Dialysis and Travel support pages - Dialysis Konnections and our Australian Dialysis Unit Guide

If on dialysis and thinking of travel 
First ask your health care team how this may affect your health. If well enough and with careful planning a holiday can boost both your confidence and wellbeing. However, when you have one or multiple conditions, there are major road blocks to negotiate, before you can travel sensibly.

The most obvious - you should have significant funds available to cover costs for ANY health emergency, plus any treatment and medicine costs etc. If on dialysis, treatment costs may be expensive. Think carefully and budget strictly around all possible medical costs especially around any emergency events.

Capacity pressure - Dialysis Units  
As the number of people with kidney failure grows there is increasing demand for dialysis treatment here and globally. Dialysis Unit staff support kidney patients wanting to travel where possible, but often do not have spare sessions available. All dialysis patients travelling within Australia should review our Australian Dialysis Unit Guide (the DUG online) for Dialysis Unit contact details. Ensure you book travel and dialysis sessions in advance. Weblinks below offer holiday/travel dialysis suggestions.

Australian Dialysis Konnections Register - Dialysis Chair Exchange Program
Australian dialysers who wish to travel within Australia can use this program to help connect with other Aussie dialysers privately, to arrange a 'dialysis chair swap'. Your renal staff must agree to this swap. Steps required to 'connect' are simple and easy to follow. Go to our ADKR webpage for more info.

Making travel dialysis arrangements in Australia
Your Dialysis Unit staff should help you to organise short or long term travel dialysis in Australia but sometimes do not have enough staff, or time available to help. Do not attempt to do this yourself without talking with them first! Confirm dialysis session times in advance - you may need to be flexible.

Private dialysis in Australia
Private Dialysis Units may offer temporary dialysis but charge a fee for each treatment. Costs for private dialysis varies. As a guide approximate cost per session is between $450 to $650 per treatment in South Australia. In eastern states costs can be between $800 to $900 per treatment, depending on location. Ensure you book in advance and receive a firm quote and confirmation of treatment dates. A minimum of 1 months notice is required.

Medically required medications
Work out expected medical costs in advance. Note: many countries, including Australia only allow you to bring medically required medications to cover you for a maximum of three months (at maximum dosage for the drug). You should hold a current treatment letter to present to Customs Officers on arrival. Check what drugs are considered illegal in countries you may travel in, especially pain killers etc.

Travel health insurance
Firstly, as a guide, health insurance cover may be granted to anyone with kidney disease if you have had a transplant which is at least six months old; there must never have been a rejection or infection and your overall health must be stable. Travel insurance will not usually cover anyone on a transplant waiting list or with a complex kidney health history. (More below)

MEDICALLY NECESSARY TREATMENT UNDER RECIPROCAL HEALTH CARE AGREEMENTS

The Australian Government has signed Reciprocal Health Care Agreements (RHCAs) with several countries which is meant to cover ill health arising during your stay, including inpatient and outpatient care. However each agreement is different and varies in benefits for medically necessary treatment and duration of eligibility. This is a complex area of travel health cover especially if you have any or multiple chronic health conditions.

Not all treament is covered under an RHCA
Some exceptions are: treatment which is pre-arranged or elective, not immediately necessary, ambulance cover and para medical services, dental care, medical evacuation to your home country, funerals, treatment and accommodation in private hospitals, or as a private patient in a public hospital.

Reciprocal Health Care Agreements (RHCA) and eligible visitors to Australia are entitled to use dialysis services in Australia as a public patient. The number of dialysis treatments a person receives depends on availability of resources of the treating hospital.

Note: individual Australian states may impose limits on the number of free treatments offered and this varies.

Countries under Australian RHCAs which cover medically necessary treatment INCLUDING dialysis:
Netherlands - New Zealand - United Kingdom These countries may provide access to dialysis to RHCA eligible visitors, but there are limits.

Countries offering RHCA cover via Medicare for medically necessary treatment but NOT dialysis:
Belgium - Finland - Italy - Malta - Norway - Republic of Ireland - Slovenia - Sweden

• Renal Service Limits are imposed on the provision of dialysis to residents of reciprocal countries. Australia has agreed to provide RHCA visitors with free dialysis services for the lesser of either a maximum period of four weeks (covering all service sites) or a maximum of 12 sessions within a 12 month period, commencing from the date of first treatment.
  
• Dialysis in Medicare funded units for eligible patients is based on clinical need, however, the ability of the Australian health system to fund eligible overseas patients must not interfere with the physical, clinical and/or financial capacity of the Area Health Service to meet the clinical priorities of Australian residents. In reality you may have difficulty in finding spare capacity in public Dialysis Units.
  
• Capacity guidelines - dialysis is limited to one RHCA patient at each site and subject to availability of staffing and resources. No eligible Australian patient will be disadvantaged due to this decision.

Most temporary visitors to Australia are not covered under an RHCA - Medicare benefits are not an option for general care. It is strongly recommended all travellers with a chronic disease try to acquire some level of travel and health insurance, if at all possible. If no cover is possible, ensure you have sufficient funds to cover emergencies, medications needed and treatment.

If travelling on a Student Visa in any RHCA country - A condition of this Visa is that you also take out Overseas Student Health Cover - ask if dialysis or treatment if transplanted, will be covered.

In Australia and overseas delays can be expected if a bed in a public hospital isn’t available. Even if eligible for free treatment you may prefer to have control over when and where you’re treated and by whom, via private travel health cover if eligible.

Australians overseas - entitlements for treatment under an RHCA (Click link)
To receive medically necessary treatment for any ill-health or injury whilst visiting an RHCA country, you should provide local health authorities with:

• your Australian passport or other passport which shows you are a permanent Australian resident
• a valid Medicare card - ensure your Medicare card will cover you until you return to Australia
• if known treatment is expected, advise medical staff that you wish to be treated under an RHCA with Australia, to establish dialysis capacity and be aware of co-payments that apply - there are limits

Visitors to Australia - entitlements for treatment under an RHCA (Click link)
As a resident of an overseas RHCA country you are entitled to the following for medically necessary treatment for any ill-health or injury whilst in Australia. This does not include treatment considered ongoing, or elective and does not cover treatment in a private hospital. You are entitled to:

• free treatment as a public in-patient or outpatient in a public hospital
• subsidised medicines under the Pharmaceutical Benefits Scheme (PBS)
• Medicare benefits for out-of-hospital medical treatment provided by doctors through private surgeries and community health centres

Medicare Australia - Call 132 011 for advice on location of nearest Medicare office (for TTY 1800 552 152 hearing/speech impaired - use 131 450 for translating/interpreting service). Note this support information.

• Medicare - Australians travelling overseas and Medicare - Visitors to Australia
• Private Health Government resource 1300 737 299 (local call) 9am-5pm Mon-Frid (EST)
• Australia's Reciprocal Health Agreements - Health Insurance Consultants Australia 

TRAVEL HEALTH INSURANCE - WHEN YOU HAVE KIDNEY DISEASE

When you have any chronic disease you should be realistic about the likelihood of getting travel and health insurance for a pre-existing condition and consider these costs. For Australians, If you need a break from routine, local travel to city centres may be a better option to consider, rather than choosing a remote or long distance destination.

If you had private health insurance cover when you developed your ill health, you may be able to obtain travel cover from your usual health insurance company. If you have had a complex path to kidney failure, have current dialysis issues, or multiple health conditions, you will be very lucky to find a travel insurer.

As a guide: Travel insurance may be granted to someone with kidney disease if you have had a transplant at least six months old; there must never have been a rejection or infection and your overall health must be stable. Travel insurance will not usually cover anyone on a transplant waiting list or with a complex health history.

Travel insurance for pre-existing kidney disease varies considerably. Travel insurance agencies always display policies on websites, but these can be difficult to interpret or understand. Do lots of research first, ask a travel agent to make suggestions or contact an insurance broker. Consider basic travel insurance, to cover emergencies at least, perhaps via your credit card, union, bank or even your super fund, but ask specific questions on the cover, if you have one or multiple pre-existing health conditions.

Travel insurance agencies who have offered cover to people post transplant include: *Allianz Australia -Travel Insurance  *Cover-More Travel Scene  *Chartis Travel  *Columbus Direct  *Travel Scene Insurance  *World Assist Australia. Each applicant is assessed on individual health - insurance may be refused if you do not meet their criteria and may not cover existing chronic conditions.

TRAVEL TIPS FOR OVERSEAS TRAVEL WITH CKD

Obtaining haemodialysis in other countries is possible - be aware standards of care may differ to Australian standards, each country is different. Some globall holiday dialysis centres specialise in this field and a quality service is guaranteed - but charge for their services. See some travel destinations to consider from weblinks below but enquire about their standards and care and what is covered for your fee.

Travel on Peritoneal Dialysis (PD) is simpler - but requires careful planning. Dialysis supplies in most cases can be delivered to your destination. Make arrangements for delivery of your dialysis supplies in advance. Ask your health team if they can arrange contacts for back-up medical care, essential in case of ill health.

You may find this article helpful 'food for thought' - Peritoneal Dialysis Travel 'Tool Box' Nephrology Nursing Journal, Sept-Oct 04 by Bobbie Knotek, Laurie Biel - USA

Travel when waiting for a Kidney Transplant - consult your doctor and Transplant Co-ordinator to decide if you will be able to return in time, if a kidney becomes available. You are unlikely to receive travel insurance whilst on the transplant waiting list, or for up to two years post transplant, and your health must be seen as stable.

TRAVEL - WITH KIDNEY DISEASE  Medical and treatment advice

• Our Australian Dialysis Unit Guide (DUG online) helps you locate an Australian Dialysis Unit. Ensure your unit staff to confirm dialysis arrangements a few weeks before you start travel, as capacity can change, especially in a public unit. Read: Travel & dialysis: How can nurses help? Educational Supplement Ren Soc Aust J 5(3) 152-154 Black, K (2009)
  
• Transfer forms providing detailed personal treatment references (ask at your unit) will be sent in advance to your destination unit. Carry this with you at all times. If travelling in an emergency, dialysis details can be forwarded by your unit staff to the Dialysis Unit which accepts your request.
  
• When on holiday your health care team must be able to contact you especially if on the transplant waiting list. Ensure the health team have your detailed travel itinerary with relevant contact information. Advise dialysis unit staff of any changes you make to your travel itinerary or plans.
  
• Don’t book any travel arrangements until you are sure you will be covered by travel health insurance for pre-existing medical conditions and budget for emergencies.
  
• Be aware that pre-holiday blood tests are compulsory for most units at home or overseas - allow enough time to have the tests done and to receive the results. Check if vaccines are needed in countries where you are travelling - some vaccines are not recommended for dialysis patients. Transplant patients have to be especially careful of vaccines.
  
• Keep an up to date treatment letter from your doctor with you at all times summarising your health, results of recent lab results and medications you are taking, and why. You may need to provide this for Customs authorities and is essential information if you need to consult a doctor away from home. Store copies of this letter in safe places in case it is needed (store via email scan copy).
  
• Take enough medication for the whole trip with some extra in case of lost luggage or spillage. (Note max. three month supply allowance limit). You may arrange for supplies to be delivered ahead of time to destinations. If pre-ordering ensure supplies arrive at your destination before departure. Ask your doctor if you may need a different type of drug or prescription in other countries.
  
• Travel with at least a three day reserve of supplies in case of unexpected travel delays - weather, flight delays, unexpected scheduling problems or shipment delays. Bags can go astray, they may arrive on the next flight, but to be safe always pack all medications in carry-on bag, never in checked luggage.
  
• Planes don't have fridges for personal use - if you have a drug which must be kept cool ask your pharmacist how to pack it for travel. Check if your hotel has a fridge as some do not - they may suggest options. Consider packing medications in a thermo-bag with re-usable freezer packs. A wide-necked thermos chilled in advance also works. Make sure you allow time for transfers and delays when calculating the length of a trip when medication may be unrefrigerated.
  
• If you bring syringes you must bring the drug you inject, like insulin etc (some countries including Australia require a special licence for certain drugs). Any drug you carry must have a professionally printed label that clearly identifies it. There is no limit to how many empty syringes you can take as long as you also have the drug with you. On your return trip make sure you declare any drugs you were given or prescribed. Your treatment letter may also be requested.

Consular advice for emergencies - Australians travelling overseas Australian Department of Foreign Affairs and Trade 24-hour Consular Emergency Centre: Call 1300 555 135 within Australia or +61 2 6261 3305 from outside Australia.

*Smart Traveller Register to ensure access to updated Australian Government travel advice and consular assistance quickly if needed. Refer also to  Getting help when travelling overseas and Importance of travel Insurance.

TRAVEL - WITH A CHRONIC DISEASE  Advice to make travel planning easier

• When you make travel plans ask the airline to make contact with their Disability or Special Assistance Co-ordinator. If you need assistance boarding a plane or train, inform personnel when you check in.
  
• When making a hotel reservation online or by phone, remember to request a ground floor room or handicapped-accessible room, if stairs or distances are a problem.
  
• If booking via a travel agent tell them of special needs you have - speciific diet, accessible rooms and assistance to change planes. The agent can also advise on safe transport of dialysis supplies while travelling to foreign countries.
  
• If you travel by plane or train, make arrangements for special meals (e.g. low-salt, low-fat or diabetic) when you book in advance. If diabetic carry glucose tablets and snacks such as low-potassium juice to treat low blood sugar. Travel with lunch or nutritional supplement in case of delays. Managing your diabetes can be simpler by having insulin, syringes and blood glucose monitoring handy.
  
• Take emergency supply of bandages, pain killers, insect-bite ointment and anti-diarrhoea pills. Check with your health team regarding over-the-counter drugs you may use. Avoid over-exposure to the sun - take a high-factor sunscreen and use it. Sun protection is very important for transplant patients.
  
• Watch what you eat and drink. Talk to your dietician before you go about what foods to avoid. Don't take the risk of drinking local water - this includes water used for brushing your teeth. Unless you are sure it is absolutely safe, use bottled water. Avoid salads and ice cubes unless you wash the salad or make ice cubes yourself from bottled water. Avoid ice cream and other foods from street vendors.
  
• Carry at least two universal connectors, one in personal bags and one in checked luggage in case one is lost in transit. Ensure you arrange in advance, a clean space to do exchanges and store supplies.

RECOMMENDED TRAVEL LINKS