Co-authored by Ellen Offner, Offner Consulting, LLC, Health care strategy and program development
The two of us love to travel and we particularly like to explore challenging environments in places different from are usual haunts. 
We recently traveled, between us, to China, Laos, Myanmar, and Thailand, and didn't limit ourselves to major cities where accessibility for people with varying levels of aches, pains, and disabilities is relatively easy. We went to remote places with few, if any, accommodations for people with physical limitations.
In Laos and Thailand, where Ellen traveled, she faced many stairways, often with at least 300 uneven steps with no handrails, as the means of getting to a magnificent temple. Many stairs, no hand rails, but worth the trudge with a guiding hand of trusted companion. 
Along the Irrawaddy River in Myanmar, Ruth found that access to the boat might lack both a dock and a stairway down the bank.
What these countries lack in physical accommodations they make up for it by a willingness to help. In America most people will help if you ask; in Asia, they offer. Even at rush hour, a seat on the subway goes to those with gray hair. (Sorry, Clairol!) So leave your need to be independent at home and enjoy the hospitality. By the end of the trip we prefered nice human contact to cold elevators. By contrast, In the newer parts of Chinese cities, the sidewalks have paths for the blind and the subways have braille signs on the bannisters indicating the beginning and end of the staircase. These cities are built with universal access in mind.
Both of us found that getting in and out of boats can be challenging.
Sometimes not only is there not a dock, but there may also be a very challenging path down the bank to the Irrawaddy River, Myanmar.
When Ellen wanted to reach her favorite restaurant, Supatra River House, situated on the east bank of the Chao Phraya River, she had to take a small boat from her hotel, Riva Surya, on the west bank about a mile away. She witnessed this marvelous restaurant graciously lift a guest and her wheelchair into the boat.
In Luang Prabang, in Laos, one of the major Buddhist temples, Wat Prathat Doi Suthep, offered a cable car to reach the top of the mountain where one could experience the Buddhist monks in their colorful saffron robes chanting. This was a remarkable accommodation, quite unusual for this part of the world. For those of us challenged physically, this saved having to climb up 309 steps to
reach the summit.
Sometimes even the most remote places make very unusual accommodations. To reach Li'an Lodge, an exquisite lodge at the top of about one hundred rudimentary stairs with sheer drops on either side except where there is a charming market flanking the stairway, people have to climb these stairs.
For elderly or disabled travelers, a sedan chair can be arranged. There are no cars or roads in this lovely village, only stone footpaths to lead people from one place to another at a leisurely pace.
Ellen (left) found hiking on The Great Wall of China very challenging. Fortunately her understanding and nimble spouse (right) is very understanding, so the two of them settled for seeing just an easily walk-able section. Of course this was disappointing, but all of us must accommodate to our abilities and personalities.
"The majority of sections of the Great Wall of China that have been maintained over the years are still quite challenging to navigate, with no guard rails and steep, slippery stairs. Up until the 2008 Beijing Olympic Games, no part of the wall was accessible to people with disabilities. However, in preparation for the Olympics, an elevator was installed at the Ba Da Ling section of the Great Wall so those in wheelchairs can finally partake in the experience.
Those of us in good health, with a bit of income, and who love to travel still can. However, if your aches and pains have grown beyond the minor nuisance you need to plan ahead. . We can still do many of the activities we used with minor modifications
Here are sixteen rules of travel for those of us with mild infirmities. Or maybe I should say still trekking but creaking.
Before Leaving
1. Visit your local travel medicine clinic to be sure your immunizations are up to date.
2. Bring all your medications. Even the ones you only use occasionally. They are not available everywhere or the formulation is different. Take medications along in the event you are struck by travelers' diarrhea.
3. Buy medical evacuation (medevac) insurance if visiting a country without excellent hospitals that meet the standards of the United States or your home country. A helpful, reputable website where you can shop for the best option for your needs is Squaremouth.
4. Call ahead and get a wheelchair! If you have less than a mile of walking in you, go online and ask the airport for transport from your plane to the immigration area or to your connecting flight. Save you walking stamina or some place more interesting. They will have a wheelchair and attendant waiting for you when you get off your plane. If necessary, they will have an electric cart. The service is free though you will probably want to provide a tip and you do not need medical certification.
5. Pack light. Weight is the enemy of all travelers, but for those with aching joints the heavy lifting and pushing become even more difficult.
6. Wear only comfortable, sturdy shoes or sneakers. This is not a time for glamour!
Once you arrive
7. Use bathrooms when you see them. You might not find another one for a while. Men with enlarged prostates and that's' most men over over 70 and many even younger lads do not have quite the control they used to and peeing by the road is frowned upon in most cities (though more acceptable in the countryside). In Asia, Western-style seated toilets can be a rare resource. If you can't squat, go at your hotel or look for fancy restaurants. Be prepared to discard used toilet paper in a wastebasket and not flush it (plumbing can be primitive).
8. Follow good preventive health measures when eating. Those in developed countries take the FDA (or their country's equivalent) for granted to assure our food supply is safe. Though even so we occasionally have a food-borne disease outbreak. In many developing countries there are no such protections. Do not eat uncooked vegetables or fruits you cannot peel yourself. Eat only hot food that has not sat around. Drink only bottled water and use bottled water for brushing your teeth. (Just think if it as washing your toothbrush in feces and you will follow the rule!) Assume that not everyone who handles your food has adequate washing facilities at home such as soap and running water. The hotel may be five-star, but the waiters and kitchen workers homes' may lack rudimentary sanitation or clean water.
9. Do not eat street food, no matter how appetizing it may look. That includes ice cream.
10. Expect the unexpected. Be willing to change your plans. In the past, you may have enjoyed climbing 777 uneven steps with no railing to see a beautiful monastery. Now you may need to view it from a lovely restaurant on the next peak. If you hire a guide, make sure the guide will be willing to modify your plans if the walks are too long or difficult. The guide may know of alternative routes for reaching the pinnacle.
11. Take a break. In the old days you might have been able to go-go-go all day and then go out at night. Maybe not so much today. Either take a nap, if you love your evening restaurants, or if you are not a foodie go all day and then snack in the hotel. You may need to do both.
12. Travel with a caring, compassionate companion.It will be disappointing and frustrating at times. You might want to agree in advance that sometimes one of you will go ahead alone and the other will sit in a cafe observing or reading. You may have different physical challenges, so empathy will be indispensable.
13. Accept help. Think of it as a great way to meet kind caring people and to renew your belief in the kindness of humanity. You will find many barriers to entry unless you do. It could be a sandy boat ramp, a way to large step or a steep passage.
14. Talk to the people around you, exercising your usual good judgment. Meeting other people is as interesting as sightseeing and a lot less strenuous. People are very quick to let you know they are not interested in talking. A one-word reply is a good clue to move on.
15. Use a walking stick or a cane. It helps with balance on uneven sidewalks, open sewers and other unexpected obstacles.
16. Be grateful for what you can do, rather than bemoan what you can't. This may take discipline, but it's good practice.
(Ruth decided not to forego a thirty minute steep climb up a rocky volcanic plug and traded it for a superb lunch at the Poppa Mountain Resort with a magnificent view of Mt. Poppa)
How can we complain? 
