Air travel is an occupational hazard of being an expat, whether it’s flying to visit friends and family ‘back home’ or business travel connected with work. The vast majority of people have no health issues related to flying, but there are times when air travel is not appropriate, such as later in pregnancy, soon after surgery, or if you’ve been suffering from an infectious disease. Dr Jace Clarke provides some basic guidance on the health issues expats should consider before taking their seat on a plane – but the golden rule is to consult a health professional if you are in any doubt about your fitness to fly.
Air travel is one of the safest means of transportation around the world today. But the very fact that passengers sit for hours on end in a pressurised cabin with limited space to exercise, slightly reduced oxygen saturation and hundreds of other people’s sniffles and sneezes means that you should always make sure that you’re fit to fly before getting on an aircraft.
Modern aircraft are pressurised to fly with an equivalent cabin altitude of between 5,000 and 8,000 feet. This results in a fall of oxygen saturation of about 5% to around 90% of normal at sea level – this is not a problem for healthy passengers, but reduced oxygen does need to be taken into account if you are suffering from serious heart or breathing conditions. Most minor cardiovascular and pulmonary problems are usually unaffected by air travel, but do consult your doctor for advice and if necessary contact the airline to arrange for additional oxygen to be available.
The fact that cabin pressure is lower than that normally experienced at sea level also means that any gas in our bodies expands in volume by around 30 per cent. This is why some passengers suffer from ear discomfort as air trapped in their ears expands. Normally people are well able to tolerate this change, but for those who have recently been thorough surgery – especially where gas has been introduced into the eye or abdominal cavity or chest, it can present real problems as it expands and flying should be avoided for up to ten days subject to the surgery performed.
Travelling long distances across many time zones not only causes the inconvenience of jet-lag, it can also play havoc with the timing of medication for people taking drugs to control conditions such as diabetes. Travellers with time-sensitive drug regimes should consult a medical professional for guidance on adjusting timing and dosage to avoid complications. If you need injections for drugs such as insulin, be aware that you will need to request permission from the airline to carry needles on board. Also bear in mind that you should also carry any essential drugs in your hand baggage as the risk of lost luggage could present a serious problem if your drugs are lost on arrival. You will also need official documentation from your medical practitioner to validate the drugs in your possession.
The lack of room on most commercial aircraft greatly restricts people’s ability to get up and move around. Sitting for long periods of time in one position on a long haul flight does increase the risk of developing deep vein thrombosis – sometimes referred to as travellers’ thrombosis or even ‘economy-class syndrome’. Again this is only likely to present a problem to people with circulation problems and can generally be addressed by undertaking a high fluid intake and lower limb exercises during the flight or getting up every now and then to walk down the aisles. High risk passengers can also consider wearing anti-embolic stockings – sometimes known as ‘flight socks’.
Flying on a commercial aircraft is not considered to be hazardous for a normal pregnancy, but to avoid any risk of a delivery during a flight most airlines prevent women from flying after 36 weeks and some will require a certificate to confirm that the pregnancy is progressing normally if a woman wishes to fly after 28 weeks of pregnancy.
The fact that you will be cooped up with many other people for a long period of time means that you should seriously consider delaying your travel if you have been suffering from an infectious condition such as the ‘flu. If in doubt just think what you’d feel like sitting next to a person with an obvious attack of ‘flu for twelve hours or more! If you have been exposed to an infectious disease such as chicken pox don’t be surprised if the airline refuses to let you board if there is obvious evidence of a rash on your face or exposed skin.
Most airlines will prevent passengers from flying within 48 hours of receiving a plaster cast as air may be trapped under the cast which could expand in flight and could compromise the blood supply to the limb . So if anyone in your party has broken a bone away from home, perhaps on a skiing holiday, there is always the risk that your travel will be delayed.
As well as consulting your own doctor for advice, most airlines also have medical advisers who can provide advice and can give permission for a passenger to fly. Any normally fit expat will have no problem flying, but if there is any question about your health, do seek advice or consult you airline in advance. The final decision whether to carry a passenger is the airlines and it would be inconvenient, not to say embarrassing to be turned away at departures simply for not taking the right advice at the right time.