Interest in practicing and teaching emergency medicine around the world has increased exponentially. Many of our colleagues now have some international experience, many others dream of following a path to remote regions, and most academic centers are considering, if not running, fellowships related to international emergency medical care.
Yet most emergency physicians don’t know how to identify and evaluate global volunteer opportunities, what to expect when they travel to remote lands, and how to prepare for their experience. This article, the second of a three-part series based on The Global Healthcare Volunteer’s Handbook: What You Need to Know Before You Go, provides some of the basic information that emergency physicians need for these ventures.
Aside from brushing up on infectious diseases and mastering some phrases in the local language, key preparations for international medical experiences include arranging your flights and your local transportation needs, investigating and obtaining appropriate electronic communication methods, getting the necessary immunizations and medications, and obtaining money in various useable forms. What follows is only a brief summary of each of those issues. The timing depends on how soon you will depart.
The first step will usually be to arrange your flights. Before doing so, consider several variables. Do you want to get the lowest fare, the shortest travel time, or a route that will allow for an interesting layover? These options are not necessarily mutually exclusive. Layovers allow for some sightseeing as well as a respite during a long journey. Consider upgrading your airline seat, either by using frequent-flier miles or by paying more. If you hit it right, premium seats can be less expensive than flying coach. Unfortunately, studies don’t show an optimal time to get the best online international airline fares.
Once you get to your destination airport, a local driver will normally collect you. For security reasons and for your peace of mind, have the driver’s name and phone number with you. The organization that helped arrange your volunteer trip should be able to supply that information. If you need to call the driver (my experience is that they are there to meet you less than half the time) and don’t yet have a local phone, ask a security guard to make the call. If you plan on driving yourself (usually not a great idea in most countries), you will need to not only have a current personal driver’s license but also an International Driving Permit (IDP) and, in many Latin American countries, an Inter-American Driving Permit (IADP). In the United States, these can be obtained up to six months in advance at AAA or the National Automobile Club (NAC).
Finding ways to communicate both locally and with the folks at home is essential, but it takes planning so that you do not amass a debt surpassing your annual salary. Nearly all areas of the world have cell phone service, although they may use a GSM system that differs from that used by American carriers such as Verizon and Sprint. Because you need to avoid exorbitant roaming charges, you will probably want to leave your phone in airplane mode and only use it as a “portable brain” and through Wi-Fi connections. Note that even using phone-based Skype via Wi-Fi can be pricey with some carriers. Ahead of time, consider buying an unlocked GSM quad-band phone that will work in 212 countries and a local SIM card when you get to the country’s airport or your work site. Alternatively, rent a local phone. For international calls, use a Wi-Fi connection to access a VoIP service, such as Skype. Also, be sure that you have the correct electrical adaptors and converters (if necessary) to recharge your electronic gear.
Check with a travel clinic or the Centers for Disease Control and Prevention website to see what immunizations and preventative medications and personal care items (usually antimalarials, DEET, and sunscreen) you will need. Some of these immunizations require weeks to months for the series to be administered and for you to acquire immunity. Remember to get a dental checkup before you go and to obtain more than enough of your routine medications as well as some analgesics, antidiarrheals, and basic antibiotics.
Don’t leave home without at least three ways to pay your bills abroad. U.S. dollars or Euros usually work everywhere as long as you use new, undamaged bills. Carry at least two different brands of credit cards, preferably with no international surcharge and with an embedded chip, which you can get by calling your credit card company. (Although “chip-and-PIN” credit cards are not common in the United States, some countries, such as the United Kingdom, favor them over cards with magnetic strips.) Finally, if you cannot get any local currency before you arrive, get at least $100 in local currency at the airport to pay for immediate costs. Note that most places no longer accept traveler’s checks.
Dr. Iserson is a fellow of the International Federation for Emergency Medicine and professor emeritus in the department of emergency medicine at The University of Arizona in Tucson.