Travelling to remote locations

What preparation and advance planning are required for remote travel?

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.

Ensure your personal safety

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 are 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.

Conduct a self-assessment

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.

Be cautious of what you eat 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. Remember that if the water is not safe to drink, then neither is ice in other drinks, and that food such as salad may have been washed in the local water.

Be aware of environmental hazards

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, natural disaster, and difficult terrain. Inform yourself before you travel.

Ensure you're fit to travel

If you have ongoing health or fitness issues which are due for a medical review, then arrange this well before your travel. Your GP will not usually be able to certify you as fit to fly, or fit to travel in general, as they are not trained or insured to do this. If you need this service then you should arrange it via a private travel doctor - again, allow plenty of time for this.

• Make sure that you have declared any existing medical conditions to your travel insurer and that you are insured against any activities that you plan to carry out whilst away - not all policies include cover for certain sports or other activities.

• Remember, if you travel against medical advice you may invalidate your insurance.

• Be aware that some countries do not allow some medicines to be taken across their border. This may include some commonly prescribed pain medication. The penalty for breaking these laws may be severe and ignorance is unlikely to be accepted as an excuse, so do your homework before you go.

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.

Make dental preparations

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.

Think about 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 glasses with you just in case. Consider whether it would be sensible to switch to glasses 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.

Consider your children's well-being during 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 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.

Advice for 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.

Get your vaccinations

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. GPs in the UK are under severe pressure at the moment, with demand for healthcare exceeding supply. If there isn't a travel appointment when you need it, you may need to visit a private travel clinic. You can reduce the risk of this by contacting the GP many months before you travel.

• 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, Zika virus, malaria, most viral haemorrhagic fevers, schistosomiasis, HIV, sleeping sickness, and leishmaniasis. Visit the Fit for Travel website (see under 'Further Reading and References' below) for country-specific advice and to understand how you may minimise your risk of exposure to any or all of these.

Yellow fever vaccination and certificate
Your practice can advise you whether you need yellow fever vaccination. You may 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 NHS Fit for Travel website offers more detail on yellow fever risk areas.

Which medical conditions are more frequent in remote locations?

Skin and sun damage

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), or try to be inside during these hours if possible. 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.

Health complications to do with 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. Read more about altitude sickness.

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.

Health complications to do with 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 the 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.

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. This is not something that your GP will be able to help you with - if you need advice from a medical professional about a first aid kit then you will need to contact a private travel clinic. 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.

Do not approach your GP to prescribe 'just in case' medication, unless it is something that you are given 'just in case' when at home - for example, some people with the lung condition COPD keep a standby prescription for antibiotics and steroids at home. If you consider that you might need 'just in case' medications purely due to the remoteness of your travel then you would need to visit a private travel clinic.

You will have to pay for 'just in case' treatments, as use outside the UK falls outside the remit of the NHS. You will also not be able to consult your GP by phone or email whilst travelling abroad, as they are not insured to offer advice, so make sure that you know how to access healthcare in the country that you are visiting.

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.

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.

Reference book

• 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.

Equipment

• Thermometer (or 'FeverScan®').

• Tweezers (pointed-end).

• Scissors.

• 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.

Medication

• 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, esomeprazole).

• 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 private travel doctor and/or 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.

Dr Mary Lowth is an author or the original author of this leaflet.