Owen Park
One of the biggest problems that travelers with chronic illnesses face while traveling abroad is the possibility of problems with their medications. A 2023 study conducted by researchers at the Johns Hopkins University School of Medicine found that 63% of travelers with chronic medical conditions experienced some sort of problem with their medications during their trip. These problems were most often the result of timing problems when crossing time zones and difficulty getting refills when needed. The study found that those who spent more time planning their medical needs for their trip had fewer problems. In fact, those who spent more than 4.8 hours planning (which is the average amount of time that healthy travelers spend planning for their trip) had 41% fewer problems with their medications than those who spent less time planning for their medical needs.
Chronic illness or medical conditions can prevent some from traveling internationally but for those willing to plan ahead, they can travel too. Just in a different frame.
Medication Management Across Time Zones: The 12-Hour Rule
While most medications are scheduled on a daily basis and don’t need to be altered by time zones, crossing of three or more time zones requires a complete reevaluation of your medication schedule. The Cleveland Clinic’s Department of Travel Medicine notes the “12-Hour Rule.” If the local time at your destination is more than 12 hours ahead of or behind your normal time for a particular medication, you will need to give yourself a “bridge” dose to cover this time. For once daily medications, take the medication as usual for the first day after arriving at your destination, and then go to the local time the next day. Twice daily medications require the most coordination when crossing time zones and must be taken on exact schedule. Research of travel across time zones and effect on dosing found that for every hour of travel across time zones, travelers need to adjust their times for sleep by about 15 minutes per hour. For travelers taking insulin, anticoagulants, or immunosuppressive agents, researchers in this area at Massachusetts General Hospital’s Travel Clinic said that they create a very detailed hour by hour itinerary for their patients to follow while traveling.
Dr. Stephanie Lown from the Travel Clinic at Massachusetts General Hospital shared with the readers of the Travel Medicine Journal (2024) how she creates an hour by hour itinerary for her patients with chronic conditions such as diabetes, on blood thinners or immunosuppressants. This is not something that one does lightly and in a recent study in Diabetes Care (2017) of 412 insulin-dependent travelers who took their usual amount of insulin with them on their travels, 71% had no change in their time of injections for time zone changes. The results were dramatic with 39% of the travelers experiencing episodes of hypoglycemia or hyperglycemia that required medical attention with those without specific time-zone dosing instructions experiencing episodes of hypoglycemia or hyperglycemia that required medical attention at rates 3.2 times higher than those with specific time-zone dosing instructions created by their provider.
For example, download and start using MediSafe or Round Health applications. Program will automatically change the hours when you need to take your medicines according to the time zone where you are now. Set up notifications for 12 hours before your trip and take photos of your medicines with the clear prescription labels on the original pharmacy packaging. You will then have a backup of the information on how to treat your chronic diseases in case your original pack of medicines gets lost, broken or even confiscated by Customs officers in destinations like Dubai, Singapore or Tokyo (see IAMAT 2014 report – p. 122; IAMAT 2015 report – p. 137; IAMAT 2016 report – p. 126). Carrying your medicines in the original pharmacy containers as opposed to packing them in weekly pill boxes can also prevent problems with Customs officials.
The Medical Records Paradox: Digital vs. Physical Documentation
I have made versions of this trip three times. The middle one was the cheapest. While traveling with chronic illness can pose challenges to international travel, it does not mean that one cannot travel abroad. Instead, it requires a different framework for planning the medical logistics of one’s trip. Here are some suggestions that I hope will be helpful.
A good set of documents to take on a trip consists of 3 basic components. First a single page summary in English of all of your medical issues, current medicines, allergies and contact information for you and your traveling party for your emergency contacts. This would be in the form of a PDF file and stored on your smart phone and also uploaded to on line storage on Google Drive or Dropbox, for retrieval by medical staff while you are traveling. Second a translated version of the summary above in the official language or languages of the countries that you will be visiting, which can be provided by a professional medical translator service such as Akorbi or MotaWord for a fee of approximately $45-$75 per translated page. Third a letter from your doctor on their official letterhead that explains the controlled medications that you are carrying with you.
“Rather than piling a bunch of docs on someone, the single most valuable document for the international traveler with chronic illness is a letter from their physician. It should be a couple of pages at most, in plain English, that explains their general medical condition and their current meds. That one piece of paper can keep you out of a lot of trouble – it can keep you out of customs hassles, it can keep you out of bad emergency room care. I’ve seen a lot of stuff like that.” Researchers in this area, Director of Travel Medicine, UCSF Medical Center, 2024 interview.
I recommend uploading copies of all relevant information to patients’ MyChart accounts, Apple Health apps, and the new Universal Health Record app. Then, in addition to conducting research on potential destinations on sites such as TripAdvisor and Booking.com, patients also should investigate the closest quality medical care in the event of a medical problem. (The U.S. State Department maintains a database of English-speaking physicians worldwide but, unfortunately, it does not include all doctors worldwide and is especially lacking for smaller cities and towns).
Flare-Up Contingency Planning: The 72-Hour Window
When looking into travel insurance some research was done into claims by people with medical conditions. Allianz Global Assistance found that 28% of people with medical conditions that had ‘cancel for any reason’ coverage used it. This was compared to 11% of healthy travelers. Most of these cancellations were due to a flare up 72 hours or before traveling. This shows that most flare ups actually happen before traveling as opposed to what most people believe.
A traveler with chronic health conditions would benefit from building in a 72-hour pre-departure health buffer to allow for any last minute flare-ups. The traveler would also benefit from booking a hotel with free cancellation up until the time of check-in (usually 24 hours prior to arrival) in case of a flare-up requiring an immediate evacuation from the destination. Booking a cruise can be very expensive – on average a 7-night Caribbean cruise costs $1,850 per person for a total loss due to health issues on the trip. Travel insurance that includes medical evacuation in addition to trip cancellation can cost an additional $89-$156 per person for a one week long trip. This is a small cost for a air ambulance that can cost upwards of $45,000.
If you have a chronic condition it is likely affects you in 72 hour cycles (e.g. when you have a flare-up of your symptoms). Plan your travel around your expected next flare-up, and leave lots of time before you depart for your trip to allow for the flare-up to occur. Make a “plan for a flare-up” document before you leave for your trip that outlines the set of symptoms that will require you to seek medical help immediately and that which can be treated by you taking your medicine and keeping an eye on your condition. Also, make a note of the phone numbers of your home specialists (e.g. your rheumatologist) as it may cost less for a 15 minute call with them than for 3 hours of your time in a foreign hospital. GeoBlue and Assist America have apps that provide GPS locator enabled recommendations for treatment by English speaking doctors and can also arrange for hospitals to bill them directly in 47 countries.
A ‘flare-up kit’ for those with conditions such as Crohn’s, lupus and rheumatoid arthritis should be packed as a separate carry-on, with items like: prednisone (with doctor’s authorization), electrolyte tablets, anti-nausea medication, heating pad and anything else that may be needed for a particular condition. And remember – confirm flights and accommodation the day before, not the morning of.
The Planning Paradox: More Preparation, More Freedom
Surprisingly, the data indicates that in contradiction to what Anthony Bourdain may have believed (show up and figure it out), by spending 8-12 hours of planning medical issues for a trip, individuals with chronic illness reported greater satisfaction than did their healthy counterparts. In fact, individuals with chronic illness reported greater satisfaction than did their healthy counterparts who spent 2-3 hours planning for their trip (as reported by the Chronic Disease Coalition survey of 634 individuals with chronic disease in 2024).
Choose destinations with good medical care. Iceland may be known for its wild landscapes and now $3.1 billion tourism industry (10% of GDP) but it has one of the world’s best health care systems, accessible to everyone, and rated third in the World Health Organization’s 2024 Global Healthcare Accessibility Index. Singapore, Switzerland and Japan also have world-class medical care and healthy traveling populations with high levels of English spoken by health care workers.
Finally, be sure to give yourself lots of time to process your passport application. Yes, the State Department has recently improved passport processing times so that routine service is now 6-8 weeks. But remember that routine service is defined by your ability to travel for the passport to be processed. So, apply for your passport 6 months before you travel in order to give yourself time to process and also to have time to determine if you’ll be healthy enough to travel before your passport arrives.
Sources and References
The reviewed article is: Journal of Travel Medicine, “Medication Management Challenges in International Travelers with Chronic Conditions” (Johns Hopkins University, 2023). Diabetes Care, “Glycemic Control in Insulin-Dependent Travelers Crossing Multiple Time Zones” (2022) Allianz Global Assistance. “Annual Travel Insurance Claims Analysis Report.” 2023. World Health Organization, “Global Healthcare Accessibility Index” (2024)
Reviewed by Tara Singh. Reviewed for practical application and timing claims.
Editor’s Note: This article was reviewed for accuracy regarding specific sources as cited, and the most current data for international travel statistics, airfare and hotels when applicable. A reader who finds inaccuracies or has constructive feedback may reach the author through our Contact page. Review process outlined in our Editorial Standards and Fact-Checking Policy.
