News from Around the World

Travel assistance insurance/Adventure sports/Lack of coverage. Carefully reading insurance policies is always a good "policy," but it may be especially important when you carry travel assistance insurance and you participate in adventure-type activities, says National Geographic Traveler magazine. In fact, check the fine print even if the activities that you participate do not seem all that adventurous - skiing off marked trails, for example. You may find that your activity may not be covered.

Travelers' complaints against companies generally arise from: companies refusing to compensate for injuries arising from activities excluded in the fine print; vague wording in the policy that favors the company; and in case of serious medical problems, the company - not the traveler - deciding whether the traveler should be evacuated, and to where the traveler should be taken.

The companies say that their policies are designed for mainstream travelers, not for individuals who participate in adventurous activities. Adventurous activities result in many injuries, some of them serious and, for the companies, very expensive. Moreover, the number of travelers participating in adventurous activities is growing proportionally more rapidly than the number of conventional travelers. As a result, the number of activities that companies exclude from coverage has greatly increased in recent years. Some of the companies are planning special policies for travelers participating in activities excluded by the regular policy.

But only travelers who read the fine print on the policy itself or click on the hard-to-find "terms and condition" section on the company's website are aware of the exclusions. For example, one company's website says, "You must review the Terms and Conditions section periodically because they govern your use of this Web Site and are binding upon you. The company may modify these Terms and Conditions at any time at its discretion by updating this posting." And many companies have done just that. Often, policies are sold over the telephone. In such cases policy holders may not have the policy to read until after they have purchased it and no one tells the buyer to read the website. Exclusions are generally not included in the companies' glossy brochures. Also, activities that are excluded vary widely from one company to another.

Activities that have always been excluded from coverage include bungee jumping, hang-gliding and mountain and ice climbing when ropes are involved. But many companies now exclude coverage for "high altitude" activities such as heli-skiing and hot air ballooning, scuba diving, ice climbing (all), and skiing outside marked trails. And besides these general exclusions, some companies' policies have lower benefit caps for certain sports such as scuba diving and snow skiing. Many policies use language that requires travelers to avoid "extreme risks" and/or "exposure to needless perils," which, experts say leaves insurers the opportunity to avoid claims.

Air evacuation of a seriously ill patient can cost up to $50,000 and, occasionally, much more. Such patients would, of course, like to be returned home. However, policies state that the company will evacuate the patient back home only if in the opinion of the company's medical experts the caliber of treatment that the traveler requires is not available where the injury occurred or nearby. A traveler seriously ill in Nepal, for example, and in need of sophisticated medical treatment, may be transferred to Bangkok, Thailand or Singapore, not back home.

Travelers/Dental problems. Travelers should get a dental check-up before going overseas, and they should read their health insurance policies to see whether dental work is covered overseas (Int Dent J 2001 Aug;51(4):268-72). Some travel assistance insurance polices do not cover dental problems. Eight percent of medical claims made by Australians traveling abroad were for dental problems. The majority of claimants were 60 years and over.

Children/Down's syndrome/Altitude. Children with Down's syndrome are enjoying an improved quality of life, and more of them are accompanying their families on high altitude vacations. As a result, it has become evident that these children are more likely to develop altitude-related problems than other children, and do so at lower elevations (Pediatrics 2001:108:443-447). Down's syndrome children have a higher incidence of congenital heart disease, especially right-sided defects. Such defects generally result in increased blood flow through the lungs, a known risk factor for acute mountain sickness and high altitude pulmonary edema. Moreover, altitude-related problems are appearing many years after congenital heart defects were optimally repaired. Occasionally, heart defects become symptomatic for the first time at higher altitude.

Another known risk factor for altitude-related conditions is upper respiratory infections. Down's syndrome children have a higher incidence of such infections, probably due to immune system deficiencies.

Traveling/Carrying syringes across borders. A Canadian was recently arrested by U.S. Custom agents for carrying a medical kit for his personal use, says Health Canada. The kit, supplied by a travel clinic, contained several syringes and needles. The traveler had not declared the kit. The traveler was on his way to Mexico where he planned to stay for six months in a rural area.

This case indicates the importance of providing proper credentials for the millions of travelers who carry medically-advised syringes and needles and controlled medications when they travel. A letter on a physician's stationary is generally sufficient. For example:

Similar letters can be written for diabetics or other individuals carrying such items.

Snowmobiles/Children and adolescents. Children younger than 16 years should not operate snowmobiles, and children younger than 6 years should not ride them as passengers, says the American Academy of Pediatrics (AAP).

The popularity of snowmobiles is increasing, along with their size and speed. About 110 people die each year in the U.S. while riding them and about 13,000 people are seen with injuries in emergency rooms.

About 10% of injuries and deaths occur in children younger than 15 years, with head injuries the leading cause. Most accidents involving children result from operators striking fixed objects, such as trees, cables, wires, or other vehicles, or snowmobiles falling through thin ice. Children are also injured when they fall off vehicles, have vehicles roll over them, and while being towed, on a sled, for example. Towed sleds can strike objects or be hit by another vehicle. Rarely reported injuries include frostbite and hypothermia, hearing loss from prolonged exposure to excess engine noise and hand/arm vibration syndrome from the vibrations of the handlebar. This syndrome consists of diffusely distributed finger neuropathy, and pain and decreased muscular strength in the arms and hands.

Safety rules recommended for operators of all age include:

• Drive only well-maintained vehicles.
• Wear approved helmets, well-insulated protective clothing, goggles, waterproof snowmobile suits, gloves, and rubber-bottomed boots.
• Carry a first aid kit, a survival kit that includes flares, and a cellular phone.
• Be able to recognize the signs of hypothermia and frostbite.
• Travel in groups of two or more and only on designated, marked trails away from roads, frozen water, railroads, and pedestrian traffic. Avoid unfamiliar terrain. Hazards such as barbed wire are difficult to see.
• Check weather forecasts and condition of trails.
• Do not carry more than one passenger.
• Keep head- and taillights on at all times.
• Never pull saucers, tubes, tires, sleds, or skis behind a snowmobile.

The Lighter Side of Travel

Travel/Clean toilets. www.thebathroomdiaries.com is the Michelin Guide to free, safe, clean and easily accessible toilets in 94 countries," says one reviewer of this web site. Descriptions of the facilities may include toilet style (Western or "other"); gender-specific; hours of operation; availability of diaper changing tables; accessible for the disabled, and special esthetic amenities. A Swiss facility features seats rotating through a cleaning mechanism after flushing. A Hong Kong hotel has an attendant that helps patrons wash their hands. In Finland there is a toilet with a commanding view of Helsinki. Several Japanese department stores have heated seats.

An award, the Golden Plunger, is bestowed on the world' best public toilet. One recent winner is in Kawakawa, Bay of Islands, New Zealand. Described as "gorgeous, creative and democratic," it was designed in 1997 by a famous Austrian architect. "These colorful restrooms feature smashed tiles and glass in curves and spirals reminiscent of Gaudi. Bottles embedded in the wall allow natural light to enter. The building is topped off by a glass roof."

A First Runner Up: "Art Nouveau Toilet. Place de la Madeleine, Paris France. Just to the east of La Madeleine's main entry. Take the spiral staircase down to the subterranean, art nouveau restrooms. Built in 1905 with carved wood, brass, mirrors, and floral frescoes, each toilet has a stained glass window and a private sink. There is a fabulous, imperial chair for shoe shining. Attended by `Madame Pipi' this toilet is clean and safe, as well as beautiful."

An Honorable Mention: "The Talking Toilet, a Neo-Victorian Space Pod, in San Francisco, California. This free-standing, self-cleaning kiosk is a wonder. You pay your money, the door automatically slides open with a Star-Trek kind of whoosh. Everything is stainless steel - the walls, the floor, the ceiling, the plumbing fixtures (keep in mind you are stepping into a cylinder). The door closes behind you and you have 20 minutes to yourself. When you open the door and exit, a cleaning solution is sprayed from the ceiling. A microprocessor and infrared beams on top of the toilet gives audible directions to itself for the visually-impaired. Variations of these toilets can be found in England, France and Australia. Newer models have changing tables! Available 24/7."

Also available is a section, "Bathroom Diaries," a collection of essays about travelers' travails with toilets that are not recommended, for reasons that are made obvious in the essays.