Specific Medical Risks for the Traveller

The next two chapters deal with specific and general medical risks for the traveller. The topics covered are not exhaustive nor are they always exclusive to the traveller. However, they do focus on the problems most likely to be encountered when travelling and, as such, the responsible travel health advisor must be familiar with them.

Setting up a Travel Clinic

Setting up a travel medical service involves time, money, patience, and continual updating of information. Ultimately such a service cannot be viable unless there is a sufficient throughput of patients to warrant its existence. It is likely that in a multipractice clinic one practitioner will be very interested in travel medicine. Other members of the group should refer all travellers to him or her. In many countries, particularly in the UK, the practice nurse is the one who does most pre-travel consultations. However, this should be a shared responsibility between nurse and doctor so that maximum benefit is provided for both the patient and the clinic.

Medical Care Overseas

One is never really prepared for a mishap or an illness overseas, and whenever such an eventuality occurs one is faced with the problem of accessing the best local treatment. The travel health provider at home should always advise the traveller about the need to check out travel insurance and local medical facilities in the destination before travel, especially in the case of long-term or high-risk travellers. In addition, the traveller should be given a contact number for the clinic in his or her home country and be instructed to use this contact whenever necessary.

Fish Hazards

Most people know that, apart from choking on a fish bone, eating fish overseas can cause a variety of gastrointestinal upsets. Most travellers would not wish to eat raw fish. However, raw fish dressed up in spices or marinated or undercooked may well be acceptable to them, especially in a foreign land. There are also occasional dangers in eating some fish that are salted or even wellcooked, and which look, smell, and taste normal.

Special Groups

It is convenient to separate those who differ from the general travelling population into easily identifiable categories or special groups. Each of these groups will require advice, medication, or vaccines that are tailored for their specific needs. Thus, the pregnant traveller must be warned of the increased risk of air-travel-related venous thrombosis, the diabetic of the danger of poor glycaemic control, and the young (male) traveller of the risks of casual sex. While there are very few people for whom overseas travel is absolutely contraindicated, common sense should always be heeded.

Vaccines

A working knowledge of vaccinology is essential for anyone involved in travel medicine. This includes the storage, indications, scheduling, common side effects, usefulness, technique of administration and management of acute adverse reactions to any vaccine one gives. Those who administer vaccines should also be fully aware of the type of vaccine they are giving, should know exactly what is in the vaccine in question, should know its expected efficacy, and be able to roughly estimate a BCR. Giving unnecessary vaccines is reprehensible and unworthy of any doctor or nurse. In travel medicine, the ‘patient’, who is normally a healthy person, must be informed of the pros and cons of any proposed vaccine. Giving vaccines is only a part of the pre-travel consultation and is certainly not the most important part.

Selected Arthropods

It is important that the travel health provider has some knowledge of medically important arthropods. While visual identification of some of the most common arthropods, e.g. Culex pipiens, is difficult, identification of others is easy, e.g. a resting female Anopheles spp. or an Aedes albopictus (tiger mosquito). There is hardly a more neglected field in the undergraduate curriculum of nurses, doctors, and pharmacists than medical entomology. Many well-qualified professional healthcare workers do not know that a spider has eight legs (class arachnida) or that an insect (class insecta) has six legs. Although it may seem that this information borders on trivia sometimes it may be extremely important.