Are you a globetrotting business traveller? One of the growing tribe of executives who think nothing of crossing a couple of time zones a week, arriving in a city at 7am and rushing for a meeting at 9am? Well, then you’d better watch out for your health while travelling.
Mind you, we are not talking terrorist threats, natural calamities or pandemics and epidemics. As far as these are concerned, we found the level of awareness and preparedness among corporate travellers pretty high. But there are a whole host of hidden health hazards related to frequent travel that spell big trouble.
Take complications that arise from being cooped up in a pressurized cabin at 35,000ft. Mumbai-based travel-medicine specialist Dr Anil Mehra, who runs an air-ambulance service, says he finds himself attending to air passengers more frequently these days. He points out how hypoxia, deep-vein thrombosis and dehydration-related problems are risks of long-haul flights. Vikas Kuthiala, general manager, International SOS India, which also has air-ambulance facilities, confirms that there has been a rise in emergencies—he links it to “more airlines, more disclosures, more passenger volumes, and the fast pace of business pitch”.
Certainly Indians are crossing borders like never before. According to some estimates, last year, seven million people travelled out of the country. The World Tourism Organization forecasts that by 2020, about 50 million Indians will be global travellers. A huge number of these are business travellers.
ONGC’s Dr Diwan S. Rawat points out that there has been a 40% increase in employees travelling on work as compared to five years ago. Dr T. Rajgopal, vice-president, medical and occupational health, HLL, and head of occupational health, Unilever Asia, confirms that there has been a significant rise in the number of employees travelling abroad on work.
Apart from the risks of frequent flying, food- and water-borne and communicable diseases are other hazards while travelling. Frequent traveller Richa Goyal, director, marketing, STIC Travels, points out that Indians travelling to the West tend to take the water issue lightly, but “it could happen that even if the water is clean, our systems are not used to certain types of mineral content and that could lead to problems later”. Her advice is that one should stick to bottled water. And while most travellers to third-world nations are aware that they are entering virus and bacteria-heavy zones, it’s not as though the West is totally sanitized. Health advisories put out by travel health companies for UK, Germany and others warn about Legionnaire’s disease, Lyme disease (a dangerous tick-borne disease), and so on.
Here are some pointers for frequent travellers:
Kolkata-based travel-medicine specialist Dr Santanu Chatterjee says that if you were just to go by statistics, only one or two passengers per million succumb to a cardiac arrest during air travel. However, some heart patients need to avoid flying, at least temporarily, because of the increased risk posed by being confined to a high altitude and, therefore, low-oxygen environment. Patients should not travel by air if they have had a heart attack or if they have had coronary artery stent placement up to two weeks prior to the journey.
According to Dr Mehra, if you are hypertensive, on oral contraceptives, have a low haemoglobin count, or are dehydrated, you are just the right candidate for deep-vein thrombosis (DVT). This occurs when restricted blood flow leads to the formation of a blood clot in a deep vein of the leg—symptoms include a swollen or painful calf or thigh. In some cases, when the clot moves to the lungs, it causes a pulmonary embolus, which could be fatal.
There are other risks. As Dr Mehra points out: “Those with sinus problems are at risk of hypoxia while cruising at altitudes of 37,000ft. Even smoking just before boarding the flight can tamper with oxygen absorption.” He adds, “Those who have had their appendix removed should not travel for 10 days after the operation.” Also, travellers who are accustomed to humid climates could suffer from discomfort because the dry air in a plane causes headaches, dry skin and eyes, and a scratchy throat.
But don’t get too alarmed: The risk can be minimized. For instance, doctors advise that a hypertensive woman on oral contraceptive pills should pop an aspirin before flying, as it thins the blood and reduces the chances of clot formation. It’s a good idea to drink as much water as you can, and flex your leg muscles through gentle exercises or by walking down the aisles a couple of times. The aim is to get your circulation going to prevent clots. If you’ve just undergone any kind of surgery, avoid air travel for at least two weeks.
Jet lag: Till last year, Rahul Deans, who has just joined the AVM Birla Group’s new retail venture, was a typical ‘living out of suitcases’ case. In his 10-year innings with an FMCG giant, he estimates he would have spent one year at airports alone—mostly in countries such as Russia, CIS, Iran and Afghanistan. Because of uncertain flights to and from these destinations, he would often find himself hopping across as many as seven countries in six days. For instance, a simple three-hour direct flight from Delhi to Almaty turned into an arduous 33-hour trip as the originally scheduled flight was cancelled. Says Deans: “I have lost count of the times I have gone into a meeting two hours after coming out of a 10-hour overnight flight, with little sleep.”
You may be able to do this once, twice, thrice, but do it week after week and doctors mince no words about the long-term consequences. Frequent business travellers display symptoms of disorientation, exhaustion, confusion and stupor. Doctors also warn that jet lag can affect your immune system as your body is too exhausted to defend itself effectively against germs.
Unilever’s Dr Rajgopal admits that “employees do complain of jet lag and travel weariness”. But he says, “We deal with that through in-house travel health education. This is done on a one-to-one basis in our occupational health departments as well as through appropriate articles in the in-house magazine, Hamara.”
Frequent flier Arun Kanodia, whose export business takes him to Europe very often, makes it a point to start work only the day after he arrives at his destination. He has evolved a near-spiritual approach to travel, and his advice is that one should try to be relaxed and not be annoyed by trivial things. Practical tips include eating light and drinking lots of water. “Most important, set your watch to local time even before you reach your destination. This will help you overcome jet lag,” he says.
However, the best way to cope with jet lag—sleeping it off—is often not possible. As Deans bluntly points out, “Spending a day recovering from your flight is not the solution because, for executives, time is important. Most employers would be reluctant to pay for an extra day in a hotel just so you can catch up on lost sleep!”
Of course, there are jet-lag medicines available. ‘No Jet Lag’, for instance, is a popular brand retailed at pharmacy stores at most airports round the world—but the trouble is that nobody knows how safe these pills are in the long term. Again, medicines to aid sleep are all right in the one instance, but avoidable in the long term.
So, as far as your health is concerned, try negotiating with your boss to give you some time to sleep off the effects. You could always quote NASA, which estimates that a person needs a day to recover for every time zone crossed! And do try not to board a plane when you are overly excited, stressed out or suffering from a hangover—jet lag will not be far away.
On this count, the preparedness level among corporates and frequent travellers is very high. Says Dr Rajagopal: “We monitor pandemics like SARS and avian flu and give out a travel advisory that is in line with WHO recommendations.” Merrill Lynch Tech Services MD & COO Murali Subramanyam says that his head office puts out travel advisories every week, updating all employees on epidemics in any part of the world.
Several companies are also quick to take pre-emptive steps. For instance, at the height of the SARS scare, when a couple of visitors arrived from Hong Kong and Singapore, Subramanyam did not let them enter his Mumbai office. He asked them to remain in their hotel rooms and interacted over the phone with them. “We do take these ad-hoc precautions, depending on the situation,” he says.
But again, while the obvious hazards are well taken care of, how many corporates actually talk to their employees about issues like safe sex? Travel medicine specialist Dr Chatterjee, who is a consultant with several corporates, says most companies do not talk about the issue. Ask Dr Rajgopal and he says: “For HIV/AIDS, there is no specific advisory, except to maintain standard universal precautions, which, in any case, they are advised to do even in India.”
A lot of confusion and misconceptions also abound on diseases like malaria. While anti-malarial medicines are advised for foreigners travelling to countries like India (to be started a week before the journey and continued for a week after return to the home country), doctors actually advise Indians against taking these, even if travelling to zones prone to vector-borne diseases such as dengue and malaria. As Dr Mehra says, “Our immune systems are well developed to cope, in most instances.” Instead, he stresses on precautions that include wearing long-sleeved and light-coloured clothing, using insect repellant lotions, and so on.
Medical emergencies can strike anyone, at any time, any place. It could be a sudden dental problem, a cardiac complication or an accident. How well equipped are you to deal with it? Are you ‘covered’? Has your company made adequate provisions for this eventuality?
Most frequent business travellers do have comprehensive international health insurance. Take Merrill Lynch Tech Services. “For every Indian employee travelling out, comprehensive international health insurance cover is provided (roughly between $200 and $300 per employee),” says Subramanyam. Most MNCs—especially the Fortune 500 A list—also equip employees with an International SOS card. “Some 80% of the Fortune 500 companies have a tie-up with us,” says Kuthiala. Often, the global tie-up ensures that India-based employees, who are frequent travellers, get covered, too.
The advantages of an International SOS membership, according to him, are many. “When you become a member, you can call any of our 29 help centres, identify yourself and obtain comprehensive information on pre-travel requirements like innoculation, medical insurance, health advisories on the country you are visiting, and so on. Once you are actually travelling, the services cover a whole range from referrals, fixing up appointments, payment guarantees, and even medical evacuation in an emergency.”
Now ask Kuthiala how many homegrown companies avail of their services and the answer is just one—Wipro. The bottomline appears to be that Indian companies appear to be less concerned about the issue. Kuthiala says diplomatically, “In developing countries like India, general awareness and general OH (occupational health) policies are not as well understood as elsewhere.”
Then again, we found that Indian companies operating in obviously hazardous areas such as mining, drilling, oil extraction, etc., show a high level of concern for their employees’ wellbeing. It’s after all mandatory. As ONGC’s Dr Rawat says, if there are more than 30-40 employees at a location, then training in first aid and a comprehensive first-aid box is mandatory as per the Mines Act. At installations, ONGC always sends a doctor along. In spite of that, the company admits that casualties do happen.
The mandatory vaccination requirement for any country is strictly followed by most travellers—yellow fever for countries where it is endemic, and so on. Certain countries like Uzbekistan and Syria require that anyone staying for more than 15 days has to produce a recent HIV test certification. But there are several optional shots that many travellers default on—either through ignorance or carelessness. For instance, a tetanus shot became part of routine immunization programmes in most countries only after 1961 (in India this happened as late as 1981), so people born before that year may never have been vaccinated. Besides, revaccination is advised every 10 years.
Says Dr Chatterjee: “Optional vaccines like those for flu are recommended for those who travel regularly. They should also be up to date on Hepatitis B vaccinations. If you travel to South and SE Asia and Eastern Europe, typhoid shots are also recommended.” He suggests checking the status of Hepatitis A antibodies and advises vaccination if negative.
This should contain basic medicines such as aspirin, digestive pills, anti-allergants, anti-diarrhoeals antiseptics and band-aids. As Deans points out: “Pharma products in India cost a fraction of what they do abroad, so it makes sense to buy these before travelling.” Goyal, who is prone to allergies, advises that you make a note of the generic name of the medicine you use rather than the brand name—she once had to telephone her doctor from New York for clarifications.
Dr Chatterjee says: “Your first-aid travel kit should contain essential medicines for nausea, vomiting, fever, diarrhoea and colic. An antibiotic cream, band-aids and pain-relieving gel are useful. If you use spectacles, take an extra pair. Pack these and medicines in your hand baggage, especially if you are on a long-haul flight (please note that you should be aware of airline regulations and restrictions that change from time to time). He also says it is good policy to keep a back-up supply in your check-in luggage. If you have allergies, react to certain medicines, food, or insect bites, or suffer from a particular medical problem, consider wearing a “medical alert” bracelet. You may also wish to carry a letter from your physician explaining what may be required should you fall ill. And don’t forget to carry a prescription for all the medicines you carry.”
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