Coping with medical needs overseas

Annie and Fred Dintzis of Peoria, Illinois, sent in a request: “We’d like to know how travelers with medical problems cope in different locations overseas. Please solicit readers’ experiences, comments and tips on dealing with diabetes, various allergies, high blood pressure, etc.”

So we invited each of you to write in. We limited any experiences cited to those outside of the US and requested the following. Along with any experience and the steps you took, include where you traveled and when your trip was (or when your recent trips were). If pertinent, name the airline and the seating class you were in.

A few replies were printed last month, and here are more. Have experience to share? Write to Coping with Medical Needs Overseas, c/o ITN, 2116 28th St., Sacramento, CA 95818, or e-mail editor@intltravelnews.com. (Include the address at which you receive ITN.)

Less than an hour after landing at the international airport in New Delhi, India, late Tuesday night, Jan. 4, 2011, my traveling companion and I faced a medical emergency. Her carry-on bag — with all of her prescription drugs — had been left in the airport parking garage and had disappeared by the time our hotel’s representative went looking for it. (He had no success at Lost & Found, either.)

Luckily, we were able to reach her doctor by telephone in New York and obtain a list of her drugs by their generic names as well as the prescribed dosages. I had already discovered that most drugs are sold over the counter in Indian pharmacies.

The active ingredient of the malaria prophylactic that my American insurance company had refused to cover (they would pay for a malaria cure if I contracted malaria but not for a preventative drug) existed in generic form in India in somewhat different dosage. In fact, the drug my doctor had prescribed was actually manufactured in India, so I had planned to purchase it in New Delhi, where the price would be about 90% less than in the US.

The morning after our arrival, my companion and I shopped the pharmacies around Connaught Place. They did not have the shiny appearance of typical American pharmacies, but the personnel were unfailingly well informed and helpful. We found everything she needed in three pharmacies. We were careful to check the dosage and expiration date on each package. After an hour of shopping, she was resupplied and we were ready to begin touring.

A word to the wise — travelers each should carry with them a list of all prescription drugs they take plus their dosages and their generic names.

They should also keep in their possession the names, telephone numbers, fax numbers and e-mail addresses of their physicians and dentists as well as the details of their medical and accident insurance data, including any travel and evacuation insurance, Medicare and supplementary insurance.

Elsa A. Solender
New York, NY

Traveling changes both your internal clock and your pill schedule. If you take a number of medications and over-the-counter items, trying to compensate for differing time zones can result in taking pills in the wrong combinations.

For example, calcium, alcohol and grapefruit can reduce the efficacy of several medications, especially when they’re consumed within three hours of taking the medication. If you are not sure about the interactions of your drugs, there are many informative websites to help. I prefer www.drugs.com.

I swear by a digital pillbox with a timer. It is very useful at home as well as when traveling, so I can be sure my calcium and prescriptions are spaced two to three hours apart.

From May through July in 2008, I did a six-week ’round-the-world trip with Star Alliance airlines while taking 23 pills a day. This caused several problems, the first being convincing my insurance carrier and druggist to issue prescriptions ahead of time so I could take eight weeks’ worth with me.

My rule of thumb is to take one extra week’s supply for each three weeks gone. So far, this has been adequate for any unforeseen schedule changes.

Another headache is that drugs can have different names in other countries. I always carry a physician’s letter listing all of my pills, including over-the-counter medications. In the letter I draft for my physician, I try to include the common foreign-language drug names.

If several websites agree on one language’s translation for the name of a medicine, I’ll go with that, but if they disagree, I’ll leave that name off the physician’s letter and add it to my personal translation list.

(For countries where I don’t speak the language, I keep a list of needed words/phrases, such as “I am allergic to turmeric” and “No onions, please.” For countries like Russia, China and Egypt, I will find a picture book for teaching English to their children and photocopy pertinent pictures and text.)

If all else fails, you can take the drug manufacturer’s inserts, which include chemical names and formulas. (I ask my druggist for one for each prescription every year, just to see if they have come up with any new warnings or side effects.)

For my ’round-the-world trip, the next problem was figuring out when to take the pills. To start, I made a chart with my standard pill groupings down the left side: “After Breakfast,” “No Food/No Calcium,” “Calcium & Dinner” and “Night.”

Across the top, I listed all the time zones I would be in and entered my destinations in the proper zones. With a little lumping, they all could be put in four columns: “Home,” “Europe,” “India” and “Asia.” Then, in each column, I posted the desired local time at each destination to take certain pills.

I found that when it was 11 p.m. at home, it would be about breakfast time in France, lunchtime in India and, roughly, teatime in Asia. Thus, when it was breakfast time in France, I would take the pills I always took at home at about 11 p.m. (with minor adjustments of an hour or two).

Pills do not care what you call your mealtimes, as long as they are with or without the correct food, so eating cereal with dinner pills and roast chicken with morning pills can work fine.

I was able to stick by my home-time pill schedule for most of the trip. I did carry some granola bars for when the airlines or hotels could not accommodate my scheduled need for food with which to take particular pills.

In addition, to avoid jet lag, several days before I left home I tried to get on the schedule of my first destination’s time zone. I started changing my sleep and meal times, gradually eating later each day and going to sleep later each night until, by departure, I was on Germany time. (I was eating breakfast at 11 p.m. at home.)

I have used this pre-trip adjustment for years. The only difficulty is finding something to do in small-town America at 3 a.m. (Once overseas, I continued gradually adjusting my schedule before each next major destination.)

My time-zone chart was also useful for posting flight departures and arrivals. I am always confused about elapsed times, especially when crossing the International Date Line. The chart had columns for “Date,” “Flight Number,” “City,” “Departure Time,” “Arrival Time” and “Elapsed Time.”

On one line I put the airline information, leaving blank the Arrival Time for the departure city and on the next line leaving blank the Departure Time for the destination city. Using the time zone chart, I calculated the times for the two blanks and the Elapsed Time. If the Elapsed Time for both the Departure and Arrival lines agreed, I knew I’d done it right.

This was one of the handiest charts on my trip. I referred to it many times, and in addition to helping me keep my pill taking in order, it helped me prevent jet lag by mentally preparing me for each next step.

Because sometimes my carry-on is not accessible (especially when someone thinks they are doing me a favor by moving me, a handicapped person, into a bulkhead seat), I always carry a tiny emergency bag that has in it an extra day’s pills, a throwaway paste-filled toothbrush, earPlane® plugs, paper undies, tissues, a sandwich bag (for dentures overnight), a credit card (for drinks), a pen (for Customs declarations) and a toilet-seat cover.

If nothing else, this bag can fit in the front-seat pocket as they whisk away my carry-on bag to an unknown overhead bin.

Kit Stewart
Sequim, WA

It may be helpful to know that pharmacies in Switzerland can dispense some meds without the prescription necessary in the US.

Years ago, while I was still teaching, I picked up ringworm from one of the kids and did not discover it until I arrived in Zermatt. Fortunately, the pharmacist was able to give me a prescription-strength ointment without a doctor’s script.

Jon Lafleur
Kent, CT

My husband had cancer surgery in his mouth in 2005 and was unable to chew or eat spices. Because we would be taking a Douro River cruise of Portugal and Spain that year and he needed to maintain his weight, he was drinking Ensure Plus® (a nutritional supplement) every day.

On that trip, I learned that in both Belgium and Italy, Ensure Plus® was marketed by its own name in pharmacies but not in supermarkets. We did not need a prescription to buy it in those countries.

I also learned that Ensure Plus® was not sold in Portugal, so I contacted the American Embassy in Lisbon and was referred to a nurse, who told me about a similar product: Fresubin Original Drink.

The nurse gave me the addresses of two pharmacies in Lisbon (Farmacia Estacio, Rossio 60-63; phone 213211390… and Farmacia Azevedo, Pr. D. Pedro IV, 31, Rossio; phone 213430482), through which I ordered the 72 eight-ounce bottles of Fresubin that we needed. The Fresubin was charged to my credit card and delivered to the hotel in Lisbon, which kept it in their storage room until our arrival.

Abbott Nutrition (Columbus, Ohio), the makers of Ensure Plus®, has been very helpful to me; I found them on the Internet. When at home, I order cases of 24 eight-ounce bottles from the Abbott Store (800/258-7677). These are delivered by UPS or FedEx — very convenient, as they weigh a lot!

In 2006 we took a cruise from Venice to Barcelona. I faxed Abbott Nutrition & Pharmaceuticals in Italy (Abbott S.p.A, Via Pontina km. 52, 04010 Campoverde di Aprilia, Latina, Italy; fax 011 39 06 925 3193) and was contacted by a woman, who told me how to obtain Ensure® in Venice. I bought it there and took it to the ship, putting a couple of the bottles in our cabin’s refrigerator each day.

After the cruise, we went to Brussels, Belgium, for 10 days, where I bought Fresubin Original Drink at a pharmacy there.

Ann Koehler
Seattle, WA