Guest Blog by I Dale Carroll, MD.

Recently, an expatriate living in a remote Asian city contacted our office for advice regarding her pregnancy.  She was about eight months pregnant and an ultrasound had detected that her baby was not growing normally. She emailed us the ultrasound pictures and we confirmed the diagnosis.  Her parent agency was recommending that she be airlifted back to the United States for specialty care. Unfortunately, traveling by air would have exposed her already sick baby to the added risk of a low oxygen level in an airplane at high altitude. Through our overseas contacts we were able to direct her to travel by train to the appropriate specialists in her own host country, thus possibly saving the life of her baby and saving her sending agency the thousands of dollars that a medical evacuation would have cost. Two days later she emailed us pictures of her healthy newborn baby!

Whether you are going on a vacation, taking a business trip or even leaving for a long-term assignment overseas, it may be wise for you to consult a Travel Medicine specialist. The goal of these doctors and nurses is to prepare you for travel, keep you healthy during your trip and get you back to health if you become sick during your journey.

Travel Medicine has been a recognized specialty for over 25 years now and there are even subspecialists in such areas as wilderness travel, high altitude travel, space travel and traveling while you are pregnant.

A travel medicine specialist is a doctor or nurse who has had special training in the health care of (mostly international) travelers. Most of them have chosen this specialty because of a burning interest in travel.  Many have lived or worked overseas and have experienced first-hand the sort of problems that other travelers encounter.

Since present day travel often involves going to tropical locations, Travel Medicine training goes quite extensively into tropical diseases, disease outbreaks and exotic rashes. Vaccines and preventive medications play a big part. Environmental issues such as altitude sickness, air pollution and heat exhaustion also show up, as do scuba diving and such unusual things as snake bites and jelly fish stings. Medical evacuation, mental health issues, and cultural adaptation are all part of the curriculum. While the emphasis is on prevention, diagnosis and treatment of unusual ailments also play a big part.

The types of travelers that these specialists care for include tourists, business travelers, students, people going on pilgrimages, missionaries, military personnel, refugees and immigrants, flight crews, news journalists and others who travel for work. These specialists also are consultants for people who live and work overseas such as embassy personnel, aid workers and even oil company employees working on oil rigs.

If you were to consult a travel clinic before your trip, likely areas of discussion would be:

• Documents you may need
• Travel insurance
• Air travel
• Vaccinations
• Traveler’s diarrhea
• Malaria and other disease prevention
• Crime and safety
• Sun and water safety
• Air pollution
• Altitude sickness
• Transportation dangers
• Food safety
• Animal bites
• Motion sickness

In fact, in our clinic the checklist of preventive measures to cover includes 92 items, only one of which is shots.

Reasons you might consult a Travel Medicine provider during travel include:

• Deciding if medical care is needed
• Locating medical care when needed
• In some cases, getting assistance with medical evacuation

Common complaints that people consult a travel medicine specialist for upon returning from travel include:

• Persistent diarrhea
• Rash or skin lesions
• Suspected parasitic infection
• Fever

The advice given by a Travel Medicine provider will vary greatly depending on the type of travel, the destination, type of accommodations, activities planned and a host of other factors.  Here are several types of travelers that may require special attention,

• Business Travelers
  • With business travel the problem is a too tight schedule. Business meetings, facility tours, business dinners all can be exhausting and then when one wants to add in sightseeing it may be just too much. Adequate rest must be high on the agenda if a business trip is to be productive. On another note, few business travelers have time to deal with traveler’s diarrhea, so preventive medication may be a good idea.
• Pregnant Travelers
  • There are some conditions associated with pregnancy that are clear indications not to travel. But for the most part, with some modifications, travel risks can be minimized. One important area is preventing blood clots while travelling. Simple comfort issues become important as well, such as wearing loose clothing and choosing a hotel where the bathroom is not down the hall.  It may be wise to locate appropriate and available medical care at the destination.  Questions often arise surrounding vaccinations and medications and consultation with an experienced professional is a good idea.
• People with Chronic Diseases
  • As the traveling population gets older, it is increasingly common that a traveler will have heart or lung disease, diabetes or some other chronic disease. Wearing a medical bracelet is always a good idea. It may be necessary before the trip to have a pacemaker checked or to make arrangements for supplementary oxygen.  Diabetics may need to adjust insulin timing as they change time zones and those on medications will need to take along enough to last the whole trip.
• Expatriates and Long-term Travelers
  • Expatriates are people such as embassy personnel, aid workers, missionaries and others who live for long periods of time in a country other than their native one.  Many of these, because of the nature of their work, live in remote areas where medical care is scarce and transportation is difficult. It is common, after a while, for them to stop using the preventive measures (such as malaria prevention) that they used when they first arrived.  The most common health problems in this group, however, are the psychiatric ones brought on by cultural adaptations and long periods of work with inadequate rest. Depression and post-traumatic stress disorder are frequent problems in this group.
• Handicapped Travelers
  • Travelers with mobility problems may need to be reminded to allow extra time between flights. If they use a wheelchair, some airlines may require that they use the airline’s escort service and check their own chair at the baggage check.  If it is a motorized wheelchair, an extra battery might be needed. Those who travel with service animals may find that the country they are visiting requires that the animal must be quarantined after arrival. Allowances are often made for visually impaired or hearing impaired travelers, but those who need a lot of assistance may be required to travel with a caregiver…often at a reduced fare.
• Traveling with Children
  • If the purpose of the trip is to do children’s activities, such as at a theme park, traveling with children will probably be no problem. But if a lot of adult activities are planned it is important to remember to make plans for the children too. Also, have a plan if someone gets lost. Sometimes extra attention needs to be paid to vaccinations, for instance considering rabies vaccine if the children will be around domestic animals. In many locations, sunburn and insect bite prevention are especially important. Whether to take car seats on airplanes is often an issue as well.
• Students
  • When students travel abroad, homesickness may be an issue, but far more commonly the problems that arise have more to do with drugs, alcohol, tattoos, body piercings and unprotected sex. Exchange students staying in host homes may be exposed to environmental risks not common in other travelers and may have difficulty with cultural adjustment.
• Women Travelers
  • With packed agendas and little time for proper hygiene, female travelers often suffer from annoying infections such as vaginitis or urinary tract infection. Contraception and menstrual hygiene may be problematic in some circumstances. Personal safety is often an issue, and care must be taken not to violate local cultural norms.
• Refugees and Migrants
  • Most immigrants will be tested for a number of communicable diseases before they will be allowed to enter a host country.  Many will have spent months or years living in refugee housing where sanitation is poor and disease outbreaks are common.  They may, as a result, be in poor health and in need medical care.
• Wilderness Travel
  • Wilderness travel often includes travel to high altitudes with extensive exposure to the sun and other environmental hardships.  A thorough health screening may be required prior to travel, along with extensive training and preparation. Illness or injury far from medical care is often a risk.
• People Visiting Friends and Relatives
  • People visiting friends and relatives (often referred to as VFRs) are often the most problematic of travelers. Much of the time these are people who grew up in low- to middle-income locations and are returning for a visit.  The problems arise out of a combination of the fact that they don’t think they need medical advice having grown up there, and then take risks that other travelers are advised against.  They travel by unsafe modes to locations where they often eat foods that their bodies are no longer used to.  They think (incorrectly) that they are immune to local diseases, such as malaria, and therefore do not take measures to prevent them. It is no secret that as much as 70% of typhoid occurring in developed countries occurs in these travelers.
• Health Tourists
  • A new and expanding group of travelers are those known as health tourists.  These are people who travel to a different country for health care, often major surgical procedures, usually for financial reasons.  The health care that they receive is usually up to the same standards that they would receive at home, but problems arise when they do not follow the same precautions that other travelers are advised to do.  They become careless about food and water safety or forget mosquito bite prevention. Another problem sometimes is confusion that occurs when the medicines they are given abroad do not have the same names or ingredients as their at home ones.

Hopefully, this blog has enlightened you about what Travel Medicine is and why you may need to consult a travel medicine specialist. The initial investment often will save you a great deal of money in the long run and keep you in better health.

The easiest way to find a travel clinic near you is to consult a directory such as those found on the web sites of the International Society of Travel Medicine (www.istm.org), the American Society of Tropical Medicine and Hygiene (www.astmh.org), The National Travel Health Network and Centre (NaTHNaC, www.travelhealthpro.org.uk) or Travel Health Canada (https://canada.ca/en/public-health/services/travel-health.html).

Take the extra time to travel knowledgeably and you will ultimately have a safer and more productive trip.

Safe travels to all!

---

About the Author

I Dale Carroll, MD, FACOG, DTM&H, FFTM RCPS (Glasgow)

Dr. Carroll is an obstetrician who also specializes in Travel Medicine.  Born in Michigan, he grew up in India, studied tropical medicine in Peru and worked in mission hospitals in Central America and East Africa.  He has traveled extensively, having visited over 50 countries.

Over the past 20 years he has become a world-renowned expert on Pregnancy and Travel.  He lectures frequently in the U.S. as well as international venues and has authored many articles in both medical and secular journals.  He writes for the CDC “Yellow Book” and has published chapters in seven medical textbooks.  While still practicing obstetrics full time, he is also a professor at Michigan State University and is a Fellow of the Faculty of Travel Medicine at the Royal College of Physicians and Surgeons in Glasgow.