TORONTO - Some people think of them as the ultimate in no-muss, no-fuss travel. But while a cruise can be a dream vacation, it can turn into a nightmare if health problems mar your trip.
A few precautions — and some smart choices onboard — could help ensure your cruise is memorable for all the right reasons, experts say.
A key piece of advice, especially for travellers who are older or who have experienced health problems in the past, is to find out what kind of medical insurance you have and compare it to what you might need.
Jennifer Geduld, acting director of the Public Health Agency of Canada's travel health division, says it's always a good idea for people to find out what their provincial or territorial health-care program will cover when they are travelling out of province.
People whose jobs provide extended health insurance should also check with their provider to see how much out-of-country coverage they have through their work plan.
The idea is to find out whether you need to buy additional insurance to cover emergencies, such as an air evacuation if a serious health problem arises.
"A cruise is a pretty low-risk kind of trip. But if you have a chronic condition that could lead to an emergency … you might need to be put on a helicopter ... and be air evacuated," explains Dr. Pierre Ploudre, who chairs the committee to advise on tropical medicine and travel, an expert panel that advises the Public Health Agency.
"You want insurance _ and it doesn't cost that much _ that covers that. Because that helicopter, air ambulance trip to Miami or wherever they take you is like a US$20,000 to US$25,000 tab. And for $100 or $200 of insurance, it's well worth having."
Dr. Kevin Kain agrees.
"They're not going to handle anything serious. They are going to get a helicopter or they're going to punt you off at the first port. And then it's up to your medical insurance, right?" explains Kain, who is director of the centre for travel and tropical medicine at Toronto's University Health Network.
Kain has actually taken a number of cruises, including to some pretty exotic places. He says people need to match their cruise choice to their reality.
If you aren't fit, don't go for the one with the day trip that involves climbing steep steps. If you have medical conditions, maybe a cruise that plies the waters near places where you could get specialized care might make the most sense.
"Aligning expectations with what's realistic for your health background is important," Kain says.
Cruise ships do have medical facilities and doctors onboard. "Medicine on board our cruise ships is similar to what you find in a small city," Lanie Morgenstern, director of public and media relations for the industry organization Cruise Lines International Association, explains in an email.
She says guidelines from the American College of Emergency Physicians call for ship doctors to be graduates of accredited medical schools and have at least three years of experience, including some in emergency medicine.
Ships offer the best care possible "within the limitations of practising at sea," Morgenstern says, and have digital X-ray machines, defibrillators, ventilators and laboratories for blood testing, along with other equipment.
Geduld suggests that while you are doing your research on health insurance, you should check out what the cruise line and the ship you are thinking about travelling on have to offer in terms of medical services.
"You can't be too prepared. It's not just packing your bags, it's also being prepared for any health hazards they might encounter," she said.
Other preparations that could make your cruise more enjoyable include ensuring all your vaccinations are up to date. That means shots for influenza, hepatitis A and B, tetanus and the pneumococcal vaccine, if you are a senior citizen.
Malaria medication probably isn't necessary for most cruises, Kain and Ploudre say, because off-ship excursions are normally daytime affairs and the mosquitoes that transmit the disease are night-time feeders.
But depending on where the cruise is heading, precautions against mosquitoes may be in order. "All of the tropics have a big problem with dengue," says Kain. "And that's a daytime biting mosquito. So they should carry and used DEET, on the boat and when they do their (day) trips."
In some parts of Latin America, yellow fever is a concern. Cruise lines may demand customers have proof they've been inoculated, because authorities might refuse to allow boats to proceed without that proof from all onboard.
Kain says this is a vaccine people want to discuss with a travel clinic doctor. He says they may sign a waiver indicating the person should not have the vaccine for medical reasons, depending on the age of the traveller.
"When you're 20 and you get a yellow fever vaccine, you handle it really, really well.... But if you're getting your first yellow fever vaccine older than 70, you don't always tolerate it very well and occasionally there can be really serious side-effects," he explains.
"The risk of getting yellow fever is not that high. So why would we want to give you a vaccine that has a higher risk?"
Gastrointestinal outbreaks can be a problem with this kind of travel, so be careful about what you eat and drink. Ploudre suggests bottled water is the best option. And that means drinks with ice while you are in port are a no-no.
"You can easily slip by having that nice margarita that's very inviting made with crushed ice and water that you don't know the source of, and it could be just that one exposure that gives you whatever that illness is," says Ploudre, who is a medical officer of health with the Winnipeg Regional Health Authority.
A few years back, cruise ships were notorious for having norovirus outbreaks. Noroviruses are nasty, triggering vomiting and diarrhea. The illness resolves itself after a couple of days, but they can be a couple of tough days, particularly for older people.
The industry worked hard at learning how to combat the outbreaks, which are not as common anymore. But Kain and Ploudre both stress that good hand hygiene and liberal use of hand sanitizers are key to having a healthy cruise.
Passengers who need prescription medications should bring enough for the entire trip, plus a bit extra in case of delays getting home. Ploudre suggests people with medical conditions could bring a letter from their doctor that outlines what they suffer from and how it's treated and include a list of medications they take.
It will expedite care if something comes up, he says.
On the Net:
Travel health advice from the Public Health Agency of Canada: www.travelhealth.gc.ca.
Health Canada inspects and scores cruise ships. Their findings can be found here: