WE HAVE really come a long way since the Wright brothers first successful flight just over a century ago, especially if we consider that their flight distance was only about the length of our modern jumbo jets! We have truly become a race of globetrotters, and regardless of age, race, gender or status, travel has, in many ways, stopped being a luxury affordable only for the elite, it has become our way of life. To add to this, the World Health Organisation (WHO) predicts that travel to the more exotic destinations (such as SE Asia and South America) will increase 80 per cent by 2010! Not to mention the huge rise in business travel, where often several continents can be spanned in just a matter of hours or days.
The faster our modes of transport become, the greater the potential for the rapid spread of disease. Many moons ago, intercontinental travel was only possible by ship, and however romantic this now sounds, it also had a very important function … disease control. The long voyages were effectively a sort of enforced quarantine, so that any disease caught on another continent had time to develop while the person was on board, and (if it happened to be particularly virulent) only spread to the remaining passengers, who either got better or died (thus eliminating the infective agent with them!) before arriving at their destination.
Our ever increasing adventurousness, and almost obsessive quests for the ultimate extreme travel experience, is starting to have a big impact health wise on not just the travellers (30-50 per cent of travellers get ill or injured during their trip), but the general public as well, as we start spreading and importing more and more “exotic” illnesses upon our return from such holiday destinations.
A new medical field –
Medicine has also come a really long way. Our diagnostic and treatment capabilities have become a state of the art science, available to almost everyone. Some may argue, however, that progress has not been all that great if we still use leeches and maggots for medicinal purposes … but at least we now know how to sterilise them properly!
So, sooner or later these two completely divergent fields had to come together, as the more travellers there are, the more SICK travellers there will be. Doctors started realising that, in many such cases, prevention is actually better than cure. This, ladies and gentlemen, was the birth of the humble and as yet still fledgling discipline of Travel Medicine.
Travel Medicine is not (as yet) a bona fide medical speciality, but is fast becoming recognised as a distinct clinical and academic interdisciplinary speciality, as more and more of us travel both for business and pleasure. In the last decade, Travel Medicine has grown into a many faceted giant that has incorporated fields previously considered as non hands-on in the medical fraternity. Areas such as epidemiology, infection control, microbiology and physiology now work hand in hand with tropical medicine, traumatology and all the other “standard” specialities to form a new, united interdisciplinary front. Its primary goal is to protect travellers from disease and death, as well as minimize the impact of illness and accidents through teaching the principles of prevention and self-treatment, both while abroad and upon their return. These are the things that the travel industry (and even many doctors) often blatantly ignore and neglect to tell their clients about.
GPs are not obliged to keep up with the latest recommended vaccination and prevention schedules for travellers (such as for malaria and traveller’s diarrhoea), hence more and more specialised, and recognised Travel Clinics are opening up all over the UK. These are often run by specifically trained nurses and/or doctors who now have several academic programmes available to them to further their knowledge (right up to a Master’s degree) in Travel Medicine, as well as all the on-line back-up from the WHO and Centre for Disease Control (CDC). Unfortunately, the rest of Europe is not as well prepared, and official Travel Clinics are still few and far between, with the only “official” advice centres being part of the State controlled Yellow Fever vaccination centres.
Be aware of
In 2003, around 1,100 Britons came back from their holidays with malaria, 180 had typhoid, and one in 330 travellers came back with hepatitis A. You might say to yourself that these are not terribly high numbers, but both typhoid and hepatitis A are seriously communicable diseases and, until the diagnosis is made, the sufferer is potentially infecting others in his/her community. What is even more tragic, is the fact that both of these diseases are perfectly preventable, through a very simple vaccination programme.
So what stops these people from protecting themselves and others? More than half of annual travellers do not even seek any form of travel related health advice, even if they are travelling to medium to high-risk areas (i.e. areas of moderate to high risk of contracting communicable diseases such as malaria, traveller’s diarrhoea or Hepatitis A). 67 per cent do not get advice at all and 24 per cent get advice less than two weeks before departure. The reasons for this are quite varied. Some people just can’t be bothered with the sometimes lengthy and costly procedure of having multiple vaccinations before departure. Some are simply not aware of the risks involved in travelling to a certain destination, or think that the risks are too low to bother with any kind of prevention. They may well have travelled to that destination before, and as in any other relationship, familiarity (with risk) breeds contempt for preventative measures. Some have even stated that their acute needle phobia has stopped them from seeking any vaccination before travel. But what is most worrying is the fact that a vast majority of travellers have simply been wrongly advised. The greater percentage of misinformation came unfortunately from travel agents (35 per cent), with friends and family coming in at 26 per cent, magazine info at six per cent, and nurses at three per cent. What is really scary is the 28 per cent of wrongly informed travellers who sought advice from GPs!
This is where Travel Medicine steps in. Slowly the public in general is realising that a well-timed pre-travel visit to a Travel Clinic is more than just getting your shots. The Travel Health practitioner has the responsibility of being aware of the latest global health alerts, so that they can advise you about the necessary precautions to take with regard to all travel related matters, from food hygiene and malaria prophylaxis to dealing with snake bites and diving with a hangover (NOT recommended!) Business travellers and large corporations are now making it compulsory for their jet-setting execs to have such consultations, as even in the high powered world of cut-throat corporate business, a dose of “Delhi-belly” may not be enough of an excuse for poor judgement!
So often we see a perfect family holiday ruined by a simple, preventable disease and think … if only … getting good, common-sense advice may seem like a waste of time, but often when dealing with even the most minor of crises in a foreign country, we so easily forget about the basics, which a travel health practitioner should cover during such consultations. So next time, be prepared and allow for only the travel bug to bite you … and the rest, well, just bite them back!
• DR JO is available at LUZDOC for consultations in TRAVEL HEALTH.