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What Health-Care Professionals Need to Know             
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By Christopher Bajkiewicz RN BSN

Copyright © 2004, 2005 by Christopher Bajkiewicz. All rights reserved. Not for publication or partial use.

Health-care professionals are traveling overseas in greater numbers to participate in medical and
health-care outreaches.  Mission opportunities abound as agencies seek professionals to lend their
skills to health care outreach projects around the world. However, with significantly different practice
environments, these practitioners often encounter health risks not usually addressed in standard travel
literature. “Don’t drink the tap water and get all your shots” is only the beginning of what you need to
know to stay healthy abroad.

Two-thirds of all travelers to under-developed regions develop some illness or symptom (diarrhea
being most common), but only 8% will need to see a doctor, and less than 1% are hospitalized. Most
deaths abroad for travelers are from pre-existing conditions (cardio-vascular, cancer, etc). However,
injury/motor-vehicle accidents are the most common cause of travel-related death. Infectious diseases
only account for 1% of all travel deaths. (ref  1, 2).

In preparing you to stay healthy on your outreach trip, prevention strategies are the critical keys to
success. A pre-trip consultation with a Travel Medicine specialist (doctor or nurse practitioner),
addressing your individual travel health needs should be planned 8 to 12 weeks prior to travel. This
allows for proper vaccine spacing and supply acquisition.

Seeking wisdom in our life and daily practice allows us to enjoy a great deal of God-placed protection
Proverbs 2: 9-11). Planning for healthy overseas travel can be guided by the acronym
K       KNOW !

I         IMMUNIZE !
S        SAFE STUFF !
D        DON’T GET BIT !

Safety is crucial. Most travel deaths and injuries are from accidents, and medical outreach has
reflected this tragic reality (ref 3). Vehicle crashes are the largest factor (27%), followed by accidental
drowning (16%). Unfamiliar environs and lack of skills in a foreign region contribute to the mortality and
morbidity (ref 4, 5). ‘Safety first’ includes:
When in a motor vehicle, use seat belts and secure seating. Avoid riding in open vehicles. Ensure both
vehicle and roads are safe secure to travel. Beware cliff-sides, riverbeds and rural routes, especially
after bad weather. Avoid night travel, especially outside of a city. Know the route before departure and
avoid short-cuts. Drivers should be sober. Brakes should be in working order.
Regional bus/airline carriers have mixed safety records; investigate before choosing to use them for in-
country travel.
When crossing any body of water in a boat, wear a lifejacket. Check to ensure the boat is trip-worthy
and has life preservers. NEVER swim along deserted shorelines… period!
When in-country, stay in groups and never venture out alone, even on tourist days.
Be watchful of fire, smoke, heat and electrical dangers, especially in poorly constructed buildings.
Guard against sonic injury from public address systems. Carefully test all on-site medical equipment
prior to use for hazards, including ‘creatively re-wired’ old/used medical gear.

If you are aware of personal health needs prior to leaving, work with your physician to plan
appropriately, and notify your sponsoring agency before arrival.
If an infant or child is traveling with you, know their destination-specific risks and consult your
Pediatrician before booking your travel. Most sponsoring agencies will not allow children on medical
outreach trips because of exposure risks.
 If you are pregnant, your obstetrician should first approve travel. Malaria prophylaxis is essential and
rigid food/water/safety measures are a must (with non-iodine purification). You will need a Rubella titer
(high prevalence in under-developed regions) and know how to minimize risks for thrombo-phlebitis.
Investigate the birthing capabilities of the health care system in the area where you will travel and
develop a stand-by illness plan in advance.

If you have a chronic condition or disability, carefully plan your on-going therapy during travel with your
physician. Pack 150% of supplies for the planned timeframe, in case your return trip is delayed. Time-
zone changes should be worked out with medication schedules, and all medicines must be in labeled
bottles (no loose pills or vitamins). Keep a physician’s letter with your passport, especially if you are
carrying needles and syringes, or any prescribed controlled substances. Medicines and supplies
should be in your carry-on luggage and not with checked baggage. Airlines require pre-trip notification
of any special needs. Realize that most under-developed regions of the world do not have
‘handicapped access’ or many types of medical supplies easily available in North America.

The worst time to look for what you need in-country is during any emergency. Update your Basic
Cardio-Pulmonary Resuscitation (CPR) and First Aid certifications before you travel, and be ready for
any emergency.
Your Personal Travel First Aid Kit should include all basic wound care and simple medications. Carry it
with you at all times (see Table 1).  (ref 6)

^ Wound care items (bandages, 4x4’s, Betadine swabs, tape, tweezers)
^ Topical Antibiotic, Hydrocortisone, Sunburn gel
^ Analgesics/Antipyretics (Tylenol, Ibuprofen)
^ Anti-histamine/Decongestant (Benadryl/Pseudoephedrine)
^ GI meds (Pepto-Bismol, Antacid)
^ Oral Rehydration salts
^ Motion sickness (Dramamine, Scöp-patch)
^ PRN/Rx meds: Floxin, Cephalosporin, Anti-malarial, Anti-fungal
^ Misc: water purification tabs, DEET repellant, sunscreen, extra glasses, Epi-pen if severe allergy, ?
5cc syringe w/ needle        

The Outreach Team First Aid Kit should be based on the type and location of outreach and size of the
team. A full ‘IV fluid/needle/syringe’ pack should be available, especially if you are headed for the
tropics. If injections or invasive procedures are part of the outreach, a ‘Blood & Body Fluid (BBF)
Exposure Kit’ should be available with anti-retrovirals and testing means. Check with sponsoring
Readiness means having plans for local transport to emergency care, hand-drawn maps to the
location, available transportation (9-1-1 does not exist in most of the world), and cash-on-hand for the
required fee-for-service (insurance cards not accepted). IAMAT (international Association for Medical
Assistance to Travelers) provides information on English-speaking physicians world-wide (call 716-754-
Evacuation from the area, region or country should be planned in the event of medical necessity or
civil unrest. Know the local contact number for your country’s Embassy. If you are working in a
politically unstable area, register upon entry to the country. There are a number of insurance
companies now underwriting outreach groups, and they frequently offer evacuation in their coverage.

K        KNOW !
Studying the conditions that exist in your destination helps you prepare appropriately. The Centers for
Disease Control ( ) is THE key travel health resource, and easily internet-
accessible (including in-country via ‘Internet Cafes’). The CDC bi-annual Yellow Book contains the
same information for non-Web users (ref 7). Develop a profile of your destination through the
resources listed in Table 2.

               SERVICE                                                  RESOURCE             Centers for Disease Control                current disease/vaccine                        World Health Org                                 int’l info, augment CDC                       Intl Society Travel Med                        travel clinic locator          US State Dept.                                    entry/exit reqs, risks
                                   Overseas Citizen Services                   help in emergency                news agencies                                     regional info               weather service                                    regional climate/temp               travel med supply company                 gear and supplies

Know the risks for robbery, violence or unrest in the region and make ‘contingency plans’ for keeping a
low profile and reducing your vulnerabilities (ref 8). Consult U.S. State Department advisories, news
reports, national workers and missionaries for up-to-date security information .  

Good handwashing is the best prevention from hundreds of travel illnesses.
Alcohol-based hand gels are helpful but may cause dry skin.
In addition to your hand-washing, be vigilant of the sanitation of those who prepare
or serve your food, a major link to the high incidence of Traveler's Diarrhea abroad.
First treatment of ANY diarrhea is Oral Rehydration salts (ref 9), then followed with stand-by prescribed
medications (antibiotic + Bismuth preparations currently favored). Avoid anti-motility agents, especially
Lomotil, since they can prolong the gastro-intestinal infection.
Dangerous diarrheas with high fever (> than 39.5 ° C/103 ° F), bloody stools, severe cramping (> 8
hours) or massive fluid loss need immediate medical attention. There are vaccines to some
diarrheal/gastro-intestinal diseases (like Hepatitis A) that should be taken if appropriate, but NOTHING
can replace good hand-washing in preventing problems.

For medical outreach in the world of multiple viral risks, ‘watch out’ means ESSENTIAL barrier
protection during ANY contact with blood/body fluids. Gloves, glasses, plastic or latex barriers must be
used. Bring them with you to insure availability. Since health-care facilities in under-developed regions
re-use many types of supplies due to shortage, use extreme caution when cleaning instruments or
equipment. Take care when giving direct care to children in orphanages or with any street-dwellers,
use barriers when appropriate. Be sure to wash your hands after removing gloves.

Watch out for anything suspicious. Local criminals track travelers, but you can become a ‘hard-to-hit
target’ by keeping a low profile and ALWAYS stay in groups of three or four. Give NO personal or
itinerary information to strangers. Rely on the national outreach hosts as watchful eyes for your
Watch your emotions. Culture shock occurs quickly, even after repeated trips to the same region. The
waves of people, crime, poverty, unhealthy living conditions, noise and smells mixed in a strange place
WILL provoke stress in you. No outreach participant or leader is immune (ref 10). Bitterness and anger
can follow you home, and reports of post-outreach depression are increasing. Furthermore, conflict will
often arise in the outreach team. Giving and receiving forgiveness is important. Post-travel ‘re-entry
wrap-up’ group meetings can help bring emotional perspective to the outreach experience.
On the flip side, it's important to keep the risks of travel from eclipsing your capacity to be kind. The
healthy traveler learns to balance world realities with the joys and wonders of other peoples and

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STAYING HEALTHY ON OUTREACH copyright ©2004, 2005 by Christopher Bajkiewicz.
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map 2004 courtesy of
Centers for Disease Control