Pre-existing medical conditions
Generally, cruising presents no special problems to travelers with pre-existing medical conditions, provided proper precautions are taken beforehand and that your doctor has approved the vacation you have in mind. Sophisticated radio satellite communications systems now make it possible for passengers to talk directly with their own personal physician, if necessary, and make it possible to seek expert medical advice without difficulty.
Patients suffering from active stomach ulceration should not undertake a sea voyage of more than twenty-four hours’ duration as the risk of stomach perforation or hemorrhage is too great, especially in circumstances where expert facilities and blood transfusion are not available. Well-controlled cases, with appropriate medication and diet, are no problem. Patients with a subacute or ‘grumbling’ appendix should also never contemplate a sea voyage.
Changes in normal eating habits and the consumption of unfamiliar food and drink, often associated with an alteration in the social pattern, may cause considerable upset to colostomy patients, unless well controlled. Remember that cabin accommodation is often shared, so it may be necessary to make special arrangements to ensure privacy.
There is a high risk of diarrhea from eating ashore in certain countries—such as Mexico, for example. It is important to pay constant attention to the food hygiene precautions outlined elsewhere in this book.
With the ever-increasing number of older passengers taking the opportunity of a holiday cruise, the incidence of heart and circulatory disease is high. Most large passenger vessels provide facilities in the form of electrocardiography, cardiac monitoring, and resuscitation to deal with cardiac emergencies should they occur. Passengers whose pre-existing heart condition is well controlled by medication and who have adopted a sensible lifestyle present no problem.
Upper respiratory infections (coughs and colds) are all too common in the enclosed confines of an air-conditioned ship, where the opportunity for the spread of infection is high. Nevertheless, the risk to individuals who suffer from pre-existing lung diseases, such as bronchitis or emphysema, is minimal as appropriate antibiotics and medical support at an early stage of the infection is highly effective. Chest X-ray facilities will usually be available on board should complications develop.
Asthmatics prone to severe bronchospasm may run into serious difficulty at sea. Poor air-conditioning in some vessels, combined with a sense of claustrophobia in tourist-class cabins, may aggravate an attack. Oxygen therapy and expert medical treatment may not be available in all cases. Well-equipped ships’ hospitals providing steroid therapy can deal effectively with such emergencies but beware of flags of convenience vessels that operate low-cost package holidays and have minimal medical facilities. Severe, uncontrolled asthmatics should not travel by sea.
Although a sea cruise can provide an enjoyable and relaxing break from the daily rat-race, ships are poor places to suffer from a psychiatric disorder. Contrary to popular belief, depressed people do very badly at sea: the anticipated improvement from escaping the anxieties of life ashore does not occur. Individuals suffering from severe depression should never travel by sea, where the risk of suicide from jumping overboard is too great.
Attacks present no special danger provided skilled medical help is available on board if needed. Occasionally, the disruption of the normal daily routine and the fatigue of travel may exacerbate the frequency of attacks.
The convivial life at sea, freely available cheap alcohol, and no worries about getting home after an evening’s drinking can pose problems to people who have difficulty in controlling their alcohol intake or have a past history of drink problems. The complications of mental disorder and even delirium tremens are not uncommon. If you have had any problems with drink, long sea voyages are best avoided.
Normal pregnancy presents no particular difficulty at sea. Most companies do not accept passengers at an advanced stage of pregnancy, and usually, such passengers should not embark if they will be more than thirty-six weeks pregnant on the day of disembarkation. Women with histories of repeated miscarriages, especially in the first few months of pregnancy, are best advised not to travel. Bear in mind that blood transfusion on board can be a complicated and risky procedure. (See also pp. 417-22.)
Keeping fit on a long sea voyage is an ever-present problem, owing to the lack of exercise and possible overindulgence in food and alcohol. Fortunately, most cruise liners provide gymnasium facilities and swimming-pools, and many run organized fitness programmes.
Debilitating illness or infirmity
Sea travel need not present undue concern to those convalescing from a debilitating illness, nor to the aged or infirm. Special facilities can normally be arranged, including wheelchairs for the disabled, and assistance at embarkation or at ports of call, although this is not always possible at every port; it is important to confirm this in advance. Disabled passengers should normally be accompanied by an escort. The shipping company should be given plenty of notice to enable arrangements to be made. Only occasionally, where complications are likely, may travel be refused.
Most well-run shipboard medical services will endeavor to treat you on board ship and avoid disembarkation to a hospital ashore— where there may be problems such as language difficulties, nonavailability of drugs, the expense of treatment, and possibly questionable standards of care. Be prepared, however, and never travel overseas unless you have taken out adequate health insurance protection, not only for all medical expenses but for your repatriation should this prove necessary. A minimum cover of £5000 is essential, and cover for up to £500 000 may be advisable if you are traveling to the USA.
Summary of advice for travelers
- Medical hazards at sea are relatively uncommon and do not differ significantly from those ashore. Should you have the misfortune to fall ill, what better place to be than a modem luxury liner! Most major shipping companies provide comprehensive medical services which are concerned not only with treating of illness and injury on board but also with maintaining high standards of hygiene and safety throughout the ship. Good luck and Bon voyage