All the world loves a traveler. Do any Internet search and you’ll see hoards of travel quotes from St. Augustine’s, “The world is a book and those who do not travel read only one page.” to Mark Twain’s, “Travel is fatal to prejudice, bigotry, and narrow-mindedness.” The problem with these enticing quotes and the massive appeals to ‘go anywhere’ is that most of us are underexposed and unprepared to get help and home in a foreign country. Anything can happen, anywhere, but it’s a whole different world of hurt when it happens in a foreign country with different laws, medical system and language. Are you really ready to go abroad? Do you expect the best and plan for the worst?
There are a few precautions you can make to prepare for serious illness or accidents in another country, without taking any extra luggage space. As you plan your trip, make certain you and your emergency contacts have your personal health record in the local language and purchase travel medical insurance for an evacuation.
What is a personal health record?
A personal health record is a very important document with critically important information about your health. Far too many people leave critical decisions on care to memory, or to a pill bottle in their luggage. It is important for health professionals in other countries to be able to read and understand any health conditions, prior procedures, medications and allergies you have.
Microsoft HealthVault is an online system to help you keep important health information in a secure, accessible place. HealthVault is also compatible with some home monitoring systems, such a blood sugar meters, blood pressure and heart rate monitors, weight scales, pulse oximetry and others. It conveniently stores lab results and even fitness tracking. There are other easy tools if you have an iPhone ask Siri for, “Health Data.” The app comes with your smartphone and tracks activity, nutrition, sleep, mindfulness, body measurements, health records, lab results and vitals and links you to app recommendations to make health a priority. Apple Health Data is also compatible with Apple watch.
Your medical provider can provide a CDA – Clinical Document Architecture, in an email, document or may also provide an app.
Your personal health record would be separate from the electronic health record your doctor keeps for you. This is a document of your health information created by you for your purposes.
Why do I need a personal health record?
Imagine the angst of Depart Smart founders, Sheryl and Allen Hill, when they sent their son Tyler’s personal health information to Japan with his chaperones, only to discover his Japanese emergency trauma doctors did not have it. They worked furiously to fax the English version, only to discover it was useless because it was not translated into Japanese. There is evidence Tyler’s life could have been saved with timely and appropriate medical attention. Translating your personal health record into the destination language so critical life-saving decisions can be made when seconds can save a life should become a habit of mindful safe travellers.
Medical providers have moments to assess life function and make decisions. If a patient arrives with heart issues life. In a situation like this, when seconds count, it would be helpful to have some background information on your patient. Is this a heart attack or a seizure? Does the patient have a pacemaker? Is he allergic to the painkiller you’d like to give him?
Personal health records speak for you to your healthcare provider, when you are unable. They save critically important time and help prevent potential mistakes and alert care providers to chronic conditions, medications and allergies. If something happens to during travel, you want whoever is treating you to be able to read and comprehend your personal health records so they can make informed decisions.
How do I create a comprehensive personal health record?
The first thing you should try is asking your clinic or doctor for print versions of your health records. The Health Insurance Portability and Accountability Act ( HIPAA ) Privacy Rule gives you, with few exceptions, the right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the Privacy Rule. Psychotherapy may be an exception to this rule. Your health provider or insurance company may charge your for copies of your health records. These records can serve to create a summary of things you consider important to share with others in your personal health record.
If you’re creating your own personal health record, you can use a personal health record system. Make sure you select a system that has been vetted and make their privacy policies public. For example, Microsoft HealthVault is a free service managed completely by users with a prominent privacy statement on their homepage.
In the end, you get to decide what information to include and what to leave out. To make the whole process easier, when it comes to traveling with your records, you should try to be as comprehensive as possible so you can get the best treatment possible.
Here are just a few things you should seriously consider including:
- Who normally treats you: Include your primary care provider’s name and phone number on your record. That way your physician overseas can call and ask questions.
- Allergies: You should record all allergies on your personal health records, whether it’s to food, drugs or other materials. If you’re unconscious and unable to advocate for yourself, a written record of your allergies can save your life.
- Medications: You should include all of your medications, including their dosages and any potential side effects specific to you.
- Chronic conditions: Do you have high blood pressure? Hemophilia? Make sure your records say so. Your chronic conditions will control your treatment plan.
- Prior Procedures: Include all of your major surgeries and the dates you had them. Recovering from a recent procedure could impact the kind of diagnosis and treatment you receive. Knowing whether or not you had issues with anesthesia can save your life.
- A living will: Your care provider should receive detailed information on how to access your living will and carry out your comfort and end of life wishes. Be aware some countries have different perspectives and laws on end of life. For example, Tyler Hill was diagnosed with brain death in Japan. Japan has very strict laws on end of life. End of life occurs when the heart stops. You are subject to the laws and customs of the culture you are in.
- Family history: Did anyone in your family have cancer? What about Parkinson’s? Your family history will let your care provider know potential conditions to investigate.
- Immunization history: Are you up to date on your vaccines? Have written proof so your care provider will know.
- Results of screening tests: Perhaps your care provider is considering testing you for a certain disease. You can save time, money and discomfort by letting them know lab results or any tests you have had.
- Exercise and dietary habits: Let your care provider know a little bit about your routine – what you normally eat, what you normally do for exercise, whether you smoke or whether you drink alcohol and how frequently you imbibe. These signals help your doctor make more accurate diagnosis and care decisions.
- Emergency contacts: Make sure you include emergency contacts, relationship to you, and how to contact them. Your emergency contacts should also have an active passport good for at least six months beyond your return date so they can get to you and offer bedside assistance. Some insurance companies may cover the cost of their transport. Emergency contacts should have all these preparations for themselves as well.
- Travel insurance: A reputable travel insurance company will have 24×7 hotlines to help you, including medical translation services, referrals, and transport. You and your care team need to know who and how to contact them. Even so, having your personal health record in the foreign language easily accessible saves time and potentially your life!
Personal health records are called ‘personal’ for a reason. They are yours. It’s your responsibility to timestamp your personal health record and keep it updated. Keep this information organized and up-to-date, and make sure you, your travel partners and emergency contacts know how to access it.
What if my destination is in a country with an exotic alphabet?
This is a critically important question. Just as keeping a personal health record saves you and your doctor precious time, translating those documents saves you more and eliminates potential errors. You should keep your personal health records in two languages: English, and the primary local language at your destinations. Translation services are relatively inexpensive. Google translate does a good job, but a good job may not be good enough to protect and safeguard your well-being. You might consider using a software service like Babylon, in countries with many dialects, you’ll want to be as accurate as possible to the region. Peace of mind is priceless.
How can I get my personal health record translated?
In order to translate your personal health record, you’ll need a reputable translation service. This is one more expense, like travel medical insurance, that you should budget into the cost of your trip.
When you’re looking for a medical translation service, there are a few things you should remember:
- Make sure your translation service is legitimate and accurate: When you look for a translation service, you should first make sure it’s certified. There are two main translation service certifications in the United States: the American Translators Association and the Association of Language Companies. Do your homework and make sure your service has been given the stamp of approval from one of these.
- Choose a medical translation specialist: A science as complicated as medicine requires contextual knowledge and very specific vocabulary. Prescriptions need accurate dosage and definitions. A medical translation specialist is highly skilled at this work.
- Make sure the service is up-to-date: Medicine is an evolving field. Make sure your translator is up-to-date on the latest treatments and protocols. The importance of certified medical and health care interpreters cannot be stressed enough.
Who should have permission to see my personal health records?
Some personal health care systems can be accessed automatically by medical providers, but just in case, keep an emergency contact card with you at all times.
Anything else I should have translated?
You might want to get a little more personal information translated for your health and safety. Here are a few things you might want to ask a professional translator to handle for you:
- Food allergy information: If you have a food allergy and you plan on eating out, make sure your server knows about your allergy and what foods to avoid. Keep a small card on your person explaining your allergy and your emergency treatment plan – like how to use your EpiPen.
- Disabilities: If you can’t complete certain tasks due to a disability, it might save you some time and angst to written language about your disability. It will help you get through otherwise confusing situations.
- Medical devices: Do you use an EpiPen or an insulin pump? Make sure the people around you know that and what they need to do to help. Contact lenses are another often overlooked notification.
Can you ask for help?
Take a little time and learn a few key phrases to get help. You definitely need to know the emergency numbers for fire, police, and ambulance at your destination, and whether or not you can trust them.
Get an early start on your language skills with some community education classes or an online language course. You could even download a language-learning app.
Try to learn a little of your destination’s language, but for your own health and safety, learn some of these key phrases:
- Help me
- Spanish: Ayudame
- Pronounced: “Eye-YOO-dah-may”
- I need a doctor
- Spanish: Necesito un doctor
- Pronounced: “Ness-sess-SEE-toh oon doke-TORE”
- Do you speak English?
- Spanish: Hablas inglés?
- Pronounced: “Ah-blahs een-GLAYS?”
- I’m allergic
- Spanish: Soy alérgica
- Pronounced: “Soy ah-LEHR-hee-cah”
- Spanish: Fuego
- Pronounced: “FWEH-goh”
- Spanish: Policía
- Pronounced: “Poh-lee-SEE-ah”
- Are you okay?
- Spanish: Estás bien?
- Pronounced: “ess-STAHSS bee-EN?”
No matter how much you prepare, it’s always possible to be surprised, so you should download some extra insurance against misinterpretation. Some apps, like MediBabble, allow you to translate medical information in real time, so you can communicate with bystanders and medical personnel promptly about what’s wrong and the kind of care you need.
Other things you should know
Besides getting your personal health records in order, there are a few other things you can do to make yourself safer abroad. Remember to take care of these tasks before you go so you can have a safe and healthy trip.
- Visit your doctor: Always make a stop at your doctor’s office for a pre-trip checkup. Learn if you’re healthy enough to travel, what vaccines and antibiotics you’ll need, what to expect for your chronic health conditions and how much of your prescription medications to take with you. It’s also a great opportunity to update your personal health records one last time before departure.
- Get travel medical insurance: Before you go abroad, always make sure you’re insured against the kind of accidents that can put your health and your life in harm’s way. Purchase travel medical insurance. Make sure it covers medical expenses and emergency evacuation services. Spending a little money on this up front can save you and your loved ones thousands of dollars.
- Prep your emergency contacts: Make sure your emergency contacts have access to your personal health records, your trip itinerary, your contact and lodging information and a good way to reach you. You should also make sure your emergency contact has an emergency contact, in case they need to go abroad and help you.
- Learn your emergency numbers: Every country has a different system for calling emergency services. In the United States, you just call 911 whether you need police, fire or an ambulance. In other countries, those services are all under different emergency lines. Make sure you know well in advance which numbers you need to call for what.
- Stay in touch with your local embassy: The role of the U.S. Consulate is to help and support US American citizens abroad and to advance diplomatic services. It is wise to keep the telephone number, address, email, and working hours with you at all times. Register your trip with the U.S. Department of State so you will receive warnings and alerts if the safety climate at your destination changes or an emergency happens in your home state. They will reach you via text, email or phone call if you provide the information in advance. Your U.S. Embassy will also help with translation and medical provider referrals and more.
- UP the credit card limit: Some medical institutes in foreign countries demand fees for services before they are delivered. This may include medical evacuation. A deposit on medical evacuation can cost $30-50,000. Travel insurance with medical evacuation can be a lifesaver. Notify your credit card vendors of your planned travel before departure.
- Private vs. Public Hospitals: Particularly in third world countries, you will need to rely on a trusted travel insurance company or your U.S. Embassy for referrals to best care. Private hospitals may offer a higher grade of services and more specialized care. In some countries, healthcare is paid for. In other countries, you may have to show proof of insurance on entry or pay in advance. If you cannot pay in advance, you may be refused services. Travel.State.Gov can help you with determinations and preparation.
- Know your health risks abroad: The World Health Organization and Centers for Disease Control are excellent resources for health risks in foreign countries, including insect-borne illnesses, the risk of rabies and diseases. It’s always a good idea to check in with them and a specialized travel clinic for preventive health well in advance of your departure.
For more travel safety tips and resources, visit Depart Smart.org.