Journalists love to scare us with headlines about outbreaks of ‘new’ deadly diseases – but health risks haven’t changed appreciably in the past decade. However, the way we learn about risks, and how we cope with them, has evolved.
Improved communications have wrought the most significant changes on travel health. Mobile phones allow us to call for help from almost anywhere. For example, call the emergency number for the EU (112) and this will also raise the alarm in the UK. It should get you connected to the nearest possible emergency signal, even if that is in a neighbouring country. If travelling beyond Europe, find out the local emergency number and remember that huge areas of the world still have no effective emergency or rescue services – so it is crucial to take out comprehensive travel insurance.
Insurers have woken up to the fact that it’s worth getting involved in ‘rescuing’ travellers who’ve been hospitalised overseas. In some countries patients may be attached to a drip so they can’t leave hospital until they’ve paid a big fat bill. Good travel health insurance will protect you from such ‘ball and chain’ hospital care, so it is more important than ever to be insured through an agency covered by a reputable medical assistance company.
People with health problems are increasingly venturing overseas. This means there is a better range of translation cards (www.allergyaction.org; www.dietarycard.com) in addition to invaluable medic alert bracelets. There are also translation websites (try www.doctorbabel.com; www.appliedlanguage.com; www.freetrans.com) that give foreign medical vocabulary to allow you to convey your medical history to a doctor overseas. However, nothing on the web so far will be as good as a canny, multilingual medic.
Medical tourism – where people travel specifically for an operation – is on the up. Doctors providing these services often have good English-language skills but translation services can be useful, especially for those with complicated medical histories. The rise in this type of travel does mean that a traveller taken ill overseas is more likely to find recognisable health facilities.
Even ten years ago most Brits consulted the nurse at their local surgery before travelling. These nurses were good at giving injections but some knew little about travel health. In 1998 the British Travel Health Association was set up and it has improved competence among health professionals. Simultaneously there has been a huge increase in private travel clinics, and NaTHNaC (National Travel Health Network and Centre) now publishes a searchable list of approved yellow fever vaccination centres. Overseas travel clinic lists can be found at www.istm.org/webforms/searchclinics/default.aspx
The web allows browsing of a multitude of reputable and not-so-reputable sites. The problem now is in identifying what is good information. Two useful, unbiased sites are www.fitfortravel.nhs.uk and NaTHNaC; they are authoritative and aren’t selling you anything.
Good sharing of information makes a practitioner’s job easier. Strategies for preventing DVT are now general knowledge. Good communication among doctors has also led to more rapid and effective containment of outbreaks – take SARS or bird flu. Conversely, it has never been easier to spread global anxiety.
New gizmos are constantly launched claiming to save your life/limb/sanity. I’m sceptical about most of these ‘innovations’ – until I see the medical evidence. The click devices to control post-mosquito bite itching don’t work for me (hydrocortisone or even white toothpaste work better); nor do I rate antibacterial hand gels or when-you’re-cooked sunscreen monitors. There are, however, several proven products that are worth buying.
The licensing of permethrin is probably the most important recent development. This contact insecticide targets enzyme systems that insects possess but we don’t. It is sprayed on clothes and/or bednets so it doesn’t touch your skin. It is safe and effective, although I don’t rate the pre-treated clothes because they often don’t cover enough skin to protect the wearer.
A new antimalarial was launched in 2002 – Malarone, the introduction of which gave us for the first time the choice of three effective, tolerable antimalarials. Malarone, although expensive, seems better tolerated than other antimalarials. Pills can now be purchased most cheaply via the net (eg via www.stratford-pharmacy.co.uk).
Sadly, few vaccines have emerged in the past decade, although several are promised. It was good to see the launch of Dukoral, the fizzy-drink oral vaccine that protects against cholera. Ordinary travellers are at minute risk of getting ill if they acquire cholera so it was disappointing that the cross-immunity that this vaccine was expected to give against travellers’ diarrhoea was only at a low level. A good vaccine against travellers’ diarrhoea is still awaited.Lots of devices are promoted as preventing of deep vein thrombosis (DVT). There is, though, good evidence that properly fitted flight socks do protect. Along with the flight socks, these days I pack an antipollution mask – third-world cities increasingly make me cough.
The next decade will see new vaccines emerge: a dengue vaccine is likely; malaria less so. I foresee a time when an online telemedicine consultation will be possible with your favourite doctor back home, though I’m sure this will be at a price. Even when that becomes possible, though, it will still be up to the traveller to do their pre-departure homework thoroughly.
Dr Jane Wilson-Howarth is a GP who also works at the Travel Clinic, Cambridge (www.travelcliniccambridge.co.uk). She is author of Bugs Bites & Bowels (Cadogan), a comprehensive guide to travel health
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