the need or availability of various PPE prior to travel. Consider bringing a supply of PPE if you will be doing a clinical or field rotation in a remote area where medical supplies are limited. Primarily intended for personal use, but unused items can also be donated to the clinical site. The key items to include are gloves, N95 masks, and some form of eye protection.

Personal Safety

In addition to PPE and protecting yourself from clinical or medical related exposures, personal safety measures for international travel include those to help prevent you from becoming a victim of crime or harm. These include individual considerations, services offered by organizations, and country or government level resources.

Individual considerations:

Know about your housing: Will you be staying alone? Is the site secure? Are there reliable phone or internet services available? Where will your housing be in relation to the medical site? If you are offsite from the medical center, inquire about the commute and transport options.

Be street smart:
. Use the same principles for assault prevention as you would anywhere else.


. Be vigilant if traveling alone or at night.

. Do not travel with a lot of cash.

. Avoid large gatherings with potential to become violent, i.e. protests, fights, or anything where a situation appears to be escalating.

. Keep valuable electronics, jewelry, watches at home or out of sight.



Have photocopies of travel documents: Carry copies of your passport, driver's license, credit cards and/or traveler's checks, itinerary, insurance policies. Another alternative is to have electronic copies of travel documents and contacts in a cloud-based application, like Dropbox. Be sure that you can access them offline as well.

Be familiar with local laws: While abroad, you abide by local law. The U.S. Embassy cannot protect you from legal proceedings in foreign countries. Some laws, such as those pertaining to drug use or possession, are harsh.

If you lose or your passport is stolen: File a police report immediately. You will need it for replacement. Contact the U.S. Embassy ASAP. They assist in stopping anyone from traveling with your documents and will provide a replacement passport for you to be able to return home.

Have a list of emergency contacts at home and abroad: These should be designated prior to departure and available to your host site or organization and friends or family at home.

Enroll in STEP (see below)

Institutions and organizations:

Many institutions and organizations have safety and security programs for faculty, staff, and students for travel abroad. Be sure to check with your institution or organizations if there are protocols or services in place. Some host organizations may provide security, housing, and transportation.

Government Resources:

The United States Department of State is an essential place to research any intended country or region of travel. They provide information for the traveler as well as for family members or friends. http://travel.state.gov/content/travel/en.html
Travel alerts are issued when there are "short term" events that may alter your decision to travel to a destination, such as natural disaster or an election expected to be associated with civil unrest. Travel warnings are issued when travel is not advised because of dangers such as unstable governments, civil war, escalating violence, or terrorist activities.
Remember that every situation is unique and just because a country is not on the list it does not guarantee your safety. Also, some countries cultures may be outright hostile to certain populations (e.g. women, LGBT, race/ethnic background, religion). Be aware of any issues that might exist in your intended country or region of travel.
U.S. Embassies, Consulates, or Consular Agencies are invaluable resources when traveling. Consular personnel are available at all times. Know the location and contact information for the closest agency to your destination.
Smart Traveler Enrollment Program (STEP) is a free resource provided through the U.S. Department of State Bureau of Consular Affairs. Enrollment allows for a more seamless communication between the traveler, consulates, and/or the traveler's family. The traveler will also receive safety notices from the Embassy. https://step.state.gov/step/


Insurance

Having some form of insurance while traveling is essential. The location and duration of the trip may determine the type(s) that you need. For travel abroad, there are three types of coverage: travel, medical/health, and medical evacuation. The three types can be bundled into a single policy. They are defined as the following:
. Travel Insurance - covers trip finances with reimbursement for trip cancellation, delay, or lost luggage.

. Travel Medical Insurance - insures overseas medical treatment.

. Medical Evacuation Services - provides transport including air ambulances, for medical evacuation.


Check your current health insurance for inclusions and exemptions, as it may already cover health insurance abroad. Also, if heading abroad with an organization, insurance may be included. Depending on the country, health insurance may not be recognized. In regards to priority when traveling for global health work, the most important type of coverage to have is probably medical evacuation, especially if the work is in a low-resource setting. Without insurance, the cost of a medical evacuation can easily exceed $50,000.
There are numerous companies offering policies. Be sure to know the services and extent of services provided or not provided as there are distinctions to each type of policy. A comprehensive list of insurance providers is available through U.S. Department of State website http://travel.state.gov/content/passports/english/go/health/insurance-providers.html
Things to ask about your abroad coverage:
. What does the insurance policy cover?

. Are pre-existing conditions covered?

. Are high-risk activities covered (e.g. mountain climbing, scuba diving)?

. Is preauthorization required prior to receiving emergency treatment?


. Is it necessary to carry copies of claim forms?

. Are medical payments abroad guaranteed? Are foreign doctors and hospitals paid directly?

. Who determines need for medical evacuation?

. Does the insurance company have a 24-hour physician backed support center?

. What kind of transportation is provided and to where?




References

1. Centers for Disease Control. Traveler's Health [website post]. Retrieved 4/21/15 from http://wwwnc.cdc.gov/travel/

2. Hansoti et al. "Guidelines for safety of trainees rotating abroad: consensus recommendations from the Global Emergency Medicine Academy of the Society for Academic Emergency Medicine, Council of Emergency Medicine Residency Directors, and the Emergency Medicine Residents' Association. Acad Emerg Med 2-13;20:413-420.

3. Iverson, Kenneth. The Global Healthcare Volunteer's Handbook. Tucson: Galen Press, 2014, Print.

4. U.S. Department of State, Bureau of Consular Affairs. Traveler's Checklist [website post]. Retrieved 5/1/2015 from http://travel.state.gov/content/passports/english/go/checklist.html

5. World Health Organization (WHO). Travel and Health [website post] Retrieved 4/21/15 from http://www.who.int/topics/travel/en/