The tragic death of a Winnipeg woman in Cambodia is a painful reminder to travellers of the risks associated with adventures abroad — and experts say trying to navigate foreign health systems can be one of those risks.
Abbey Amisola, 27, was found dead at a hostel in the south Cambodian city of Kampot on Tuesday along with her 22-year-old British travelling companion, Natalie Jade Seymour.
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Hostel staff told CBC News police are investigating how the women died. Cambodian immigration officials posted on Facebook that Amisola and Seymour had taken too much of a medication they got from a pharmacy.
Pierre Plourde, medical director for the Winnipeg Regional Health Authority's travel health and tropical medicine services, said he's hesitant to draw conclusions about Amisola's death before the investigation is complete.
But the case gave rise to concerns about travellers' options should they fall ill while abroad, and Plourde and other experts say there are ways to mitigate the risk.
'It's a big problem'
Accessing health care in another country can be difficult to start with if you're up against a language barrier. To get your message across, Timothy Chan, the Canadian spokesperson for adventure travel company G Adventures, recommends flipping through a guidebook or — his personal preference — reaching for Google Translate to explain your ailment.
"If you are travelling with a reputable tour operator similar to G Adventures, that offers the luxury and benefit of having access to a tour leader who [is multilingual]," he said.
But even if you get the right drug and take the right amount, pharmaceuticals in developing or resource-poor countries may not be safe, Plourde and other experts said.
"Unfortunately … it's a big problem," said Doug Thidrickson, a pharmacist in Ashern, Man., who holds a certificate in travel health from the International Society of Travel Medicine.
"In fact, up to greater than 30 per cent of products abroad might be counterfeit in some way. Either the active pharmaceutical ingredient is completely missing, it's underrepresented or it's tainted in some way, [so] that when it's ingested it's not going to have the desired effect."
Plourde said counterfeiting drugs is a "huge business," especially in southeast Asia. Taking an ineffective or dangerous med is a risk for anyone, he said.
"The counterfeiters have gotten very good at this, by putting a tiny bit of the active drug in the tablet," he said.
Regulatory oversight may not exist for pharmacies or pharmacists in all parts of the world, Thidrickson added. Even medications that start out safe may not be stored correctly, and advice from staff at pharmacies could be minimal, incomplete or incorrect.
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He advised against purchasing medication abroad.
"Sometimes there's no option but really, it should be purchased prior to travel," he said.
Thidrickson recommended bringing along a "first-aid kit" containing some commonly reached-for medications: acetaminophen, ibuprofen, Benadryl, Gravol and oral rehydration salts to be taken in the case of traveller's diarrhea.
Travel health consultations available
Michelle Rowan, an owner of Charleswood Travel in Winnipeg, said it's of "extreme importance" to travel with good health coverage. She recommended looking for a policy that covers in-hotel-room visits by doctors and considering travelling with a tour group.
Rowan also advises her clients to consult with a travel health clinic and speak with their doctor about getting a prescription to a broad-spectrum antibiotic before travelling to developing countries.
"It should be the first thing that you think of," she said.
A quick Google search will turn up a number of travel health clinic options in your area, Plourde said. In Manitoba, the consultations aren't free or covered by health insurance, but compared to the cost of travelling, Plourde said the session will be a small fraction of your overall trip budget — although vaccines, another crucial pre-travel step, may cost a little more.
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His own travel health team with the Winnipeg Regional Health Authority also offers pre-travel consultations, he added, which will run you between $30 and $50 on average.
The advice covers all sorts of travel health concerns, including a number of concerns travellers may not think of, Plourde said, from the dangers of motor vehicle collisions and sun exposure to simple, but essential, hand hygiene.
Like Thidrickson, Plourde advocates putting together a travel health kit including some basics, as well as a general antibiotic, provided to you by your regular doctor.
If you fall ill while away and a doctor at your destination prescribes an antibiotic, you can show that doctor the one you brought with you and ask if you can use it instead.
"It's just like having insurance," he said.
Health advisories online
Of course, even if you've done everything right, you may still find yourself in the position of needing to visit a pharmacy or doctor while abroad — especially if you're away for a long time, Plourde said.
- Government of Canada Travel health and safety
- International Association for Medical Assistance to Travellers
In those cases, he points travellers to IAMAT, the International Association for Medical Assistance to Travellers. The association provides a wealth of information on health concerns by destination, but it also vets hospitals and clinics around the world and provides a list of reputable options in various regions so travellers can find a safe spot.
But Plourde said he's never advised anyone not to travel, and he wouldn't do so in the future.
In his experience, the No. 1 cause of death for Canadian travellers abroad is the illness they bring with them, he said — cardiac issues, for instance, or other health problems that have more to do with your personal health history than an exotic destination.
"Everything in travel is about risk mitigation," he said. "I love travel. It's an incredibly enriching experience."