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| Travel medicine advice allows you to visit beautiful places safely |
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The mission of a travel medicine clinic is to assess travel risk and provide appropriate information and prophylaxis to the traveler. Travel risk is dependent upon the destination, length of time there, activities while there, and the health of the traveler. Destination risk includes exposure to infectious disease and may be environmental or political in nature.
Travel Risk Assessment
Even with the internet at our disposal, obtaining information concerning current country-specific risk is a challenge. The best official governmental website sources of information concerning political unrest or various physical dangers are listed below by country of origin.
United States http://travel.state.gov/travel_warnings.html (for travel advisories you must link to http://www.travel.state.gov/travel/travel_1744.html).
United Kingdom http://www.fco.gov.uk (for travel advisories you must link to http://www.fco.gov.uk/servlet/Front?pagename=OpenMarket/Xcelerate/ShowPage&c=Page&cid=1007029390590).
Canada http://voyage.gc.ca
Australia http://www.dfat.gov.au/consular/advice/index.html
The United States Department of State lists several levels of advice, namely travel warning or public announcements. Their website describes this information as follows:
Travel Warnings are issued when the State Department decides, based on all relevant information, to recommend that Americans avoid travel to a certain country. Countries where avoidance of travel is recommended will have Travel Warnings as well as Consular Information Sheets.
Public Announcements are a means to disseminate information about terrorist threats and other relatively short-term and/or trans-national conditions posing significant risks to the security of American travelers. They are made any time there is a perceived threat and usually have Americans as a particular target group. In the past, Public Announcements have been issued to deal with short-term coups, bomb threats to airlines, violence by terrorists and anniversary dates of specific terrorist events.
Consular Information Sheets are available for every country of the world. They include such information as location of the U.S. Embassy or Consulate in the subject country, unusual immigration practices, health conditions, minor political disturbances, unusual currency and entry regulations, crime and security information, and drug penalties. If an unstable condition exists in a country that is not severe enough to warrant a Travel Warning, a description of the condition(s) may be included under an optional section entitled "Safety/Security." On limited occasions, we also restate in this section any U.S. Embassy advice given to official employees. Consular Information Sheets generally do not include advice, but present information in a factual manner so the traveler can make his or her own decisions concerning travel to a particular country.
General information on countries with regard to social and economic issues can be found at the CIA website http://www.cia.gov/cia/publications/factbook/
Even with this wealth of information at your fingertips, it is still difficult to access and interpret much of it in a meaningful manner for your consulting patients. Much of this is due to the level of risk that they are willing to assume. There is also a lack of convenience in trying to access the websites and in printing out and reading through this information.
Also there is a matter of political filtering of data. It is very likely that risk material is suppressed if the country in question takes offense to remarks made (this has happened with regard to areas of banditry in Mexico which appeared briefly and were removed due to political pressure) and, conversely, travel may be discouraged to an area in response to U.S governmental displeasure with a country. Check out the Islamic country of your choice and note the vast differences in travel alerts provided citizens, which seems to follow more of a political line than a true travel risk line. For example, compare Syria with Egypt. Islamic terrorists in Egypt have killed many more tourists than in Syria, but this would be hard to tell from the warning system.
Geographic location of travel death, when adjusted for the number of travelers, provides a surprising result. Per capita is appears to be riskiest to travel to the Carribean and to Central America and Mexico. This would provide some correlation to the death statistics from drowning and alcohol related deaths due to the number of sea front and water related activities in those locations.
Risk of harm to travelers has been shown to be greater than that of local people engaging in the same activity. Carey and
Atkin in the Annals of Emergency Medicine (1996;28:424-429) looked at 657 cases of road trauma in Bermuda and found that 82% involved motorbike. When the rates of injuries of tourists and locals were compared rate in 1000/p-y for tourists was 93 as compared to 17 for locals. The peak age for the accident for tourists was 50-59 as compared to 20-29 for locals. Being older does not make the traveler wiser.
Comparing trauma and cardiovascular death rates for travelers vs age adjusted rates of US non-travelers, we see what is probably a selection process that sends healthier people traveling (less per capita cardiac deaths in age related travelers), but more risk prone (higher trauma death rate).
Observing the following precautions can minimize traumatic travel risk:
- Don’t ride on the back of trucks
- Use helmets on motorcycles and bicycles
- Use seat belts
- Avoid unscheduled aircraft
- Carefully select swimming areas and avoid alcohol consumption when swimming
- Avoid travel or driving at night
- Encourage traveling in groups or pairs.
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