Longer Stay Travellers and Expatriates
The term expatriate refers to people who take up residence in another country, this may be for occupational or leisure reasons. Longer stay travellers refers to those travelling for 6 months or more.
Prior to departure all longer term travellers should undergo thorough medical and dental examinations to identify underlying disease. This is particularly important if travelling to areas where medical and dental care is not readily available. In some countries poor quality and counterfeit medicines are used. It is important to ensure that appropriate travel health insurance is arranged.
Preparedness in advance and learning about the culture and language can greatly enhance the experience. The following general health advice may be useful:
More vaccines may be advised for the longer stay traveller and as vaccines take time to become effective, ideally advice should be sought about 6-8 weeks prior to departure. Destination specific information can be found on individual country pages.
- For countries where tetanus, polio and diphtheria are present, it is important to ensure all UK vaccinations plus any relevant boosters are up to date.
- Travellers staying in polio-affected countries (see individual country pages) for longer than 4 weeks will require to have a polio booster, and obtain proof of vaccination, at least 4 weeks prior and not more than 12 months prior to departure from the polio-affected country.
- There is a risk of tuberculosis (TB) in unvaccinated individuals visiting countries with a high incidence of TB and mixing with the local population.
- only for those under 16 years residing in a TB risk area for more than 3 months. Protection against TB is only achieved 4-6 weeks after BCG vaccination.
- Hepatitis A and typhoid vaccines are routinely advised for countries where cleanliness of food and water supplies is questionable.
- Meningococcal type ACW135Y infection is a risk for those visiting the meningitis belt in sub-Saharan Africa and mixing closely with the local population. There is an increased risk of outbreaks during the dry season (December – June).
- Hepatitis B vaccine is recommended for those staying for longer periods in intermediate or high risk areas and for those at risk through occupation or lifestyle.
- Japanese encephalitis is recommended for longer stays in endemic regions (Asia and Western Pacific region).
- Yellow fever is recommended for endemic countries in Africa and South America and a yellow fever vaccination certificate may be necessary for crossing borders.
- Rabies vaccination is important for those who will be remote from accessing good medical facilities, in regions where post exposure rabies treatment may not be available e.g. more than a day away from reliable supplies of vaccine. Rabies vaccine is particularly advised for children who may be more inclined to approach animals.
The same main principles of malaria prevention apply to longer term travellers and expatriates as for the short term visitor. However, it is known that the risk of malaria increases with the length of stay while adherence to preventive measures decreases. The risks for longer term travellers varies depending on multiple factors including reason for travel, whether staying in rural or urban areas and access to medical facilities. There may be a reluctance to continue with malaria chemoprophylaxis and compliance can become poor. While it may be appropriate for certain travellers to stop taking chemoprophylaxis altogether (e.g. the expatriate who has access to medical facilities), this approach is not suitable for all longer stay travellers (e.g. backpackers with uncertain access to medical facilities). Specialist advice should be sought to allow full discussion around this subject. It is important for individuals to know that if chemoprophylaxis is stopped, there is a real risk of contracting malaria. Malaria prophylaxis is very important for infants, children and during pregnancy.
- Further information about the prevention of malaria.
Psychological and Cultural Issues
Most travellers experience culture shock to a certain degree. The term culture shock is used to describe the early process of cultural adaptation and symptoms include:
- Disliking the food, accommodations or lifestyle
- Fear of physical contact with local nationals.
- Fear around personal safety and security.
- Anger and frustration around the new country and local customs.
- A terrible longing to go home.
Difficulties with cultural adaptation can be exacerbated by:
- Separation from family and friends.
- Time differences between continents which make it difficult to maintain contact with friends and relatives.
- Problems adjusting to a different climate.
- Unusual food.
- Changes in living standards and different social amenities.
- Language differences and difficulties.
- Religious differences.
- Coming to terms with difficult societal differences such as overt poverty and begging.
- Further information about culture shock