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Copyright © 2004, 2005 by Christopher Bajkiewicz. All rights reserved. Not for publication or
partial use.
STAYING HEALTHY ON OUTREACH:
What Health-Care Professionals Need to Know page 2 of 3
By Christopher Bajkiewicz RN BSN
I IMMUNIZE !
Consult your Travel Medicine specialist 8-12 weeks before departure (see www.istm.org for
travel clinic listing). Immunizations specifically needed for your outreach region are updated
regularly at www.cdc.gov and www.who.int (ref 11). If you are allergic to biologics/vaccines,
especially any REQUIRED vaccines, carry a physician letter and MedAlert bracelet on the trip.
REGULAR vaccines – read the current child schedule (see www.cdc.gov/nip). As an adult, you
may lack current Regular vaccines important in travel, such as Hepatitis B/HBV. Your last
Tetanus booster should be within 5 yrs, given the rural nature of most under-developed
regions and lack of vaccine availability if injured.
REQUIRED vaccines must have an official WHO International Certificate of Vaccination (only
obtained from a physician when you receive immunizations) for country entry and exit under
International law. Without the official certificate, you can be detained until vaccine is
administered. Requirements vary for each country, and may include Yellow Fever (most of the
tropics), Cholera (limited) and Meningococcal (especially during Hajj in the Middle East).
RECOMMENDED vaccines are person and destination-specific. Besides the Regular and
Required vaccines, most outreach to under-developed regions globally will frequently
recommend Hepatitis A/HAV, Typhoid and a 1-dose oral Polio boost. Other vaccines may be
recommended due to risk. Rabies vaccine should be taken if contact risk is moderate or
greater. Tuberculosis ‘coverage’ should be pre-and-post travel Manntoux testing. In addition,
BCG vaccine may be appropriate when working with a high-TB endemic group of people (ref
12, 13, 14).
S SAFE STUFF !
Insuring the basics of life on foreign outreach requires a tremendous amount of time and
energy, much more than most are accustomed to at home.
Water management is different in the under-developed world. Drinking water must be purified
or purchased commercially. Drink ONLY from sealed and designated containers. ‘Don’t drink
the tap water’, close your eyes and mouth in the shower, and brush your teeth with bottled
water. Safe self-purification of water requires 15 minutes of boiling, chemical products (such
as Potable Agua® ) or a rated purifier (employs filters + chemical process). For water sources
abroad, filtering systems alone are insufficient.
Clear water can be used for washing but is not safe to drink unless purified. ‘Black’ water is
waste water used for crops. Avoid eating water-heavy ground vegetables such as melons and
lettuce.
The proven safe-food rule is “boil it, cook it, peel it, bottle it, open it… or FORGET IT!” Easy to
remember, but hard to do when the street vendor’s aroma fills your nostrils! Soak all
fruits/vegetables prior to peeling (15cc bleach/liter water). Eggs should be over-cooked, milk
may require boiling. Salads, ice, and all raw cheeses, fish and meats should be completely
avoided.
Shelter protects you from creatures and the elements, but may need small repairs upon arrival
to make it safe. Duct tape is good for temporary repairs and a travel ‘must’: attach strips of
tape to your suitcase pre-travel for quick access.
Waste should be buried, burned or covered. Pit latrines come in many forms world-wide, and
you may need to learn how to squat for your daily sanitation needs (ref 15).
D DON’T GET BIT !
Many ‘vector-bite’ diseases have no vaccine or treatment, so prevention and protection from
any bite is essential (ref 16). Called Personal Protective Measures (PPM’s) by the CDC, to
avoid vector bites:
<> Use DEET (N,N-Diethyl-m-Toluamide), the ONLY proven repellant (ref 17). Choose 30-55%
for adults, 15-25% for children, apply as directed, especially during known feeding times of
regional disease-carrying vectors.
<> Use Permethrin (or deltamethrin) insecticide on clothing, bednets and room perimeters.
<> Wear loose clothing that covers arms and legs.
<> Sleep under treated mosquito nets (even if the nationals don’t) (ref 18).
<> Keep quarters food-free, cover latrine openings and garbage pits.
<> Help eliminate community vectors (especially filling in old tires with dirt).
<> Inspect skin daily for ticks, rashes, etc.
<> No perfumes, scented lotions or deoderants.
<> Be sure to guard CHILDREN, who can't 'do it for themselves'
Malaria is the most dangerous mosquito disease, with 0.7 to 18 cases per 1,000 travelers
reported (ref 19). All travelers to malarial regions are at risk, and must enact prevention
measures plus chemoprophylaxis. Be aware that the ONLY dependable symptom of malaria is
HIGH FEVER (>38.8° C/ 102° F) lasting 2-8 hours, requiring your stand-by medicine and
immediate medical attention (ref 20).
Some vector diseases such as Yellow Fever are vaccine-preventable, but other serious and
widespread diseases have no protection except bite-avoidance (ex: Dengue). Protect yourself
against all vector bites, including flies, ticks, lice and bedbugs (ref 21).
Larger vectors include dogs, bats and rodents. Do not pet or approach any wild or street
animal. Use established footpaths. Ensure secure and ‘gap-free’ doors and screens in your
quarters. Don’t reach into any blind areas, especially woodpiles. Always knock out your shoes
before use. Rabies is a weighty problem in certain rural regions (dogs and bats), pre-travel
vaccine may be indicated (ref 22, 23).
Venomous creatures may inhabit out-lying/rural areas. Avoid bites/stings and know where the
antivenin is regionally available. Immediate transport is the priority treatment in venomous bite
(ref 24).
Many tropical lakes and bodies of fresh water are schistosome-infested. Do not swim in them
make or bare-skin contact with the water (ref 25).
Sunlight (UV rays) are especially strong in the tropics. ‘Stay in the shade- whatever form’
means regulating exposure, use of wide-brimmed hats, sunglasses, umbrellas and liberal use
of high SPF (>30) sun-block on exposed skin.
Medical outreach carries the significant risk of needle sticks and cuts with ANY invasive
procedure in high-incidence HIV regions. Although World Health Organization (WHO) has new
recommendations for using ‘auto-disable’ syringes (ref 26), due to severe shortages, under-
developed regions commonly clean and re-use injection supplies (as well as gloves). Carefully
follow sharps procedures and avoid high-exposure activities such as re-capping needles. Find
creative ways to avoid direct sharps contact, especially in cleaning and handling contaminated
items. Surgery poses a unique exposure risk, requiring constant vigilance and frequent
adjustment of the surgical team practice. Full barrier protection (gloves, gowns, eyewear)
should be employed when blood/body fluid exposure is even possible.
If you sustain a stick/cut, begin aggressive wound cleansing with alcohol or Betadine ®, notify
your team leader and enact the BBF Exposure protocol, which should include anti-retroviral
meds (ref 27).
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STAYING HEALTHY ON OUTREACH copyright ©2004, 2005 by Christopher Bajkiewicz.
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