In a perfect world, you’d be so on top of everything on this list that you could just book a one-way flight and go. Unfortunately, American healthcare is a shithole abyss of expense and hassle. Despite that reality, world travel requires medical preparation.
There are upsides here. How often in life do most of us really go whole hog on our health? There’s really no better excuse to say “Check everything!” to your doctor than an upcoming trip around the world.
The six things I list here add up quickly, though I do suggest ways to cut costs at the bottom of this page.
One last exam top-to-tail to find things that might create trouble later. Even if your doctor finds nothing, you’ll establish some helpful baselines for the future.
This is also an excellent time to request a digital copy of your medical records and the emergency number foreign doctors can call if they have questions during off hours. If you happen to check into a hospital in the middle of the day in Ethiopia, Australia or anywhere else more than 8 time zones away, no doctors offices in the States will be answering their main lines.
Just because you’ve never had a serious reaction doesn’t mean you don’t have serious allergies, and you don’t want to find out your sensitivity to felines has gone from a level 2 to a level 4 at a cat café in Tokyo. This is especially true of food or medicinal allergies.
Allergies often get underestimated when people travel, leading to a lot of misery and wasted time. If you know you have one, bring meds. Just verify whatever you’re bringing into a particular country is legal. Some countries ban certain common medications.
Looking at my pearly whites, you’d think I have a healthy, natural smile, but teeth have been drilled like Alaskan wilderness preserves in Sarah Palin’s wet dreams. My grill is actually a color-matched marvel of engineering. I’m the punchline in a joke about the Darth Vader School of Dentistry.
Suffice to say, I’ve spent a lot of time in the chair, and have a lot to say about dentistry in the US and abroad that I’ll be happy to share whenever we we’re drunk at a tiki bar in the Philippines. For now though, take this sage advice:
Make two dental appointments before you go.
The first will be three months before departure and the other will be two weeks prior. If the first one goes well and second one is unnecessary, you either cancel it or downshift one last routine cleaning.
Also, let’s get morbid for a moment. If, god forbid, something spectacular happens and the only way to identify your remains is through dental records, it’d be a good for your dentist to have current ones.
IMPORTANT CAVEAT: If you pay for your dental care out of pocket, there are a lot of countries that do better dental work than we do, and they cost a lot, lot less. Turkiye, Colombia, South Korea, Poland and more are on this list. So scheduling dental care into one of your first stops might be a really good idea.
If you have poor vision, get a backup pair of glasses made before you go. If you wear contact lenses, stock up on those too, but think hard about whether they’re worth it.
Daily wear disposables won’t be possible, so you’re looking at longer-life lenses, and those present problems for people who are adventuring far and wide.
The stories I hear from contact wearers about the hazards of dust and vision loss from corneal ulcers make my eyes water more than a One Chip Challenge. Those kinds of disasters are thankfully uncommon, but I’ve also watched contact wearers spend an entire night in a bazaar tormented because “the air was spicy” and miss a day of admittedly frigid skiing, which, if you ask Gwyneth Paltrow, is basically the end of the world.
The cost and hassle of replacements and solution as well as the burden of carrying both are enough to convince a lot of backpackers to simply wear glasses. If you follow their example, don’t forget to take a pair of prescription sunglasses as well. You’ll appreciate them when you’re faced with something painfully sunny and bright, like my disposition.
You are going to be on your feet a lot and a lot and a lot, often wearing a backpack. For most people, this presents no issue beyond tired legs and a sore back, but for people who are flat footed and over-pronate, this is rough.
I count myself in this category, and I was well into middle-age before I got proper foot care. To be honest, I did my first around-the-world without any arch supports and thought I did just fine. After visiting a podiatrist and getting custom orthotics in the middle of my second though, I realized how wrong I’d been.
Arch support is that thing you think you can live without until you get it and then instantly wonder how you ever did. Nothing has made a bigger difference than this. I suggest everyone at least get a checkup.
In the US, we’re told to approach STIs with shame, but in the timeless wisdom of the gender-nonconforming cabaret singer in Berlin wisely noted, “If you got gonorrhea, all that means is that you had fun.”
Though a badge of sex-positivity STIs may be, unfortunate and annoying they most certainly are too, especially to your gut flora after a week of doxycycline and a hot shot of penicillin.
Immoral of the story: Everyone should get tested before departure. If you’re sitting on a sneaky case of syphilis or even just garden-variety gonorrhea, you really need to get that sorted before you leave. You also don’t want to sow that around the world — at least you better fucking not.
With some STIs, you have to test, treat, retest and maybe retreat and test again. All that takes time, so make an appointment at least six weeks before you depart. Remember to confirm the tests include hepatitis C, trichomoniasis and Mgen.
Some of you are reading this and thinking to yourselves “Not me; I’m in a relationship.” And hooray love. That’s beautiful. If the married men who message me on Grindr from their hotel rooms in Times Square are any indication though, you need an STI workup more than than the rest of us, because it’s probably been a long, long time. Just do it.
Most of us take medications in our daily lives and will need to continue taking them in our travel lives. Whether its statins, insulin, pregabalin, birth control, an SSRI, Viagra or whatever else, there’s no way you can schlep around enough for the duration of your travels. Most countries wouldn’t let you anyway. That means you’ll need refills on the road.
Your doctor should know how to do this, but generally it entails a letter from the prescriber explaining the medical necessity and detailing the dosing, strength, quantity and instructions. It should also include the prescriber’s name, office address, telephone number, signature and prescriber number. This should be accompanied by an original signed copy of the prescription.
Before you travel with large amounts of medication, research the import limits in each country. Some prohibit anything beyond a one-month or three-month supply, for example, without completing an import request. Also, some common medications are outright prohibited, so check overall legality.
Remember to always keep medications in their original bottles for easy identification.
The Quebecois have a saying I love: Tu es majeur et vacciné. Translated for context, it means “You’re a grownup. You’re vaccinated. Do as you wish.”
They’re right. Vaccination is a miracle of science that protects you from nasty things that will literally kill you. Don’t be a dumbfuck. Get vaxxed. in many countries it’s a requirement for entry anyway.
So which vaccinations should travelers have? Here’s a list that’ll make RFK’s head explode, starting with the basics you should already have.
Next are the vaccines all travelers need:
Finally, the vaccines necessary for specific locations and/or circumstances. These tend to be costly:
Afterward, you’ll receive printed proof of what you received. Scan it and store the images in the cloud, then keep the hard copies in your passport carrier and guard them with your life.
Malaria: If you’re going places where malaria is common, have a really honest conversation with your doctor about the different types of malaria and your personal susceptibility as well as tolerance for risk. Malarone (atovaquone/proguanil), doxycycline and mefloquine, are typically prescribed, but they have major costs and/or downsides.
Traveler’s diarrhea: When I get mild or moderate travel trots, I let it pass on my own. When it’s bad, I pop antibiotics. Usually that’s azithromycin or ciprofloxacin. Those kill the bugs, but the effects of diarrhea linger. Carry rehydration tablets to replace critical electrolytes.
Constipation: Travel isn’t conducive to daily routines, and that can block up your plumbing. When this hit me, I took a tablet with senna, a natural laxative, and docusate sodium, a stool softener. Those plus a nice bowl of fruit got things moving in a day or so. If you’re prone to travel constipation, bring as many as you need, but remember prevention really is your best strategy. Fruit for breakfast works miraculously.
Altitude sickness: If you have asthma, you probably carry an albuterol inhaler. You may not know though that albuterol was first used for high-altitude mountain climbing. Even if you’re not climbing Kilamanjaro, the elevation in places like Peru or Georgia can really fuck you up. Ask your doctor if an inhaler might help you acclimatize. Also, ask about acetazolamide, which can help some people adjust more quickly.
Whichever vaccines and medications your health insurance covers, get them from your doctor. For the rest, you theoretically have to go to a travel clinic, but that presents one glaring problem: Healthcare in the US is a ludicrous ripoff, but our travel clinics take this to offensive new heights. When I called to quote prices, just hearing the numbers made me feel like someone had kicked me straight in the asshole.
Then, in a flash of genius, I discovered a solution: Canada.
I was already heading to Quebec, so I made an appointment at the travel clinic there and saved literally 70 percent. It was the exact same chain of travel clinics too. Unfuckingbelievable, except totally believable.
You can do this too. Just make your first stop in Germany, Australia, Mexico, Singapore, etc. and make an appointment. Not only will you save money, you’ll get better care and access to vaccinations and medications unavailable back home.
The amazing new perspective you gain on how awful healthcare is in the US will just be a bonus.
This is a huge topic with real financial risks, consequences and far too many options. Start here to get a good sense of the lay of the land and use it as the basis for your own research, including conversations with professionals.
My privacy policy is simple: I don’t share your information.
Yea, it’s just a name, email and nationality, but I’m sure there are people who would pay for it. My thoughts on that: fuck those people and fuck those fuckers who sell personal information to them. You’ll find none of that monkey business here.
If I get hacked and your info get stolen, I’ll shoot you a note to let you know. I don’t deal in passwords, credit cards or anything like that though, so there’s almost nothing for anyone to take.
To see the full privacy policy — it’s pretty boring and cost me a lot of money — you can follow the link at the bottom of the page or in the confirmation email.
Domestic American air travel is a racket run by three major companies and a few smaller ones who effectively collude on prices to screw passengers and support their bloated executives and corporate structures.
Even regional jets, which are technically independent, are fucking death traps that I literally never, ever fly.
It’s not this way in other countries, because most people are sensible and see transportation as akin to a public utility. It’s therefore common to find flights on foreign carriers for under $100. I frequently see fares less $50.
Booking far in advance is therefore unnecessary, except of course in places where tickets sell out. Avoid the temptation to book months or weeks out if you’re just trying to save money. Not only will doing so lock you into dates you might regret, you may end up paying. Why? Booking sites now sniff for your computer’s location and display higher prices for foreigners.
Rude, right? Blame the mirror. We invented that.
First, some bad news for most Americans: automatic transmissions are as rare overseas as manuals are in the US. Unless you want to seriously overpay, make friends with someone who owns an old Miata and learn.
Second, anyone who wants to rent a car should obtain an international driver’s permit. This is easy — just 30 minutes at AAA.
When it’s time to rent, don’t get tempted by lower prices with small, local companies. Go with a big multi-national.
Understand your insurance situation through-and-through. Know the limits of your credit card’s automatic coverage and have a printout of the policy. If you can get a translated copy, even better. If you’re still in doubt after all that, just pay for their coverage.
Research the scams. Before you drive off the lot, walk around the vehicle and video record it. When you return the car, do the same. Also record yourself locking it and depositing the key in the night box if you return after hours.
If you get a notice from the rental company later saying you owe for damage or not returning the car, you can send them those videos with an E-vite to go get fucked. You might also copy tourist law enforcement, so they get fined to oblivion.
It’s tricky, but you need to basically study each country’s road laws and signs like you’re getting your student driver’s permit again. Most places have tricky rules, and they love to fine gringoes like us for violating them.
In Cyprus, for example, you can be fined for eating or drinking anything behind the wheel, even a Snickers. In Denmark, you’re legally required to look under your car before you get inside to ensure no one is underneath. In Spain, drivers with poor vision have to carry a spare set of glasses. Dirty cars are illegal in Russia, as is splashing pedestrians on a rainy day in Japan.
In some places, driving is really difficult. I pity any fool who tries to drive in Cairo. You can also very swiftly kill yourself on a German highway if you’re untrained. Driving at 120 MPH is far more complex than simply pressing the accelerator further.
Fare classes are highly inconsistent.
First class in one country is generally different to first class in any other. The same is true of second, third and so on. They vary wildly by country and system.
If it’s fiscally reasonable, I choose first for early mornings and overnights. They really are better, even just for security of your belongings.
The one time I settled for a second-class overnight, I had to physically fight a mouth-breathing Russian girl who was sweating vodka and wouldn’t stop burying her face into my lap to huff my underpants like Whip-Its. I wish I was making this up, but it’s true. I arrived sleepless, angry and ugly. It ruined my first day in Lisbon and I only had five. First class would have been worth the cost. Second class is my usual go-to. For shorter trips or anything after 9 a.m. I go second.
If I want an adventure, I go even lower. Some agents won’t sell those tickets to tourists though unless you insist.
Nomads and backpackers who don’t do the travel hacking thing usually buy cheap flights. Be careful of taking that too far.
For starters, you need to observe weight limits on baggage. In the US, no one gives a shit, but elsewhere they care. The care deeply. Never buy a ticket that forces you to pay weight overages.
Seats are also important, but not for comfort. I never take bulkhead or exit-row seats unless I pay for early boarding. Both offer less (or zero) under-seat storage, so being in a later boarding group puts you at risk of having nowhere to put your carry on — or as you’ll hear them called “cabin bags.”
I’ve even been on a flight where the attendant nearly made me check my personal item. I shut that down by threatening to create a scene and de-board, but I could have avoided it by paying $8 for priority boarding.
Countless people have asked if I used an around-the-world plane ticket for my first trip.
My simple response: Don’t ask dumb fucking questions. Also, no, I didn’t.
ATW tickets are nearly useless. They typically require you to book your stops in advance, so there’s too little flexibility. The fine print is also brutal and changes constantly.
Last time I researched them, the price was based on allotments of miles. The number of stops also changed the equation. All of them required you to choose a direction (east-to-west, for example) and none permitted travel in the reverse direction even slightly. Some airlines even insisted all departures had to occur from the same point as arrival, meaning if you traveled by land elsewhere, the airline penalized your mileage allotment.
I said airline there, but ATW tickets come come from a single carrier. Instead, you buy into an alliance, of which I believe there are still only three. Quite the lack of competition there.
ATW fares do lend themselves marvelously to itineraries where you go to a different city each month and make it the base from which you explore the region. This is something we’ll talk about later when we discuss hub-and-spoke travel.
If you have status with a particular airline, you may want to consider their ATW option — emphasis on ‘may’ — but be warned that flying everywhere robs you of some great experiences.
Domestic American air travel is a racket run by three major companies and a few smaller ones who effectively collude on prices to screw passengers and support their bloated executives and corporate structures.
Even regional jets, which are technically independent, are fucking death traps that I literally never, ever fly.
It’s not this way in other countries, because most people are sensible and see transportation as akin to a public utility. It’s therefore common to find flights on foreign carriers for under $100. I frequently see fares less $50.
Booking far in advance is therefore unnecessary, except of course in places where tickets sell out. Avoid the temptation to book months or weeks out if you’re just trying to save money. Not only will doing so lock you into dates you might regret, you may end up paying. Why? Booking sites now sniff for your computer’s location and display higher prices for foreigners.
Rude, right? Blame the mirror. We invented that.
The beauty of hub cities is the slow pace. How slow you take it will vary according to the number of side trips as well as your pace. If you commit to a month though, this introduces the possibility of renting an apartment. Even if you don’t plan to stay the full 30 days, apartment rental is generally very cheap. It can also make cooking easier, which also saves cash.
Cooking for yourself doesn’t have to mean eggs for breakfast and chicken dinners. You can dial up the adventure full throttle if you sign up for a greenmarket food tour and a cooking class right after you arrive. Not only will you know what to do with the local ingredients, you’ll eat better. Plus if you know what you’re doing, the vendors may screw you less, which will offset the price of the guide.
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