Call-back

In our experience a call-back service is the best answer.  It should be one that you are billed for later rather than a pre-paid one.

How call-back works: you phone a designated number, let it ring once and put down.  The service then calls you back automatically almost immediately.  When you answer, you are prompted to dial the subscriber number and you are put through.

Most call-back services are based in the USA, which means that you get the more favourable US rates instead of the higher rate that the hotel would charge you.

Call-back with a mobile phone

In order to avoid the bother of having to access the Internet in order to keep changing the call-back number, it is convenient to use the call-back in combination with a mobile phone.  That way the number stays constant even when you move between countries.

For this you need an “international” SIM card and a GSM phone.  The SIM card can be obtained from the same service provider as the call-back service, and they frequently also rent or sell suitable GSM-compatible phones.

The number is usually Estonian because Estonia has a very liberal phone system (and is the country that Skype came from).  Anyone phoning your number will pay the international call costs to Estonia.  You will also be able to receive SMS text messages from anywhere in the world, which the sender pays for.

Limitations

Check if the phone you intend using is compatible with your service provider.  For instance, we found that a Nokia 95 could not send SMSes with a United World Telecom SIM card.  The similar but older Nokia N70 is fully compatible, which we only found out by experiment after returning home.  As a result we could not send text messages whilst travelling across Europe.

We suggest that you select a service provider that states phone compatibility on their web site.  One such company is One SimCard, who have an exhaustive list of compatible GSM phones.  (If you are aware of others please feel free to register and add a comment.)

For travel within the US different arrangements will have to be made as it is a stronghold of the CDMA phone system.  Cheaper calls can be made with a mobile phone and direct dialling rather than call-back.

This food advice is useful even if you are not travelling – even in the USA 250,000 people are hospitalised each year for diarrhoea, and the food safety in the United States is a great deal better than it is in many countries.  There are other examples too: thousands of people got sick and dozens died in mid-2011 from eating raw vegetables originating in Germany, which were contaminated by a strain of E. Coli bacteria.

The cause

Traveller’s diarrhoea (unkindly called various local names including Delhi Belly and Montezuma’s Revenge) and related problems are caused by contaminated food.

Avoiding illness while travelling – What you touch

Good personal hygiene, particularly about one’s hands is critically important in preventing infection whilst travelling.  Wash your hands before and after using the toilet, after handling money, and before meals.  Also wash your hands before touching your face or putting your fingers in your mouth.

Only use potable water to rinse your mouth and toothbrush when you brush your teeth.  Also, do not use water you would not drink to clean items in close contact with eyes and mouth, such as contact lenses.

Be careful about swimming in fresh water.  Aside from the risk of pollutants, you may also unwittingly be exposing yourself to parasites including river blindness and bilharzia, caused by parasitic worms.

First aid

Stay hydrated.  The volume of liquid you take in must approximate the amount of liquid you lose.

The water that you drink must be clean and uncontaminated.  If it is at all suspect you can boil it for twenty minutes to kill off the bacteria.

Research has established that pure water is not absorbed by the body as fast as a mild solution of electrolytes.  You can buy “Oral Rehydration” sachets to add to water, or you can make up your own in an emergency.  The basic recipe is:

1/2 to 1 level teaspoon of salt

6 to 8 level teaspoons of sugar

1 litre of clean, drinkable water

Antimotility drugs are useful as they slow down the rate at which food passes through your body.  This will at least give you the time to get back to your hotel, call a doctor, etc.  Your doctor or pharmacist can advise you which ones to take with you.

See a doctor

Several food poisoning causes are potentially life-threatening and you should always 1) stay hydrated with clean water and 2) exercise caution and see a competent doctor, particularly if the symptoms are severe or protracted.  Diarrhoea can even be a symptom of a serious tropical disease that needs additional specialist medical treatment.

Avoiding illness while travelling – What you eat

The most frequent cause of  illness while travelling is food contamination, caused by:

• Improper food storage and handling leading to bacterial contamination
• Infection by micro-organisms: bacteria and amoebas, protozoa
• Chemical residues and contamination
• Toxins produced by fungi

You should avoid:

• Hot food that has been allowed to cool down
• Cold food that has warmed up
• Reheated food
• Food that has been uncovered or exposed to flies or other creatures

Chicken is particularly treacherous if undercooked.  Even if grilled, it can have uncooked portions if it was put on the griller directly from the freezer.  Boiled or baked is probably the safest.  Microwaved chicken is probably the least safe because you do not know if it has been heated sufficiently right through.  If there are raw or undercooked parts of the chicken, don’t eat it.

Beef should be well done unless you have sound reason to trust the kitchen (for instance if it is a Michelin-Star kitchen then the chances are that even Steak Tartare is safe to eat).

Avoid food prepared in the street, particularly if there is a possibility for cross-contamination between raw meat and cooked meat.

Buffets can be suspect.  The food is exposed for extended periods to contamination, including people coughing and sneezing near them.  You do not know how good the hygiene is of people that have used the serving utensils, so you could be getting germs on your hands while serving.  It is also possible for tongs or spoons to fall into the dish, thus contaminating the food.

Buffets are also bad because it is rare that the temperature control is adequate.  Hot foods need to be kept hot in order to destroy bacteria.  Once they cool down to merely warm they actually promote bacterial growth.  Hot food kept hot (over 40° C) will be over-cooked in a relatively short period of time.

Cold foods also need to be kept cold.  The rate of bacterial growth doubles with every 10° C increase in temperature.  (Around 20° F temperature change.)  A salad may be at freezing point at the bottom but near room temperature at the top surface.

It there is any slight symptom at all of fungus infection of food, do not eat it.  Visible fungus is often very small in relation to the mycelium penetrating the food, so by the time it shows the whole mass of food may be infected.  Fungi produce poisons called mycotoxins that are not destroyed by cooking.  One group of such poisons called aflatoxins are among the most carcinogenic substances known, but you first have to survive the initial poisoning for that to be a worry.  Many do not survive aflatoxin poisoning.

Fresh fruit and vegetables

Fresh fruit and vegetables are potentially dangerous because you have no idea if they are contaminated or if they have been properly cleaned.  In the tropics it is necessary to do more than merely washing fruit and veg. : they need to be soaked and scrubbed in a dilute chlorine bleach to kill off the amoebas and avoid things like amoebic dysentery.

Avoid salads for this reason.  Not only are salads rarely washed thoroughly enough, in addition to bacteria and amoebas they can also harbour parasitic organisms like flukes and snails, particularly in tropical regions.

Eat only vegetables that have been boiled for an extended period, or baked.

Avoiding illness while travelling – What you drink

Bottle of water

Avoid anything containing ice as it is only as good as the water it was made from, as clean as the kitchen it came from, and as pure as the containers and plumbing it has been handled with.

Some countries have entirely safe tap water supplies, which you can determine when researching your destination.  Others, even first-world countries, may have dubious water quality and you should drink only bottled water.  Some countries (for instance Turkey) have water certification procedures and your hotel will display a certificate that indicates their care in relation to water supply.  That does not mean that you can drink their tap water, but merely means that they may, for instance, have safe drinking water available to guests.

It can be difficult or impossible for you to purify contaminated water by yourself as a traveller.  Treatment with iodine or chlorine tablets will help to kill off bacteria if done correctly.  However, this is not magic, and cannot remove metal contamination, or chemical and pesticide residues, etc.  There are other possibilities that first filter the water, then sterilise it usually with activated charcoal, or ultraviolet light.

If the local water is unsafe then use only reputable bottled water (or water stated as potable that is provided by a certified hotel).  If you cannot get bottled water then drink brand-name bottled soda drinks: Coke, Pepsi, etc.  Staying hydrated is more important in the short term than a few extra calories or the state of your teeth

It is best to be prepared.  If you are not insured on that lovely ski holiday in Austria and you break a leg (or both legs, or even an arm and a leg) the medical and evacuation bills could be astronomical.  If you are not insured, how are you going to pay them?

You may already have some very basic insurance cover linked to your credit card, if you pay for your flights by credit card.  Most major credit cards have this facility, though in some cases they must be “activated”.   Find out (in writing) exactly what insurance benefits your card company offers.  If you have a premium card such as a gold card, or higher, the automatic cover may be extensive.  With an entry-level credit card the insurance cover may be very basic, possibly limited to the immediate costs of a medical emergency and nothing else.  Even then, it may be an insufficient amount of cover.

If the “free” insurance is inadequate you should buy top-up insurance.  The bank or credit card company may offer this.  You could also shop around, though, as many insurance companies sell top-up insurance for credit card holders with basic travel insurance.

Bearing the above in mind, here are a few ‘musts’ that should be included in your cover:

• Medical emergency
• Medical Evacuation or repatriation
• Medical expenses – due to terrorism
• Accompanying family member
• Compassionate emergency visit by one person (some companies will restrict this to a family member)
• In-flight accident
• Lost baggage (including delayed baggage)
• Death (removal of mortal remains)
• Follow-up treatment in your home country
• Travel delay
• Premature return in case of death of a family member
• Legal assistance
• Personal liability.  (This could prove to be a big problem if you, say, knock over a camel that was trying to sleep on the road, while you are in Dubai.  You may find out that it was a very ‘special’ camel to the owner and you have to ‘cough up’ for it.  … For some reason favourite camels seem to suffer many more tragic accidents than unloved ones.)
• Hijack

Some of the above, such as baggage, are regarded by insurers as optional extras.  If you are carrying special equipment, such as cameras, expensive sporting equipment (specific “Golf insurance” is available) or other valuable goods that are pricey, check if they are covered under the baggage cover.  If not, and some travel insurance companies don’t cover these items (except for a low maximum amount not equal to the actual value) consulting your broker for specialist advice about this may be helpful.

In most cases you should insure with a company based in your home country as they will have worked out appropriate risk profiles.  Travel insurance from a foreign company is less likely to have adequate covering and claims are more likely to be repudiated or payouts reduced.

Many countries require proof of travel insurance, sometimes not below a certain amount and may be a visa requirement, for instance for Schengen visas.

As with all guidelines on this web site, the above is based on my own professional experience and my personal travel and does not replace the advice from your registered broker.   The main thing is to be adequately insured.  You never know when it will be needed!

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