Advice for Long-Term Expatriates

Preparation should not be Rushed

Vaccinations, prevention of malaria (if appropriate), making enquiries about likely food and water hygiene problems and other disease risks are all-important. A brief visit to the proposed destination in advance can help reduce fear of the unknown.

Check-Ups in Advance

If you are travelling with children, plan to become pregnant or have any existing health problems you should plan well in advance in consultation with your doctor. A dental and eye check-up prior to departure is wise.

First aid equipment may be important and consider what you might do in an emergency, particularly those going to areas remote from or with only basic medical facilities.

Contacts Abroad

The British embassy may give helpful advice about English speaking doctors and you should keep in touch with the embassy especially in areas of political unrest. Homesickness after the initial excitement is common when you realise the visit is not short-term. Going out of your way to make new friends and being sensitive to cultural differences rather than critical will help you adapt more quickly.

Risk of Accidents

Accidents are very common when trekking and also when travelling on poor roads in badly maintained vehicles. Motorcycling can be extremely hazardous.

Contamination of Food and Water

This is a major cause of illness in travellers in particular travellers' diarrhoea. Unless certain of the purity of the local water supply, stick to boiled or bottled water and avoid ice in drinks. Alternatively, water can be sterilised with iodine drops/tablets or with a quality filter. Dishes and cutlery should ideally be washed with sterilised water. Hot tea, coffee, beer and wine are usually safe.

Ensure that milk has been pasteurised and that cheese, cream and ice cream are made from milk that has been pasteurised. Peel all fruit, eat only cooked vegetables and avoid salads.

Ensure that seafood, fish and meat are thoroughly cooked and eaten hot whenever possible. Avoid leftovers. Wash hands before eating or handling food and always after using the toilet.

Mosquito, Other Insect and Animal Bites

These can be minimised through wearing suitable clothing, using repellents and a mosquito net. Do not approach stray dogs that are frequently not as friendly as at home.

Unsafe Sex

Particularly, but not exclusively, unsafe sex with commercial sex workers will put travellers at risk of serious infections including HIV.

First Aid Kit

You should consider including something for simple diarrhoea, sufficient anti-malarial tablets, possibly an antibiotic, and emergency malarial treatment if going to areas remote from medical facilities.

Culture Shock

This can be very real. Family or social difficulties at home and psychological problems, including alcoholism, make adapting difficult. Time differences between continents might increase isolation when it is difficult to maintain contact with friends and relatives. A situation that is exciting and welcome to one person can be daunting to another.

Possible problems include adjusting to a different climate, unusual food, religious and cultural differences, separation from family, changes in living standards, different social amenities, language differences, coming to terms with poverty, begging, and compulsory movement restrictions for safety or political reasons.

Being open to new and different cultures and being patient, rather than critical, will help the traveller adapt to new and challenging adventures.

Vaccinations

  • Vaccinations take time. Consult your doctor or nurse well before departure ideally 8 weeks in advance.
  • Tetanus and diphtheria vaccination is important for those likely to sustain injuries (tetanus) or mix closely with the local population (diphtheria). For countries where these diseases are still common you should to receive boosters every 10 years and everyone should have completed their normal British childhood schedule.
  • There is an increasing risk of tuberculosis for those visiting many of the high-risk areas and when mixing with the local population. Remember protection from BCG is only achieved after about 4-6 weeks. Boosters are not normally required.
  • Meningococcal type ACWY vaccine is advisable for those visiting risk areas in sub-Saharan Africa.
  • Hepatitis A and typhoid vaccines are important for all who are unable to be scrupulously careful about their food and water hygiene in risk areas.
  • Hepatitis B vaccine can be useful for those staying for longer periods in higher risk areas and if accidents requiring suturing, surgery or sexual risk taking are anticipated
  • Influenza vaccine can be considered for those who might get a more severe illness such as those with existing chest problems. Remember the 'flu' season in the Southern Hemisphere is from April to November.
  • Japanese B encephalitis is spread by mosquitoes and vaccine is sometimes advised for those spending longer periods in risk, especially rural, areas.
  • Rabies vaccination can be important if you are going to be more than a day or two from good medical facilities.
  • Yellow fever is a mosquito borne disease and occurs most commonly in jungle areas. It is therefore more likely in travellers going to remote areas. The disease is not present in Asia. A yellow fever vaccination certificate is necessary for crossing borders in many parts of Africa and South America.

Malaria Prevention

When you cannot be sure that your accommodation will ensure good mosquito protection, you must consider taking a good impregnated mosquito net. Sensible clothing to protect the skin from bites and careful use of mosquito repellents is also important. If your advisor recommends anti-malaria tablets make sure you take then correctly.