Why travel insurance

 

My twelve-year-old son broke his arm horse-riding this summer. Had he done this in Blighty, we'd have been looking at an ambulance, an x-ray, a cast or surgery, and a night in hospital.

 

Instead, it happened in Khövsgöl, northern Mongolia, a vast expanse of terribly scenic nothing with a vast expanse of terribly scenic Russian nothing 5km away across some terribly scenic mountains.

 

And I am honestly not at all sure how we'd have coped without travel insurance.

 

It took five hours to get a doctor out from the nearest clinic, who splinted Zac's arm with sticks and shot him up with so much Tramadol that in an hour-long jeep ride over riverbeds, gullies and rocky fields he emitted only the observation, “I think I might be tripping.”

 

Her clinic did have electricity, which was nice. And the staff were lovely, which was excellent. A few things it didn't have? Running water, indoor toilets or an x-ray.

 

Enter travel insurance

 

As it happens, the only international standard medical facility in all of Mongolia is in Ulaanbaatar, more than 30 hours overland from where we were. Further, as the nearest x-ray was at least twelve hours' drive over landscape unsullied by roads, the only sane way to extract us was on a helicopter.

 

For a pilot, a co-pilot, a doctor and a paramedic to make the nine-hour round trip cost our insurers over £20,000.

 

In Ulaanbaatar an x-ray rapidly revealed that Zac had what we laypeople term “an absolute bitch of a fracture” and would need what we laypeople term “a plate”. And, as no one in Mongolia is capable of doing a plate, and he needed to travel lying down, he (and I, as his mother) would need to be evacuated on an air ambulance to Hong Kong.

 

An air ambulance, for the record, is a private jet with a doctor (and more medics if needed), a pilot, a co-pilot and some kit. The cost of getting the jet and team from Beijing to Ulaanbaatar and then out to Hong Kong was well over $100,000.

 

Which makes the price of our private room in an elite Hong Kong hospital, Zac's tests, surgery and follow-up, plus a week or so in a Hong Kong hotel and flights back to the UK, a snip at another twenty grand and change.

 

If we hadn't had insurance? Well, we'd have been looking at long, agonising hours of overland travel, at thousands of pounds of medical expenses in the capital and thousands more on agonising flights from Ulaanbaatar to the UK with Zac's arm strapped to his chest.

 

Most importantly, however, as the rural clinic had splinted his arm so tightly his muscles were spasming and his blood flow was restricted, it's quite likely he'd have ended up with permanent nerve damage.

 

Not got travel insurance? Go buy it. You'll probably never claim on it, but if you need it, you'll really need it.

 

 

 

 

Published by Stuart Lodge

Why an Outdoor First Aid Course Could Save Your Life

 

 

 

An older man is clinging to a tree, at the top of a steep, slippery slope, screaming. He's fallen from the path, and he thinks his arm is broken.

The sun will set in half an hour, and bandits infest the valley after dark. Slip-sliding up the hill, armed with a tarp and a medical kit, we steady him and try and work out how the hell to get him down.

No, it's not a scene from a typical RTW trip, mercifully. It's a practice scenario, part of the Outdoor First Aid course we're doing with High Peak First Aid, outside the pretty village of Hope in the Peak District.

“Outdoor First Aid is defined as any situation where you are at least an hour from medical care,” explains Nicola, our course instructor. “We call the first hour the Golden Hour, because that's the timeframe in which treatment can best help the patient survive.”

It was a cousin, an expedition caver, who pointed me in the direction of Outdoor First Aid, after my son broke his arm in the middle of bloody nowhere, Outer Mongolia, and I realised neither of us had any idea how to patch up a broken arm – let alone how to move him safely if he'd had head or spinal injuries.

“In normal first aid courses, they'll teach you never to use a tourniquet,” my cousin explained chirpily, over a beer. “In expedition medicine, they'll teach you to use one in some situations – you'll lose the limb, but save the life.”

Like a lot of RTW travellers, I've routinely been more than an hour's travel – sometimes a day or more – from any form of medical care, even the most basic and unskilled. You don't have to be trekking high in the Himalayas, upriver in the Amazon or exploring the Western Desert on a camel – all it takes is to be on a bus from point A to point B when it crashes, and, bang, you can be hours from help.

My son and I are doing the entry level course: 16 hours, over two days, alternating between the classroom and the muddy wilderness around us. (The course isn't usually open to under-16s, but Nicola figured that after Mongolia and Everest Base Camp Zac should have a reasonable handle on the principles of wilderness emergencies.)

Over the first day, we cover the management of routine injuries – burns, sprains, fractures, bleeding. We practise CPR and learn how to use a defibrillator. We're drilled, again and again, on the basic principles of ABC – airway, breathing, circulation – and discover how to assess and monitor a patient. And we learn an impressive amount of physiology and anatomy.

Day 2 takes us out into the muddy, chilly woodland for a range of scenarios. After inadvertently killing a couple of victims, I learn how to move victims with suspected spinal injuries, how to remove a helmet safely, how bloody difficult it is to keep a victim warm and, importantly, how to patch up a broken limb.

“The reason he's screaming,” explains Nicola helpfully, as I hastily wrap bandages around the poor guy's arm in fear of the approaching bandits, “Is that you're bandaging the wrong bit of his arm. You need to stabilise the break.”

Have I had to use these skills yet? Thankfully, no. But I have them, and if your RTW will take you off the beaten track, I'd recommend you consider acquiring them too.

 

 

 


Published by Stuart Lodge

Medical evacuation

 


1: You Don't Need to Be at Death's Door to Need Emergency Medical Evac
In places like Laos, Mongolia and many Pacific island nations, even apparently routine problems can lead to emergency evac.

2: Emergency Medical Evacuations Rarely Happen Instantly

The insurers' assistance company, your first point of contact during a medical emergency, needs to balance the patient's needs against the underwriters' desire to control costs. Both underwriters and assistance companies work 24/7 but negotiations do take time.

3: Aircraft Companies Need Money Upfront

No air charter company will send a helicopter, let alone a plane, without a solid “guarantee of payment” in place from your insurers (or cash or credit card if you've been unwise enough to travel without insurance).

4: Logistics Are Insanely Complicated
Even for an emergency helicopter evac within a single country, the nearest helicopter needs to be found, the medical team, equipment and crew need to get to the helicopter, and a flight plan, often including refuelling, needs to be agreed.

5: Most of the Time, the Patient Needs to Be “Fit to Fly”
With most medical evacuations, a medical professional will need to certify that the victim is “fit to fly”: in an emergency mountain rescue situation, the rules are less strict.

6: Most Helicopters Don't Fly at Night

Most helicopters are not allowed to fly at night. So unless an emergency happens early in the day or near the helicopter base, you are likely to have to wait until morning.

7: International Emergency Evacs Take Days
International air ambulances are not designed to rush victims to the nearest hospital. They are intended to transport patients whose condition is stable – be that conscious with a broken leg or in a coma on a ventilator – from one medical facility to another.

8: Air Ambulances Are Not Well-Equipped

Air ambulances are lightly customised private jets, not flying hospitals. They don't have operating theatres, MRI scanners, blood banks or pharmacies and they can't just set down at the nearest airport if something goes wrong.

9: Seriously Injured Patients May End Up in the Nearest Public Trauma Hospital

Because of the “fit to fly” rule, the ultimate treatment option in a developing country may be the best public trauma hospital in the capital. If you survive, once you're stable, you can then be moved internationally for treatment.

10: International Air Ambulances Take Aeons to Arrange

International air evacs are a logistical nightmare. A plane and team needs to be found, and a flight path has to be cleared through at least two, and sometimes several, countries. Medical crew need visas for the country where the patient is, the country where the patient is going and the country where they are meeting the air ambulance.

11: It's Rare for an International Air Ambulance to Leave on Time
Even once the plane is signed off, last minute holdups are legion. Bad weather and customs inspections can delay a flight for hours, as can plain old paranoia, like the air ambulance that left Tel Aviv for Addis Ababa only to sit on the runway for five hours because the Ethiopians decided the patient must be an Israeli spy.

 

 

 

 

 

 

Published by Stuart Lodge

Scam avoidance

 

 

 

Graduate professionals do not hang out at tourist sites bothering tourists

From Bangkok to Cairo, from Beijing to Marrakesh, I've been approached by more “teachers”, “lawyers”, “archaeologists”, “film-makers” and “doctors” than I could shake a stick at – much as I would have loved to.

Most of these encounters have resulted in an invitation to some scammy, over-priced tat shop for the sort of hard sell that makes the Kray Brothers look like Mother Teresa, though a few, by way of variety, have endeavoured to introduce me to travel agents offering tours for the price of my firstborn, or perhaps a kidney.

People who invite strangers to tea usually have ulterior motives...

After a while in the Middle East, the simple word “tea” can trigger a fight or flight reflex that sends one soaring back to the prehistoric savannah. In the Arab world, extensive emotional-cultural blackmail, riddled with guilt-tripping references to “traditional Arabic hospitality”, tends to lead to an eye-bleedingly awkward afternoon resisting the siren lure of the sort of carpets and statuary Michael Jackson used to buy during his glory days in Vegas, perhaps with the occasional offer of money exchange by way of variation.

...especially if they're Chinese

The Chinese take the ancient art of the tea ceremony to a whole new level with the tea scam. Here new friends gauge your gullibility and susceptibility to flattery over small talk then invite you to join them for tea. Where there are no prices on the menu, the dishwater concoctions we Brits so politely sample can run to hundreds, or even thousands, of pounds. Where there are prices, the thirty quid loss hurts the ego more than the wallet.

If someone says somewhere is shut, it probably isn't...

There are, of course, exceptions to this rule. Typically, however, the taxi driver who claims your guesthouse is closed is receiving commission from the competitor he will take you to, a gratuity that will be added to your already extortionate room bill. And the “archaeologist” who explains that the museum is shut will rapidly suggest an alternative destination, typically a “government bazaar” with a special sale.

If someone says something is government-run, run...

Tying with the very special temple only open on “Buddha Day” for the coveted position of most popular scam in Bangkok is the TAT tuk-tuk tour, allegedly donated by the government for a token 20 baht, because, lord knows, there really aren't enough tourists in Bangkok. The Egyptian government also has a range of eminently avoidable special offers, from government bazaars to discounted entry to the pyramids.

If something sounds too good to be true, it probably is

Rather as with the folk who send their life savings to that charming Nigerian general with the winning email style, it's difficult to feel too sorry for travellers who fall for the gem scam, dropping thousands of quid on coloured glass and painstakingly smuggling it overland, let alone the various variants on the poker scam. Because those Filipino poker sharks you're playing with so totally want your money to extort the OTHER guy, right? Err, right?

 

 

Health

 


 

Travel health is a major priority when planning your Round the World flight. Researching your travel destination beforehand is essential to find out the vaccination requirements as well as health advice regarding safe drinking, food, STDs, insect borne diseases and other travel related health issues.  Before setting off on your gap year travels, it's worth spending some time getting fit by walking, running, swimming and any number of different sports. Although travelling will make you fit and walking for long distances will seem quite normal after some time, exercising and eating healthily before you go will help prepare you for the journey ahead.

 

Also ensure that you leave plenty of time to obtain all the necessary vaccinations before setting off on your travels (although they can be done pretty quickly - this is an expensive option). This could be a few months in advance in some cases. Travel health issues will vary from country to country but some of the things to look out for include:

 

Too much sun
Heat stroke, sunburn, skin cancer and a variety of ill effects can all result from too much sun exposure. Babies, children and fair skinned people are at greater risk especially in tropical areas. The general advice here is to use a good sunscreen, drink lots of water, avoid over exertion, avoid alcohol, wear a hat, stay out of the mid day sun and minimise time spent on tanning.

 

Water and food
There are a large number of diseases which can be contracted from infected water and food including Escherichia coli, dysentery, giardiasis and hepatitis A. Less common diseases for travellers include typhoid and cholera. The general rule here is to drink bottled water (where the top has not been tampered with) and to use bottled water for brushing teeth. Water can also be treated by boiling, chemical disinfection through a tincture of iodine and through the use of portable water filters. With regards to food poisoning, travellers must be cautious when travelling in areas of poor hygiene and sanitation. Milk products, salads, uncooked or undercooked vegetables and meat must be avoided. Fruit which can be peeled and piping hot food is generally safe.

 

Sexually Transmitted Diseases (STDs)
Diseases such as syphilis, gonorrhoea and AIDS are commonly contracted through casual sex. Symptoms vary but early treatment is often essential to avoid long term complications. Prevention is through abstinence, using water based lubricants and through the use of latex condoms. Condoms can vary in quality and if in doubt, always try to purchase well known brands or buy them from home before travel.

If you have any concerns regarding a condition you may have or a travel health issue, consult your doctor before going and also ensure that you take out a good travel insurance policy.

 

Malaria

This is transmitted by the female mosquito usually during the period from dusk to dawn. Malaria can kill and early symptoms include chills, fever, body aches and sweating. For the prevention of malaria, travellers are advised to:
- wear light coloured long sleeve tops and trousers 
- take the appropriate malaria prophylaxis before, during and after the period of travel. 
- apply insect repellent. Both DEET based products and natural insect repellents such as those based on oil of eucalyptus and citronella are available.
- Use a mosquito net or stay in a room with mosquito netting on the windows.

 

Vaccination Chart

One vaccination does not automatically offer protection against a disease for life. Many vaccines need to be routinely boosted to offer continued protection. The following chart gives some idea of how often boosters should be administered according to the UK Guidelines. This chart is offered as a guideline (it is not definitive!) and should be used together with specialist advice from your travel health advisor or GP. Before travel you should ensure you have had all of your childhood routine vaccinations. Take advice from your GP about whether you really need Yellow Fever and Rabies inoculations depending on the areas you are going to. The following is a very general list of jabs most people would take on most general RTWs - but please make sure you see a qualified medical professional before you go.

 

Diphtheria/Tetanus Following initial course of five doses boost every 10 years for adults and adolescents Given as a Tetanus/Diphtheria combination for travel to risk areas
Hepatitis A First injection gives protection for one year. Booster at 6-18 months gives protection for 10 years - some vaccines can be boosted up to three years after first dose Protection occurs 10-14 days after the primary dose.
Japanese B Encephalitis Following primary course boost after 2 years  
Meningitis A&C After initial vaccination boost every 3-5 years Travel to Mecca - certificate of injection valid after 10 days.
Polio (oral) After initial course - boost every 10 years  
Tetanus/Diphtheria Following initial course of five doses boost every 10 years for adults and adolescents Given as a Tetanus/Diphtheria combination for travel to risk areas
Typhoid (injection) After initial vaccination boost every 3 years Partial protection occurs 10-14 days following first injection
Typhoid (oral) Following 3 capsule course protection lasts for 1-3 years Protection against typhoid following a 3 capsule course is 70% after 7-10 days after initial course
Yellow Fever After initial vaccination boost after 10 years Certificate valid 10 days after vaccination