We want to spend three or four weeks in the USA next year, probably in the autumn, stopping for up to a week in three or four different areas, for example New England, Mt Rushmore, California, and the Deep South. We are prepared to drive but do not want to spend all the time in a car.

Sean O'Meara


The travel editor replies: The USA is the easiest country in the world to visit on a fly-drive basis. Flying from one part of the country to the next - and picking up cars from each airport you arrive at - can be arranged by plenty of operators in the UK. I suggest that you spend proportionately more time in the Deep South than in the Mid-West.

Bridge The World (tel: 0171-916 0990), for example, can put together a London-Boston-Rapid City (the nearest airport to Mt Rushmore)-LA-New Orleans-London flight from with United Airlines for pounds 642 per person, including tax. This is for travel in May or October, when the weather will be warm but not too hot. The company can also arrange your car hire in each centre, priced between pounds 28 and pounds 33 per day, as well as any accommodation you need.

Another operator which specialises precisely in what you are asking for is US Airtours (tel: 0181-559 7721). In that company's opinion, four centres on one holiday is excessive, though it can arrange a flight from London- Chicago-Los Angeles-Boston-London for about pounds 470 each, travelling in the autumn. Extra stopovers can cost as little as pounds 50 extra.

Within the big cities, you are advised to book your hotels in advance (to avoid seedy neighbourhoods) though when driving through the countryside there is usually no difficulty in finding small motels as you go. Hotel prices are a lot cheaper than their equivalents in the UK. Reckon on pounds 40 to pounds 100 per room in cities; half that in the countryside. In New England in the autumn prices are a lot higher because of the flood of "leaf-peepers".

Take a photo of your new razor-sharp image

I recently shaved my beard off and as a result look even less like my passport photo than before. Do I need to get a new passport, or can the photo be updated?

M Gerrard


The travel editor writes: Congratulations on your new clean-shaven image. The UK passport agency (tel: 0990 210410) states that you can update the photograph on your passport without applying for a new one.

You must fill out the new SE0101 form, which now covers all passport applications and is available from post offices and larger travel agents.

You must include a fee of pounds 11 and two recent passport photos of yourself. You will need someone who has known you for several years, like your doctor or employer, to certify that the photos are of you. Enclose a letter from them which reads "I certify that this is a true likeness of..." and state who they are and their relationship to you.

The cost of a new 10-year passport is pounds 21, so if yours is nearing expiry it may be more cost effective to apply for a new one.

Do-it-yourself blood transfusions

Does anybody know anything about those packs which you can carry around and which contain a packet of blood in case you need an emergency transfusion in a place where the blood banks may be infected by Aids?

J Kitt

South Wales

Dr Larry Goodyer replies: It is not really feasible to carry around blood, mainly because it would need to be refrigerated. The best policy, if it is judged that a blood transfusion is essential, would be to try to ensure that this came from a source that had been well screened. Most countries in the developing world now have limited stocks of such blood, usually located in major centres. They are expensive but a local consulate will be able to offer advice in locating them.

Of course, if one is in a life or death situation there may not be enough time to find such supplies, but this is unlikely. I think you are referring to substances known as plasma expanders, which can be infused into the circulation to maintain blood volume in cases of severe blood loss, such as following an accident. Such an infusion could maintain life for a while, until the patient has been transferred to more reliable medical facilities.

However, plasma expanders may be in short supply in some developing countries. Although expeditions and overland groups will often carry a supply in their medical kit, most backpackers would not feel it was practical to devote the space, with all the added weight, in the remote chance that one would be needed.

Don't forget that as well as Aids, hepatitis B and C can be transmitted by blood transfusions or other hospital treatments. Therefore, it is a sensible policy to carry one of the sterile injection kits that are widely available. You should also make sure that you know your blood group before travelling.

Dr Larry Goodyer is the superintendent of the Nomad Pharmacy (3-4 Turnpike Lane, London N8; tel: 0181-889 7014). Contact the travel medicine helpline on 0891 633414. (Calls cost 50p per minute.)