International travel is easier than ever, and the number of people who travel abroad to remote and exotic locations continues to increase. This leaflet offers some basic health-related advice on preparation to those who may be travelling off the beaten track, or to environments to which they are not normally accustomed. It also offers advice on first aid kit preparation for remote locations. This is not so that you can bypass medical help and self-treat. It is so that if you seek medical help from other travelling health professionals, they can advise you what medicines you need to take and you can then follow their advice.
What preparation and advance planning are required?
Remote travel is easy and accessible these days. However, once you get off the plane you may find yourself in a very different environment from the one you are used to. Time spent in preparing, and understanding your destination and the conditions you can expect, will help ensure you get the most out of your trip.
Consider what medical support is available. If travelling with a group or expedition find out what level of medical support is being offered. Remember, even if a doctor is attending your trip they are unlikely to be equipped with a large supply of medication. Consider what you are likely to need.
Not all destinations are as safe as home. Remote travel involves a degree of risk over and above that of a 'normal' trip. In the event of serious illness or injury it could be hours or days before you can be evacuated.
Before travelling, consult the Foreign and Commonwealth Office (FCO) website for advice on conditions at your destination. If travelling in areas where there is political instability or disorder notify the British Embassy or British Consulate in that country of your intention to travel. Understand your destination. There could be local unrest or terrorist activity that does not make daily news in the UK but which could be a risk to you. In addition to political problems there may be hostility towards 'wealthy' travellers or sensitivities and specific laws around dress codes and behaviour. Consider whether to leave jewellery and valued watches at home.
If you will be travelling 'off the beaten track' leave an itinerary, even if only approximate, with a friend or family member and arrange to contact someone at regular intervals, so that they will raise the alarm if you are not in touch.
Be aware of law and expectation around alcohol, drugs and sex in the countries you are visiting. Misunderstandings can generate hostility or legal difficulties. Be aware that in some countries sharing a hotel bedroom with someone who is not an opposite-sex spouse can be considered a crime. Illicit drug use can attract extreme penalties.
The most common reasons that travellers get into serious difficulty when abroad is from traffic-related accidents and injuries such as falls. Relaxing into 'holiday mode' and forgetting your usual caution can contribute, particularly if alcohol is involved.
Make sure that you are psychologically prepared for your trip. It can be difficult to adapt to being away from family and friends, in the company of strangers and in an uncomfortable or difficult environment. Your connectivity to friends and family through telephone and social media may not function. Problems and low moments may be less easily shared. If you have a history of any psychological problems such as alcohol dependency or depression, make sure that you feel that these issues are under control before you plan to travel.
Consider particular challenges of your planned journey, such as extremes of temperature, humidity and altitude. Make sure you are fully prepared and physically able to meet the challenges you are planning.
Food and drink
Consider what food will be available to eat. The risk of infection of the gut (gastroenteritis) is very high in travellers to remote locations. In some circumstances (such as where no refrigeration is available) avoiding meat may limit the risk to some degree. If trekking, consider taking snacks with you from the UK, such as fruit and nut mix, which will provide slow-release carbohydrate for energy. Sugar sweets can help with short-term low energy on a walk; however, over-reliance on these whilst exercising can lead to blood sugar swings and a sensation of being tired or 'hypo'.
Consider what drinking water will be available. If you will need to take water purification tablets or filtration systems check them before you leave. Make sure that they work and that you find the taste of the water palatable.
These include extremes of temperature, weather and altitude, which are discussed below. They also include dangerous animals (large and small, on land, in the air and in water), infectious disease and natural disaster, and difficult terrain. Inform yourself before you travel.
Health check and fitness to travel
If you have ongoing health or fitness issues, see your doctor well before you travel. You can then make sure that he or she agrees that you are fit to make the journey.
- Make sure that you have declared any existing medical conditions to your travel insurer.
- Remember, if you travel against medical advice you may invalidate your insurance.
Remember the risks of long-haul air travel in terms of deep vein thrombosis and pulmonary embolus. When travelling by air try to move around the cabin at intervals. Consider using flight socks to reduce the risk still further.
Remember that extreme environments stress the human body and if you are not well you may not be fit enough to enjoy the challenge. Consider whether, if taking an adventure holiday to a difficult environment, or one which involves a level of physical activity which is unusual for you (such as trekking), you have prepared adequately.
If you take regular medication make sure you have a sufficient supply for your trip, building in an allowance for any travel delay.
- If your medication includes controlled medicines, be aware that it is not always possible to take these with you. Get advice before you travel: the USA in particular has a long list of prohibited medications which will at the very least be taken from you if found. Carry medication in your hand luggage if possible and carry documentation that it is legally prescribed for you if required.
- If you have diabetes and use insulin remember that your insulin should not travel in the hold of the plane. It may freeze there and become less effective, or less predictable.
- Take medical advice on how to adjust your insulin if travelling between time zones.
- Carry a medical letter with details of any therapy with medicines and their generic names and dosages. Take prescribed medicine in the box labelled with your name by the pharmacist - this is the only way that you can prove to a customs official that it is yours.
When travelling to remote locations a tooth problem can be distressing and impossible to solve. If you will be travelling off the beaten track then make sure that you have had a dental check-up within a reasonable interval of travel.
Eye protection: contact lenses and sunglasses
If you use contact lenses consider whether conditions will allow you to manage your lenses hygienically. Take a pair of spectacles with you just in case. Consider whether it would be sensible to switch to spectacles or daily disposable lenses for your trip.
Travellers to altitude and to extremes of cold may find that contact lenses become uncomfortable because of the drier air at altitude. Take lubricating drops in addition to your lens steriliser.
If travelling to mountainous regions where there is snow take a pair of good sunglasses, ideally those that protect your eyes at the side as well as the front. These will protect against snow blindness, a painful condition caused by overexposure to ultraviolet light.
Pregnancy and remote travel
Consider whether, if pregnant, you really need to travel to a remote or unsafe location. No pregnancy is risk-free. If there are problems in a remote place they may be difficult or impossible to solve in the way they could be solved at home.
- Some infectious diseases such as Zika virus and malaria are more serious in pregnant women, and some vaccinations cannot be given in pregnancy.
- Make sure that your travel insurer knows that you are pregnant.
- Most airlines will carry pregnant women up to 28 weeks without a doctor's letter, and up to 34-36 weeks with one.
Children and remote travel
Taking children to remote and exotic places is both exciting and educational for the child. However, children also face risks to health and welfare. If they are very young, consider whether they would benefit more from that challenging trip when a little older and able to remember and participate more. Consider whether there is enough medical provision at your destination to keep your child safe.
- Seek medical advice for your children before you travel. Make sure they are fully immunised against those diseases against which they can be protected.
- Children generally find antimalarial medication difficult. Chewable tablets taste bitter, and liquid preparations are often even worse. Make sure your children can cope with the recommended medication before you arrive in the malarial zone.
- Children are very susceptible to lack of fluids in the body (dehydration) if they develop traveller's diarrhoea.
- Children's skin is more susceptible to sunburn, especially at high altitude.
- Children are just as likely as adults are to develop altitude sickness, but less likely than adults are to be able to describe the symptoms.
- Children are less wise than adults when it comes to physical risks like swimming in fresh water or crossing a busy road.
- Children are less likely than adults to show caution with strange animals and are therefore at greater risk of rabies and other animal-related injury.
- Always take high temperature (fever) seriously when travelling with a child in a remote location.
- If children become unwell, seek advice - children do not always have the same symptoms as adults have if unwell and they may have difficulty describing symptoms.
Humanitarian aid workers and remote travel
If you are travelling overseas to provide disaster relief of humanitarian support you face greater health risks than regular tourists. This is because of your close contact with the local population, and the fact that you are going into a hazardous environment. You may also have to contend with the aftermath of natural disaster yourself.
Travel with an approved aid organisation and attend their briefings before you leave. Look after your health whilst there. If not, you not only cannot help, you become a part of the problem you hoped to assist with.
Visit your GP or practice nurse some months before departure to plan a vaccination schedule. Some vaccinations require a course of two or three injections over a period of several months. Also, many cannot be given at the same time as one another. Follow the recommended schedule for the countries you will be visiting.
- Depending on where you are travelling to there are likely to be a number of specific vaccines that you require - for example, yellow fever and Japanese B encephalitis.
- If you are travelling off the beaten track you should always consider and discuss the need for protection against typhoid, hepatitis A, hepatitis B and rabies.
- Your diphtheria, tetanus and polio immunisations may also need boosting.
- Your immunity against tuberculosis may need to be reviewed.
Diseases against which you cannot be immunised
There are many diseases against which vaccination is not available. These include dengue fever, Zika virus, most viral haemorrhagic fevers, schistosomiasis, HIV, sleeping sickness, and leishmaniasis. Visit the National Travel Health Centre and Network (NaTHNaC) website (see below) for country-specific advice and to understand how you may minimise your risk of exposure to any or all of these.
Consult the NaTHNaC website for up-to-date advice on the malaria regimen recommended for the countries you will be visiting. There is normally a choice of medication. Make sure that you can tolerate the medication you choose before you go.
- Remember that malaria prophylaxis does not offer absolute protection: minimising exposure to mosquito bites is also important.
- Remember that if you are visiting a malarial country where you once lived, even if for many years, you will not have maintained your immunity to malaria. This fades to nothing when you leave.
Yellow fever vaccination and certificate
Your practice can advise you whether you need yellow fever vaccination. You made need it because there is a risk of yellow fever in the country you are visiting, or because the country does not have yellow fever and so insists on yellow fever immunisation in all travellers as a protection for itself. These countries require you to show a certificate of yellow fever vaccination on immigration: make sure you are prepared if this is the case.
- The NaTHNaC yellow fever zone website offers more detail on specific country requirements.
Which medical conditions are related to travel?
Probably the greatest health challenge of remote travel comes from food and water. Traveller's diarrhoea is the usual result of eating food or drinking water contaminated with germs such as bacteria, viruses and parasites that cause illness. In many remote locations it is almost impossible to avoid this condition; however, precautions to minimise risk are listed below. See also separate leaflet called Traveller's Diarrhoea for more details.
- Be scrupulous about hygiene, washing hands before eating and after using the bathroom.
- Eat only food that's cooked and served hot: avoid food served at room temperature.
- Eat only hard-cooked eggs, not soft-cooked (runny) or raw.
- Eat fruits and vegetables you have peeled yourself. Avoid salads and unpeeled raw fruits.
- Pasteurised dairy products are fine but unpasteurised food is not.
- Avoid food from street vendors, including flavoured ice.
- Avoid 'bushmeat' (local wild animals - eg, bats, monkeys).
- Drink water, sodas, or sports drinks that are bottled and sealed (carbonated is safer).
- Drink water that has been disinfected (boiled, filtered, treated).
- Use only ice made with bottled or disinfected water. It most often isn't made this way, in which case go without.
- Drink boiled hot drinks like coffee or tea.
- Avoid tap or well water, water fountains, ice, unpasteurised milk.
Fresh water (rivers and lakes) should not be assumed safe for swimming, even if the local population seem to be swimming there. In addition to the possibility, in some parts of the world, of encountering dangerous animals, a disease called schistosomiasis is present in fresh water through much of Africa and many parts of Asia and the Americas. Most cases in the UK are seen in returning travellers who have swum in Lake Malawi, where they presumably felt sure it was safe because others were swimming there too.
Sometimes travellers behave carelessly in sexual encounters abroad. If you think there is a chance you may be sexually active with people who are strangers to your usual life, even if you think it highly unlikely, take condoms with you on your trip.
- Remember that oral contraceptives may fail if you have diarrhoea or are being sick (vomiting).
- Remember that sexually transmitted infections (STIs), including HIV, are widespread amongst sex workers in many developing countries.
- Remember that condoms do not guarantee protection against HIV and other STIs, and that some sexual practices are much more risky than others in this respect. See also separate leaflet called Safer Sex.
Skin and the sun
The sun is much stronger at the equator (and at altitude). You can be sunburned when in shadow, when it is cooler because of wind, and when you are on the sea (when sun cream may swiftly wash off with the spray). Ultraviolet (UV) rays can reflect on to you from the sea and the ground, increasing your exposure.
- Protect yourself particularly from the midday sun (11 am-3 pm). Cover your skin, wear a hat and use the highest factor sunblock you can obtain. This does not block UV rays; however, it increases the time that you can be exposed to the sun without burning. This time may still be extremely short, particularly if you are near the equator and your skin is fair.
- Protect children's skin - it is thinner than that of adults. Ideally, wear a hat, but if not protect the tops of ears.
Travelling to high altitude
If travelling to high altitude, the thinner air means that the sun's rays are intense. Severe sunburn can occur even if the temperature is very low.
Travel to high altitude brings particular challenges. These partly relate to low oxygen levels and partly to extreme environmental conditions. The low oxygen levels make exercise more tiring. If you have a heart or lung condition that is not troublesome at sea level it can become a problem when expending effort at altitude. See separate leaflet called Altitude/Mountain Sickness for more details.
Developing a lack of fluids in the body (dehydration) is common at altitude. This is both because the air holds less moisture and is drier and because the body's response to altitude is to dehydrate. Take lip salve for dry lips and eye drops if you tend to experience dry eyes, and keep your fluid intake high. Read about altitude sickness and make sure you have some understanding of how this might feel.
Travelling to very hot climates
Travelling in a hot climate is particularly tough for children and the elderly. Particular risks are dehydration and heatstroke. Risks are greater if undertaking strenuous activity in the heat of the day. See separate leaflet called Dealing with the Effects of Heat.
- Heat exhaustion and heatstroke cause headache, dizziness, feeling sick (nauseated) and sweating and, as the condition gets worse, dry skin, collapse and confusion. Heatstroke is a life-threatening condition and needs urgent medical help. Patients need to be rested, given sufficient fluids (hydrated) and cooled.
- Small children may just become quiet and listless.
Travelling to very cold climates
Travel to very cold environments may include such destinations as Antarctica, but also includes high altitudes in Europe, such as those visited for skiing in the Alps. Cold environments are tough for young children and the elderly and they can be tiring and draining. A cold environment challenges your body by air temperature, air movement (wind speed), and humidity (wetness). See separate leaflet called Dealing with the Effects of Cold.
- Protective clothing is needed below 4°C. It should be in multiple layers, as the air between layers provides most of the insulation. Wear a hat. Gloves are needed below 4°C. Below −17°C, mittens are advised.
- In bright snow, eyes need protection against UV light.
- Have balanced meals and make sure you drink enough. Avoid caffeine during the day as it increases dehydration. Alcohol also reduces your ability to keep warm.
- Watch for the signs of frostbite. The risk of frostbite depends on the temperature and wind; however, exposed skin may develop frostbite at any temperature below freezing point.
- Be aware of the signs of hypothermia, a condition which usually occurs gradually. These are:
- Shivering, cold, pale and dry skin.
- Tiredness, confusion and irrational behaviour.
- Slow and shallow breathing.
- Slow and weakening pulse.
Bites and stings
Diseases are not the only things that can affect your health. Biting and stinging creatures are widespread in the world. They may represent a danger to health, as may larger animals.
- Remember in particular to check boots for insects in the morning.
- It is best to assume that all snakes are both aggressive and venomous.
- Never handle insects or spiders you do not recognise.
- Assume that all dogs, cats and monkeys could have rabies. Avoid them, however appealing.
- Remember the dangers posed by some marine animals, including corals, jellyfish, octopuses and sharks. Some carry powerful poisons (toxins). Only swim in areas where you have been told it is safe to swim.
Protect yourself against insects: take an effective insect repellent (at least 20% DEET) and cover your arms and legs as much as possible to minimise biting. Garlic and citronella do not prevent mosquitoes from biting you. Cover your skin to avoid bites, especially after sunset when malarial mosquitoes bite. Use mosquito nets and insect repellent devices such as candles and coil burners
- The risks of mosquito-borne disease are always greater where there is disease in the human population. Consult the NaTHNaC website for the risk where you are travelling.
Illness after your return
Some tropical diseases have long incubation periods (meaning that it can be many days or even weeks between exposure and developing symptoms). If you develop unexplained illness or high temperature (fever) after remote travel, seek medical help and tell your doctor where you have been. Falciparum malaria, which is the severe form of malaria, is a serious cause of fever and chills in returning travellers. Whilst this normally occurs within a month of return, this is not always the case.
What should I have in my first aid kit for a remote trip?
Putting together a useful first aid kit is an important part of preparation for a remote holiday. You will need your doctor's assistance in doing this. The purpose of taking this medication is so that you have it and can take it if advised by another health professional. Self-diagnosis and self-treatment are generally not wise except where there is no alternative and things are very clear: even health professionals' judgement about their own health is often biased or inaccurate.
Consider asking your doctor to prescribe 'just in case' medication for conditions you know you are likely to experience. For example, if you have frequent bladder infection (cystitis) or thrush (candida) it is sensible to take a course of your usual treatment.
You will have to pay for 'just in case' treatments, as use outside the UK falls outside the remit of the NHS.
Personal first aid kit for a remote trip
The following lists a comprehensive first aid kit for two people travelling together to a remote environment. It is based on the advice given in 'Pocket First Aid and Wilderness Medicine', a book written by two well-established expedition doctors with experience of remote locations.
The intention of such a kit is not that you bypass medical help and give yourself treatment when unwell. It is so that if you seek medical help from other travelling doctors and nurses, they can advise you what medicines you need to take and you will then be able to follow that advice.
Your doctor is unlikely to issue you with prescription-only medicines unless he or she has explained when you might use them and advised you strongly to make every effort to seek independent medical advice before using them. Self-treatment is a last resort, as it is very difficult for anyone, even experienced health professionals, to make treatment decisions about themselves. In remote environments you will often meet other groups who will have a medic or experienced expedition first-aider with them. These individuals will be able to advise you.
- Pocket First Aid and Wilderness Medicine: Drs Jim Duff and Peter Gormly (2007). This is an excellent handbook covering what to do as a layperson in most medical situations you might encounter.
- Thermometer (or 'FeverScan®').
- Tweezers (pointed-end).
- Sewing needle.
- Safety pins x 2.
- 10 ml syringe, 2 ml syringe and needles (in packets, sterile).
- Protective gloves - 1 pair.
- Sticking plasters - 1 pack.
- Blister plasters - 1 pack assorted.
- Gauze squares 5 cm x 5.
- Sterile non-stick dressings x 5.
- Sanitary pad x 1 (for absorbent padding).
- Cotton bandage 10 cm x 1.5 cm.
- Crepe bandage 10 cm x 1.5 cm.
- Duct tape - 1 small roll.
- Wound closures (Steri-Strips®) - 1 packet.
- Alcohol swabs x 5.
- Sunscreen (high-factor if at altitude).
- Burn cream - eg, silver sulfadiazine or aloe vera gel.
- Insect repellent (ideally containing at least 20% DEET).
- Lavender oil - mild antiseptic for wound sterilisation.
- Antihistamine tablets - eg, chlorphenamine 4 mg x 10.
- Hydrocortisone cream 1% 15 g tube.
- Single course of one broad-acting antibiotic - eg, azithromycin 500 mg 3 tabs or ciprofloxacin 500 mg 10 tabs (take your doctor's advice - some antibiotics cannot be taken by children or pregnant women): for severe bacterial diarrhoea.
- Single course of co-amoxiclav or amoxicillin: for chest infections.
- Metronidazole 400 mg 15 tablets (for stays of more than 3-4 weeks); for infection of the gut (gastroenteritis) caused by giardia or amoeba (a doctor needs to advise you if you may have this sort of diarrhoea).
- Antibiotic ointment (eg, fusidic acid) 15 g tube.
- Antifungal cream (eg, clotrimazole) 15 g tube.
- Loperamide 2 mg (for diarrhoea) - pack of 10.
- Senna tablets x 5.
- Small bottle of antiseptic (eg, Savlon®).
- Antibiotic eye ointment (eg, chloramphenicol).
- Indigestion remedy (eg, ranitidine) 150 mg: 10 tabs.
- Buccastem antisickness tablets x 5.
- Paracetamol 500 mg x 10.
- Ibuprofen 400 mg x 20.
- Dioralyte oral rehydration salts x 10 sachets.
- Throat lozenges 1 packet (eg, Strepsils®, Vocalzone®).
Additional medication for very high-altitude trekking
- Acetazolamide 250 mg tablets (Diamox® - for prevention and management of altitude sickness) x 10-20.
- Discuss with your GP and trekking group whether your very high-altitude trek also necessitates carrying dexamethasone tablets or nifedipine tablets. Both are used in altitude sickness emergencies by doctors and nurses experienced in altitude medicine. You should not self-medicate with these medicines, which can themselves be dangerous if used incorrectly.
Further reading and references
Duff J; Pocket First Aid and Wilderness Medicine, 10th edition, 2007
International Travel and Health; World Health Organization
Infectious diseases of potential risk for travellers; World Health Organization
Immunisation against infectious disease - the Green Book (latest edition); Public Health England
Fit for travel; Health Protection Scotland
Yellow Fever Zone Maps; National Travel Health Network and Centre (NaTHNaC)
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Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.