Friday, January 9, 2015

KIDNEY DIALYSIS AND TRAVEL

If well enough, with careful planning, a holiday can boost your confidence and well being. However, when you live with any chronic disease, there are major road blocks to negotiate before you can travel sensibly.
  • Ensure you have funds for costs for health emergency treatment and medicine. Dialysis can be expensive!
  • Do not organise dialysis without talking with your health team about how travel may affect your health. 
Home dialysis on the road
Quick reference guide to help planning - Home dialysis on the road>

Booking travel dialysis arrangements in Australia
With increasing demand, lack of spare dialysis chairs is a problem (capacity). Dialysis sessions should always be booked well in advance and confirmed before travel. You must be prepared to be flexible.
Private temporary dialysis in Australia
Capacity is a problem even in private units. If available, a dialysis session is approx cost: $450 to $650 per treatment (Sth Australia), eastern states $800 to $900 per treatment, depending on location. Strict minimum 1 month notice.
Medically required medication
Many countries, including Australia only allow medically required medication to cover you for a maximum of 3 months at maximum dose. Ensure your doctor updates your treatment letter with current health and medication list for Customs. Your dialysis unit will also give you an introduction letter - Travel overseas with PBS medication

TIPS FOR AUSSIES OVERSEAS - TRAVEL WITH KIDNEY DISEASE


Obtaining haemodialysis in other countries is possible - standards of care may differ to Australian standards. Some global holiday dialysis groups specialise in this service and offer quality service guaranteed - but charge for the service. Ask what is covered in the fees and get a firm quote.
Travel on Peritoneal Dialysis (PD) is simpler - with careful planning dialysis supplies can be delivered to a destination, if arranged in advance. Ask your health team if they can arrange contacts for back-up medical care, essential in case of ill health. Peritoneal Dialysis Travel 'Tool Box' Nephrology Nursing Journal. Bobbie Knotek, Laurie Biel USA
Travel when waiting for a kidney transplant - consult your doctor and Transplant Coordinator 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 some time post transplant. Your health must be confirmed as stable.
Travel anywhere, when you have a chronic disease - when making hotel reservations - remember to request ground floor room or handicapped-accessible room, if stairs or walking distances are a problem.
When making travel or flight bookings - contact a Disability or Special Assistance Co-ordinator - if booking via a travel agent advise special needs - specific diet, accessible rooms and assistance to change planes. If you need assistance boarding a plane or train, inform staff when you check in. An agent can also advise the best method for safe transport of dialysis supplies to foreign countries.

Aussies with kidney disease wanting to travel
Australian Dialysis Unit Guide (DUG)  Find a particular Dialysis Unit in Australia
BigDandMe - Holiday Dialysis Blog  Tales from an Aussie and his Holiday Dialysis adventures
Dialysis Escape Line: Australia PD & haemo dialysis nurses on all cruises
- call 08 8227 0181 or Wayne Cooper 0448 588 880
Dalysis Abroad
International escorted tours on dialysis - 08 8362 6657
NephroCare Australia - Fresenius Travel and dialysis Fresenius - Dialysis Clinic Finder
RenalInfo Support and Resources (Baxter) all countries including Australia

Australian Dialysis Units who may offer travel on dialysis places

State Booking ahead essential - no guarantee space is available - click links in red below
Session fees apply for private units listed
New South
Wales

EnableNSW - The Away From Home Haemodialysis Program>
Eligible haemodialysis patients access dialysis services at no cost when traveling away from home - education, work, holidays. Subject to availability & funding. Eligible patients may access up to 3 sessions per year at participating private renal unit (N/A Tasmania) away from usual place of residence. For NSW residents only!

Newcastle: Wansey Dialysis Centre - John Hunter Hospital NSW>
Call Team Leader, High Dependency 02 4943 9635 or send written request to:
Wansey Dialysis Centre, 1A Dudley Road Charlestown NSW 2290

Northern
Territory
Alice Springs Renal Unit> (public) staff try to keep shift for travelers - advance notice essential
Visit MacDonnell Ranges or Standley Chasm - call Dialysis Unit on 08 8951 6750

Alice Springs - Dialysis Unit> (private - dialysis fees apply) Fresenius Medical Care

Queensland
Townsville Renal Unit> private/public units have capacity problems but worth trying - call 07 4433 2650

Caloundra Private Renal Unit> (dialysis fees apply) read brochure then call 07 5492 0215

Tasmania
Launceston Community Health Centre Renal Unit>
Call 03 6336 5132 - dialysis sessions North/ North West Tasmania residents - advance notice essential


Victoria
Dialysis & Transplant Association of Victoria D.A.T.A. datavic.org/index.html
Members may access low cost holiday homes to enable family holidays with dialysis

Kyabram & District Health Services
Provide holiday dialysis: *Tues *Thurs *Sat (morning) call Natalie Sheehan 03 5857 0217

Lorne Satellite Dialysis Unit - Satellite unit of Geelong Hospital (Barwon Health)
M-W-F am sessions, Christmas to February, dialysis unit open 2 morning sessions (M-Sat) but no renal physician on site. Enquiries reception@swarh.vic.gov.au or call 03 5289 4300 - see travel brochure>


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We would all love to hear about your path with kidney disease, particularly any travel on dialysis adventures you may have enjoyed, or post transplant.

Email Cassandra Bradshaw, the Editor of Kidney Community News at cassandra.bradshaw@kidney.org.au with suggestions for articles.

Call 1800 454 363 - our staff will help you to subscribe.


KIDNEY HEALTH AUSTRALIA - DIALYSIS AND TRAVEL PROGRAMS

Big Red Kidney Mobile Dialysis Bus - bookings now open!
Holiday dialysis at Victorian holiday spots for up to 6 weeks at a time, parked at local caravan parks (see current session detail below). Dialysis patients need holiday accommodation, but can book to dialyse on our Big Red Kidney Bus, to enjoy a real holiday with family and friends. We need your help to develop the project nationally. Find out more about this program at: Big Red Kidney Bus>

  • The Grampians: 23 March to 26 April 2015  Vacancies at 9 January 2015>
    Big4 Grampians Parkgate Resort, 2372 Grampians Road, Halls Gap
    If you wish to book a cabin - 1800 810 781 (freecall) or stay@parkgateresort.com.au
    Big Red Kidney Bus Offer:
    stay 7 nights-pay 5 or stay 5 nights-pay 4


  • Phillip Island: 5 January to 1 February 2015 Bookings closed
    Big4 Phillip Island Caravan Park, 24 Old Bridge Drive, Newhaven
    Book a cabin - 03 5956 7227 (freecall) or info@phillipislandcpk.com

Travel Freedom on Dialysis - Campervan Program
Exciting initiative to provide respite or holiday dialysis options for Aussies living with kidney disease. Each Kidney Campervan fitted with dialysis machines (see prototype) initially available in Queensland. Future plans are to expand program nationally. See media>
The Wade family made a generous startup $50,000 donation to dialysis campervan program. Every dollar raised helps put a fleet on the road. To raise more funds the Vintage Adventurer drives his 1930 Model ‘A’ Ford to remote locations - the intrepid team recently drove across America from East to West on Route 66. For more visit Vintage Adventure>


TRAVEL HEALTH INSURANCE WHEN YOU HAVE KIDNEY DISEASE


When you have any chronic disease be realistic about the likelihood of buying travel insurance for a pre-existing condition. Aussies should consider locations in Australia as better options to long distance travel overseas. Don’t book travel until travel health insurance cover is secure and ensure you budget for any emergency.

Will you qualify for travel health insurance? If you had private health insurance cover when you developed a chronic health condition, you may get travel cover from your health insurance company. If you had a complex path to kidney failure, are experiencing dialysis issues, or have multiple health conditions, you may not find a travel insurer.

Consider basic travel insurance to cover emergencies.  Pay for travel with a credit card which offers some level of travel insurance, or consider general travel insurance via a union, bank or even Superannuation. Ask questions about travel insurance especially with multiple pre-existing health conditions. Most travel cover will exclude existing chronic conditions. Some level of travel insurance is strongly advised. We recommend you use an insurance broker to find travel insurance to save time.

As a guide: travel insurance MAY be granted if you have kidney disease, 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 agencies who are known to offer cover to people post transplant
An applicant is assessed on individual health - if it does not meet the criteria you are likely to be refused.
*Australia Post Travel Insurance (extra premium)  *Allianz Australia -Travel Insurance  *Cover-More Travel Scene  *Chartis Travel  *Columbus Direct  *Travel Scene Insurance  *Worldcare Travel Insurance Australia or compare travel cover and conditions at www.comparethemarket.com.au
Useful reading:  Getting help when traveling overseas  *  Importance of travel Insurance
Important contact information for Aussie travelers overseas
Australian Department of Foreign Affairs & Trade Australians traveling overseas may access a 24-hour Consular Emergency Centre - Consular advice for emergencies: call 1300 555 135 within Australia or +61 2 6261 3305 from outside Australia. Important: Australians traveling should register with Smart Traveller to receive up to date travel advice and receive consular assistance quickly - especially if you have a chronic health problem.
Private Health Insurance - Ombudsman 1800 640 695
Private Health (Australian Government site) compare health insurance policies 1300 737 299
Travel Doctor Australian Traveler's Medical & Vaccination Centre Travel Kits Medical

INTERNATIONAL TRAVEL ON DIALYSIS AND POST TRANSPLANT


Be aware delays can be expected if a bed in a public hospital isn’t available - a global problem. Even if eligible for free treatment, you may prefer to have control over treatment using travel health cover.
Reciprocal Health Care Agreements (RHCA)
Countries signatories: New Zealand, United Kingdom, Republic of Ireland, Sweden, Netherlands, Finland, Italy, Belgium, Malta, Slovenia and Norway. More detail on individual country benefits here>

RHCA are not designed to replace private travel health insurance for overseas travel as not all treatment is covered. Each agreement is different and varies in benefits, duration and eligibility for medically necessary treatment - a complex area of travel health cover, especially if you have multiple chronic health conditions and there are limits.

  • Australians overseas: may receive help with the cost of essential medical treatment
  • Visitors to Australia: residents of RHCA countries listed above can get essential medical treatments
Exceptions where no cover is available are: pre-arranged or elective treatment not immediately necessary, ambulance cover and paramedical services, dental care, medical evacuation to a home country, funerals, treatment in private hospital, or as a private patient in a public hospital.
An Australian RHCA may cover medically necessary treatment INCLUDING dialysis for eligible visitors from: Netherlands - New Zealand - United Kingdom but there are limits.
To receive medically necessary treatment for any ill-health or injury whilst visiting an RHCA country, you must provide local health authorities with:
  • Australian passport or other passport which shows you are a permanent Australian resident
  • valid Medicare card - check expiry date to ensure you are covered until you return to Australia
  • if known treatment is expected, advise the relevant medical staff that you wish to be treated under an RHCA with Australia, to establish dialysis capacity. Be aware co-payments apply - there are limits.
Important contact information

Reciprocal Health Care Agreements
Travel with PBS Medicine 1800 500 147 - Department of Human Services 132 290
Medicare: Australians traveling overseas and Visitors to Australia 
Health Insurance Consultants
- independent review of RHCA
Medicare 132 011 - or to locate a Medicare office
TTY 1800 552 152 for hearing/speech impaired - 131 450 interpreting service

VISITORS TO AUSTRALIA - ON DIALYSIS OR POST TRANSPLANT

Eligible RHCA country residents visiting Australia are entitled to medically necessary treatment for ill-health or injury whilst in Australia, but this does not include treatment considered ongoing, elective or in a private hospital. Visitors to Australia - can expect these entitlements for treatment under RHCA>
  • free treatment as a public in-patient or outpatient in a public hospital
  • subsidised medicine under Pharmaceutical Benefits Scheme (PBS)
  • Medicare benefits to cover some out-of-hospital medical treatment provided by doctors through surgeries and community health centres - be aware that a co-payment usually applies.
RHCA eligible visitors to Australia may be entitled to use dialysis services in Australia as a public patient
The number of dialysis treatments available depends on availability of resources of a treating hospital. Australia has agreed to provide RHCA visitors with free dialysis for the lesser of: either a maximum period of 4 weeks (covering all service sites) OR a maximum 12 sessions, within a 12 month period from date of first treatment.However, it is important to note these points:
  • Dialysis in Medicare funded dialysis units (public) for eligible patients is based on clinical need.
  • The ability of the Australian health system to fund eligible overseas patients must not interfere with the physical, clinical and/or financial capacity of any Area Health Service to meet clinical priorities for Australian residents.
  • In reality, travelers needing dialysis may have difficulty in finding spare capacity in public Australian Dialysis Units. Dialysis is limited to one RHCA patient at each site, subject to staffing and resources - each state may impose their own limits on free treatments offered.
Dialysis is NOT covered under these RHCA agreements - emergency treatment only
Visitors from New Zealand and Republic of Ireland should present their passport to Australian hospital clerical staff to be eligible for cover under Medicare. Access to public health care in Australia for visitors under an RHCA is restricted to a person ordinarily resident in the Republic of Ireland and temporarily in Australia. Such visitors will not be issued with Medicare cards.
Visitors from Finland - Norway - Sweden must take your passport and travel visa to a Medicare office to be registered and given a Medicare number. This card and number must be presented to hospital clerical staff to prove Medicare eligibility. Registration may be done during or after your hospital stay. If you do not register you may be liable for the costs of treatment.
Visitors from Belgium - Slovenia - Netherlands present your current European Health Card and passport.

Residents of Malta and Italy - only covered for six months from date of arrival and must provide passport.
Considering skilled work in Australia? You and your family must be healthy - strict health criteria!
Overseas Skilled Workers: health requirements: Australian Immigration Refer to Fact Sheet 22
Translated resources - Australian Immigration Department

TRAVEL HEALTH AND KIDNEY DISEASE

When on holiday your health care team must be able to contact you, especially if on the transplant waiting list. Give your health team a detailed travel itinerary with contact details and remember to advise dialysis unit staff of any changes you make to your travel itinerary or plans. Be aware, blood tests are compulsory for most units anywhere in the world - allow time to have the tests done and receive results. Check if vaccines are needed in countries where you travel - some vaccines are not recommended for dialysis patients - note: transplant patients need to be especially careful when having vaccines.
  • Keep an up to date treatment letter from your doctor with you at all times (copy in checked luggage) summarising your health, recent lab results and medication prescribed and why. You may need to provide this letter to Customs - also essential if you need to consult a doctor away from home. Keep scanned e-copies in an email (Yahoo, Hotmail) for access in emergencies. Your doctor can provide a copy in an emergency, but not ideal if you need urgent treatment or medication.

  • Check that medications you need are not considered illegal in countries you may travel to, especially pain killers or opiates. Erythropoietin is banned for sports persons - so ensure if you need this drug, it is noted in your treatment letter - otherwise you may be fined, face lengthy delays in Customs, or worse!
    Prohibited list; Therapeutic use exemptions
     World Anti-Doping Agency

  • Travel with at least a 3 day reserve of supplies - to cover you for flight delays, unexpected scheduling or shipment delays. Bags can also go astray - they may arrive on the next flight, but to be safe always pack medications in a 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 offers a room fridge as some countries do not - they may suggest options. Consider packing medications in a thermo-bag with re-usable freezer packs or use a wide-necked thermos chilled in advance. Make sure you allow time for transfers and delays when calculating the total length of your travel to avoid times when medication may be unrefrigerated.

  • Ensure you arrange a clean space in advance to do exchanges and store supplies. Carry two universal power connectors, one in personal bag and one in checked luggage, in case one is lost in transit.

  • If you bring syringes, you must bring the drug you inject, like insulin etc (some countries including Australia require a special license for certain drugs). There is no limit to how many unused empty syringes you can travel with, but you must display a professionally printed label on the associated medication which clearly identifies it. On your return trip ensure you declare any drugs you were given or prescribed. A treatment letter listing medication may be requested by Customs when returning home.

  • If you travel by plane or train, make arrangements for special meals (e.g. low-salt, low-fat, diabetic). If diabetic, carry glucose tablets and snacks such as low-potassium juice to treat low blood sugar. Travel with lunch or nutrition supplement, in case of delays. Managing diabetes can be simpler by having a travel pack of insulin, syringes and blood glucose monitoring unit in your hand luggage.

  • Pack an emergency supply of bandages, pain killers, insect-bite ointment and anti-diarrhoea pills. Ask your health team for names of over-the-counter drugs you could use if needed. Avoid over-exposure to 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 dietitian about foods to avoid overseas. Don't risk drinking local water, use bottled water only, including water for brushing teeth. Avoid salads and ice cubes unless prepared yourself using bottled water. Avoid any foods from street vendors, especially ice cream.

INTERNATIONAL TRAVEL LOCATIONS - OFFERING DIALYSIS

Be aware that the quality, standards & charges may vary greatly in cities overseas

Asia Pacific Nephrocare - Global Dialysis Clinic Finder
Dalysis Abroad Australian escorted tours with quality dialysis - Japan, Bali & Italy
Dialysis at Sea - USA Cruise with medical and dialysis needs managed by trained medical professionals on board - USA, Alaska, Hawaii, Mexico, Canada, Bermuda
Diaverum Holiday Dialysis - many global locations
Eurodial Global dialysis group - guarantee sessions with reputable private dialysis centres
eNeph Clinicfinder for list of global Dialysis Units.
Dialysis Freedomrun in conjunction with British Kidney Patients Association See list of all UK dialysis units
Fresenius Medical Care: Travel & Dialysis Internatiional Locate holiday dialysis unit - global
Fresenius Holiday Dialysis - global Private dialysis unit finder
Global Dialysis Resource for travel on dialysis patients
Holiday Dialysis International - dialysis cruises online booking/query form 
Holiday Dialysis - Dr Berger  UK and European dialysis travel eligible for subsidised dialysis at these centres. For quote for treatment/availability info@dialysis-travel.com
International Federation of Kidney Foundations - Member Inventory Global members give valuable information on local availability of dialysis, quality of care and relevant charges
The List: Dialysis & Transplantation Global guide to travel and dialysis - extensive resource
National Kidney Foundation UK Dialysis Centres worldwide and support information


INTERNATIONAL DIALYSIS PROVIDERS FOR TRAVEL ON DIALYSIS


BALI - INDONESIA Nusa Dua
BIMC Hospital Dialysis Unit  Upgrades to facilities ensure high Australian standards - 4 star Hotel nearby. Contact unit well before travel - e-brochure US$249 per session. PD support - Australian staff speak: English, German, French, Japanese & Indonesian (9-5, 6 days no Sunday)
Jo Skala - Haemodialysis Coordinator - Call +62 361 300 0911
jo@bimcbali.com * dialysiscentre@bimcbali.com or nusadua@bimcbali.com
CANADA
Traveling Dialysis RV Associates - water purification system No training given - patient must be trained with this type of unit.
CANARY ISLANDS
Club Haemodialysis Fresenius Private Travel info@dialysecanarias.com
Bulgaria, Croatia, Czech Republic, Egypt, Greece-Crete, Hungary, Italy, Poland, Spain, Tunisia, Turkey Holiday Dialysis: by Dr Berger for extensive travel service for dialysis patients
Cyprus Dialysis via Cyprus Health Service Promotion Board - Cyprus Holiday Dialysis Unit
Greece and other countries Treatment Abroad: Dialysis holidays
Greece - Rhodes
Helionephro Dialysis (approx 250 euros a treatment) Helionephro Sun Dialysis Unit
Apollo Bramwell Hospital holiday dialysis - get quote and confirm booking before travel.
PACIFIC REGION
Fiji Islands: Colonial War Memorial Hospital in Suva (east coast - 200 km from west coast holiday spots) Session approx $500 Fiji. Call +679 310 0020 or fijidialysiscentre@gmail.com
Western Samoa: +679 310 0020 Motootua Hospital in Apia - very important to check with staff on status of current dialysis care, access to care by qualified doctors during dialysis and availability.
UNITED ARAB EMIRATES - Dubai
Zulekha Hospital - Holiday Dialysis Most countries (inc Australia) are offered free Travel Visas
UNITED KINGDOM
Dialysis Freedom - dialysis holiday specialists
Dialysis Holidays UK
Private Dialysis UK Find a holiday/ private dialysis clinic - get quote for anticipated treatment
Renal Assocation of UK - Lists over 70 main Dialysis Units Sort by map or postcode
Haemodialysis in Edinburgh Scotland
UNITED STATES OF AMERICA
Dialysis Units in the USA
Dialysisfinder.com Travel links Book your dialysis sessions early
NKF (USA) Holiday Pages
Traveling on dialysis advice DaVita USA - hints for travel on dialysis and more
WhereDialysis.com  Find dialysis facilities in the USA

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