Question: I am a sickle cell warrior and I’m afraid to travel to certain countries like Ukraine or China. Help!
Okay, so I know that one of the main tenets of this blog is that sickle cell should not limit you. And I say that if you wish to travel to other countries, go for it. Just be sickle smart, plan and prepare for every eventuality.
Do everything in your power not to fall sick. Pace yourself, listen to your body, hydrate, be transfused before you leave your home base, avoid stress, get rest…you know, the usual sickle cell regimen. That way, should you get sick, hopefully it won’t be a full blown crises but just a mini one that you can deal with in your hotel room.
If you can afford it, get traveler’s medical insurance. This will cover most emergency room visits and treatments post ER visits while you are abroad. Some countries require this as a contingency plan before you get a long-term visa (greater than 90 day stay). Just make sure before you buy in, that you read and understand the Pre-Existing Conditions clause. If you have Kaiser insurance, you are extremely lucky. They will cover the full bill of your medical care abroad, and might even fly you back to the US for treatment if you need to be hospitalized.
When traveling abroad, make sure you have some of your medical history with you. You should have a printout of your current labs, your last discharge summary, and a list of medications that you are on. I usually visit my doctor a few weeks before my trip for a routine checkup and ask for a letter that I can give physicians in other countries that details my most common sickle cell complications, medications and treatment plans. I also ask for a prescription for my pain meds that will cover me for the full period when I am abroad. I never want to run out of meds in a foreign country, because it will be hard to get the same meds and doses abroad. Keep all this stuff in a safe place, probably close to where you have your passport.
If you are visiting non-English speaking countries, make sure you understand the language. If not, I suggest to stay away from the rural areas and visit the big cities where there are alot of tourists and more English speakers. Chances are there, you will be able to find an English speaking hospital/physician that can attend to your needs. Some cities have hospitals that are exclusively English speaking, a good internet search or phone call to the embassy can help you in your research.
Know something about blood transfusions. If the country you are going to has a low population of Africans/African Americans, it might be hard to come up with the right antibody/antigen match for your blood. Sure, they can match your phenotype real easy, but each cultural group has antigen markers that are not present in others and put you at risk for having a transfusion reaction. This was one of the reasons that the embassy of Australia did not want to give me a work visa, because they were concerned that there wouldn’t be a blood match if I did need a transfusion. This is why I highly recommend a pre-transfusion before you travel abroad.
Not all countries have a significant sickle cell population i.e. Scandinavian countries and some parts of Asia. You might find a couple of sickle cell warriors, but not a huge community. As a result, most hospitals and doctors will not have current exposure with treatment of a sickle cell warrior in full blown crises. (This can actually be a good thing). However, all physicians learn about sickle cell in school, it is a hematologic condition and is studied in all medical schools. The only thing is that not having current exposure puts the doctor at a disadvantage as to what to test for, and what to prescribe for your treatment. But not having exposure also means that the doctors are not prone to misjudge, discriminate, or stigmatize against sickle cell patients. The medical professionals are more compassionate, are more prone to listen to you and try to help you.
Ask for a hematologist or oncologist. They generally have more experience with blood disorders and may have come across sickle cell. If all else fails, I guess you have to settle for an internal med doctor, but don’t worry…they aren’t like the internal med docs here…they actually do not act like they know everything, will research your condition with peers and professional journals, and will read the documents you give them from your physician.
Know that medications are different when abroad. They have different drug manufacturers, different drug concentrations and different meds, just the same way they have a different currencies. So the docs might be giving you a different drug that hopefully will have the same effect. If you have any allergies, research the alternate names and tell the docs so they know prior to your treatment. For example, Tylenol is called Paracetamol…(sorry, this is the only one I know offhand).
Beyond this, just follow the basic traveler rules. Only drink bottled water, get your immunization shots, stay safe and have fun!