Health & safety
Because of the high cost of health care, international travelers should take out comprehensive travel insurance before they leave home. If you have a choice between lower or higher medical expense options, take the higher one for visiting the USA.
Bring any medications you may need in their original containers, clearly labeled. A signed, dated letter from your physician that describes all medical conditions and medications, including generic names, is also a good idea.
If your health insurance does not cover you for medical expenses abroad, consider supplemental insurance. Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures.
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No special vaccines are required or recommended for travel to the USA. All travelers should be up-to-date on routine immunizations: tetanus-diphtheria, measles, chicken pox and influenza.
Recommended items for a personal medical kit:
acetaminophen (Tylenol) or aspirin
anti-inflammatory drugs (eg ibuprofen)
antihistamines (for hay fever and allergic reactions)
antibacterial ointment (eg Bactroban) for cuts and abrasions
steroid cream or cortisone (for poison ivy and other allergic rashes)
bandages, gauze, gauze rolls
adhesive or paper tape
scissors, safety pins, tweezers
DEET-containing insect repellent for the skin
permethrin-containing insect spray for clothing, tents and bed nets
There is a wealth of travel health advice on the Internet. The World Health Organization publishes a superb book, called International Travel and Health, which is revised annually and is available online at no cost at www.who.int/ith. Another website of general interest is MD Travel Health at www.mdtravelhealth.com, which provides complete travel health recommendations for every country, updated daily, also at no cost.
It’s usually a good idea to consult your government’s travel health website before departure, if one is available:
United States (www.cdc.gov/travel)
By and large, California is not a dangerous place. The most headline-grabbing problem is violent crime, but what the news often fails to convey is that the majority of incidents take place in areas where few travelers would venture anyway. Wildlife may pose some danger, and of course there is the dramatic, albeit unlikely, possibility of a natural disaster, such as an earthquake. Prepare for the worst, but expect the best.
Travelers will rarely get tricked, conned or attacked simply because they’re tourists. Potential violence is a problem for all but there’s really no need to be overly worried. Most cities have some ‘bad neighborhoods, ’ which should be avoided, particularly after dark. Outside the cities, crime of all kinds drops dramatically.
To minimize the risk of trouble always maintain your street smarts and an awareness of your surroundings. Exercise particular caution in parking areas at night. Try to use ATMs in well-lit and well-trafficked areas. Don’t carry lots of cash; keep the bulk of your money and your passport in a money belt inside your clothes; stash valuables inside your room safe, or the hotel safe. If your car is bumped from behind by another vehicle in a remote area, try to keep going to a well-lit area, gas station or even a police station.
If a mugger accosts you, there’s no fail-safe policy. Handing over whatever the mugger wants may prevent serious injury, and having a separate amount of money in a front pocket, which can be handed over quickly, is often recommended. Muggers are not too happy to find their victims penniless.
That said - don’t dwell on crime. The American media tend to blow crime out of proportion, giving the impression that you’re going to get shot if you set foot on the wrong street. Don’t panic. Protect yourself as best you can, then focus your awareness on having a great trip. You’ll save yourself a lot of unnecessary mental anguish.
Earthquakes happen all the time but most are so tiny, it takes sensitive seismological instruments even to register them. Chances of getting caught in a serious shaker are minuscule, but here are a few pointers on what to do (and not to do), just in case. Basically, if indoors, get under a desk, table or doorway. Protect your head and stay clear of windows, mirrors or anything that might fall. Don’t head for elevators or go running into the street. If you’re in a shopping mall or large public building, expect the alarm and/or sprinkler systems to come on.
If outdoors, get away from any buildings, trees and power lines. If you are driving, pull over to the side of the road away from bridges, overpasses and power lines. Stay inside the car until the shaking stops. If you’re on a sidewalk close to buildings, duck into a doorway to protect yourself from falling bricks, glass and debris. Prepare for aftershocks. Use the telephone only if absolutely necessary. Turn on the radio and listen for bulletins.
There are no scams unique to California. A healthy skepticism is your best defense. In restaurants it pays to study your final bill as some servers have been observed slipping in extra charges or adding their tip to the final tally without telling you (thereby hoping for a double tip). European visitors, who are perceived as cheap tippers, are especially prone to falling victim to this annoying practice.
Availability & cost of health care
In general, if you have a medical emergency, your best bet is to find the nearest hospital and go to its emergency room (ER). If the problem isn’t urgent, you can call a nearby hospital and ask for a referral to a local physician, which is usually cheaper than a trip to the emergency room. In a serious emergency, call 911 for an ambulance to take you to the nearest ER. Many city hospitals have ‘urgent care clinics’ designed to deal with walk-in clients with less-than-catastrophic injuries and illnesses. Note that these are for-profit centers and they tend to perform large numbers of expensive tests, even for minor illnesses.
Pharmacies are abundantly supplied, but you may find some medications that are available over the counter in your home country require a prescription in the USA. As always, if you don’t have insurance to cover the cost of prescriptions, they can be shockingly expensive.
In addition to more common ailments, there are several infectious diseases that may be acquired by mosquito or tick bites.
This parasitic infection of the small intestine occurs throughout North America and the world. Symptoms may include nausea, bloating, cramps, and diarrhea, and may last for weeks. To protect yourself from giardia, you should avoid drinking directly from lakes, ponds, streams and rivers, which may be contaminated by animal or human feces. The infection can also be transmitted from person to person if proper hand washing is not performed. Giardiasis is easily diagnosed by a stool test and readily treated with antibiotics.
As with most parts of the world, HIV infection occurs throughout the USA. You should never assume, on the basis of someone’s background or appearance, that they’re free of this or any other sexually transmitted disease. Be sure to use a condom for all sexual encounters.
West Nile virus
This virus was unknown in the USA until a few years ago, but has now been reported in almost all 50 states. The virus is transmitted by culex mosquitoes, which are active in late summer and early fall and generally bite after dusk. Most infections are mild or asymptomatic, but the virus may infect the central nervous system leading to fever, headache, confusion, lethargy, coma and sometimes death. There is no treatment for West Nile virus. For the latest update on the areas affected by West Nile, go to the US Geological Survey website (westnilemaps.usgs.gov).
Visitors from lower elevations undergo rather dramatic physiological changes as they adapt to high altitudes, and while the side-effects are usually mild, they can be dangerous if ignored. Some people - age and fitness level are not predictors of who these will be - will feel the effects of altitude strongly, while others won’t even notice.
Symptoms, which tend to manifest after four days and continue for about two weeks, may include headache, fatigue, loss of appetite, nausea, sleeplessness, increased urination and sometimes hyperventilation due to over-exertion. More severe cases (usually affecting hikers over 10, 000ft who don’t take time to acclimatize) display extreme disorientation, breathing problems and vomiting. These people should descend immediately and get to a hospital.
To avoid the discomfort characterizing the milder symptoms, drink plenty of water (dehydration exacerbates the symptoms) and take it easy. Schedule a nap if you have a sleepless night and put off serious hiking and biking for a few days, if possible. A mild painkiller like aspirin should take care of the headache.
Visitors to the desert may not realize how much water they’re losing, as sweat evaporates almost immediately and increased urination (to help the blood process oxygen more efficiently) can go unnoticed. The prudent tourist will make sure to drink more water than usual - think a gallon a day if you’re active. Parents can carry fruit and fruit juices to help keep kids hydrated.
Severe dehydration can easily cause disorientation and confusion, and even day hikers have gotten lost and died because they ignored their thirst. So bring plenty of water, even on short hikes, and drink it!
Heat exhaustion & heat stroke
Dehydration or salt deficiency can cause heat exhaustion. Take time to acclimatize to high temperatures and make sure you get enough liquids. Salt deficiency is characterized by fatigue, lethargy, headaches, giddiness and muscle cramps. Salt tablets may help. Vomiting or diarrhea can also deplete your liquid and salt levels. Anhydrotic heat exhaustion, caused by the inability to sweat, is quite rare. Unlike other forms of heat exhaustion, it may strike people who have been in a hot climate for some time, rather than newcomers. Always use water bottles on long trips. One gallon of water per person per day is recommended if hiking.
Long, continuous exposure to high temperatures can lead to the sometimes-fatal condition of heat stroke, which occurs when the body’s heat-regulating mechanism breaks down and the body temperature rises to dangerous levels. Hospitalization is essential for extreme cases, meanwhile get out of the sun, remove clothing, cover the body with a wet sheet or towel and fan continually.
Skiers and winter hikers will find that temperatures in the mountains or desert can quickly drop below freezing. A sudden soaking or even high winds can lower your body temperature rapidly. Travel with a partner whenever possible.
Seek shelter when bad weather is unavoidable. Woolen clothing and synthetics, which retain warmth even when wet, are superior to cottons. Carry a good-quality sleeping bag and high-energy, easily digestible snacks like chocolate or dried fruit.
The symptoms of hypothermia are exhaustion, numbness, shivering, slurred speech, irrational or violent behavior, lethargy, stumbling, dizzy spells, muscle cramps and violent bursts of energy. Get hypothermia victims out of bad weather and into dry, warm clothing. Give hot liquids (not alcohol) and high-calorie, easily digestible food. In advanced stages place victims in warm sleeping bags and get in with them. Do not rub victims.
Do not attempt to pet, handle or feed any wild animal, no matter how cuddly it looks; most injuries from animals are directly related to people trying to do just that.
Any bite or scratch by a mammal, including bats, should be promptly and thoroughly cleansed with large amounts of soap and water, followed by application of an antiseptic such as iodine or alcohol. The local health authorities should be contacted immediately for possible post-exposure rabies treatment, whether or not you have been immunized against rabies. It may also be advisable to start an antibiotic, since wounds caused by animal bites and scratches frequently become infected.
When mosquitoes are present, keep yourself covered (wear long sleeves, long pants, hats and shoes rather than sandals) and apply a good insect repellent, preferably one containing DEET, to exposed skin and clothing. Don’t overuse the stuff, though, because neurologic toxicity - though uncommon - has been reported from DEET, especially in children. DEET-containing compounds should not be used at all on kids under age two.
Insect repellents containing certain botanical products, including oil of eucalyptus and soybean oil, are effective but last only 1½ to two hours. Products based on citronella are not effective.
Ticks are parasitic arachnids that may be present in the brush, forest and grasslands, where hikers often get them on their legs or in their boots. Adult ticks suck blood from hosts by burrowing into the skin and can carry infections such as Lyme disease.
Always check your body for ticks after walking through high grass or thickly forested area. If ticks are found unattached, they can simply be brushed off. If a tick is found attached, press down around the tick’s head with tweezers, grab the head and gently pull upwards - do not twist it. (If no tweezers are available, use your fingers, but protect them from contamination with a piece of tissue or paper.) Do not rub oil, alcohol or petroleum jelly on it. If you get sick in the next couple of weeks, consult a doctor.
There are several varieties of venomous snakes in the USA, but unlike those in other countries they do not cause instantaneous death and antivenins are available. Rattlesnake bites are fairly common. First aid is to place a light constricting bandage over the bite, keep the wounded part below the level of the heart and move it as little as possible. Stay calm and get to a medical facility as soon as possible. Bring the dead snake for identification if you can, but don’t risk being bitten again. Do not use the mythic ‘cut an X and suck out the venom’ trick, as this causes more damage to snakebite victims than the bites themselves.
Many snakebites result from people picking up the snake, either out of bravado or mistakenly assuming that the animal was dead. Keep a healthy distance away from snakes and watch where you step.
Spider & scorpion bites
Although there are many species of spiders in California (check out www.calpoison.org for a list of potential biters), one of the most common biting spiders is the black widow. This spider is black or brown in color, measuring about 15mm in body length, with a shiny top, fat body and a distinctive red or orange hourglass figure on its underside. It’s usually found in barns, woodpiles, sheds, harvested crops and bowls of outdoor toilets.
If bitten by a black widow, you should apply ice or cold packs and immediately go to the nearest emergency room. Complications of a black widow bite may include muscle spasms, breathing difficulties and high blood pressure.
If stung by a scorpion, you should immediately apply ice or a cold pack, immobilize the affected body part and go to the nearest emergency room. To prevent scorpion stings, be sure to inspect and shake out clothing, shoes and sleeping bags before use, and wear gloves and protective clothing when working around piles of wood or leaves.
Poison Control Centers have staff available 24 hours a day and advise about bites, stings and ingested poisons of all kinds. Call 800-222-1222 anywhere in California for the one nearest you.
American health-food stores and many of the regular groceries abound with so-called ‘natural’ remedies. These are a few of the more successful ones, in our opinion. They’re not guaranteed, of course, but they may work great. You never know…
jet lag: melatonin
mosquito bite: oil of eucalyptus
motion sickness: ginger