Planning the medical side of travel

I’ve already written about the list of camera gear I’ll be taking on this trip, but there’s more to be organised than just the gear and the flights/accommodation. For many people there are medical issues to be tackled as well.
“Swine” Flu
I’ve managed to survive through the Australian winter without contracting the H1N1 flu (some of my friends have had it however). But with this trip to the European winter, I’ll be in contact with hundreds of people and if swine flu does flare up over the coming six months, Europe would be my guess for a likely location.
In October 2009 Australian Government started providing the Panvax H1N1 vaccine at no cost. All I had to do was ring up my doctor and arrange an appointment (which was free!) for the jab (which was also free). I’ve also had the seasonal vaccine for the common “normal” flu varieties in Australia (I had last year’s version before going to Antarctica). There may be some flu strains I’m not vaccinated against, but I’m about as protected as I can reasonably be.
Other vaccines
I’m not expecting to be exposed to any other nasty diseases on this particular trip, but from previous trips I’ve got current vaccinations for almost everything under the sun.

The main drag through town
Muang Beng, Udomxai, Laos
40D, 17-40mm (A2_003962)
I’m insulin-dependent. We used to call people like me “diabetics” but these days it’s not PC to use labels and I’m now “a person with diabetes”. This isn’t something I’ve talked about much on my photography websites in the past, as it simply isn’t important most of the time. It doesn’t define who I am, it’s just part of who I am. I’ve been living with this condition since 1982, and am used to the routine of finger-prick blood tests, four-times-daily injections, watching what I eat, etc. Backing up all this are regular consultations with a bunch of medical specialists of course!
As an insulin-dependent person I have a few extra things to deal with than many people when considering travel plans. But I’ve been having insulin injections since 1982, and have never really let it stop me doing outdoor activities such as hiking, camping, skiing, 4WD’ing across the Simpson Desert, climbing Mt. Kinabalu and camping in the jungle in Borneo, bicycling around northern Laos, travelling to East Africa, Thailand, Singapore, Argentina/Chile, or even Antarctica (and now the polar winter). I don’t take irresponsible risks, but neither do I let it control my life. The move from syringes to insulin “pens” years ago certainly made the routine of injections simpler and much more convenient (and the gear easier to travel with) and now injections are quick, easy, and subtle (sometimes even in semi-public areas). Even doing it in the back of a truck bouncing along a highway in Borneo is a bit more awkward, but no real problem. In early 2010 I plan to move to a “pump” delivery system and keep the pens as backups for emergencies, but for now it’s all pens.

Village dinner
Sabah, Malaysian Borneo
D30, 17-35mm (N1_86C)
Just as exposing an image depends on the tuple of shutter speed, aperture, and ISO, with diabetes maintaining your BSL (blood sugar level) depends on the tuple of food, insulin, and exercise. Change any one and you need to balance the others. In the dynamic world of travel where schedules can be a bit vague, I do need to insist on fairly regular meals. Luckily I usually don’t need to ask for special food as I manage to eat appropriate amounts of normal food (although some regional delicacies are too sweet and I end up not eating all of them, and sometimes have to ask for extra bread or rice to build up the carbohydrates in the meal to balance my exercise).
It is important for at least some of my travelling companions to be aware of my condition. They can help me keep an eye on things, and in the event of an emergency they can at least make sure that reasonable things are being done.
I think the sickest I’ve been while travelling was in Borneo in 2001: I got a stomach bug from some contaminated water after a hike, and was lying in bed retching into a bin for hours. With the recent extreme exercise we knew my blood sugar was going to be low, and the inability to hold any food down was a big concern. My wife ended up nursing me for the evening, feeding me jelly beans to suck on (the sugar can be absorbed in the mouth without having to swallow them). We also adjusted the insulin dose of course, and did frequent BSL tests. I did recover overnight and we were able to continue with our trip the next day but that evening while I was busy throwing up, most of our party were heading out to dinner and saying to my wife “Come with us. He’ll be fine!” I can imagine Jane fixing them with a steely gaze and saying something like “He’s got diabetes. He might die if I did that.” At which point they sobered up (they did go out, but they checked how we were getting on as soon as they got back).
That was an extreme case of travel sickness, just complicated by the diabetes. But we managed and survived.
Travelling with medical supplies

A major hassle when travelling is that I need to carry enough medicines and equipment to last the trip (typically duplicated for safety) and I need to ensure the insulin doesn’t get frozen or overheated during the entire trip (if it does I have to throw it out). For hot climates I have a Freo water-powered cooler. Most of the time (especially for short trips) it’s sufficient to just keep the insulin well-insulated and in the centre of baggage.
If my medicine got lost or damaged when in a remote location I could die before I got help, so I was taught a long time ago to take spares of everything, pack them in more than one bag, etc. Maybe it’s this that has taught me to have good backups for my camera/computer gear also!
With this trip I’ll be away from home for almost 50 days, which with 4 injections per day (and with spares/duplicates) means I have to pack a large volume of needles, swabs, insulin vials, injection pens, lancets, blood test meter, test strips, etc as well as snacks and juices. And my camera gear, and my clothes, etc. Travelling internationally with this stuff has never been a problem for me: Customs officials typically don’t bat an eyelid, but it’s important to carry prescriptions and a letter from your doctor to help you when they do start asking questions!
Travel/medical insurance
Having diabetes does complicate the issue of getting medical insurance to cover my trips, with insurers asking lots of extra questions and wanting higher premiums, but as a member of Diabetes Australia I get easy access to some insurers who make the process fairly straightforward. Even the extra insurance required for trips to Antarctica (due to things like the huge costs of evacuation) isn’t hard.

Cruising the Mekong
Udomxai, Laos
40D, 24-105mm (A2_004124)
Hopefully I’ve crossed all the t’s and dotted all the i’s, and the medical side of this trip goes as smoothly as in normal life!

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