Travelling with medication

Due to restrictions on many flights across the globe those travelling with existing medical conditions need to be aware of restrictions when travelling with medication.

Some airlines now restrict the amount of hand luggage allowed on flights, it is essential to check with your individual airline prior to flying.
The Chief Medical Officer in the UK has issued a procedure for those taking medication on flights (UK Department of Health 2006).

• It states that travellers should be discouraged from taking medication onto flights unless it is for the immediate journey and an allowance of time at the other end to pick up your baggage (allow at least 4 hours).
• It also recommends that all extra supplies of medication for your arrival should be placed in the hold luggage.
• Any powder/inhalers or tablets can be carried in the hand luggage - up to 50 grams.
• Any liquids, creams or gel medications which are essential for the flight may also be carried in the hand luggage as long as they are smaller than 50ml (such as a GTN spray).
• If the amount is larger than 50mls you must make sure it can be tested before getting on the flight. In order to test the medication you will be asked to taste it. The airports have been advised to have plastic cups available for this procedure!
• If an adult is travelling with a young child and wants to carry non-prescription medication onto the flight they will need to taste the child's medication (as long as they are not allergic to it!).
• If any of these regulations don't fit your medication then further checks will be necessary.

These regulations have been issued by the UK Department of Health and any updates to the information should be checked on the DOH web site. As well as trying to follow these guidelines it is a good idea to carry a copy of your prescription or a letter from your doctor stating the amounts and types of medication verified for your use, including any essential non-prescription medication. Special Advice for Travel with Insulin: If you are a diabetic you should first try to get an exemption certificate from the airline you are travelling with - for this you will need to get a letter from your doctor stating your need for insulin. If this is not possible there is advice that has been issued by Novo Nordisk an Australian company. While it has been written for those travelling from the Australia to the UK and USA it is good advice explaining how to pack insulin when it needs to go into the hold luggage as well as what to look out for to prevent it freezing.

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Specific circumstances

Travelling with Specific Needs:

If you have a physical disability, travel can often be pushed aside for fear of often not knowing where to turn if you need help. As soon as you are aware of a trip, make an appointment to visit your GP or Specialist Nurse for a check up and to discuss the details of your trip.

Plan Ahead:

Visit your GP or specialist nurse as soon as you can to get repeat prescriptions - get enough for the trip and a bit extra. To make it easier when you go through customs, get your GP to write a letter if you need to carry equipment or needles with you.

Malaria and Vaccinations:

Disabilities do not stop you taking malaria medication or having vaccinations if they are recommended for your destination, unless you have contra-indications to them. Sort these out with your Travel Health Specialist as soon as possible.

Transport Needs:

Plan ahead - inform the airline or travel operators of your needs. They are used to providing special chairs, seats or meals, so do not feel you are 'putting them out' - it is their job to help you and make your trip as safe and comfortable as possible.
Choose your method of transport with care, and when flying, go with the most direct route so that you are not left trying to change flights at numerous locations around the world. Discuss with the airline if you will need any assistance.
Look into international organisations that can help with your particular needs. A search of the Internet can bring up all kinds of organisations - there is even an organisation dedicated to providing a dialysis network in certain countries. Choose good insurance with a company that is aware of your condition. If you are travelling with a companion, make sure they are aware of their role in helping you prior to leaving. JetAir are able to organise assistance for you to and from an aircraft and for passengers using wheelchairs.

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While you are away

Preventing Insect Bites:

Malaria is not the only disease that is transmitted by mosquitoes - Dengue Fever is becoming increasingly more common in tropical climates. First line protection for the traveler against any insect borne disease is not getting bitten in the first place. Risk of contracting certain diseases varies with location of your accommodation and for those travelling to rural areas certain risks increase

• While malaria mosquitoes feed between dusk and dawn, other types of mosquitoes carrying different diseases bite at other times of day. It is important to discuss with your Travel Health advisor
  1) when you are at risk of mosquito borne disease and
  2) what time of day carries the greatest risk. Mosquitoes tend to respond to light in their feeding habits, some preferring daylight, others darkness.
• Malaria mosquitoes usually prefer low light hours after dusk until dawn. Dengue mosquitoes' peak biting times are the few hours before dusk and the few hours after dawn and are present during the day light hours.
• Avoid being bitten by mosquitoes by applying a good mosquito repellent to exposed areas every 6 hours. Clothes can also be impregnated with repellent for further protection. If wearing sunscreen, apply your repellent on top.
• Keep your legs and arms covered with clothing to lower risk of bites on the skin. Avoid wearing dark colours, as they can attract mosquitoes. While mosquitoes are able to bite through many materials, canvas mosquito boots and thick denim jeans will make it more difficult in rural areas, where the risks are always the greatest.
• Use a 'knock-down' spray in the evening to get rid of mosquitoes before going to sleep. Avoid strong perfumes, hair sprays or after-shaves as they can attract mosquitoes!
• Use air-conditioning if it is available. Because air conditioning helps keep the mosquitoes away due to the lower temperature, it is important that it is left on all day and that the windows or shutters are not left open at night!
• Try to avoid evening walks beside rivers and ponds as this is where mosquitoes breed.
• Use this information along with any medication advice your doctor has given you.
• In a risk area, it is wise to use a bed net, which is impregnated with permethrin. For a net to be effective, it needs to be impregnated with permethrin at least every six months or whenever it is washed. While sand flies will be able to get through the holes, by landing on a net that is impregnated, they will be killed.
• Use a repellent that has DEET or contains a natural repellent such as lemon and eucalyptus; try to avoid using products that are connected to homemade concoctions!
• Clothing that has been impregnated with permethrin will also help repel insects if you will be working in a rural area. This clothing, along with impregnated wrist and ankle bands, lower the risk of being bitten. If you are reluctant to impregnate everyday clothing, impregnated netting worn over the clothing will prevent chemical contact with the skin. It is important that fellow travellers are protected in a similar way, as repelled mosquitoes will go to another person who is not protected!

Other biting insects include the small sand fly, which is capable of spreading Leishmaniasis in certain locations; ticks, which are responsible for diseases such as Lymes disease; and mites which can cause scabies; as well as many other different species.

Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional. Please discuss your travel health requirements with your regular family doctor or practice nurse.

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Safety in the Sun

In the United Kingdom cases of skin cancer have doubled over the last 20 years. Each year thousands of new cases of skin cancer are reported, however due to the fact that people are recognising the disease early 'five year' survival rates are increasing. In order to be safe in the sun we should have both an understanding of the prevention of skin cancer as well as knowledge of the early recognition of skin cancer.

Protection through sun cream

Recent media reports have questioned our faithful trust in our high factor sun creams. The results of studies have suggested that sun cream alone will not prevent skin cancer and reports suggest that increased rates of skin cancer could possibly be, directly or indirectly, related to our use of sun cream. Sun cream is often applied too thinly - to cover the whole body about an eggcup amount is needed every 2-3hrs. It should also be applied at least 30 minutes before going out into the sun. Insect repellents should be applied top of sun cream where needed. You should never stay in the sun for excessive periods of time in the belief that your sun cream will offer unlimited protection. The higher the SPF factor on your cream, the greater the protection against UVB rays which cause burning. When used regularly and in proper proportions - you should not need more than a factor 15 - even in a tropical climate. A high SPF factor will only help prevent burning - it will not always protect against UVA rays, which are not taken into account when calculating the SPF. UVA protection is usually rated separately between 2 and 4.

Protection through clothing

It is important when travelling to recognise both the long and short-term risks associated with too much sun exposure. This is true not only on the beach, snow, sand and water will also reflect the sun's rays and our choice of clothing can play a part in protecting our bodies. Wear clothes that will protect you in the sun - sunglasses, clothing of tightly woven fabric and a sun hat covering the neck, ears and back of the neck.

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Travellers Checklist - A helpful guide

BEFORE YOU GO:

1. Take out adequate travel insurance

Make sure your policy provides adequate cover, particularly for medical treatment and repatriation. Make sure any dangerous activities you've planned are covered (e.g. skiing, scuba diving). Remember to extend cover if you extend your stay.

2. Know your destination

Find out about local laws and customs and take a guidebook. Talk to your travel agent or tour operator about possible risks and check the FCO's country-specific travel information so that you're one step ahead of situations that may change quickly. If you are travelling to areas where there may be conflict, wars or violence, it might just save your life.

3. Make sure you have enough money

Take at least two forms of payment - ideally travellers cheques and a credit card - so that if you lose one you have the other as a standby. Check the expiry date and make a separate note of serial numbers on your travellers cheques.

4. Check that your passport is valid

Your passport should be valid for at least 6 months - some countries won't let you enter if it isn't. Make sure you have filled in all the details, including the information on your next of kin. Take another form of photo-ID and a photocopy of your passport with you.

5. Check whether you need a visa

Ask your travel agent, check with the relevant Embassy or visit the FCO.

6. Check if you need vaccinations

Check online here; preferably see your doctor AT LEAST 6 weeks before you go.

7. Check your medication

If you take prescribed drugs, take the prescription with you in case you need replacements. Pack your medication in your hand luggage. Check your medication is legal in the country by calling the relevant Embassy in London.

8. Tell friends/family where you're going

It is important that people are able to contact you in an emergency. Make sure you leave a way of getting in touch.

9. Car insurance

If you are taking or hiring a car make sure you have proper insurance and breakdown cover. Make sure your driving licence is current and valid for the country.

10. Keep records

Make copies of your credit card, traveler's cheque numbers, passport, driving licence, insurance policy, E111, and emergency telephone numbers of the local British Consul and your travel insurer. Leave a set at home with friends or family.

11. Tell someone where you are going and when you expect to be back.

Leave an itinerary and details of where you might be able to be contacted during your time abroad. You should also make two copies of your passport (including pages with relevant visas), insurance details and any other important travel documents. Leave one copy at home with a family member or a reliable friend and take one copy with you, packed separately from your passport.

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WHILE YOU'RE AWAY

1. Money

Only carry as much money as you need for the day. Leave extra money, documents and tickets in the hotel safe. While travelling keep your money and important documents in separate places.

2. Know the rules of the road

In many countries there are on-the-spot fines for traffic offences - exceptions are not made for foreigners.

3. Avoid any involvement with drugs

Never carry anything through customs for other people or leave your baggage unattended. Some countries have the death penalty.

4. Respect local laws and customs

For instance, in the UAE it is a punishable offence to drink in public; offenders may be put in prison.

5. Eat and drink carefully

Find out if the local tap water is safe to drink. If not, drink bottled water and avoid having ice in your drinks. To avoid contaminated food, only have food that has been freshly cooked.

6. Keep in touch with home

Especially for long trips. If they know you are safe they won't need to panic if there's an emergency in the country you are visiting.

7. Be security conscious

Avoid unlit streets at night and only carry the minimum amount of cash when sightseeing.

8. Protect yourself from the sun

If you are travelling to any country where the sun is hot then take care - always use sun lotions with UVA and UVB protection and avoid the sun between midday and 3pm.

9. Protect yourself from mosquitoes

To reduce the chances of being bitten while abroad use insect repellents, wear long sleeves and long trousers and sleep under a mosquito net.

10. Passports are valuable documents, and you are responsible for taking all reasonable steps to protect your passport. While we can usually issue replacement passports overseas (and see Passports & Visas), if you repeatedly lose your passport while overseas we may need to interview you for security purposes before issuing a replacement. In certain circumstances, we may need to restrict the validity of replacement passports. We will explain this to you in full. Fill in the contact details at the back of your passport for your next-of-kin or someone who can be contacted in an emergency. Apart from your passport, take another form of identification with you (preferably one with a photograph, such as a driving licence).

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IF THINGS GO WRONG ... how the British Consul can help

Consular officials can:

• Issue emergency passports
• Put you in touch with local lawyers, interpreters and doctors
• Visit you if you have been arrested or put in prison
• Contact relatives or friends if you need emergency money or tickets
• Arrange for next of kin to be told of an accident or a death and advise on procedures

Consular officials cannot:

• Pay your hotel, legal, medical or any other bills
• Give legal advice
• Intervene in court cases
• Get you out of prison
• Get you better treatment in hospital or prison that locals
• Replace lost airline tickets

The contact number for the Foreign & Commonwealth Office in London is +44 207 008 1500

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