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Travel & Health & Seeing the Right Specialist


Alan Spira, M.D.

Thirty million Americans travel or live abroad annually. A rapidly increasing proportion of these people travel to regions where health and environmental conditions are less than we are used to in the USA and these can endanger the health and welfare of travelers.

Traditionally, as a group, Americans have not been adventurous travelers; however, this is now changing, with people seeking more and more exotic locales to visit. Humid tropical jungles, parched deserts, the frozen poles, and the highest mountains are all fair game for Americans hunting new thrills and pleasures. With a tradition of traveling to safe areas, we tend to follow old habits of preparation that may have served well for Europe, but can fail us when heading to the Amazon. Conditions differ widely around the world; diseases and lack of resources can test even experienced travelers, and proper preparation is essential.

Different parts of the world have different environments and differing socioeconomic conditions. These factors are intimately tied-in to the health and well-being of local populations, and this will naturally affect visitors to these regions. Factors to consider are the temperature, humidity, pollution level (air, water, etc.), altitude, rainfall, season, poverty, warfare, crime, epidemics and societal infrastructure. These vary from country to country and even within countries -- but this is hardly limited to the tropics. For example, the former Soviet republics have disintegrating infrastructures, with the result that violent crime, motor vehicle accidents and diseases such as diphtheria are on the rise. The medical establishment can no longer cope adequately with these problems and the level of care is plummeting.

To put travel health in perspective, the greatest threats in reality to the health and welfare of travelers are motor vehicle accidents; the next threats are by the same diseases that would affect people if they were home. For example, a person with angina has as much or possibly more of a risk of a heart attack as back home. Lower in risk are exotic diseases of travel and violence from crime or combat, even through these get the greatest press.

Diseases often change faster than governments. Indeed, it is difficult even for most doctors to stay abreast of rapidly changing disease patterns and epidemics, which may change from month to month, week to week or even day to day. Many of these diseases are serious: for example, diseases for the most part once eliminated from industrial nations and newly emerging diseases which we know little about.

There are several ways to deal with these issues. First, and the most extreme, is to stay home. I mention this option first because it is absurd and should be dispensed with as quickly as possible. Few activities in life offer as much as travel: it is the best teacher, the best destroyer of bigotry, and the finest way to put life in perspective and show all the richness that life offers.

Second, you could 'Mr. Magoo' your way through your travels, blithely ignoring all risks and threats, either pretending they don't exist or not taking the effort to prepare for them. This is as bad as not leaving home, perhaps even worse. Many people gamble on their health in this way, and too many lose -- some with their lives. The Muslim sage, Mushariff-ud-Din, said almost a thousand year ago "A traveler without knowledge is like a bird without wings."

This beautiful and apt sentiment leads us to the third option for the traveler and that is to intelligently prepare for a journey by reading about the culture, the environment and the health situations present in the lands to be visited. By reading and talking to travelers and qualified consultants -- i.e. a travel agent, a travel medicine physician -- you can gain an understanding of what may face you and how to prepare for your journey. This maximizes your being able to fully appreciate what you experience once you get to your destination and stay safe and healthy throughout the way. Preparation shows responsibility -- an indispensable asset for traveling.

Preparation requires certain foresight and decisions on your part. Of course, there is the fundamental decision of where to go and when. Next, how to get there, followed by where you will stay and how you will travel. Preparing options for unforeseen obstacles and staying flexible are vital for enjoyment of the journey and for insuring one's health and safety while abroad.

In terms of health preparation it is wise to be fit before you leave -- this reduces your chances of illness while traveling. Before your trip, see a doctor who specializes in and has been trained in tropical medicine and travel diseases and who stays up-to-date on the ever changing disease courses around the world.

Routine vaccines need to be brought up to date and specific travel vaccines should be administered as needed. Any current illness should be brought under control. You should also be sure to take enough of your medications on the trip. It is a good idea to take "just in case" medicines for certain ailments, like dysentery, which may occur while abroad when your are far from medical help. Since, the risks of these ailments vary with the the type of travel and the area, you should discuss these potential illnesses with your travel medicine specialist who will also advise you on the types of exotic diseases you might encounter and how to avoid them.

Take a first aid kit and know how to use it, and some additional travel health essentials -- such as insect protections and sunscreen. Take care of dental problems before you leave and carry extra eyeglasses if you wear them. Make sure you have health insurance that will cover you while abroad or evacuate you in case of emergency: you would be shocked at how much medical care and emergency evacuation can cost you if you don't have insurance coverage. Before your trip it pays to travel learn where you can seek help if you get ill or injured while abroad.

What Qualifies Someone As a Travel or Tropical Medicine Specialist

Be warned that few American doctors know much about travel or tropical medicine; the last time most doctors have heard of tropical or travel-related diseases was when they were in medical school! There are many good travel clinics in the U.S.A. or Canada, and also many of questionable quality. The staff must know about travel and tropical diseases. They should have training in those fields which may have started with working in developing countries, or training in infectious diseases, tropical medicine or related specialties. They must stay up to date on current therapies and prevention of travel diseases not to mention being aware of epidemics and outbreaks of disease around the World. Ask yourself and the clinic if they fill the bill for all these points. Also, can they take care of you once you return home and feel ill, or do they pass you on to someone else? If they are able to take care of you, both before and after a trip, they are more likely to be people you can really trust.

The American Society of Tropical Medicine & Hygiene has a list of recommended specialists around the country who meet their standards; the Society also has a Certificate of Knowledge in Clinical Tropical Medicine and Traveler's Health for physicians which serves as a basic standard by which you can judge the reliability and sophistication of the physician you are seeing. Ask if your doctor has it.

With education, vaccinations, travel counseling, and common sense (THE most important piece of luggage you need to carry) you will have taken the most important steps to ensure a healthy, safe trip. As with all thing in life, nothing is certain; but you will have the peace of mind knowing that you are as ready and safe as possible -- so enjoy your travels!

Healthy Travels!

© 1996 Alan Spira M.D., The Travel Medicine Center Beverly Hills, California.

Last Modified: July 11, 1997

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