Travel medicine: A high return on investment for business travellers

It’s a busy morning at the travellers’ clinic. In among the usual crowd of tourists, four apparently unrelated persons await their turn. François works in a large law firm, Simon is a CA, Louise is an engineer and Sue is a digital imaging producer.

What is travel medicine?

Travel medicine is a medical speciality focused on disease prevention, education and treatment of health problems associated with international travel.

For business travellers going to foreign destinations, travel medicine experts offer advice, providing essential education and tools for prevention. Business people learn how to deal with the most common problems they are likely to encounter abroad, whether it’s a short trip or relocation.

Whatever the destination, the reason for travel, the type of travel planned, the age of the traveller or their medical condition, the travel medicine consultation will be customized and adapted to specific personal needs for each traveller. A travel medicine consultation could include:

•immunization or booster shots;

•prescriptions ;

•blood tests that may be required before departure for entry visas or upon return;

•first-aid kits, adapted to destination and conditions of stay;

•counselling on the use of risk-reduction products such as water purifiers and insect repellent;

•medical examinations that have been requested as conditions of pre-employment;

•counselling on how to access medical services while travelling, as well as details about insurance coverage; and

•customized health advice about a broad range of issues including safe sex.

Who should consult a travel medicine expert?

François works in a large law firm. He specializes in intellectual property and travels around the world to negotiate contracts for his clients.

Simon is a certified accountant who receives occasional contracts from the Canadian International Development Agency (CIDA) that require some travel, mainly to South-East Asia.

Louise is an engineer for a multinational enterprise. She travels to Peru regularly to oversee the progress of an important mining project. She has stopped visiting the travel clinic because her trips are always to the same destination.

Sue is a digital imaging producer with a rapidly growing company. Her work takes her to Eastern Europe where she has small but lucrative consulting contracts.

Last month, all four became very sick. Simon even thought he was dying.

What happened?

François was hospitalized with jaundice. He had severe hepatitis A and will likely be unable to work for six to eight weeks. He feels foolish. Hepatitis A is the most frequent vaccine-preventable disease for travellers, and just one shot could have protected him. His family, his secretary and two close colleagues had to be immunized in order to protect them.

Last month, Simon had an episode involving a high fever, nosebleed and some skin lesions. He also complained of feeling like all his bones had been broken, and feared that he had contracted malaria or some rare and possibly fatal tropical disease. This morning he received laboratory confirmation that he had contracted the increasingly common dengue fever, sometimes called break bone fever. He just learned that a second episode could really be life threatening. He intends to use the best mosquito repellents from now on.

Louise’s headache during the flight to Lima was so intense that she felt her head was about to explode. She never thought that the pressurization of the aircraft would make simple sinusitis so intensely painful. It caused bleeding of the tissue inside her sinuses and she will likely suffer from recurrent headaches for many months. But she will not get on another plane with congestion anymore. She learned the hard way.

Sue had a bizarre non-painful rash on her skin after one of her trips. Luckily, her family doctor included a blood test for syphilis as part of the diagnostic process. Sue had spent some good times in Leningrad, “the capital of Eastern Europe…” and of syphilis. Like many travellers, she has very safe sexual behaviours at home but becomes more adventurous abroad.

How can travellers prevent problems?

The preventable problems experienced by these four business travellers would all be covered by the counselling available from the medical professionals of any good travel medicine clinic. An initial consultation should take 45 to 90 minutes to collect a medical history and immunization status. Subsequent visits wouldn’t normally take that long.

No reason is good enough to travel to a high-risk destination without proper protection.

Travellers should preferably not wait until the day of departure for a travel medicine consultation. The best timing is four to six weeks before departure, but clinics understand that business travellers don’t always have much advance notice of their trips, so they try to accommodate last-minute consultations.

A lot can be accomplished with a single visit. Knowing the countries or area of the world where your trips could take you, a travel medicine consultant could advise you on the immunizations recommended and the other risks present in the area. Most of the vaccines have a long protective effect. Some only need to be updated once every 10 years, and others last even longer.

Diseases like malaria may vary depending on the destination, and may require a new consultation each time if you travel to areas where malaria is endemic. But other like dengue, which are present in cities in tropical and sub-tropical areas, can only be prevented with the use of good mosquito repellents.

First-aid kits need to be refilled after use, or checked every year or two. Safe-sex counselling would vary depending on individual need. Food and water precautions are easy to remember once learned.

How can corporate travellers integrate a travel medicine consultation into busy schedules?

Some companies may find it worthwhile to organize a special on-site immunization update clinic. Travel medicine experts will provide booster shots for hepatitis A and B, diphtheria, tetanus, polio, measles, mumps and rubella and other diseases that are prevalent in some parts of the world. Specific vaccines for diseases such as Yellow fever can be made available to people who travel to countries where there is a risk.

Travel medicine sessions in the workplace can inform workers about many issues including:

•mosquito repellents;

•sun protection;

•immunizations;

•prevention and treatment of travellers diarrhea;

•altitude sickness; and

•the importance of carrying clean needles to use in case of emergency, with a letter from a physician to avoid problems with custom agents and more.

Special sessions that can be held at lunch can easily be arranged for the workplace. It’s an easy and efficient way to provide the basic information needed for travellers, leaving only the individual recommendations, immunizations and prescriptions for the consultation in the clinic. This also insures that all travellers will receive the same basic information, avoiding fears and problems related to misinformation.

Dominique Tessier is the medical director of Medisys Travel Health Clinics in Canada. She has been a member of the International Society of Travel Medicine since its founding in 1991. She is also the president-elect of the College of Family Physicians of Canada. For more information contact 1-800-499-1394, [email protected] or visit www.medisys.ca.

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